Fermented Foods 101: Probiotics, Bacteria and Gut Health

Adapted from episode 50 of The Perfect Stool podcast and edited for readability.

Fermentation is an ancient tradition used to preserve food without refrigeration and prevent spoilage, which uses microorganisms like bacteria and yeast to break down nutrients into their most digestible form. Some examples of common fermented foods are yogurt, kefir, sauerkraut, kombucha, pickles, miso, tempeh, natto, kim chee, kvass, cured meats, sourdough bread, apple cider vinegar that contains the mother (that cloudy stuff at the bottle of the bottle), and unpasteurized cheeses. Goat’s milk, sheep’s milk and soft cheeses made with A2 milk are especially rich in probiotic bacteria. Consuming fermented foods can help maintain healthy gut bacteria, as they are filled with good microflora called probiotics, primarily lactobaccili, bifidobacteria and one strain of streptococcus called streptococcus thermophilus, which have been shown to improve digestion and absorption of nutrients, and help with a whole host of health issues. 

Despite fermented food’s rise in popularity, many people still only consume probiotics in pill form. There is good evidence to suggest that eating fermented foods has advantages over getting probiotics and nutrients through supplements. First, a huge diversity of species live in fermented foods that you may not find in a supplement. In addition, during the fermentation process, yeast and bacteria interact with carbohydrates, releasing byproducts called bioactives or bioactive compounds. Bioactives are any chemical that have a biological effect on our bodies and include the beneficial bacteria themselves, as well as compounds like plant sterols, carotenoids, polyphenols, oligosaccharides, fatty acids and amino acid derivatives. And because fermented foods ferment for longer and interact with the nutrients in the food as opposed to growing probiotics on one substrate in a factory setting, there’s a higher quantity of bioactives in fermented foods, as compared to most probiotic supplements. Some examples of beneficial bioactive compounds that come from fermented foods are CLA or conjugated linoleic acid (an essential fatty acid otherwise found in meat and dairy from grassfed animals that’s created through fermentation from linoleic acid found in plants), genistein (an isoflavone that’s phytoestrogenic and anticancer due to its anti-angiogenic properties, meaning it inhibits the formation of new blood vessels, which feed tumors) and  gamma-aminobutyric acid or GABA, which is a calming neurotransmitter. Biocatives have numerous health benefits, like reducing cholesterol and helping with immune response. 

Another benefit of probiotic foods is that they’re already partially broken down into nutrients that are easier for your body to assimilate. One concrete example of that is how the probiotic bacteria in yogurt and kefir break down lactose, which many people struggle to digest, during the fermentation process. That’s why many people who are lactose intolerant can still tolerate yogurt. In addition, even if the microbes in probiotic foods don’t survive your stomach acid, they can still release enzymes as they die, which will help you digest your food better, leading to increased nutrient absorption. They can also break down anti-nutrients like phytic acid, which is found in grains, legumes and seeds and binds up minerals such as iron. After fermentation, the minerals become more absorbable. Eight hours of sourdough bread fermentation, for example, almost completely breaks down phytic acid in wheat and rye breads. So even though live bacteria are killed during cooking, nutrients in fermented sourdough bread are still more available because of the fermentation process. 

To make sure you’re getting the maximum benefits from live fermented foods, be sure to choose non-pasteurized or raw fermented foods or foods marked lacto fermented. So for example, the bags of sauerkraut you find in the supermarket are not raw and will have been cooked, killing the bacteria, which doesn’t mean they’re devoid of benefit, but they won’t have the live bacteria. You’ll find much more expensive raw, fermented sauerkraut in the refrigerated section of health food stores and of course you need to eat it cold to keep from killing the beneficial bacteria. Same with typical pickles found in grocery stores versus the more expensive fermented pickles found in the refrigerated section. This of course leads to the question of whether these bacteria actually survive the stomach acid and are delivered to the colon, where most of the fermentation in your own gut takes place. It turns out that lactobacilli and bifidobacteria, the strains most common in fermented foods, are especially resistant to stomach acid and have special strategies to ensure their survival, in particular when they’re traveling on food. This doesn’t mean that they will all arrive intact, but some portion of them will. 

In terms of quantities of probiotics in fermented foods, a serving of typical yogurts, kefirs and fermented beverages like kombucha will have around 10-40 billion CFUs or colony forming units, which is comparable to many commercial probiotics, although when I recommend lacto-bifido probiotics to clients I often shoot for 100 billion CFU per day and one of the most studied probiotics, VSL#3, which is now sold under the name Visbiome*, is 450 billion CFU per packet. There’s a wide range of CFU for other probiotic foods, so here’s an article that gives you the range of possibilities. But for packaged foods, they should list the CFUs on the containers. 

You may be wondering whether you should eat fermented foods if you have SIBO (that is, small intestine bacterial overgrowth), dysbiosis or IBS. I have heard and have personally felt like I’ve experienced bloating and issues from eating fermented foods and probiotics while dealing with bloating from SIBO. That being said, there is one small study supporting probiotics as a treatment for SIBO in which probiotics outperformed standard antibiotics (and by that I don’t mean the $2,000 antibiotic rifaximin or xifaxin which is often prescribed for SIBO). They believe this is because the probiotic bacteria outcompetes the overgrown bacteria but are generally transient and pass through your digestive system rather than colonize it. And I’ll link to that study and all the others I’m mentioning in the show notes and in the transcript which will come out in a week on my blog. 

Another small study showed improvement in diarrhea from bacterial overgrowth with treatment using two strains of lactobacilli, but it did show that ongoing treatment with them would be necessary to maintain the improvements. This is much more practical when considering eating fermented foods versus taking probiotics in the long term. Other reasons that fermented foods may be beneficial in SIBO are due to their anti-inflammatory and immunomodulatory effects, which may help your immune system clear the SIBO, as well as helping to promote a healthy mucous lining in your intestines. If you do feel like you have a bloating response to fermented foods and/or probiotics when you have SIBO, you can either start with very small quantities and build up to see if that helps, or stick to spore-based probiotics (like Megasporebiotic or Proflora 4R – both found in my Fullscript Dispensary*) or S Boulardii probiotics* (which is a beneficial yeast) and hold off on fermented foods until the root cause of the SIBO is addressed. 

Another potential benefit of fermented foods is with candidiasis, which is an overgrowth of the yeast candida, a normal resident in our bodies, which can take place in the mouth, also known as thrush, the digestive tract, the vagina and can also be systemic, especially in people with weakened immune systems. A 2016 review of the research on the benefits of probiotics for candida cited studies which found antifungal effects for lactobacilli and saccaromyces boulardii in vitro, meaning in petri dishes, and for lactobacilli, in vivo, meaning in human studies. In vitro, S. boulardii (whose official name is actually saccharomyces cerevisiae subsp. boulardii) was particularly good at stopping candida albicans from forming filaments called hyphae which make it particularly pathogenic, while lactobacilli were good at inhibiting its growth. Supplementing with selenium also enhanced the antifungal effects of the lactobacilli. In vivo, various strains of lactobacilli were helpful in reducing candida in the oral cavity, urogenital tract and GI tract, by inhibiting biofilm growth by reducing hyphal development. If you’re wondering where to find S. Boulardii in food, I discovered while researching for this podcast that it was actually first found in the fruits mangosteen and lychee and that’s pretty much the only place you’ll find it in food. Typical Americans might not eat those fruit frequently, but funny story, my husband loves mangosteen, which I guess he remembers from living in Malaysia and Panama as a child when his father was in the military. We lived in Australia for a few years when I was doing my doctorate and we took a trip to a small town in northern Queensland called Port Douglas and were hosted by the mayor of Port Douglas who Doug knew from his work. His property was only accessible via boat across crocodile infested waters. And on his property he had a mangosteen tree. Normally mangosteen were pretty expensive and not very good by the time they got to the store, but that evening after dinner, Doug got to eat freely from the tree as many mangosteen as he could have ever desired. But if you don’t eat those fruit much, then you’ll have to look at supplements for S. Boulardii. But anyway, those studies point to the likely usefulness of probiotic foods in preventing candidiasis, which many women likely already knew, as we’re often told to eat yogurt to prevent yeast infections, even by traditional doctors. 

In terms of fermented foods and inflammatory bowel disease or IBD, one peer-reviewed article suggested that the increased prevalence of IBD in western countries and developed Asian countries is due to rapid changes in the environment and diet. In Japan and Korea specifically, traditional fermented foods are consumed less by younger generations due to their strong smells and tastes, along with a reduction in fiber in the diet. The researchers suggest that returning to a more traditional diet should be encouraged to protect public health, create a healthier gut microbiota and decrease rates of IBD.

There are also two studies on mouse models of chemically induced colitis that offer support for fermented foods. In one of the studies, colitis symptoms were alleviated in mice fed a mixture of fermented barley and soybeans by increasing levels of healthy bacteria like lactobacilli and suppressing levels of pro-inflammatory cytokines in colonic tissue. In another study, mice fed a novel yogurt obtained by fermenting two anti-inflammatory bacterial strains, Streptococcus thermophilus CRL807 and Lactobaccilus delbrueckii subsp. bulgaricus CRL864 showed reduced inflammation and developed a healthier immune response compared to controls. 

I wanted to talk more in depth about one fermented food, kefir, a probiotic drink made by fermenting milk, alternative milks or water with kefir grains, because it has many big advocates for its positive health effects, including with gut health issues. Kefir contains more than 50 species of probiotic bacteria and yeasts, and has been found to boost immune function, fight against harmful microbes, help with digestive issues and more. In addition, during the fermentation process, the bacteria from kefir grains produce the B vitamins B1, B2, B6, B12, folate and biotin, some of which I find are commonly deficient in my clients. 

In terms of the evidence supporting kefir for gut health issues, in one study, four groups of mice received different doses of kefir over a four week period while the control group received a placebo. Results demonstrated a significant correlation between the amount of kefir administered and improved the ratio of Firmicutes to Bacteroidetes in the gut microbiome, which is considered a marker of microbiome health, improved athletic performance and decreased fatigue. Other studies have identified additional benefits, like building bone strengthdecreasing proliferation of estrogen-dependent breast cancer cellsdecreasing inflammation and allergies in a mouse model of asthmafighting against foodborne pathogens and supporting skin health

Kefir may also help with gastrointestinal symptoms according to a randomized study of 15 healthy adults with lactose maldigestion, in which participants consumed milk, plain and flavored kefir, along with plain and flavored yogurt. Yogurt and kefir were shown to have a more positive effect on patients’ GI symptoms than milk. Another small study on ten people with chronic constipation matched with healthy controls showed significant improvement in stool frequency and consistency. Another study, however, found no significant improvement in antibiotic-associated diarrhea among 125 children after giving them kefir. 

But more importantly, in a 2019 study on inflammatory bowel disease, 10 Crohn’s disease and 15 ulcerative colitis patients matched with 20 controls received 400 ml/day of kefir over a four week period. After scoring symptoms like stool frequency, consistency and abdominal pain, researchers found that consuming kefir significantly improved patients’ symptoms and helped modulate their gut microbiota.  

And keep in mind that not all kefir products are created equal. Kefir is made from the symbiotic relationship between bacteria and yeast found in kefir grains. Just as pasteurizing and mass producing supplements can reduce the diversity of nutrients available, mass producing kefir can lead to a less effective product resulting from a lack of microbial diversity in the kefir grains. In addition, the type of milk, time, temperature, and different methods of production all contribute to kefir’s effectiveness. So if you decide to make your own kefir, be sure to invest in quality grains. They can originate from different countries too, so if you’d like to learn more about the ones used in the studies mentioned, you can find those in the show notes. 

So in summary, I’m really glad I undertook this podcast topic as I personally haven’t put a lot of emphasis on fermented foods lately, other than making my own sauerkraut, since I stopped eating dairy and making my own yogurt. But now I’m feeling like it would probably be worth my time to figure out how to make kefir with a non-dairy milk or incorporate some good quality, organic kefir info my diet. And I’d encourage those of you with gut health issues to start ramping up your consumption of fermented foods. 

