Excerpts from my podcast “The Perfect Stool: Understanding and Healing the Gut Microbiome“. Edited for readability. L=Lindsey; I=Inna.
L: How did you get into this work on Crohn’s and colitis?
I: That was my long journey to healing. I got sick with Crohn’s in early 2000. I was originally diagnosed with colitis, and then properly diagnosed with Crohn’s. I tried all kinds of medications, and it didn’t bring me much relief. Being a pharmacist myself, I was also skeptical and worried about the side effects, which doesn’t help at all when you know them all. And I tried different methods. I went for different modalities of healing, and my nutrition was not at the point where it is now. But I tried changes and I did succeed to a degree, until I finally found functional medicine, which really brought me to a whole different level. That’s how I started the practice, because [functional medicine] helped me.
L: Were you already a PharmD at the time when all this started?
I: I was an RP, a registered pharmacist, at the time. The reason I [got a PharmD degree in 2017] is because I wanted to dig deeper into the studies and learn way more about evidence-based stuff. I was a pharmacist, then I took a lot of education and learned about functional medicine, integrative solutions. And then I decided, here’s the time to do my doctorate to be able to really extrapolate all the details and learn about the evidence-based studies.
L: What year were you diagnosed with?
I: –colitis, originally colitis, in 2000. And then, in 2003, I was diagnosed with Crohn’s disease, the final diagnosis.
L: When you see a Crohn’s or colitis patient in your practice, what is your first step in working with them?
I: I take them on a really long consultation, we discuss their history, we go all the way back, I listen to them, I need to hear their goals, I need to understand their gut story. And by the end of the session, I am more or less on top of what functional diagnostics they should run and what route they should take in order to heal.
L: Do you typically have to do some more testing with them or is a diagnosis of Crohn’s or colitis sufficient to start working with them?
I: For most of my clients, I recommend functional diagnostics. They really can open up and show us a whole different picture, especially the stool test with PCR technology right now—even other toxicity-related testing that doctors at this point don’t have an option or don’t have the education to dig for. That could be the root cause. And it’s great. It’s great to find out.
L: So what do you use for diagnosing toxicity?
I: Well, it’s really not diagnosing – I try to steer away from that term. But to recognize and to see and to get a lab check, I really love. First I would do an Organic Acids Test for a client. And sometimes just from that lab alone, we could see we have to dig in and see if there is metal toxicity. Then we’re going to do more extensive testing, for example, for metals, or for mold toxicity or other toxins.
L: Whose testing do you use for metals?
I: I love the Great Plains Laboratory. They’re great. I’ve just had really great success with that lab.
L: What kind of test do you use for mold?
I: Also, I love to use GPL for their mold testing.
L: And what’s that one called?
I: Multi-tox screen. I believe a full tox screen and then the Organic Acids Test.
L: Do you also do that through Great Plains?
I: Yes. For around 10 years. I’ve seen hundreds of these tests.
L: So what made you choose the Great Plains over the other labs?
I: I met the rep at an integrative healthcare symposium. They were very compatible to Genova. Genova at that point changed from Methometrix and a pharmacist’s license was no longer okay to order. And that was a perfect choice for me. GPL.
L: What kind of information will you see on an Organic Acids Test that will lead you to believe that it’s perhaps a metal toxicity issue?
I: It could be a combination of things. It could be the fact that we see that there’s a lot of issues with liver detoxification, a symptomatic presentation, along with a combination of things, plus the liver, plus the look of a client. It’s really at least a few different ways you could see and then go for metal testing. [A client with metal toxicity might have a “look”] that’s often a grayish skin, black under their eyes. They’re often feeling cold, cold sensations in the hands. Sometimes they have a metallic taste in their mouth – that’s the liver, unable to process. Again, if the bile ducts are congested, they usually have that color.
L: And would these be people who have had some knowledge that they were exposed to heavy metals, or people who were just sort of, “Oh, I have no idea how that happened?”
I: I often have someone that says, “Oh my goodness, I had no idea. I have so much lead. I have so much aluminum.” But I did have a client that was completely positive they had mercury poisoning. He goes “I went through so much sushi in the past couple months. Maybe I have mercury toxicity.” And here we go. There it was. That can happen.
L: And that I assume is primarily from fish like tuna?
I: Yeah, yeah, large fish. Again, some companies are very, very responsible and they can grab the fish before it reaches a certain weight. So there’s much less mercury in the tuna like Vital Choice. Yeah, it is BPA free and very, very sustainable and organic, very clean company.
L: Good to know. So we were talking a little bit about the mold. What kind of signs and symptoms might lead you to that or things on the Organic Acids Testing that might lead to you to suspect mold?
