Could Low Stomach Acid Be to Blame? A Deep Dive into Hypochlorhydria

Could Low Stomach Acid Be to Blame? A Deep Dive into Hypochlorhydria

Adapted from episode 134 of The Perfect Stool podcast with Lindsey Parsons, EdD, and edited for readability.

Hypochlorhydria is the official term for a deficiency of stomach acid, which is hydrochloric acid (abbreviated HCI). If you don’t have enough stomach acid, you can’t digest food properly or absorb nutrients, because hydrochloric acid is essential for prompting the conversion of pepsinogen, released by the stomach cells, into pepsin, which breaks protein into peptides, composed of amino acids, as well as prompting the release of bile and pancreatic enzymes, which further aid in digestion. Amino acids are vitally important to all aspects of health, from building tissues to creating enzymes, which catalyze literally trillions of reactions in the body every minute, to creating antibodies, hormones and neurotransmitters and nitric oxide, which keeps the blood vessels open and blood flowing, to creating, storing and transporting energy. Amino acids also assist in buffering pH and maintaining the acid-base balance in the blood. I can’t actually overemphasize the importance of amino acids and protein in the body. Without an adequate supply, or if just one amino acid is in short supply and therefore you are missing one of the amino acids that is necessary to form a protein, of which there are 20, then you will not form a protein and your body will not perform some essential function. So if your body is slowly breaking down in a variety of ways, one of the first things to consider is a protein deficiency, which may have at its root a deficiency in stomach acid. 

You may have also heard of essential amino acids. There are 9 of those: histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan and valine, which are considered essential because our bodies can’t make them and we must obtain them through our diet. If you’re taking an amino acid supplement, it should have 9 amino acids on the label. Many leave out histidine, I assume because it’s the precursor to histamine and many people with gut issues have histamine issues, but if you don’t, then you should make sure any amino acid supplement you take has all 9 essential amino acids. 

Anyway, back to other symptoms of low stomach acid, which include indigestion, bloating, burping, nausea, heartburn, diarrhea, constipation, sulfur-smelling gas, feeling full quickly, undigested food in the stool, bad breath, nutrient deficiencies like B12 or iron, brittle nails, hair thinning, Candida and frequent infections, including SIBO or small intestine bacterial overgrowth and other bacterial infections or foodborne illnesses, due to stomach acid’s role in killing pathogens. I’ll also often see low amino acid levels on clients who have inadequate stomach acids, if we run a Metabolomix+ test*, which includes both an Organix brand Organic Acids Test and urine amino acids. 

To understand stomach acid levels a bit, you should know that normal gastric pH while fasting is supposed to be under 3.0. While digesting food, you should have a pH of 1.5-3.5, but at least 2 or below some of the time as that acidity activates the enzyme pepsin, which breaks down proteins into peptides. Having a fasting pH above 7 is considered achlorhydria, or the complete absence of stomach acid, and if you take proton pump inhibitors (PPIs), you’ll have a fasting pH between 5 and 7. 

You may have heard that aging is one cause of low stomach acid, and it would appear it is. Two (first study; second study) of the few studies on this question that went into some depth showed that while fasting, 89% of subjects with a mean age of 71 still had a low fasting stomach pH, but it was in re-acidifying the stomach after a meal that the differences showed through, compared to a group of subjects with an average age of 25. In the older subjects, it took an average of 89 minutes to re-acidify the stomach (defined as a pH of 2.0) after eating a meal, while it only took the younger subjects 42 minutes. And 16.4% of the older subjects took four hours to return to a pH of 2.0.

Oddly enough, low stomach acid can cause the same symptoms as too much stomach acid or hyperchlorhydria, that is, heartburn and GERD or gastroesophageal reflux disease. But typically, doctors will assume your symptoms are a result of too much stomach acid, if you have heartburn. They may diagnose you with GERD and prescribe proton pump inhibitors or PPIs. These medications can exacerbate the problem, preventing proper digestion of foods, nutrient deficiencies, in particular in vitamin B12, magnesium, calcium, iron and zinc, and when used long-term, can lead to bone fractures and osteoporosis, chronic kidney disease and dementia. So it’s vital to distinguish between too little and too much stomach acid. In order to avoid misdiagnosis – we can look to some other signs and side effects of hypochlorhydria. 