If you’re struggling with constipation or other gut health problems and are ready to get some professional help, 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 gut health coaching 5-appointment program 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 links are affiliate links for which I’ll receive a commission. Thanks for your support of my podcast and blog by using these links.

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From Constipation to Celebration: A Conversation with Ann Marie

Adapted from episode 49 of The Perfect Stool podcast and edited for readability.

Lindsey:  

Let me start off by having you give our readers some background on what you were first complaining about when you came to see me, your major health complaints and how long they’ve been going on. 

Ann Marie:

Right. When I first contacted you, I had severe constipation. That got progressively worse over a four-and-a-half-year period. And I had done some research online because traditional medical treatments could not diagnose what my problem was. And it was getting more difficult to have a normal life with this problem that was continuing.

Lindsey:

And what kind of practitioners had you seen before me to try and get help?

Ann Marie:  

I went to my MD and then she sent me to a specialist. I’m sorry, I cannot recall the specialty… 

Lindsey:

Was it a gastroenterologist? 

Ann Marie:

Yes, that is correct. And I went to actually two or three different ones over the four-and-a-half-year period, and followed their criteria for colonoscopies, CAT scans, and to no avail. I could not get an answer for what was causing my continual constipation and intestinal upset.

Lindsey:  

So, beyond the constipation itself, what were the symptoms that you were experiencing? 

Ann Marie:

So, the constipation, as you suffer through that process, it takes away your energy. I found that my mood was a bit depressed a lot, because things were not processing properly. I spent a lot of time cooking fresh vegetables and buying fresh fish and trying to eat as much as I could organically. And my body was not responding. So it was extremely frustrating. And without a diagnosis, I had all these visions that it was something far more severe than then what I knew it to be after we started working together.

Lindsey:

Were you having stomach pain and bloating as well?

Ann Marie:  

Yes, absolutely. There was bloating, definitely pain. It was to the point where I was taking ibuprofen, two or three 200 milligrams to ease the discomfort in my gut. So, there was a lot going on. And I didn’t know how to separate out the different symptoms. That’s one of the things that you had helped me with when we started working together. What was causing the different symptoms.

Lindsey:  

And what kinds of treatments did the gastroenterologists suggest?

Ann Marie:  

Basically, they put me on over-the-counter fiber supplements and stool softeners. And, you know, things like milk of magnesia, which were not solving the problem. What happened by the time I met you, my bowels were not moving, the over-the-counter treatments were not working. So, it was extremely frustrating. And they offered me a prescription to resolve the constipation with no diagnosis. And that was extremely difficult. I could not do that. So, I kept searching. I really wish I had known somebody who had gone through the process, because that would have encouraged me to make the jump and try a holistic approach to solving my issues. 

Lindsey:  

And you had an actual IBS diagnosis though, didn’t you?

Ann Marie:

I did indeed. Right. I did. 

Lindsey:

And my understanding was it was IBS-D or diarrhea first and then after menopause it turned into IBS-C. Is that right? Correct. 

Ann Marie:

That is correct. 

Lindsey:

And that was sort of within that four-and-a-half-year period? Or was it a little before then?

Ann Marie:  

I would say a little bit longer than that when I had the diarrhea. It was on-going but it was more manageable, much more manageable. And then when I crossed over to menopause, I think things slowed down and my body obviously changed the hormonal changes and things got really, really difficult.

Lindsey:  

Okay, so I don’t know if you recall when we first talked, so we had our first appointment, which is typical that I’ll have a first appointment with clients before any testing is done, and I taught you about some things that help to relieve constipation. Do you recall what those were? 

Ann Marie:

I do not remember 

Lindsey:

So, I think I think some of the first things and I don’t know if you necessarily did them all right off the bat, but one was vitamin C, another was magnesium and another was Atrantil (find in my Fullscript Dispensary).

Ann Marie:  

Right. Yes. And I had already been taking magnesium. But based-on information from another nutritionist, she had suggested I take magnesium, but it wasn’t nearly enough. After working with you, you explained to me that the amount I was taking wasn’t really serving a purpose. So even though I was taking things like vitamin C, I was so far off the mark. I was not taking enough to resolve any of my issues. And I wouldn’t have known that without your help and assistance through the process.

Lindsey:  

Yeah. And so, you had done the GI Map and the Organic Acids Test. And that’s a really big investment in testing, it is 700 plus dollars. So, I’m wondering, why was it worth it to you to spend that much, and in retrospect, was it a good decision?

Ann Marie:  

Yes. I pay a good deal of money to my employer for my insurance premiums. And by the time I met you, I had spent close to $3,000 trying to figure out what this was in co-pays on tests and doctor’s appointments. And I was really feeling like, the only way to get back to somewhat normal existence was to invest in my health. And by taking those two tests, you had assured me that the tests were very revealing, in that we would get a lot of information. And I will tell you, I was very cynical initially, because traditional medicine couldn’t solve my problem. I really was a little bit cynical, like geez, is Lindsey really going to be able to help me? So, when I got the test results, and we reviewed them together, you were very thorough, and you went line by line explaining them to me. It was an emotional moment, because I actually had a clue to what was causing my severe issues. It was like a great relief, I finally had some answers.

Lindsey:  

Yeah. So, on your GI Map, we found that you had H. pylori, which was under the levels considered normal, and some practitioners do believe that you can have H. pylori, and it can be a healthy commensal organism, if it doesn’t have the virulence factors that cause cancer and ulcers. And yours didn’t right, but we did decide that given your symptoms, that it was worth treating, because obviously, it’s one thing if you have no symptoms and have H. pylori; it’s another thing if you have terrible symptoms and have it. And then you also had high levels of clostridia, streptococcus, and Akkermansia muciniphila, which again, some of these are commensals. They’re good bacteria, but not when there’s too much of them. And then you had a high level of a protozoa called blastocysts hominis, which some practitioners treat as a parasite, but it’s also present in healthy people and more and more practitioners are leaving it alone. And then you also had low levels of pancreatic elastase 1, which indicates suppressed pancreatic function and likely low stomach acid, especially if you have H. pylori. And you also had low levels of Secretory IgA, which is our primary immune defense in the gut that helps maintain the microbiome and protect against the toxins that can come in with your food, including bacteria. And one of the main reasons that can go low is stress. And you’d been through an extended period of stress before that all began. Do you want to share a little bit about that?

Ann Marie:  

Yeah, that’s correct. So along with continuing my full-time career as an art director, my mom became ill and the decision was made between my siblings and me to keep her home in hospice care. But she was a 45-minute drive away. We had around the clock care, along with staying at the house ourselves and caring for her for nearly two and a half years. So, we had the maintenance of the home plus the management of the caregivers, which basically fell on me. So along with trying to work and support myself and maintain a somewhat normal life, I also had the care of my mom, which was about 30 to 36 hours a week, on top of the full-time job, and it was an extremely stressful situation. And as the years and months went by, I was sleeping less and less, and I definitely suffered intestinally. The constipation got much more severe during that time period. 

Lindsey:  

I wanted you to share about that because I just did a previous podcast on stress. And yours was one of these sorts of textbook situations where yes, you might have had H. pylori and been okay with it. But I guess you were having symptoms in any case, but they got a lot worse when you were under stress. And then on the Organic Acids Test, you had some slightly elevated yeast levels, and elevated bacterial levels, in particular with closdridia, and the marker for C. difficile or Clostridium difficile. And then you had an elevated oxalate marker, which can happen when there’s excess yeast. You know, it’s normally about 3- 5% of the gut microbiome. And then low levels of a few of the B vitamins. And then most notably, you had low levels of all of the organic acids that show the levels of your neurotransmitters, that is the dopamine, epinephrine and norepinephrine, also known as adrenaline and noradrenaline, and serotonin. So yeah, you mentioned a little bit about being depressed, was there any other mental health symptoms that you were having that those markers brought to light?

Ann Marie:  

Yeah, I definitely think that the depression and low mood and my energy was just horrible. And I was attributing it to the additional stress of my mother’s care, on top of work. But I will tell you that I really wish that I had had someone that I was in contact with, that I trusted that could have said, you know, you really need to find out what’s going on inside. And because I had worked with the medical community and gone back and forth to the doctor for this issue, I thought that I was doing the best I could for my body. And then those tests revealed to me that there was so much critical information to how I was feeling that my traditional doctors could not or never suggested to look for. So, it was really an eye opener, and I came to this route, because the frustration of not knowing, number one, so I started researching online. And I’m also a little bit cynical about what I’m reading, like, is this accurate information? So, quite honestly, the podcast really helped. It really helped because you were interviewing and talking to people on The Perfect Stool, who were medical professionals who were talking about patients that had symptoms like me, or had helped patients by suggesting certain dietary changes and adding certain supplements. And I’m thinking, my goodness, this is really eye opening. There’s lots of people like me, who have this intestinal issue that have not been able to get it resolved. There was so much comfort in that.

Lindsey:  

Yeah, yeah. No, it’s good to know you’re not alone in your suffering. So, you had also had some anxiety or some panic attacks before too, didn’t you?

Ann Marie:  

I did. Those happened in early January. And you and I had connected about seven months after that. And, you know, the doctor told me that I was severely dehydrated, and I’m a woman who drinks 80+ ounces of water a day and when I think back, if everything that’s going into my stomach in my intestines is not being processed properly by my body, it may have been. I gave him a hard time and said, what are you talking about? I drink so much water all the time. And they had done two bags of intravenous, and I still didn’t need to pee. So, he said, that’s a sure sign that you are severely dehydrated. And it sorts of makes sense. Things were not functioning well at all for me.

Lindsey:  

Yeah. Okay, so when you came to get help with your gut, did you have any idea that we might also be working on your mental health?

Ann Marie:  

I did not. But I was intelligent enough to realize that the gut issues were bringing me down. Because I’m a physically active person. And if you haven’t been able to move your bowels for four or five days, it’s very hard to take a walk and enjoy that walk. So yes, I suspected that it was just strictly related to the lack of being able to move my bowels but soon learned from the testing that it was it was bigger than that.

Lindsey:  

So, then at that point before we even started doing much with your gut other than just that Atrantil (find in my Fullscript Dispensary), which is just a polyphenol product, I taught you about how to use the amino acids to bring up your levels of neurotransmitters. And once you started to use them in that way, how did your mental state change?

Ann Marie:  

Yeah, I would say the thing that’s important to notice, every time you taught me about a new supplement, I didn’t feel results within 48 hours or three days like other kinds of prescriptions prescribed by the medical world had done, you know, solving things within 48 hours. I will say, the supplements took some time. But once they started to work, and it was probably about 10 days after, the ones that were directed from my mood, I could feel the change. And it was amazing. It was amazing. I hadn’t felt that positive or uplifted in a very long time. So, it felt great. Awesome.

Lindsey:  

So, in terms of intervening on the gut health stuff, while we were working to support your gut immunity and bring up your secretory IgA with a product called MegaIgG, which is derived from colostrum and S Boulardii Probiotics, and then we were also working on your stomach acid levels with the Betaine HCl and digestive enzymes, I had you adding more fiber to your diet by increasing your intake of beans and legumes. And before that you had had trouble with fiber, hadn’t you?

Ann Marie:  

Yes, I did. So when you and I met, one of the things that I enjoyed was eating a salad or other vegetables, raw vegetables, and it was nearly impossible because I would eat my small salad, and then I would really be suffering because I had tried to eat raw vegetables, and that has changed. I can comfortably eat raw vegetables now. And high fiber foods like that. The beans and the legumes that I continue to eat probably every other day.

Lindsey:  

Now do you remember why we did that? Why I had you do that.

Ann Marie:  

Yes, I questioned you and asked you if I had to continue to do that. I don’t know if you recall that.

Lindsey:  

I’m sure you questioned me. You questioned me about everything. You let me get away with nothing.

Ann Marie:  

You had recommended that I try and eat the beans every day. At least I think it was a quarter of a cup. I can’t recall. 