I: With my clients, it gets a little harder, because my clients usually are Crohn’s and colitis, and they’re very sick to begin with. So the symptoms can kind of mix in all together. So mold I will mostly recognize from the Organic Acids Test. And that’s like, right in the beginning of the test, we will get Aspergillus being high, the different Furan markers, or Tartaric or 5-Hydroxymethyl-2-furoic. If they’re really high numbers, we will really go straight for mold testing.
L: Okay. And then how often do you find that people with Crohn’s and colitis, the root cause is some gut stuff like Candida or bacterial overgrowth?
I: Super often. Very often. Many, many of my clients have candida overgrowth, many.
L: Have you begun to form theories about what the most common root causes are for Crohn’s and colitis?
I: That’s a question I’ve been asked recently a lot. A common root cause would you believe that it’s the personality? My common thing in my Crohn’s clients is type A personality. They push themselves. It’s a combination of course; it’s a multifactorial situation. There’s so much involved. Type A personalities; very common in Crohn’s patients. And they really push themselves – they’re one of those go getters that go without slowing down, and that can really get them in trouble. It’s a root cause for Crohn’s. It’s a multifactorial base, except that being in overdrive and not letting yourself relax enough and not remembering yourself and not prioritizing your health often is an issue.
L: Tell me how that relates to gut issues. What’s the physiological process there? I assume we’re talking about stress.
I: Sure, it’s adrenal imbalance. It’s the fact that, you know, the gut microbiome, this is something interesting, many people probably don’t know, if you haven’t got a perfectly balanced gut microbiome or as close as perfect as you could get. Probably no one is perfect, but as diverse because we want it to be very diverse, to be to be healthy, as diverse as possible. And overnight, there’s some kind of severe stress, a fire, major fights, something really horrible happening. The next day, if you tested that microbiome, it would show someone super sick; a really, really different microbiome. So the gut microbiome, of course, plays a major role. And so presumably, the stress releases cortisol, and then how do you think that impacts the gut microbiome? Stress, releasing cortisol, we don’t have the exact connection to how it affects the microbiome. When your cortisol is constantly high, you will have some kind of other hormone imbalance, sex hormone imbalance, that leads to possibly blood sugar instability. Now [you get] the release of insulin, now you’ll have the cravings that you’re not going to eat properly. It’s a chain reaction, and then you get indirectly to the gut microbiome imbalance.
L: When you work with clients, do you also test their adrenals?
I: I do. It’s part of fixing the entire body. I really appreciate that from the Kalish course from way over 10 years ago. I know there’s a lot of controversy with the adrenal fatigue diagnosis. Of course, I do not diagnose. But fixing, correcting things, is really helpful for those that have chronic conditions.
L: Tell me what kinds of things you’ll find when you test the adrenals.
I: All kinds of things. High cortisol for someone, super low cortisol for another one. If they’ve really been in severe chronic situations, DHEA falls down. For women sometimes, it affects their sex hormone health, like they’re symptomatic for low progesterone because of pregnenolone steal.
L: Pregnenalone steal?
I: Steal, yes, it’s a term with adrenal health. It’s what happens when you have that low cortisol for too long, when it reaches that point, when it really can’t go back high enough, because it’s exhausted, the adrenals, you cause a situation called pregnenolone steal. And from there you’re going to have trouble making a sufficient amount of sex hormones. And that creates other symptoms. A lot of my Crohn’s patients, for example, have low progesterone, young and old, at any age point, and therefore with low progesterone, it is harder to maintain pregnancy. So no wonder now they’re confused why they’re having miscarriages – low progesterone often leads to miscarriages.
L: I know all about that. That’s exactly what happened to me. So what do you recommend for that? And are you an herbalist type with the drops? Or do you get people to use the pills or?
I: I often mix but my favorite one right now is Adaptocrine from Apex Energetics. I’ve seen great results with it.
L: So is that a mix of different adaptogens?
I: Yes, mix of great adaptogens. But again, it’s a blanket adaptogenic herb combo, but if there is a need for more of plant-derived bioidentical hormone for just a short term, DHEA, pregnenolone, they work well.
L: I know that the adaptogens help both with low and with high cortisol, do you use the same thing in that case or something different?
I: Very often I do yes, more often with low cortisol activity. And if I see them overreact to them and if I see this is just a very recent case, and they’ll be able to fix it with a quick fix. But most likely it would be for both cases.
Q. Is there something different between Crohn’s and colitis in your treatment approach or in typical protocols?
I: It’s a very good question. I understand what you’re asking me. Not one of my protocols has been the same for the past good three or four years. Everything is so individualized for every single person. Like no Crohn’s patient is the same; more probably Crohn’s patients than colitis patients but not one wellness plan that I create looks the same as the other.