First, one sign of hypochlorhydria is iron deficiency anemia. I’ve heard optimal ferritin levels quoted between 40 to 100 for women and 50 to 150 for men, or from another trusted source, 70 to 100 for everyone. But most people won’t get ferritin tested on routine blood work, so if you are below the reference range for RBC or red blood cells, Hemoglobin, Hematocrit, Mean Corpuscular Volume (MCV), Mean Corpuscular Hemoglobin (MCH), or Mean Corpuscular Hemoglobin Concentration (MCHC) or are above the reference range for Red Cell Distribution Width (RDW), iron deficiency anemia is possible and you should ask your doctor for a full iron panel plus ferritin. And by the way, if you are deficient, I always recommend the iron bisglycinate form of iron for supplementation, as I took the cheap ferrous sulfate from the drugstore for years, and had to take two pills a day, that was 130 mg total, and I could never get my levels up. But a couple months on iron bisglycinate and I got levels back up into the standard reference ranges and easily kept them there – at only 25 mg a day. Not to mention that because it’s absorbed more easily, you’re less likely to have it eaten by any overgrown bacteria or have it contribute to SIBO, or have side effects like constipation. Also, you should take your iron ideally on an empty stomach with vitamin C for maximum absorption.  

Another sign of low stomach acid is low B12 levels, which can be caused by pernicious anemia, which is when there is a lack of intrinsic factor, often due to autoimmune destruction of stomach cells called parietal cells, which produce intrinsic factor, which is necessary for absorbing B12. This leads to impaired B12 absorption, resulting in anemia. Of course there are other causes of B12 deficiency, the most common of which is a vegan or vegetarian diet, so don’t assume it’s pernicious anemia if you are on a vegan or vegetarian diet and are not supplementing with B12. Prior gastric surgery can also cause a lack of intrinsic factor, and of course our old friend, the bacteria which causes ulcers, Helicobacter pylori or H. pylori. 

H pylori can be at the root of atrophic gastritis, or inflammation and thinning of the lining of the stomach, which is a precursor to pernicious anemia and to low stomach acid, as the parietal cells lining the stomach are responsible for producing hydrochloric acid as well. Again, you will not likely see B12 tested on standard blood work, but low RBC, Hemoglobin, Hematocrit or high MCV, MCHC or RDW are indicative of a possible B12 deficiency, which should prompt your doctor to test B12 levels. And while the reference ranges for B12 start in the 300’s, optimal levels are going to be above 700 pg/mL. Or even better, you could ask to get methylmalonic acid tested, which is an earlier and more accurate measure of low B12 and is found on Organic Acids Tests*, but can also be ordered by your doctor from standard blood testing labs. If you are deficient in B12, you are likely to have a stomach acid issue, in which case I always recommend sublingual B12 in the form of methylcobalamin, which is taken in a lozenge form that you let dissolve under your tongue so it directly enters the bloodstream. Typical dosages are 1000 mcg/day or 5000 mcg 1-2 times a week. 

Hydrochloric acid also prompts the release of bile, which helps metabolize fat in the small intestine, so you can get fat maldigestion, when you’re low on stomach acid, which can lead to nutrient deficiencies, especially in the fat-soluble vitamins, which are D, E and A. 

Other signs on a blood test of hypochlorhydria are low chloride levels under 100 (with 101 to 106 considered normal), which can be from a lack of chloride in the diet, which comes primarily from sodium chloride, aka salt. It can also come in smaller amounts from seafood, tomatoes, olives, lettuce and celery, but usually when someone is deficient in chloride, it’s usually because they eat a whole foods diet without much processed food and have taught themselves to eat little salt believing it to be a harmful nutrient. But it’s a goldilocks nutrient, with too little or too much being an issue, so if your chloride levels are low, you may need to salt your food more generously, take electrolytes daily or at least when you exercise, or even sprinkle some salt in your water. 