Lindsey:  

Sometimes I tell people a half a cup, it depends on how large you are and you’re a pretty small woman. So I can’t remember if I told you a half or a quarter.

Ann Marie:  

Yeah. But initially, when I had to eat them, it was difficult. And then as things got better, feeling better, I very easily could eat them every day. No problem at all now.

Lindsey:  

Yeah. And the reason we did that, though, was to start feeding the good bugs in your gut, to start growing the healthy bacteria in preparation for killing the H. pylori so that there would be something there to take over when it started heading out. 

So, I think you’d agree that one of the biggest changes came when I taught you about how H pylori can be eradicated using mastic gum, which is a natural and gentle alternative to the triple therapy that the doctors use, which consists of like two antibiotics and a proton pump inhibitor. So how did you feel after the H pylori was gone?

Ann Marie:  

Even the process of healing, you worked on healing my intestinal lining I believe first, even that made a difference. And then we moved towards getting rid of the H. pylori. And once again, I just want to say it’s not an overnight 24-hour fix. You know, it takes a commitment to stay the course. But I find it very hard to believe that if I went the traditional route to get rid of the H. pylori, that I would feel as good as I do now. I can’t imagine that multiple antibiotics would have left me feeling so good. After a couple weeks of those I can’t imagine it would have resolved a lot of what was going on, just that alone.

Lindsey:  

Well, I think the danger with the antibiotics is that you wipe out all of the bacteria, not just the H. pylori, and then you end up with an overgrowth of yeast, and that’s where I find a lot of people, they come to me after that process has happened not necessarily for H. pylori, but just from antibiotics in general. And on your original Organic Acids Test, there was some slightly elevated yeast levels to begin with, as well as the elevated clostridia and streptococcus. And so, after that I taught you about the Biocidin products and grapefruit seed extract to work on those. And those were a bit stronger and, my recollection is you didn’t have a very good reaction when you were on those. Can you tell everyone a little bit about that?

Ann Marie:  

Yeah, so the supplements that you just recommended, I followed your recommendation to increase them as you told me titrate up, because I found that if I went to the full dosage recommended, I would really feel the difference with the grapefruit seed extract. I really felt really awful. It’s almost like a slight flu symptom that I would get when the supplement wasn’t working or agreeing with me off the bat. But I did hang in and say, okay, I might feel a little uncomfortable for a day or two. But it’s going to get me to the next level or a better place. And that’s important information. The initial introduction of some of the supplements I really felt. And I don’t think everybody probably experiences the same thing. But I hung in there believing that you were setting me on the right path. And it definitely made a difference. It was so worth it to stay the course and do the recommended suggestions that you had given me in our calls.

Lindsey:  

So when you get on supplements that are my antimicrobial, and in particular, when they fight yeast, you can have these die off reactions where you’re getting all of the byproducts of dead microbes going through your system. And sometimes it happens too fast. So I usually warn people, when you start if there’s any problems like that flu-like reaction to just stop (that’s a Herxheimer reaction), to just stop taking them and let that pass. And to take something like a GI Detox (find in my Fullscript Dispensary) or an activated charcoal in order to absorb the byproducts of the die off. Then those will be ushered out of your body. And then you can resume so that you don’t have too strong a reaction.

Ann Marie:  

Right, right. And as you said, you recommend to other people, you also recommended the activated charcoal for me. And it definitely helped on more than one occasion to have that available that it was in my house. So if I felt like I was really feeling uncomfortable, and the supplement was causing the discomfort that the activated charcoal really did take the edge off and help me through it.

Lindsey:  

Yeah. So, during the time we worked together, I had you use a variety of different probiotics. When I met you, you were already taking Visbiome, which is the new name VSL#3. And then some of the other ones that you used were the BioKult, ProFlora 4R which is a spore based probiotic, and S Boulardii, which is a beneficial yeast. So, do you have any sense of the role that the probiotics played in your healing or any that you particularly liked?

Ann Marie:  

Well, you know, it’s really hard. I can’t say clearly because I had a regime of many other supplements happening at the same time. So, I do not know the last one that you recommended, is it Mega 2000?

Lindsey:  

Megasporebiotic?

Ann Marie:  

Yes. I mean, that’s the only one that I can distinctly say, I really like taking because a lot of the other supplements I took for maybe eight weeks or 12 weeks, and then they were weaned out of my schedule. But taking so many at the same time was a bit overwhelming. I felt pill crazy. You know, I was trying to keep track of them, which I did, because I really wanted to get well. But it was hard to know, unless I introduced something new into the schedule. It was hard to know which ones were making me feel good, bad or different. Other than the mood, the mood ones I knew right away, you know, within a week to 10 days that they were really helping how I felt.

Lindsey:  

Yeah. So, we started working together like nine months ago. And now I’m a lot more thoughtful about people doing one thing at a time so they really can tell how each thing contributes. That’s one change that I made since then.

Ann Marie:  

Yeah, I think that the process has taught me that I have a very sensitive body and digestive tract. I really think that maybe others would not have had the same reactions because everybody’s body is so different. 

Lindsey:  

I have noticed that, yeah, people completely differ. There’s some people who just don’t feel like they could have H pylori. Not even feel it like they literally don’t know. So, it can affect people differently. Now that you’ve had some time for your gut to settle after the final round of supplements, how are you feeling?

Ann Marie:  

I feel terrific. And I try not to question why I didn’t do it sooner, you know, jump on board sooner when I started to learn about this different process to heal my problems. But you know, I’m an older, more mature person. And when I’ve had medical issues, my doctor has been able to help me resolve them. So I was hanging on to that thought process and listening to podcasts and reading about digestion issues. It took me a while to walk over the bridge to a different way of healing, you might say. And I can only say that I highly recommend to other people now not to wait to deal with your gut issues, because it makes a huge difference. I feel like I’m living again, I’m not analyzing everything I eat or stressing because I can’t eat something. I’m so much more knowledgeable.  So, working with you, It’s like a private education in digestive health. It really was. I’ve learned so much through this process. You know, when I first started working with you, it almost felt like a foreign language. But I have a better understanding. I don’t know, I can’t tell you exactly what supplement did what. But I do know that each one was beneficial along this path to healing.

Lindsey:  

Yeah, you were a good sport about taking a lot of pills. And you know, some people are just like, for many reasons, sometimes it’s finances in terms of being able to get all the same supplements at once, sometimes it’s more just the logistics, and sometimes it’s they can’t fit them in at certain times of the day. So, you know, I am flexible with different people, depending on those that situations. You seemed to be game to stick with whatever schedule. And so I threw everything but the kitchen sink at you to get you better as fast as possible.

Ann Marie:  

Yeah. And I desperately wanted to heal. I mean, it had been years. And you know, I was so worn down from the process. I mean, when you have digestive issues, it’s an ongoing crisis, I guess, and what happened to me was the ongoing digestive problems became my normal. And it’s really sad when you sort of just shrug your shoulders and say, “Oh, well, this is my life, you know, I guess I can’t have a bowel movement for four days.” You know, it’s just a very bad thing. So, I was I was really excited that when we first stepped in, and I got some diagnosis, that there was a possibility that I could get to a better place. And I was committed to that, as you know.

Lindsey:  

Yeah. And I appreciated your commitment and follow through because not everybody does exactly what I recommend.

Ann Marie:  

But you’re absolutely right. I mean, it’s really important that your readers know that it is definitely a commitment, but it is so worth it at the end of the line. It is so worth it to have a healthy gut.

Lindsey:  

Yeah. So I want to circle back about the oxalates. I’m not sure how much I’ve talked about oxalates before on the podcast, so I did want to just give a little background on that. Because oxalate and its acid form oxalic acid is an organic acid that comes from the food you eat and from the metabolism of fungi like Aspergillus, Penicillium and Candida, and then through normal human metabolism. But it’s really acidic, and it’s like what they actually use to remove rust from car radiators. And so most of the stones in the body like gallstones and kidney stones are made of calcium oxalate. And then the oxalate crystals can form in other places in the body,  like they can form those stones. But wherever they form, they can cause pain and damage and increased inflammation because they’re like sharp crystals. So, that can take place in the bones where they can crowd out bone marrow cells and cause anemia and immunosuppression, it can happen in the joints causing joint pain, it can happen in the blood vessels where they can cause damage. In the thyroid, like if you’ve had a thyroid nodule, at the root of it could be an oxalate crystal that your body is trying to cover up. They can cause urinary tract infections by making small cuts in the urinary tract that the bacteria can infect, they can cause vulvodynia (vulvar pain) and then even in the lungs and brain, they can interfere with normal functioning. And you had a history of gallstones and then you also showed an elevated oxalate marker. And you were also avoiding dairy products. So, my recollection is that I taught you about how taking calcium citrate with meals can help absorb excess oxalates and usher them out of the body. And then I think I suggested you move to more moderate oxalate diet. So, do you remember doing that and the foods that you were eating that were high in oxalates and the changes you might have made?

Ann Marie:  

Yes, absolutely, I was I was eating a lot of dark leafy greens, thinking that they really good for me, lots of blueberries, and nuts. I think it was almonds. But I will say that I didn’t realize that that could be causing the problem. Obviously, this whole process has been a learning experience. And the terminology, even listening to your podcast, The Perfect Stool, the terminology between you and the doctors, or the guests that you’re talking to. Many times, I would go to the internet and Google the terms so that I could get a better understanding. And I understand what you’re telling me now. But it’d be very difficult for me to tell you correctly, exactly what the supplement is. And that’s another reason to work with you. Because I’m an art director, I have expertise in my field. But this is so far away from my field. And your expertise can teach people so much more about what their body’s doing. And those tests are so revealing.

Lindsey:  

You did pinpoint those leafy greens, like the kale and spinach and nuts, and the blueberries and such that people think are healthy. So were you able to reduce those kinds of foods in your diet for a time?

Ann Marie:  

I did, I did. I was much more careful about choosing other vegetables, because I know from being a healthy eater that vegetables are very important in our diet. And so I switched more to broccoli and cabbage and things that didn’t cause that situation to happen.

Lindsey:  

Yeah. And once your yeast levels come down, usually your body can handle the amount of oxalate that’s produced. So some people in the long term do have to pay more attention to it. And especially if you start seeing like those initial things like UTIs, or urinary tract infections, that’s kind of one of those early markers that you might be starting to have problems with oxalates. So some people do have to watch it in the long term, but generally, it’s the elevated levels of yeast that are causing the excess oxalates. And then of course, if you have a meal with dairy, then you don’t have to worry about it. But for people who avoid dairy like I do, I’ll take a calcium citrate with each meal that has oxalates in it.

Ann Marie:  

Yes, yes. I’m doing okay. As far as dairy consumption, I find that if I eat less of it, I feel a lot more comfortable. I do indulge and I have it maybe once a week, but I do stay away from it. Because I like feeling really good.

Lindsey:  

And you stay away from gluten too, right?

Ann Marie:  

I do. I’m gluten-free. And that’s something that I was doing before we met right. And then I was taking some dairy out. But after we met, and you educating me on trying to eliminate the dairy for at least a time. And noticing the difference was amazing. I have so much less mucus in my sinuses, in my throat now that I’m not consuming dairy even every other day. I mean, it’s amazing.

Lindsey:  

That’s exactly how I feel without dairy. I say dairy is bad for me in all sorts of different ways. But you were pretty typical of my clients, which is to say you were you already were eating a very healthy diet. And I find that by the time people come and see me, they have already done a lot of the dietary stuff. So, I don’t usually put really stringent dietary demands. But I do often suggest reducing gluten and dairy. Now if you know that you have the gene for lactase persistence, and you know that you can digest the lactose, and you don’t seem to react to dairy, then I might not necessarily say to get rid of that unless someone has an autoimmune condition, in which case I usually like to see the dairy and the gluten and sugar and such go away. 

What was it like communicating with me over email between our sessions?