L: Do you typically use herbal products in helping people?
I: Herbal and neutraceutical supplements.
L: What kind of diet changes do you recommend for people?
I: Anti-inflammatory. That’s where I really focus on. As long as the diet is very anti-inflammatory and favorable for macro and micronutrients balance. I don’t restrict completely. The SCD (specific carbohydrate diet) diet. SCD can work for a short period of time for sure. Except completely without carbohydrates – usually, weak patients, Crohn’s patients in flares, they really need some carbs to flourish. I create for my clients usually a mix of a Paleo, with a little bit of carbs. I focus on properly-balanced plates, from macros to microbes. All thought out and colorful plates to get the most out of your nutrition, like not having them repeat meals all the time. Very important to rotate.
L: What grains do you recommend to people?
I: I concentrate on gluten-free grains like buckwheat. Many of my clients love buckwheat; actually, they haven’t used it before we speak. So that works.
L: That’s funny because I remember as a child being offered buckwheat pancakes and the first time I tasted them I’m like “this is the most vile thing I’ve ever had, what is this stuff?” And I eat gluten free but when I bake, I make a mix. I usually use sorghum and millet and cassava and tapioca starch as my starch or arrowroot. Sometimes tiger nut or coconut flour.
I: Those are all perfect; all in my pantry. I even managed to be able to make crepes; really, really thin pancakes. Yeah, it takes time. But yeah, you learn.
L: Almond flour of course, that’s my go to flour.
I: And the key is to rotate obviously, you don’t want to be stuck on one. Because then you might create another problem. You might create another food intolerance for yourself.
L: I think I probably live like 50% on almonds. What about elemental diets? Do you use those at all or semi elemental?
I: I try to steer away. Unless there’s a specific rare case. I would recommend that for really short term just to kind of calm everything down, but not for too long. Maybe a week or two.
L: And why is that?
I: Again, I won’t find an evidence-based study on this. Strictly from my experience with so many clients – when the stomach is empty for the first few days it feels great, though there’s no pain. When your gut is inflamed, what happens? Food passes, it creates pain. So food is associated now with pain; people are afraid to eat. This is common with Crohn’s and colitis patients. When you restrict them on chunky food, you will now decrease the pain so they feel better. For a couple of days to a week, things are great. What happens afterwards is that the microbiome cannot be really sustained and be really well-balanced without the chunky meal, or at least the smoothie. You need to feed the intestinal lining. You need to feed the gut microbiome. And, unfortunately, elemental diets won’t provide that in my opinion. With a decade of experience, people start to feel gassy. They will start losing natural probiotics in the gut flora. And they start to feel worse later, in pain. So yes, it’s very short term in my practice only. I’m not putting anybody’s practice down if they have success.
L: What about fiber?
I: Fiber again, very carefully, but it’s a must to reseed that flora. You can’t avoid fiber, but you’re going to have to be very careful and do a proper job putting down the fiber. I’ve learned that if there’s overgrowth of bad bacteria, no good probiotics and you give them fiber, they hurt. That’s gas, that’s pain. And in the beginning, it took me a while to understand how to gently, gradually put it back in.
L: When they’re flaring do you use fiber? Or do you wait until the flare stops?
I: Depends on the flare. If it’s a real flare, then yes, I would wait a little bit until they’re better.
L: And how do you gently introduce fiber?
I: Small amounts, little by little, pinches in the beginning only, and then we grow.
L: And then probiotics. Which probiotics do you use?
I: I really use a lot. I use probiotics depending on the results that I see on the GI map and other labs. I love Garden of Life original professional formulas and Multiprobiotic their soil-based I love. S. boulardii, depending only if there is a need. I love Probiomed from Designs for Health. I am very choosy. And I pick and choose for every case.
L: Will you typically have people do multiple kinds of probiotics, like the spore-based and the lacto-bifido and the S. boulardii?
I: It depends. Most of the cases I do not combine. Most of the cases I don’t. I’ve had a few where I had to, there was a need.
L: And so this is basically based on what you see on the GI map, you’ll decide what they’re most lacking in?
I: Yes, exactly. What they’re lacking in, what they would benefit from, for example, Megasporebiotic by Microbiome Labs for certain cases. But if there’s Bacilli overgrowing, of course, I won’t give that to our clients. So it has to be review and then recommend.
And if you’re struggling with a gut issue, autoimmune disease or a mystery health issue, please feel free to set up a free, 30-minute breakthrough session with Lindsey to talk about what’s been going on and hear about how health coaching could help.