Another sign of hypochlorhydria is abnormal serum protein levels, which would be if they are under 6.9 or over 7.4 g/dL or abnormal globulin levels under 2.4 or over 2.8 g/dL. This is especially in the case that your liver enzymes are relatively normal (that is your AST and ALT, which optimally should be between 18 and 25, but for the purposes of determining if they are relatively normal, just use the normal reference range on the test). Another possible sign of hypochlorhydria is low phosphorus levels with a vitamin D deficiency and/or hyperparathyroidism. Additionally, a high BUN level or blood urea nitrogen level of over 20 or more, indicating a high amount of nitrogen waste found in the bloodstream from poor digestion, can be indicative of low stomach acid. And finally, a low alkaline phosphatase level can be linked to low stomach acid and poor digestion. 

Hypochlorhydria has also been postulated as one potential root cause of SIBO, or small intestinal bacterial overgrowth, according to studies on children taking PPIs. There may be a rise in pathogenic bacteria that are not killed off in an acidic stomach, such as certain pathogenic strains of E Coli, Clostridium, including Clostridium Difficile or C Diff, which you often see people getting after hospital stays and which causes explosive and frequent diarrhea, Enterococcus, including Enterococcus faecalis and faecium, Streptococcus, and overgrowths of yeast such as Candida albicans and Candida glabrata or other fungi, and/or other more pathogenic strains of H. Pylori. And taking PPIs has also been connected to SIBO, so it is clear that lowering stomach acid puts you at risk of SIBO. If you do have to take PPIs because of a condition like a hiatal hernia or a true case of high stomach acid, there is a probiotic that has been shown to prevent SIBO during PPI use, which I’d recommend alongside the PPIs, called L reuteri DSM 17938, which is found in both Biogaia Protectis Infant Drops* or Biogaia Gastrus* chewable probiotics. Nevermind that those are marketed to infants and children; the dosage is good for protecting adults too and I’ve heard great reports from several clients taking them. 

So those are the main red flags and indicators of hypochlorhydria. Now let’s move on to the root causes of low stomach acid. It is widely accepted that an H. pylori infection is a common cause of hypochlorhydria. This is caused by the release of an enzyme from H. Pylori called urease, which breaks down in the stomach into carbon dioxide and ammonia, which neutralizes hydrochloric acid and causes burping and bad breath, in addition to the destruction of parietal cells from the bacteria burrowing into the lining of the stomach. However, in the early stages of an H. pylori infection, you can have high stomach acid and symptoms of gastritis, like burning in the stomach, particularly on an empty stomach. 

Tests done by gastroenterologists for H. pylori are usually limited to urea breath tests, stool antigen tests and upper endoscopy exams, which usually include biopsies for H. pylori. Rarely, you might be offered an esophageal pH test or a Heidelberg Test to check if you have low or high stomach acid. I currently use stool tests like the US Biotek GI-Advanced Profile, which is my current favorite, or the GI Map to see if there is H. pylori and to see if it has virulence factors present, which indicate a risk for ulcers or stomach cancer. I only recommend treating it when levels are elevated, there are virulence factors or there are clear signs of issues as a result of it. Also, when you have a low stomach acid situation brought on by H. Pylori or other reasons, like aging, you will often see also low pancreatic elastase on a stool test, which is a digestive enzyme secreted by the pancreas. But it is worth mentioning that you may also see this decrease in pancreatic elastase for other reasons, such as gallstones or a vegetarian or vegan diet.  

There are other possible root causes of hypochlorhydria, including autoimmune atrophic gastritis. I honestly haven’t heard much about this in the functional medicine community, but a few possible root causes of this autoimmune form of gastritis include H. pylori, as well as the other causes common to any autoimmune disease: genetic predisposition, a leaky gut, toxins from your food or environment and vitamin and nutrient deficiencies. It also commonly occurs along with other autoimmune diseases and is more common in older adults. 