Ann Marie:  

Well, I will say that you were very prompt; you normally responded to me within 24 hours, you know, and I often reached out because I would feel the differences with the new supplements and I just wanted to be assured that that’s pretty normal to feel that way. And, you know, that titrating up carefully and slowly was the way to do things. And then I would double check with you if taking the activated charcoal would help a situation that I was feeling, so that was really important to know that I was going to get an answer quickly. I wasn’t wondering if Lindsey was ever going to get back to me, I don’t think that ever happened to me in this whole process.

Lindsey:  

I hope not. Okay. Any advice to anyone who might be sitting on the fence about getting some professional help with their gut problems?

Ann Marie:  

Yes, yes. I think that even if you have to, like I did on occasion, charge the supplements, you are worth the investment. The change of quality of life is so big. It’s so worth it. Everything is better when you’re digesting your foods properly and able to go the bathroom properly, whether it’s diarrhea or constipation, or indigestion, acid reflux, and all those uncomfortable things that we put up with every single day. I wish somebody had given me a pep talk and said, Look, take care of your health, spend the money on yourself, and get yourself to a healthier place. It’s worth every penny.

Lindsey:  

Awesome. Well, thank you so much for sharing about this. Any final words that you want to say? Or was that it?

Ann Marie:  

I think that’s it. And I wish anybody who’s thinking about entering the process, the best of luck. And once again, encourage them not to hesitate, to go ahead and start working on yourself. 

If you’re struggling with constipation or other gut health problems and are ready to get some professional help, 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 gut health coaching 5-appointment program 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.

Schedule a Breakthrough Session Now

Stress, what is it good for? Not your gut!

Stress is obviously unavoidable for most of us and for so many of my clients, a long period of chronic stress preceded their gut health or autoimmune issues. So in case you’re underplaying the importance of stress in your digestive health, I’m going to help you understand why it’s so important, and how to address it so that maybe you can start to tackle the problem and remove the root cause of your gastrointestinal problems.

So just to give one super concrete example of what a brief exposure to stress does, think about how you get nervous before public speaking or a sporting event or a blind date or whatever it is that makes your nervous. What happens? Your body immediately starts dumping serotonin into your gut, which, in addition to being your feel-good neurotransmitter, is also what prompts peristalsis, or the movement of food through your intestines, and all of sudden you have to run to the bathroom with diarrhea. This can happen with a super brief exposure to something stressful. I give that common example that we’ve all experienced to demonstrate how our bodies are such finely tuned instruments that with every thought send chemical messengers or neurotransmitters throughout our bodies, causing seen and felt and also unseen and unfelt (or at least in the short-term term unseen and unfelt) reactions.

Now let’s look at what happens to the gut during a period of acute stress, or strong and immediate but short-term stress. This might be something like almost getting hit in traffic, public speaking, having to meet a deadline at work or having an argument with your spouse. Your body will go into sympathetic or fight or flight mode.

Some people have gut symptoms during these events, like nausea or diarrhea, which is from that sudden release of serotonin, or if you eat during or after one of these periods you may experience heartburn or acid reflux. To avoid some of these unpleasant gut symptoms when you’re experiencing acute stress, avoid eating or drinking and allow enough time to calm down before eating a meal. I recommend taking several 5-5-7 breaths before starting to eat to trick your system into a parasympathetic, or rest and digest, state. This is inhale for 5, hold for 5, exhale for 7.

How does chronic stress impact digestion?

Now chronic stress, on the other hand, is longer-term, lower-level stress, like work pressures, ongoing relationship issues or caring for an aging or dying parent. This kind of stress can, over time, have significant effects on the gut and digestion. If you have chronic stress, you might find that you develop regular and unpleasant digestive symptoms, even when you are removed from immediate stressors while eating. Some of these symptoms include nausea, heartburn, acid reflux, bloating, pain and even vomiting during periods of severe stress. Chronic stress can also change how quickly food moves through the digestive system, causing either diarrhea or constipation. It can also cause muscle spasms, including in the digestive tract, which can be uncomfortable or even painful.

So what are the mechanisms behind all of this? How is it that the brain and gut are interacting, and what can you do about it? The gut-brain axis is how the brain and your gut communicate, which happens via the vagus nerve and the microbes in your gut. The interesting thing about the axis is it goes both ways, meaning the brain can contribute to gut symptoms and the gut can impact brain function.

When you’re under stress, your body releases the hormone adrenaline, and I’m sure you’re all familiar with what a rush of adrenaline feels like. Adrenaline is also known as epinephrine. Your body also releases noradrenaline while under stress, also known as norepinephrine. Together they increase your heart rate and blood pressure and release glucose into the bloodstream to give you energy and then norepinephrine also helps break down fat to give you more energy. So epinephrine and norepinephrine, along with the neurotransmitter dopamine are known as the catecholamines. And what’s important to know about them is that you need tyrosine, an amino acid, to make all of them. The order of operations is tyrosine turns into both thyroid hormones and DOPA, then DOPA turns into dopamine, the neurotransmitter that gives you pleasure, motivation and focus, and dopamine turns into norepinephrine, which turns into epinephrine. So if you’re under chronic stress and over time producing a lot of these catecholamines, you’re using up a lot of your tyrosine for that purpose.


Now tyrosine is one of the 20 amino acids that make up every protein in the human body (with the notable exception of collagen, which doesn’t contain tryptophan). But other than that, when I say every, I don’t mean that some proteins use 7 amino acids and some use 12, I mean that every single protein except collagen in the human body needs all 20 amino acids. You probably think of proteins in humans as something that builds muscle, but they do a heck of a lot more than that. Beyond creating the structures of our bodies, they create enzymes (like the enzymes you need to digest food), hormones, antibodies and other immune system cells. They also bind, transport and store molecules and pretty much do most of the work in cells. So basically, proteins are required for the structure, regulation and function of all of the body’s tissues and organs. So proteins are not just important, they’re fundamental to the functioning of a healthy body. 

So when you’re under periods of acute stress, protein breakdown increases by as much as 20% and your body will start cannibalizing muscle tissue or the gut lining to get the nutrients it needs to make energy and proteins in your body. This can lead to intestinal hyperpermeability aka leaky gut, which can then manifest as food sensitivities, and if left long enough, autoimmune diseases.

You will also run through the B vitamins at a higher rate when under chronic or frequent acute stress because B vitamins are cofactors with enzymes, they’re used in the production of hormones and neurotransmitters and serve many other important protein-related roles in the body. Some examples are B6, which is required for the production of dopamine, serotonin and GABA, an important inhibitory neurotransmitter that can make you feel physically anxious when it’s in short supply; B12, which is used in the production of serotonin; and B5, which is used in making steroid hormones, like cortisol, which is also released by the body when we’re under stress.

Chronic stress also leads to decreased production of serotonin, which as I mentioned before, triggers peristalsis, or movement of food through the intestines. In fact, 95% of it is produced in your gut. So the lack of serotonin in the gut can lead to constipation, and also stagnation in the small intestine, which can lead to dysbiosis, candida or small intestine bacterial overgrowth, aka SIBO, leading to symptoms of bloating. Once microbes become overgrown, depending on which of them take over, you can end up with either constipation, soft stool or diarrhea downstream, or some combination of those. 

What does stress do to your microbiome?

Another thing that happens during periods of chronic stress is decreased production of something called secretory IgA, or immunoglobulin A. Secretory IgA is a type of antibody, or immune system cell, that protects the mucus-lined surfaces of the body, including the intestines, and prevents pathogens from entering the circulatory system. Lowered levels of secretory IgA from stress can allow pathogens to attach to the gut lining, such as Helicobacter Pylori or H. Pylori, for example, and can lead to inflammation in the gut, ulcers and increased intestinal permeability. Then gut inflammation in turn can lead to dysbiosis and an overgrowth of opportunistic bacteria. In one of my clients I saw this exact pattern where a prolonged period of stress lead to what was probably a non-troublesome case of H. Pylori becoming a symptomatic case. Once we eliminated the H. Pylori and addressed some other aspects of her dysbiosis, her symptoms subsided.

Stress can also decrease the production of stomach acid, which is important for killing pathogens that come in with your food. One of the reasons for this is that B vitamins are necessary for the production of stomach acid, and as I mentioned, they become depleted during times of stress.

In addition, during periods of stress, some people turn to eating highly palatable, processed foods for comfort or convenience. These foods that are high in sugar and unhealthy fats have a major impact on which gut bacteria and fungi, like candida, grow and thrive. It turns out that the good microbes like healthy fiber from plants and the bad ones like sugar and white flour. In turn, these bacteria and yeast that are flourishing off of the highly processed foods and sugar are communicating with the brain by releasing neurotransmitters, metabolites and endotoxins (which are parts of the cell walls of gram negative bacteria) that can negatively impact your mood and your eating behaviors. Some of these gut microbes that grow can even encourage further dysregulated eating, which fuels the same cycle of stress and unhealthy eating, as well as a risk of depression and other mental health issues. Studies have found that individuals with depression tend to have less diversity in their gut microbiome, and have species of bacteria present that promote inflammation, which is why I’ve heard practitioners refer to depression as a disease of inflammation.

Studies have shown that gut dysbiosis is promoted by a high-stress lifestyle and a typical Western diet. One study done on university students showed that their balance of unhealthy gut bacteria increased as their stress increased over a period of time. This unhealthy balance can then deregulate the immune system, causing you to be sick more often, further increasing stress. Similarly, stress and depression can promote leaky gut, or intestinal permeability, which again promotes an inflammatory response. This again plays into the cycle of stress, inflammation, gut health problems and depression.

How can I protect my health while under stress?

So what are some ways to avoid playing into this vicious cycle of stress, a dysbiotic microbiome, and the negative health consequences? To start with, you could use a good probiotic during times of stress to increase your healthy gut bacteria and lower your risk of leaky gut and consequent inflammation. Some studies have implied that gut diversity can actually improve stress responses. One that studied Japanese medical students found that their sleep, stress, autonomic balance, bowel movements and cortisol levels all improved when they began to supplement their diets with probiotics.

A few probiotics for general gut health I’d recommend are Bifido Maximus*, a good, high-dose lacto-bifido probiotic; Proflora 4R (find in my Fullscript Dispensary), which is a spore-based probiotic that also has some gut soothing ingredients and Seed** (get 15% off with my affiliate code PARSONS15), which they refer to as a synbiotic as it also has prebiotic polyphenols in it.

And while probiotics are a great addition to any diet, of course the food you consume has an even larger impact on your gut microbiome. A typical Western/American diet that is high in added sugars, saturated fats and processed foods will lead to inflammation, dysbiosis and leaky gut. And let me just note that when I mention saturated fat, this is in the context of the Standard American Diet, not in the context of a ketogenic diet, which has benefits that are different because of the endogenous or internal production of butyrate, which feeds the gut colonocytes, or the cells lining your large intestine.  A more traditional and gut-healthy diet is high in fiber from beans, legumes, whole grains, nuts, seeds, fruit and vegetables. It’s rich in polyphenols, which give plants their color, and unsaturated fats like olive oil, which also contains polyphenols, as well as Omega 3 fatty acids like you get from wild caught seafood and pastured-raised meats, dairy and eggs. This kind of diet promotes a much more diverse and healthier gut microbiome, which decreases inflammation and leaky gut and can promote mental health and lower stress. Studies in mice have even shown that inflammation in the colon significantly increases during periods of stress due to a change in the gut microbiomes of the mice.

Is stress related to IBS or IBD (Crohn’s and colitis)?

For people with existing gut conditions such as IBS, IBD or inflammatory bowel disease, that is, Crohn’s or colitis, the additional inflammation triggered by stress and the concurrent changes in the microbiome can be even more negatively impactful. In the case of IBS, not only does stress heighten the symptoms, it can even lead to the development of IBS in the first place. As I mentioned before, chronic stress can lead to dysbiosis, which is a major cause of IBS. Also in the case of IBS, around 40-60% of people also have a concurrent psychiatric diagnosis, such as anxiety or depression.