Chronic use of proton pump inhibitors may also result in hypochlorhydria, even after you’ve discontinued their use. And not surprisingly, acid-reducing medications like antacids and H2 receptor blockers can cause low stomach acid, which is probably why you would be taking them in the first place, but after you stop using them, there is no evidence that they cause ongoing hypochlorhydria. Some people do take H2 blockers for histamine issues as well, so that’s something to be aware of. Examples of H2 blockers are Pepcid, Tagamet, Zantac 360 and Axid, and examples of antacids are Tums, Rolaids, Milk of Magnesia, baking soda, Maalox, Mylanta and Alka-Seltzer. Acid-reducing medications, especially PPIs, are something to be particularly wary of because if you’re misdiagnosed with high stomach acid, doctors may prescribe you these very medications – only worsening your symptoms, if you do indeed have hypochlorhydria. For that reason, PPIs should only be used as treatment for a 14-day period. Examples of PPIs, some of which are over-the-counter in the US, some prescription, include Omeprazole, Prilosec, Zegerid, Nexium, Prevacid, Protonix, AcipHex, Dexilant, Losec, Zoton, Pantoloc, Somac, Pariet, Rabeprazole, Pantoprazole, Lansoprazole, Esomeprazole and Ilaprazole.

So in terms of correcting low stomach acid, I have been educating my clients on the Betaine HCl challenge for a few years now. I based that on the work of Sarah Ballantyne in her book The Paleo Approach,* which is an exhaustive and incredibly well-researched book on autoimmune disease and the Autoimmune Paleo diet. I have since heard criticisms that this approach to supplementing with Betaine HCl has no science behind it. So one of the reasons I wanted to do the episode was to have the time to research this question. What I found was a 2020 study on using Betaine HCl for re-acidifying the gut. They used PPIs to raise the pH in subjects’ stomachs, and once the pH was above 4.0 for 15 minutes, they gave them 1,500 mg of betaine HCl. They found that the average gastric pH in all subjects dropped from an average of 5.2 in the half an hour prior to ingestion to 0.6 a half an hour after supplementation. On average, it only took 6.25 minutes for the pH in the stomach to get under 3.0, and the re-acidification lasted on average 73 minutes, with a pH of 3 hitting at 73 minutes and a pH of 4 at 77 minutes, with a good amount of individual differences of up to 30 minutes for that rebound effect. Note that all of this was while fasting. 

In another study using the design with pretreating with PPIs, they had subjects consume a light meal of only 336 calories, followed 5 minutes later by 1500 milligrams of Betaine HCl. In this case, it took an average of 67 minutes (plus or minus 33 minutes for the different subjects) to reach a pH of 0.838 (±0.391), which suggests it takes a lot longer to reacidify the stomach when you’re eating. Then it took an average of 76 minutes ±20 minutes to get back up to a pH of greater than 4, although the majority of the participants (5 of 8) didn’t even reach that within 3 hours. 

The researchers from the first study suggest that dosages for Betaine HCl may need to be higher than 1500 mg to compensate for meals, and that taking Betaine HCl just prior to a meal may be a good idea for acidifying the stomach in advance. Of course, this is all assuming that you have some condition that is greatly reducing your stomach acid. It may be that a person who has low stomach acid doesn’t have as low stomach acid as someone who is on PPIs. So you have to take that into account. 

So based now on this peer reviewed research paper, I’m more confident in recommending that if you suspect you have low stomach acid or hypochlorhydria, you may want to start with the Betaine HCl challenge. The way you would do that is to start with one capsule (which are sold in the 500-750 mg range) per full meal in the 500 calorie or greater range, only if the meal includes protein foods, then increase your dosage by 1 capsule/meal every 2 days. So if after taking it for the first time or at any point in the protocol, you feel a tingling, burning in your stomach, heartburn, diarrhea, unease, digestive discomfort, neck ache, backache, headache or any odd symptom, then it may be you have sufficient stomach acid or perhaps a hiatal hernia or some other issue. You can take an antacid or a teaspoon of baking soda in water or milk to neutralize the acid if it’s bothering you. If you were already doing well on a previous dose, you can decrease to the previously tolerated dose of Betaine HCl. You can go up to as much as 4-5 capsules, or 3000 mg maximum. If you’re trying to reduce the number of pills you take, I have only actually found one Betaine HCl that has 750 mg per pill and that’s the Designs for Health* one , which also has pepsin in it, which is recommended too. However, I often recommend the Vital Nutrients* one with Gentian Bitters for people who seem to have bile-related issues and obvious problems digesting fat, either based on their own experience or on seeing elevated fecal fats or steatocrit on a stool test. And do note that Betaine HCl is different than plain Betaine, also known as trimethylglycine or TMG, which is used as a methyl donor. And I’ll link to the study that outlines this suggested protocol in the show notes. If you scroll down, there’s a gray box with the protocol. But based on what I’ve read in this study, I think it is probably best to start the Betaine HCl 5 minutes prior to eating, and then periodically dose the additional pills as you’re eating. 

Also note that there are some contraindications for using Betaine HCl, which include Barrett’s esophagus, diagnosed malformation of the lower esophageal sphincter, a history of stomach ulcers, any diagnosed disease or pathology of the pancreas, or if you’re taking NSAIDs, like Aspirin, or Tylenol, or Ibuprofen or have a diagnosed blood-clotting disorder. One alternative to taking Betaine HCl is to have 1-2 tbsp. of apple cider vinegar or lemon juice mixed in water 10-15 minutes before meals. And it’s super important to dilute that vinegar, because it can erode your tooth enamel, and some people even suggest drinking it through a straw. But again, if you have a diagnosis of Barrett’s esophagus, esophageal strictures or reflux esophagitis, you shouldn’t use these either, and of course, none of these things should be used if you an ulcer or a suspected ulcer. 

So if you’ve determined you have hypochlorhydria, I’d suggest supplementing for a while as you work on other gut health issues, stress management and reduction, good sleep, adequate nutrition and supplementation of identified deficiencies, and adequate salt intake. If you have retested and determined that all these other things are in order and there are no more signs of low stomach acid on your blood tests, then it may be time to start reducing the Betaine HCl and see how you do. 

If you’re still having issues or the blood numbers still indicate low stomach acid and you have H. pylori present in your gut, but at normal levels, then it may be time to try to eliminate or severely reduce the H. pylori to see if that’s what’s causing your low stomach acid. However, be aware that many gut health practitioners caution against eliminating H. pylori, as some people end up with acid reflux after eliminating it, which is one of the topics discussed in Martin Blaser’s classic book Missing Microbes: How the Overuse of Antibiotics Is Fueling Our Modern Plagues*, in which he describes his life’s work studying H. pylori. So maybe if you have low stomach acid and no H. pylori you should find someone to kiss who has H. pylori and get some back, as it’s transferred via saliva. People have certainly done crazier things to help their gut health! But I’m just kidding. In my experience, herbal antimicrobials, as opposed to triple or quadruple therapy using antibiotics and PPIs, tend to reduce but not eliminate H. pylori. Mastic gum* is the primary one used for that purpose, but other antimicrobial agents like berberine and hydrosol silver*, as well as mucilaginous agents like marshmallow root, DGL, slippery elm, aloe* and okra are also useful in healing the gut lining. 

So if you’re dealing with low stomach acid or gut health issues of any type and need some help, I see individual clients to help them resolve their digestive issues and you’re welcome to set up a free, 30-minute breakthrough session to see if you’d like to work with me. I also have my own two products, Tributyrin-Max, which is particularly helpful for loose stool and diarrhea as it slows your motility and firms up your stool, and SBI powder, which is an all around gut pathogen binder, which is super safe and won’t harm beneficial bacteria, and is usually the first line of treatment I educate my clients about in order to avoid stronger antimicrobial herbs.

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Reversing Gut Disorders Through Clinical Hypnosis with Dr. Ali Navidi

Reversing Gut Disorders Through Clinical Hypnosis with Dr. Ali Navidi

Adapted from episode 133 of The Perfect Stool podcast with Dr. Ali Navidi, a licensed clinical psychologist and co-founder of GI Psychology where he has helped develop innovative treatments combining Clinical Hypnosis and Cognitive Behavioral Therapy (CBT) for patients with GI disorders and chronic pain, and Lindsey Parsons, EdD, and edited for readability.

Lindsey:   

So I’m curious how, as a psychologist, you ended up with a focus on GI issues? 