Similarly, for individuals with IBD, stress can also worsen their symptoms. Much like with IBS, many people who suffer from IBD also have a psychiatric diagnosis. Studies show that stress can cause flare-ups of IBD and can cause it to relapse. Interestingly, new research has shown that in two thirds of people who have both IBD and diagnosed anxiety, their anxiety began, on average, two years before their IBD. Also, people who had been diagnosed with anxiety or a mood disorder earlier in life were also diagnosed with IBD earlier than those who did not have anxiety or a mood disorder as a child.

Does stress cause ulcers?

Interestingly, a gut condition that many people believed for years to be caused by stress, stomach ulcers, is typically not. Stress can aggravate them, but typically it is not the root cause of this issue. Ulcers are usually caused by H. pylori and the overuse of anti-inflammatory pain medication, but as I mentioned, stress can give H. Pylori the opportunity to cause more trouble in the stomach and become symptomatic. And of all the things I work with clients around, H. Pylori is one of the worst in terms of symptoms of GERD, stomach pain, burping, bloating and insomnia, and when it’s gone, people feel incredible relief.

How can I reduce my stress and digest my food better?

So, if you have one of these conditions or undiagnosed gut issues and want to start addressing your gut health, it’s important to address the stress that caused or contributed to it in the first place.

First, use mealtime as a moment to enter into a parasympathetic, or “rest and digest” state. Turn off the TV, put away the smart phones; if it’s nice outside, sit outside and take at least 20 minutes to eat your food. Before eating, if you feel your body is tense, try a period of mindfulness where you take in input from all your senses before your meal, do some 5-5-7 breaths or a brief meditation. Try to chew your food 25 times before swallowing. If you have others around, make mealtime a time of pleasant conversation. We started some traditions like “Happy, Sad, Looking Forward To” when our kids were young. That’s when everyone says something they’re happy about, sad about and looking forward to. This helped create pleasant conversation and stopped some of the bickering between the kids at the table. Or we also did what we call “Family Rendition”, which was my younger son’s mispronunciation of “Family Tradition” which is where each person gets to choose one topic and they we all say one sentence about that topic.

Getting out in nature is also a great way to combat stress, so much so that some doctors are now literally taking out their prescription pads and writing a prescription for vitamin N. And studies show that the deeper you get into a natural area and away from civilization, the calmer your brain waves.

In terms of managing longer-term stressors, this can be more challenging. You can address the symptoms with practices like mindfulness, meditation, yoga or tai chi, and there are tons of good apps now to do that with. A couple of meditation apps that have been recommended to me are Calm and Ten Percent Happier.

Getting adequate sleep is also important for managing stress and incredibly important for detoxifying and rebuilding the body and brain. If you have trouble sleeping, practicing better sleep hygiene like putting away devices an hour before bed, stopping eating at least 2 hours before bed, making sure your room is completely dark with no blue lights, and sticking to a consistent sleep schedule, even on the weekends, are initial interventions. I also recommend to my clients who have issues with waking up worrying to set a time in their calendars each day to worry or list out all the things on their minds, so they won’t preoccupy them during the night. If you’re having trouble going to sleep, a couple good techniques are progressive tightening and releasing of your muscles up and down your body, or forcing yourself to keep your eyes open while repeating to yourself “Don’t close your eyes, don’t close your eyes”. It works brilliantly, trust me.

Other tips for managing stress include visualization, another aspect of mindfulness where you mentally place yourself in a positive, calm space. I like to take myself to North Litchfield Beach in South Carolina and the house we used to vacation at every summer. I then take in input from all my senses of what it feels like to be there.

Positive self-talk is also a key facet to managing stress and improving your self-image. Try and reflect on whether you would use the kind of language you say to yourself in your head or even out loud to another person. If you wouldn’t, work on being kinder to yourself and picturing and believing you’ll have a positive and healthy future.

It may help to keep a journal to note when you have stressful incidents and when they coincide with gut symptoms, so you can be more aware of the connection between the two. And if you’re struggling with stress from work, spend some time figuring out how to address it. That may mean being more firm in setting hours and sticking to them or talking to your supervisor about taking some work off your plate. This may mean having a conversation like: “I won’t be able to get to all these tasks this week, which ones are the highest priorities?” Or it may mean delegating some tasks or accepting something less than perfection on others. And it’s also important to take vacations, even if you can’t afford to go anywhere or are still in lockdown mode. Being a workaholic or working long hours is nothing to brag about if it’s hurting your health. Our brains badly need those weekend breaks, as well as longer week or two-week breaks periodically. Inevitably, my digestion drastically improves within 4 or 5 days of the start of a vacation so I have seen this play out in my life.

If you have IBS, IBD or other gut issues, joining a support group or a Facebook group to discuss your symptoms, ask questions and vent can be really helpful in not feeling so alone and can help alleviate some of the stress that come with these gut health issues. I have a Facebook group called Gut Healing where you’re welcome to come vent or ask questions.

And sometimes getting out from under chronic stress may mean taking courageous steps to make major life changes, like leaving a stressful job, taking a course on better managing your money or getting out of a toxic relationship. While I consider myself to be in a happy marriage now, there were times in my early marriage where the stress of the fighting with my husband was so bad, I remember sitting on the toilet and thinking – this is literally killing me; this is taking years off of my life. Fortunately, counseling, life changes, maturity, compromises, the passing of time and releasing of unrealistic and unfair expectations, as well as better self-control on both of our parts has helped us get to a much happier place.

And please don’t let fear or stigma stop you from seeking help from a licensed mental health professional. It’s done wonders for me in my life. And what’s nice is that now, unlike years ago, mental health treatment is covered by insurance in the U.S. like other regular medical care. You can even get couples therapy covered under insurance if it’s causing one of you mental health issues. So please, take that courageous step and find a therapist who fits well with you if you’re struggling with high stress.

Well I hope this has been helpful and will get you thinking more about stress and how it’s impacting your gut health and life in general. I have a practice I do every Friday morning, called super thinking. I go for a walk for 30-45 minutes or so without any distractions and I just think about my business and my life and problems I need to solve and come up with creative solutions for them. This is been really helpful in giving me the mental space to look at the big picture and think of bigger solutions for day to day stressors that aren’t going away.

If you’re looking to start solving your gut health problems and want to address the physical side of it as well as the mental, 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 gut health coaching 5-appointment program 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.

Schedule a Breakthrough Session Now

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**I am affiliate of Seed but do not receive a direct commission on their products.

Fecal Transplants and Bipolar Disorder: One Miraculous Recovery that Spurred Many More

Adapted from episode 47 of The Perfect Stool podcast with Jane Sullivan and edited for readability.

Lindsey: 

So we’ve had various people on the blog who have talked about their FMT experience, but none with bipolar disorder. I’m really excited to hear about how this all came about for you. So why don’t we start with your basic history of when you were diagnosed, when you first had symptoms, and how long that went on before FMT became an option.

Jane Sullivan: 

Bipolar disorder is a very difficult illness to be diagnosed with; it usually takes quite a long time for people to actually be diagnosed. I had experienced serious mental illness for 13 years before I was even diagnosed with bipolar disorder. Growing up, I had quite a lot of adverse childhood experiences, you know, I had a very stressful childhood, my mother was physically and mentally ill, and that really affected her parenting ability. And that caused significant trauma in my childhood, and then a lot of bullying. So it wasn’t a happy childhood. But I was functional up until my mid-teens when I was, unfortunately, groomed and molested by my uncle. This trauma put me into a health spiral very shortly afterwards, and I developed chronic tonsillitis and then ended up taking multiple courses of antibiotics over a two-year period. In Australia, we have free health care, which is fantastic, but if you need surgery, you get put on a waiting list. I needed to get my tonsils out, but I kept getting pushed down on the waiting list. Every six weeks or so I was given another course of antibiotics because the tonsillitis would flare up, and it was only until I got glandular fever and was hospitalized that they were finally taken out. From 16 to about 18 I took around 12 different courses of antibiotics.

Shortly after the abuse is when I fell apart and became basically non-functional. The trauma, for sure, was the trigger for serious mental illness. But knowing what I know about the gut microbiome and then the success later with the FMT resolving my symptoms, I really think that the trauma probably was the stress that affected my immune system and made me ill, and then the multiple courses of antibiotics must have just knocked out my gut microbiome into a state of dysbiosis and knocked out some keystone species that were really important for mental health.

So from the age of 16 onwards, I basically dropped out of school, I couldn’t work, I couldn’t study, and life from the age of 16 onwards was a living hell of just trying to not die. Because I became suicidal, I became disabled by serious mental illness. And then I wasn’t diagnosed with bipolar disorder until I believe I was 29, and this was after a few manic episodes where I became hospitalized. I believe I was diagnosed in 2011, and my psychiatrist was excellent, and we experimented with a whole lot of different drugs to try and find something that worked. And eventually, we found three drugs that stabilized me to the point where I wasn’t suicidal 24 hours a day. But still, I had no quality of life, and I was extremely disabled. I needed to be taken care of by my family, my partner and basically government assistance.

Lindsey: 

Now, before you continue, let me just start by saying I’m so sorry for everything that you went through.

Jane Sullivan: 

Well, I mean, trauma happens to a lot of people, it’s actually not an uncommon story.

Lindsey: 

Yeah. And I’m wondering, you mentioned your partner and such. So you describe being completely disabled, but obviously, life to some extent was going on in the midst of all that, what kinds of things were you still able to do in the midst of all of this mental illness?

Jane Sullivan: 

There were times where I was able to work in my early 20s. I worked in call centers, doing insurance call center work, or working as a medical assistant. There were times where I was functional enough to work, but the longest I was ever able to hold down a job was 12 months, and then I would relapse into serious depression. There were various levels of functionality. Just because I could work at times doesn’t mean that life was enjoyable or easy. It was a really big challenge; it was psychologically challenging to work, etc. There were brief times where I was more functional than others. And in my late 20s, I was functional enough to travel to Canada and live in Canada for a year or so.

While I was in Canada, another trigger that maybe amped up the bipolar was taking drugs at a party. I took a lot of drugs, started with magic mushrooms, and then when I lost my mind, I took everything that was there. And when the party ended, it didn’t end for me. And I ended up in a psychiatric institution in Canada, which was very frightening for my parents to get a call at 5 a.m., saying your daughter has lost her mind. The drug experience set something off in my brain or my gut, and from that point on, I rapidly cycled between suicidal or severe depression, and severe mania or psychosis where I would lose touch with reality and have the experience of leaving my body and traveling intergalactically with my alien friends. So before the drug experience, I was severely mentally ill, but had periods of functionality where I could work at times. But after the drug experience, it was rapid cycling, and I was basically almost completely non-functional. And I spent two years in and out of the hospital. But magically, in that time, I somehow met my husband.

Lindsey: 

So you met him in Canada?

Jane Sullivan: 

No. After I had this process of being in and out of hospital, I needed some actual kind of rehabilitation. I think what people don’t understand about the public psychiatric health system is that its emergency care. When you go into hospital you’re a danger to yourself or a danger to others, and then you get well enough to a point where you’re no longer a danger to yourself or to others, and you’re kind of sent back in the community, which doesn’t mean that you’re well or rehabilitated. So I actually had an opportunity to live and work on an organic farm, because a job that I did do previously was work as a landscape gardener.

Being outdoors and being in nature had a noticeable impact on my mental health. I took myself to this farm, and I had a routine and I was outside all the time, and I had my hands in the soil. That was kind of helpful in trying to stabilize myself and try to work out how I can possibly live and survive with this illness. Because in those two years, I tried to commit suicide multiple times, and if you succeed on your first attempt, you don’t see the damage that it causes to your loved ones. But if you fail in your attempts, you are confronted with the trauma that your suicide attempts caused to your family. And basically, I saw the damage that I was doing and decided that no, I can’t kill myself, which kind of made me feel really trapped in this life, in this body, and in this incredible suffering.

So living on the farm, I was trying to work out how I was going to live and survive and function and be in the world and on that farm. I say I found this magic frog in my raincoat. It was a very beautiful frog and I didn’t know how to identify it and I wanted to know about it. And I remembered that my sister had this friend Alex who was a zoologist who knew about frogs. So I sent him a photo of the frog, and we chatted, and we connected and seven years later, we’re married.

Lindsey: 

So that’s amazing that in the midst of all that you still managed to meet your partner and your future husband.

Jane Sullivan: 

Yes, that’s pretty incredible in itself. It was a period where I was kind of okay, kind of well, and so I moved to the middle of nowhere in rural Australia to live with my husband, and I’ve been out here seven years. Before the whole poo transplant, gut microbiome stuff, just moving to the bush and spending an inordinate amount of time in nature was very healing, very helpful, and reduced my stress. It was helpful, but I was not functional. I didn’t have much of a quality of life and he was really my carer.

Lindsey: 

So how many different medications Did you try before you settled on the few that kind of stabilized you but with no quality of life?

Jane Sullivan:

At least 15.

Lindsey: 

And do you, having gone through that experience, have any general feelings about the mental health institution and the way we treat it?

Jane Sullivan: 

I have a lot of feelings about it. Medications absolutely saved my life. I am not against medications; they currently are the best we have to offer. Unfortunately, for a lot of people, they’re not good enough. There are vast amounts of people that have bipolar disorder, who have success with medication, reducing their symptoms or eliminating their symptoms to the point they can live full fulfilling lives with careers and families. I just happen to not be one of those people, unfortunately. There are many people that have bipolar disorder, who even on medication, have a very limited life, and psychiatric care. I’m exceptionally grateful that I live in a country where I had access to free psychiatric care, which absolutely saved my life, but it is not rehabilitation. It saved my life. It didn’t give me stability. It’s pretty great. But it’s not good enough. And it’s not a solution.

Lindsey: 

Yeah. So how did you hear about fecal transplants? And how long did you sit with that information before you moved on it?

Jane Sullivan: 

Yes. Well, my wonderful husband, because he is an ecologist, he has an understanding of ecosystems and the human body, and the gut microbiome is an ecosystem. Because he reads a lot of journals, he doesn’t even remember where he came across it, but he read an article in 2016. Actually, the first time he put the idea of a fecal transplant to me was when he read an article about how obesity has shown to be transferable. The fecal matter of an obese person was put into a germ-free mouse, and then they rapidly put on weight and vice versa. And an unfortunate side effect of one of the medications that I was on was rapid weight gain. So before being on this medication I was 60 kilograms. And then within six weeks, I put on 25 kilograms.

Lindsey: 

Yeah, wow. That’s like 50+ pounds.

Jane Sullivan: 

In six weeks.

Lindsey:  

That’s a lot of weight to gain quickly.

Jane Sullivan: 

I know. So it was like, oh, great, thank you, I’m insane and obese. Thanks for that. So Alex put forward the idea of, hey, I’m a tall, wiry, slender guy, maybe this could help you with your weight loss. And I didn’t love the idea because I’m not doing that to lose weight. That’s a crazy idea. So that’s when he first kind of put the idea of fecal transplants to me. And then a few months later, he happened upon another study, he can’t find this study. He’s been looking for it. But it was a mouse study or a rat study that showed that germ-free mice were given a fecal transplant from a mentally ill person, and they started to exhibit mental illness symptoms, and vice versa. And that really, really intrigued him.

And he thought, well, this is a preclinical mouse study. But you know, we test all our pharmaceuticals on mice, we share a common ancestor, so it didn’t seem that far-fetched that this could possibly help me. He’d seen the suffering that I that I had, and it was daily and incessant, and I guess, you know, he wants to help and wants to fix me. He pushed for this idea that maybe this could help me. Maybe this is a gut issue. And so I sat with the idea for six months, because I was like “What? You want to do what? That’s disgusting.”

And up until that point I’d never even heard and no one had even mentioned, the gut microbiome, or its potential link to mental illness. It was just such a foreign concept to me. And then what made me finally decide to truly think about it was when my grandmother turned 88, I believe. And she’s in perfect health, which is amazing, and she’s now in her 90s. But it also horrified me because it’s like, oh, my gosh, I have actually good genes, I could live for another 50 years, I can’t do another 50 years of this. I’ve already done 18 years of this, and I can’t survive it. It was out of desperation. And it was kind of like, if this didn’t work, we were going to have the discussion of how do I end my life without him going to jail? The level of suffering that I was experiencing was unsustainable.

Lindsey: 

Did you look into doing it at a clinic, because I know a lot of people go to Australia to get their fecal transplants?

Jane Sullivan: 

Well, at the time, we weren’t educated enough. We didn’t realize that there were clinics in Australia that offered FMT, but I doubt that I would have been accepted into one of those clinics. Anyway, there is a person that I’m in contact with, a friend who has been accepted and actually started FMT yesterday for bipolar, but he got into the clinic because he also has gut issues, and I didn’t have gut issues. I didn’t have any IBS symptoms or anything like that. This was in 2016. We felt there was no option to do it, except DIY, but I was hesitant to even try it without speaking to my psychiatrist first.

And I’m very grateful and very lucky that my psychiatrist is a pretty cutting-edge guy who seems to stay up to date with the latest research and I live so far away from him that we had a telehealth appointment. I just called him up. I was very hesitant to mention that we were thinking about doing this, but I said, Doctor, you know, what do you think about fecal transplants and bipolar? And he goes, “Jane, it’s the medicine of the future. In 20 years, I’ll be out of a job, they’ll be able to analyze your gut microbiome and see what species you have missing and give you a tailored probiotic. And all your symptoms will go away. Why do you ask?” I was like, well, we’re thinking about trying fecal transplant for my bipolar symptoms, and there was a bit of a pause. And then he was like, well, I’ll be very interested to see how that turns out. Tell me how that goes. Which was kind of like a thumbs up from him. But then he followed that with, you know, Jane, the research is showing that there is a clear link between the gut and the brain, but it’s all preclinical. There hasn’t been a human trial. So that was what gave me the confidence to go for it. I’m lucky that I have an understanding psychiatrist. And I was definitely lucky that my husband was a perfect and safe donor and one of these unicorn people that have like, never had an illness and no history of mental illness. No history of gut issues, no allergies.

Lindsey: 

No allergies. Wow. Yeah, that is a unicorn.

Jane Sullivan: 

Yeah, and was born naturally, breastfed, grew up around pets, has been crapped on by a million different types of Australian animals living in the bush, eating with indigenous people, and anyway, just a really healthy guy who hasn’t really experienced stress in his life.

Lindsey: 

Yeah, wow. Had you tried any probiotics or any kind of supplements to try and help with your mental health at all along the way?

Jane Sullivan: 

I had. I had discovered the work of the Walsh Institute with regards to nutrient therapy. And I saw a special GP who had been trained in looking at nutrients, like vitamins, minerals, etc. to see if there’s an imbalance. I got all these tests done and then I was given a tailored supplement plan and it didn’t really help. I didn’t try probiotics because they were not really regulated, especially at the time too. It was kind of like there wasn’t a huge amount of evidence that probiotics could be effective, I guess. I don’t know. But we kind of figured well, FMT is like the ultimate probiotic.

Lindsey: 

Right. Right. So you kind of jumped straight from that. I’m curious, did they test your amino acids?

Jane Sullivan: 

I think they did.

Lindsey: 

So let’s get to the FMT. So you finally decided you’re going to do it. Did you have your husband tested for anything before you did it? Or did you just jump in?

Jane Sullivan: 

Well, I hesitantly say that we jumped in and for anyone reading, don’t do that. That is extremely dangerous. We didn’t get him tested. He has since been tested, because he’s been a donor to other people. We found an FMT clinic in Australia and went to their website, and it had the donor questionnaire, donor history, etc. and the exclusion criteria, and we knew his history enough that we thought he was safe. Luckily, he was, but he could have had some kind of parasite or something, right? We were reckless, and we were lucky. But yeah, that’s dangerous. And we’ve kind of figured that the fact that he’s never experienced any kind of mental health problem would just suggest that he had the right microbes that I am missing, potentially. That was his theory.

We started FMT in November 2016. And really, I was highly skeptical about it, because there was no precedent for doing it for bipolar. I joined all these FMT forums and was asking, has anyone tried this specifically for mental illness, and I couldn’t find anyone. We didn’t know how often to do it. So basically, we just did one FMT, via enema, every couple of weeks, maybe every two weeks, and at that time, I was severely depressed, like severely depressed, barely able to get out of bed, barely able to even look after my basic hygiene, level of depression. I didn’t experience any improvement at all for three months. I don’t even know why we kept going. I just kept trying, I guess.

And after about the sixth FMT, and about the three-month mark, something started happening within, and it was like, something started to change. And I remember that my depression just started to subside. It was like this bell curve of the depression starting to get less and less and less and less and less and less. And it was like, Okay, this is actually working, let’s do more. And there was a specific day, Lindsey, where I woke up and I had this strange feeling that I’ve never felt before of an adult, and it was like, do I feel good? Is this what feeling good feels like? It was confusing, because I had never felt good before, I never was not depressed, really, since the age of 16. It was just various levels, the spectrum of depression. And the only time I felt good was when I was hypermanic, and feeling good would soon turn into, you know, I’m the Savior of the world. I’m here to save humanity. And then I would start to see aliens, etc. So this good feeling just felt stable.

And there was a day where I stopped being depressed, and I started feeling good. And that good feeling just continued day after day. And it was this exponential increase in this feeling good. And of course, I started to be a bit worried, when am I going to start seeing aliens? When am I going to feel ecstatic? When am I going to be hypermanic, and it just didn’t happen. I just started feeling better and better and better. About maybe the six-month mark, all my symptoms were gone, I was no longer depressed, I felt amazing. And then I started to even have motivation. And I started to have confidence and feel joy for no reason and feel happy to be alive, which had never happened in my adult life. So that was really incredible. I felt amazing, didn’t have mania, wasn’t depressed, and it was like, wow, this is what it feels to be a normal human being.

I thought the test to see if it had actually truly worked was to try going off my medications, which is always a dangerous time. And for anyone who has bipolar one disorder, which is what I have, you are medicated for life, basically. And so I had tried to go off my medication many times and always ended up in a psychiatric institution because it’s just extremely dangerous. So my psychiatrist hesitantly agreed for me to be weaned off my three medications. Lithium was to stop me being depressed. Lamotrigine, I believe, was to stop me being manic. And then Seroquel was to help me sleep and to stop me, if I started to be manic, and it took a few months to wean me off, but still, it was too quickly.

He took me off too quickly. And I did have my last manic episode, in September 2017. And it was quite severe. But that was the last time I’ve been manic. So I was extremely manic in the middle of the bush in Australia, three hours from a hospital, and it was dangerous for me to get into a car, I couldn’t get to hospital, and my husband was unwilling to call an ambulance because they would have called the police on a mentally ill woman. And I was actually violent. I’d never been violent before in mania, but I was violent. I don’t really know what was going on there. There were other circumstances around that time. But my husband was really worried that if he called the ambulance and then the police, and then I might be violent, and then I would be shot.

Because it happens. It actually happened around that time that a woman in Melbourne had a manic episode and was on the street. She had a knife in her hand. She wasn’t attacking anyone. But the police showed up and within a few minutes, she had been shot dead. Well, that is actually a reality. Right? The thing is, he was stuck in the bush with this very mentally ill woman who didn’t sleep. And antipsychotics weren’t bringing me down. But then he remembered reading this case study of a woman who had GI surgery with bipolar and that the GI surgery triggered mania and they couldn’t give her anti-psychotics. So they tried giving her activated charcoal, there’s evidence that maybe the activated charcoal would soak up these inflammatory cytokines in the gut that somehow cross the blood brain barrier. And it worked. So Alex gave me activated charcoal, and I came down within three days.

Lindsey: 

And how long would a manic episode typically last?

Jane Sullivan: 

I wouldn’t come down for 15 days, at least. It was incredible to see. You know, my psychiatrist was guiding him to give me like high doses of antipsychotic, which wasn’t working. It takes a long time for that to work. But yeah, activated charcoal brought me down to a safe state. Like I was still manic, but I was not dangerous. I wasn’t dangerously manic. It was two or three days and since then, there have been other people who have had success with activated charcoal as well for mania, which I think is really interesting.

Lindsey: 

So did he put you back on the medication then at that time, and then did you then have to go back again and wean off?

Jane Sullivan: 

I didn’t go back on medications once I came down from the mania. I mean, I was on Seroquel. I was on antipsychotics. When I came down from the mania I didn’t go back on lithium or lamotrigine. And then eventually, over time I was able to come off Seroquel. So yeah, FMT definitely resolved my bipolar symptoms in the sense that I no longer had depression. After that last manic episode, I haven’t experienced mania. I’ve basically been well for the last four years and in remission, and I say the word cure, but that’s a very controversial term. So I’m trying not to say that because I think it ruffles people.

When I said that, I think I was getting overconfident, that maybe I’m never ever going to get ill again. And then in 2020, I picked up three viruses, none of them were COVID. But my husband and I were doing some conservation work in the tropics. And I got bitten by a mosquito that had this virus called Russell River Fever, and I became very ill. And with incredible fatigue, I had post viral fatigue for six months, but at the beginning, I actually experienced mild depression. And I hadn’t done poo transplants for a couple of years. I thought, well, it worked before. Let’s try it again. We did one fecal transplant and within two days, the depression had lifted. I think potentially, I might have always have a weakness there. Even if I remain well, I know that I will have to continue to look after myself properly.

Lindsey: 

Okay. important question. Have you stored some of your husband’s poo in the freezer? In case he gets sick and has to take antibiotics and he no longer becomes a source?

Jane Sullivan: 

Maybe we should do that. But like, how long can you store poo in the freezer?

Lindsey: 

Well, you know, maybe you freshen it up every six months. But I mean, if he has to go on antibiotics and ruin his perfect microbiome, then you could lose your source.

Jane Sullivan: 

Well, does he have a perfect microbiome? I don’t know if there’s anything particularly magical about his microbiome.

Lindsey: 

Well, I can tell you there are a lot of people out there struggling to find a good donor. So the fact that he had a good enough microbiome.

Jane Sullivan: 

That’s probably a good idea. Thank you, Lindsey. We’ll do that.

Lindsey: 

So how frequently at the most frequent were you doing the transplants?

Jane Sullivan: 

It was every couple of weeks. We didn’t know what we’re doing. There was no precedent.

Lindsey: 

Okay, so maybe if had you done it much faster, you might have seen resolution a lot quicker.

Jane Sullivan: 

Well, that was a theory when my two older sisters, who have bipolar two disorder, decided to give it a go.

Lindsey: 

And so tell me about that.

Jane Sullivan: 

Right. It was kind of frustrating because I had had this miraculous transformation. And my psychiatrist even said that if he hadn’t witnessed it himself, he probably wouldn’t have believed it. It’s an incurable illness, you don’t recover. It’s unprecedented that I have been in remission for as long as I had, especially not being on medication. It just doesn’t happen. Which is why I continue to say that I’ve cured it. Anyway. So in 2017, I was well, and my sisters saw this, and I was like, “Hey, guys, you’ve got bipolar disorder, you really struggle. How about you give it a go?” But there’s a psychological wall that you have to get over to consider taking someone else’s feces.

Lindsey: 

Yes, I spent three years dabbling in the idea before I finally took the plunge.

Jane Sullivan:

Alright, so you’ve taken the plunge as well?

Lindsey:
Oh yeah.

Jane Sullivan: 

I don’t think I was a very good communicator, because my eldest sister, Dionne, she thought you have to do it forever. It’s not like I take medication, you take poop every day. I’m like, I don’t do this recreationally! Why would I continue doing it? When all my symptoms have gone? I’m just a terrible communicator. I didn’t make it clear: we only did 10. It took 10. She’s like, Oh, okay. All right. Well, maybe I’ll consider it. She thought it was like an everyday thing. In February 2019, I got my older sisters to do it.

The oldest, she’s a high functioning person with bipolar 2 disorder, in the sense that she worked full time, and she has two children that she took care of. She was functioning, but she didn’t have any joy. She experienced anhedonia, which is like nothing. It was just this bland. She was doing the things because she had to do the things to pay the bills and look after the kids, basically. So it was kind of like dragging herself through life, which isn’t fun.

And then my other sister Catherine was quite disabled by bipolar disorder; she was in her 40s and had to move home with my parents. And she rapidly cycled. I think her hormones are involved because around her period, she would become hypermanic. And that’s when she would live and she would plan and she would spend money and do all these things. And then within a week, she’d go down into this depression, and severe anxiety, like crippling anxiety, to the point where her executive function had been so affected by anxiety that she couldn’t put her thoughts together to even make a sandwich for lunch, like crippling anxiety, couldn’t leave the house. And that was her life, month after month. So that was really unbearable for her.

So February 2019, they decided to do FMT. We live seven hours from where my family lives. So luckily Alex does contract work, so there are times where he isn’t working. And we drove the seven hours, and I think we spent a weekend there. And they did three in a row, because we were like, alright, I didn’t want to go every two weeks. What if we do it more frequently? Maybe there’ll be faster results. I can’t remember how many they did. But we did one or two every time we would visit every couple of weeks. And then my sister Catherine actually came and stayed with us for a week and we did one every day. And I think that they improved more rapidly than I did. But it wasn’t like a magic, oh my god, I’m cured. It was still a process. It took months, and it was definitely just a lessening of their symptoms, and a noticing of, I’m not depressed anymore, or that thing that normally made me anxious doesn’t make me anxious anymore.

Like FMT absolutely resolved my sister’s anxiety and she started feeling and experiencing a broad spectrum of emotions and now they’re both doing really well. And I’m so grateful that we started FMT for them in 2019. Because by the time the pandemic hit, they were mentally quite well. And their stress tolerance was quite good as well. And this is a stressful time, even though we live in a country that has very little COVID. I hate to think about if they’d weren’t well, and having to deal with a pandemic. I really feel for people who have mental health issues, and then had to deal with the stress of the last year.

Lindsey: 

And so for your sisters, I assume they use your husband as a donor, obviously, right?

Jane Sullivan:

Yes, they did.

Lindsey:

And did you do testing before he donated to them?

Jane Sullivan:

Yes.

Lindsey:

What kind of testing did you do?

Jane Sullivan: 

The international guidelines for selecting donors – so blood and stool tests, basically, to make sure we didn’t have any nasty parasites or sexually transmitted diseases. We haven’t done like a Viome or Microba kind of analysis to see actually what general species are there. I don’t know what value that would be.

Lindsey: 

Another main reason to do that would be if you could access the raw data. You know metagenomic sequencing would pull out any potentially pathogenic species.

Jane Sullivan: 

Right. Well, interestingly enough, he wouldn’t be accepted as a donor in any clinic because of his age, but also, he does have blastocystis hominis.

Lindsey: 

Oh, okay. So that’s an interesting one, because there’s a lot of controversy around that even in the functional medicine community. And there have been studies and in one, 85% of healthy adults had blasto in them of them and showed no signs of illness or problems. I think it’s coming to not to be considered a parasite.

Jane Sullivan: 

That’s when we did our own research. I was like, huh, it’s pretty inconclusive whether it is pathogenic. Well, maybe. I haven’t read the data. But I’ve heard that there’s potentially like seven subspecies, and that maybe one or two actual species is pathogenic or has definitively been linked to GI issues. But what was interesting was that I didn’t have gut issues. Both my sisters had IBS. And then later on, my mother started FMT, with Alex’s a donor, because my mom has had gut issues for a long time.

Lindsey: 

Wow. And so have those resolved as well?

Jane Sullivan: 

Partly, but we think she needs more. Okay, but were your sisters’ gut issues with the first things to be resolved? Well, that was the gut issues, or IBS issues resolved, and then the, you know, mental health issues over time.

Lindsey: 

Okay, but for your sisters?

Jane Sullivan:

Their gut issues were the first things to be resolved. Well, it was the gut issues, and then the IBS issues resolved, and then the mental health issues over time.

Lindsey:

And were they more in the IBS-C or IBS-D spectrum or mixed?

Jane Sullivan: 

I haven’t discussed in depth their IBS issues.

Lindsey:

And how many total transplants did your sisters end up doing? Over what period of time?

Jane Sullivan: 

10 or 11?

Lindsey:
Each?

Jane Sullivan: 

Yeah. Over . . .  I don’t remember Lindsey. They want to do more.

Lindsey:
So months to years?

Jane Sullivan: 

A year. I don’t think we’ve done anything this year. It was just enema that we did. And at the time, I was really scared about top-down pills. But interestingly enough, when I had the post viral fatigue issues, I was like, well, maybe we can fix this, because obviously, the viruses had changed my microbiome, you know, so doing enema again actually made the fatigue worse. But then I learned how to make enteric coated, double encapsulated pills. So I thought, maybe it’s a different and maybe the poo goes through the whole digestive tract, it’ll colonize other areas. So I did top down method, and it definitely helped. I felt a difference. And so now my sisters want to do pills as well. And I think my mom as well. I mean, I think, psychologically it’s a bit more palatable to just swallow pills that look like supplements then an enema.

Lindsey: 

Yeah, not for me. I assume you double encapsulate them to make them clean? You pretty much just do the one that may be messy, but then you put it inside another one?

Jane Sullivan: 

Well, I’ve done it so it’s not messy at all.

Lindsey: 

Oh, really? How do you do that?

Jane Sullivan: 

Well, I found a video online of this guy in a lab going this is how you can make pills at home. So I bought size 00 enteric coated capsules because that’s the biggest size you can get in Australia and so enteric coated capsules survive the stomach acid because I figured you don’t want it to break down in the stomach. And I looked at medical trials without using capsules, they usually do an enteric coated and then a double layered kind of thing. So I got the poo. And instead of mixing it with saline, I mixed it with food grade glycerin, because saline actually breaks down the capsules very quickly. And I was like, okay, well I’ll make some and take them fresh but also freeze them and glycerin has a bit of a cryoprotective element to it. Apparently, it’s not the best cryoprotective thing to mix it with; apparently maltodextrin is. I had fleet enema bottles, and they’re actually perfect little squeezy bottles that I could squeeze the FMT slurry into the pills and I had a size 00 or a pill machine and filled it up, squeezed a bit of the poo into it, put it together, and then you’ve got 25 capsules in the enteric coated capsules. And it’s like well, you can kind of see the poo in it. So let’s double coat it. So I did triple zero veggie caps that were green. And then that just looks like a green supplement and I consumed them fresh and then froze them and I found that the frozen ones probably didn’t have as big as a kick as the fresh ones. But they seem to work. So yeah, that’s how I made pills.

Lindsey: 

And so this machine, is this an expensive thing to get, what does it look like?

Jane Sullivan: 

It’s an encapsulating machine and cost me like $30. It’s just a little machine that you put the capsules in, press it together. It’s not very expensive.

Lindsey: 

Yeah, no, that sounds very doable, especially for people who are pretty hesitant to do an actual fecal transplant rectally.

Jane Sullivan: 

Well, I mean, you still have to handle poo.

Lindsey: 

I don’t know that that’s the part that grosses people out. Although I’m less easily grossed out than a lot of people.

Jane Sullivan: 

I’m not grossed out anymore. Obviously, by this discussion. I even went on national television in Australia and put poo in a blender on national television.

Lindsey: 

Okay. And you wrote that there are 12 people now that that have experimented with FMT for bipolar disorder with success. Can you tell me a little bit more about who those people are?

Jane Sullivan: 

Well, there’s actually more than that now. There are currently six people who have been in remission for a while. So there’s me and my two older sisters, And then there is a guy in Peru called Kerwin who has bipolar 2 disorder. He found my story a few years ago and experimented with FMT, with his wife as a donor. And he’s basically been in remission for a few years, although FMT didn’t resolve his anxiety, so he’s adopted a low carb kind of ketogenic style diet, which keeps his anxiety under control. But his wife wasn’t the healthiest of donors.

Lindsey: 

And of course, there can always be other underlying issues, at a genetic level that are causing, for example, low serotonin.

Jane Sullivan: 

It’s very complicated. It’s an ecosystem. My story was very linear. I did the poo and then within a few months, all my depression went away. And that hasn’t been the case for everybody who has tried FMT.  Some people that has been, but other people, my friend who lives in the United States, she has a very different kind of bipolar that I’d never heard of until I started communicating with her. It’s called mixed bipolar, which is an incredibly dangerous kind of bipolar, because people who have mixed bipolar can be exceptionally depressed but manic at the same time. So it’s like you’re suicidal and actually have the energy to follow through with it. So she started FMT three months ago, and she’s done a lot of FMT and it has not been a linear process. She’s definitely improved dramatically, but it was like up, down, up, down, up, down, and the ups and downs got less up and less down kind of thing. It was just this dramatic depressive manic cycle and then it got less and less so. So it’s kind of like evening out over time, but it was not a linear process for her. With my sisters it was pretty linear, with Kerwin it seemed pretty linear.

And the most kind of incredible story recently was this guy Steve in Australia. People want Alex’s poo. People contact us, like can you be a donor? It’s not logistically possible because of where we live and etc. So this young guy, Steve has bipolar 1 disorder and had a severe manic episode, mid-2020. And then after the manic episode became exceptionally depressed and suicidal and it was in the middle of this depression and his girlfriend found my story and contacted us and wanted Alex to be a donor and we were like, we’re really sorry, he can’t be a donor.  But we left them with some resources about  if you’re serious about this, these are these clinics, or if you want to find your own donor, make sure you do it safely. This is the way to make sure your donor is safe. And just because it worked for me doesn’t mean it’s going to work for you. We don’t know. It’s all anecdotal, etc., and left at that. And then a few months later, we got an email from them, saying that his girlfriend had been tested and she was a safe donor. And they did FMT and he came out of his depression within 30 minutes from one FMT. Like severe depression to not being depressed anymore in 30 minutes, and that is unprecedented.

Lindsey:

And he didn’t do a second one?

Jane Sullivan: 

He’s done more. Wow, that was incredible.

Lindsey: 

That is incredible. So your story has been printed in a journal, is that right?

Jane Sullivan: 

So my psychiatrist, he was rejected so many times, he was very frustrated, but he eventually got published in a respected journal called the Australian and New Zealand Journal of Psychiatry, but they only let him write 400 words about my story. But I see it as a victory because it’s now a drop in the ocean of the research. And I’m so humbled, I was actually asked by Professor Felice Jacka from Deakin University, who’s a world pioneer in nutritional psychiatry to be an associate investigator for an upcoming clinical trial, which hopefully they’ll get funding for in the next few months, to treat major depressive disorder with FMT. And so they used my case study in their ethics application. So it’s like my story is helping science.

Lindsey: 

I see they’re applying for grants, but if they want donations, is there a place that people could donate to help on that research?

Jane Sullivan: 

Oh, for sure, you could go to Food and Mood Centre at Deakin University. If you look that up, you’ll be able to find them. I would love that.

Lindsey: 

Okay, great. Anything else that I haven’t asked about that you would like to share about your experience?

Jane Sullivan: 

I think I’d like to say that FMT didn’t kill everything. I’m kind of worried that I’ve painted a false narrative of like, I took poo and all my suffering went away, and all my problems are resolved. The life-threatening problems were resolved. I mean, the bipolar dramatically reduced my capacity to live, you know? So FMT resolved my bipolar symptoms, which gave me quality of life, which made it possible for me to live and be functional, and at the age of 37, learn how to be an adult. But what it didn’t do is it didn’t resolve my trauma. So, interestingly enough, FMT resolved my sister’s anxiety, but it didn’t resolve my trauma. I had PTSD and complex PTSD, that still kind of limited my ability to really function in the world. But what FMT did do for me is it resolved my depression and mania, and gave me space to now finally work on healing that trauma, which I have been doing for the last three years, because, you know, sexual abuse changes you, that changes your perception of the world and yourself. And so I had a lot of anxiety that was still debilitating. So I think I just wanted to mention that because it’s like, you know, FMT isn’t going to resolve your trauma.

Lindsey: 

And one more question. Do you know anybody who you’ve talked to with bipolar who maybe didn’t have gut issues, but instead of going the FMT route just went the route of trying to heal their gut in another way?

Jane Sullivan: 

I followed for a while a woman in the United States who seems to keep her symptoms under control with a ketogenic style diet. I don’t know if the mechanism there is to do with inflammation or not, but a ketogenic style diet kind of concerns me a little bit in the long term if there isn’t enough fiber, just because we know how important fiber is.

Lindsey: 

Oh, yeah, no, you should look at Lucy Mailing’s work on this question. She’s a PhD who’s studied the gut microbiome and exercise for her doctorate, but she just put out an article talking about the flexibility of the gut microbiome and in particular, when you’re on a ketogenic diet, how there is butyrate produced as a ketone body, and that that will feed the gut epithelial cells the same way that butyrate produced by bacterial fermentation of fiber will.

Jane Sullivan: 

That’s really heartening to hear then.

Lindsey: 

Yeah, so that’s why that would probably work.

Jane Sullivan: 

I know that I’ve heard many stories, anecdotal case studies that people that I’ve actually talked to who control their bipolar symptoms through a ketogenic style diet. However, you know, the underlying issue isn’t resolved.

Lindsey: 

Yeah. And I think that that’s the fundamental problem and that few people are able to sustain a ketogenic diet indefinitely. Because let’s face it, carbs are delicious. And nobody wants to live like that when everyone else is eating carbs all around them.

Jane Sullivan: 

Well, having a serious mental illness is a pretty big motivation.

Lindsey: 

No, I understand deprivation. I have for autoimmune disease gone for many years very strictly without gluten and dairy. But fortunately, I’ve been able to reverse my conditions through healing my gut.

Jane Sullivan: 

I think one thing I wanted to add, Lindsey, is that there has been a clinical trial already in Toronto, Canada, treating bipolar disorder with fecal transplant. And that data hopefully will be published this year. So I’m exceptionally excited about this trial. Because, at the moment, people are desperate, people are doing FMT at home, which you can limit the risks by ensuring that your donor is properly screened, etc. But really, this is not going to become mainstream. It’s not going to become available to people until we have the data from randomized, controlled, double blind trials. And this is the first trial. And yeah, I’m very excited about the data being published for that. So awesome. That’s really exciting.

Lindsey: 

Thank you so much for coming on and sharing your story with us.

Jane Sullivan:

Thank you, Lindsey.

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

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

Lindsey: 

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

Dr. Ian:

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

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

Lindsey: 

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

Dr. Ian:

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

Lindsey: 

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

Dr. Ian:

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

Lindsey: 

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

Dr. Ian:

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

Lindsey: 

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

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

Dr. Ian:

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

Lindsey: 

And so are you talking about the Cyrex arrays?

Dr. Ian:

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

Lindsey: 

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

Dr. Ian:

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

Lindsey: 

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

Dr. Ian:

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

Lindsey: 

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

Dr. Ian:

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

Lindsey: 

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

Dr. Ian:

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

Lindsey: 

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

Dr. Ian:

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

Lindsey: 

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

Dr. Ian:

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

Lindsey: 

How do you do that?

Dr. Ian:

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

Lindsey: 

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

Dr. Ian:

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

Lindsey: 

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

Dr. Ian:

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

Lindsey: 

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

Dr. Ian:

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

Lindsey: 

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

Dr. Ian:

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

Lindsey: 

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

Dr. Ian:

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

Lindsey: 

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

Dr. Ian:

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

Lindsey: 

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

Dr. Ian:

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

Lindsey: 

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

Dr. Ian:

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

Lindsey: 

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

Dr. Ian:

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

Lindsey:

That may be why they restarted.

Dr. Ian:

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

Lindsey: 

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

Dr. Ian:

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

Lindsey: 

What about the sublingual?

Dr. Ian:

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

Lindsey: 

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

Dr. Ian:

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

Lindsey: 

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

Dr. Ian:

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

Lindsey: 

. . . isn’t better.

Dr. Ian:

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

Lindsey: 

Not the natural doctors.

Dr. Ian:

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

Lindsey: 

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

Dr. Ian:

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

Lindsey: 

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

Dr. Ian:

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

Lindsey: 

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

Dr. Ian:

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

Lindsey: 

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

Dr. Ian:

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

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

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12 Common Causes of Bloating and Their Solutions

Adapted from episode 45 of The Perfect Stool podcast.

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

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

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

#1: Your Eating and Drinking Habits

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

#2: You’re Lactose Intolerant

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

#3: You Might Have a Gluten Sensitivity

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

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

#4: You Eat High Fiber Foods Inconsistently

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

#5: Poor Enzyme Function

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

#6: You Have Low Bile Flow

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

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

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

#8: Too Many Sugar-Free Foods

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

#9: SIBO

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

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

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

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

#10: Candida Overgrowth

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

#11: You May Have Low Stomach Acid

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

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

#12: H. Pylori

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

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

Schedule a Breakthrough Session Now

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

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

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

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

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

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

Lindsey: So did your scoliosis resolve or become manageable?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Lindsey: That seems like a reasonable ask.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Lindsey: Have you ever done the ibs smart test?

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

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

Dr. Mueller: It does.

Lindsey: Anti-vinculin?

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

Lindsey: And so yours were positive.

Dr. Mueller: Mine were positive.

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

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

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

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

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

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

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

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

Lindsey: What are the most common ones, then?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Lindsey: Always on that five:two pattern?

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

Lindsey: Which herbs are good for Lyme?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Lindsey: How does mold impact the digestive system?

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

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

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

Lindsey:  37:19

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

Dr. Mueller:  37:33

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

Lindsey: Is that what mold does?

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

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

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

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

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

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

Dr. Mueller: Correct.

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

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

Lindsey: What about GI Detox?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Lindsey: How many calories is that in a day?

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

Lindsey: How many days does it go on for?

Dr. Mueller: Typically five.

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

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

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

Dr. Mueller: It’s worth trying.

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

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

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

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

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

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

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

Schedule a Breakthrough Session Now

Could you be lactose intolerant?

Could you be lactose intolerant?

What is lactose and how is it normally digested?

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

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

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

What are the symptoms of lactose intolerance?

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

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

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

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

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

What are primary and secondary lactose intolerance?

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

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

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

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

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

How do you diagnose lactose intolerance?

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

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

How much lactose is in different dairy foods?

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

Could I also be reacting to casein?

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

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

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

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

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

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

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

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

How do I avoid dairy?

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

What can I replace dairy with?

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

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

Schedule a Breakthrough Session Now

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The Carbohydrate Malabsorption Theory of Acid Reflux

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

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

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

Lindsey: That’s anthrax, right?

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

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

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

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

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

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

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

Lindsey: I’ve recommended that to clients.

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

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

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

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

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

Lindsey: LIBO meaning large intestine. . .

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Lindsey: How do you calculate it?

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

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

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

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

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

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

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

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

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

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

Lindsey: That’s a lot!

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

Lindsey: Wow.

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


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

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

Lindsey: Right.

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

Lindsey: And that’s per meal, right?

Dr. Norm: That’s per day, per day.

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

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

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

Lindsey: So you can eat white bread, right?

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

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

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

Lindsey: Not me!

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

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

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

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

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

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

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

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

Dr. Norm: I didn’t know that. Wow.

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

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

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

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

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

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

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

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

Lindsey: Pernicious anemia, you mean?

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

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

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

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

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

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

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

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

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

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

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

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

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

Lindsey: Yeah.

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

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

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

Lindsey: Yep. It’s casein.

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

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

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

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

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

Lindsey: I know!

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

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

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

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

Dr. Norm: My pleasure, Lindsey.

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