Dr. Ali Navidi:   

That is a great question, that kind of cuts right to it. Well, I can tell you, I did not expect that to be the case. I came in as a generalist. I just enjoyed treating all different kinds of patients, different ages, kids to elderly. Yeah, there was no plan to focus on GI. If someone had told me that while I was starting, I don’t think I would have believed them. But what I did have was a love of clinical hypnosis as a tool in therapy. And at the time, at the beginning, I didn’t realize what an amazing tool it was for the GI and how much research there was already supporting it. I slowly discovered that, and slowly started to use it with patients. And it was just such an incredible response that I just kept doing it and adapting it, building it, and eventually it became like 80% of my practice, because the gastroenterologists in the area would find out about me, and then they would tell other gastros, and it was like, those are all the people that were coming to me. And there was no one else, there was no one else in the area that was trained to do this stuff. So I really felt bad turning any of these people away.  

Lindsey:   

Yeah, and so initially, these weren’t people who had come to you for GI issues? They were seeing you for other things, but they had a GI issue, just by chance, and you happened to realize that that could also be dealt with? 

Dr. Ali Navidi:   

Yeah, I had done a training years and years back about treating IBS with clinical hypnosis. 

Lindsey:   

Oh, okay.  

Dr. Ali Navidi:   

It was part of a larger training in clinical hypnosis. And I was like, this is interesting, but I’m never going to use it. So I just put it in my back pocket, and it turned out to be useful. But yeah, the first patient I used it with was someone I was treating for anxiety, and I already knew they responded well to hypnosis, and they were talking about going through this process of figuring out what was going on with their gut, and they had gotten scans and tests and then scoped, and they didn’t find anything, and eventually they came back to them with this diagnosis of IBS. And that’s why I said, “Well, you know, I’ve done this training, so if you want, we could try this thing.” And it ended up working. 

Lindsey: 

Wow, wonderful. And was that person a person who tended towards loose stool and diarrhea, or towards constipation . . . or . . . I’m curious? 

Dr. Ali Navidi:   

I’m going back into my memory banks, I want to say it was IBS-D.  

Lindsey:   

Yeah, because I can imagine that that’s probably more the type that would be associated with anxiety, because when you’re nervous, the bowels tend to loosen. 

Dr. Ali Navidi:   

Yeah, I found that while IBS-C is treatable with these techniques, IBS-D tends to respond even better, and it might be good to get into the model behind why this works, because the anxiety is a part, but there’s more.  

Lindsey:   

Yeah. 

Dr. Ali Navidi:   

Not just anxiety. And I think that’s a big misunderstanding. A lot of times with patients, they’ll be like, “Well, I don’t think I’m that anxious. I don’t think that’s the reason this is happening,” And it’s more than just anxiety. 

Lindsey:   

So yeah, go ahead and delve in. 

Dr. Ali Navidi:   

Yeah, so basically, there’s four elements to understand. First off, something you’re super familiar with is the brain-gut axis. So that communication system between the brain and the gut and between the gut and the brain. I was just looking at your podcast list, and you’ve got quite an impressive list. You’ve been doing this for a while, and you’ve covered a lot of interesting stuff. A lot of what I saw is from the gut up, what’s happening in the gut, how it affects the brain and how it affects the body. In my world, it’s what’s going on in the brain and how that affects the gut. So the elements are the brain gut axis – so this powerful communication between the brain and the gut, and then hypervigilance, catastrophizing and something called visceral hypersensitivity. And so when I talk about hypervigilance, I’m not talking about general hypervigilance, I’m talking about body focused. 

Lindsey: 

Yeah 

Dr. Ali Navidi: 

And so usually people lock in on something. Maybe there’s a certain area of the gut where they usually get pain or discomfort, maybe that’s in the upper GI. But there’s an area where they’re getting symptoms, could be nausea, it could be pressure, bloating. So there’s this hypervigilance, and then when they notice there’s something happening there, then they’re like, “Oh, oh, man.” And then they start catastrophizing. And then that anxiety feeds down into the gut, and it can cause a worsening of those symptoms. And then before that gets sent back to the brain, we’ve got visceral hypersensitivity, which is essentially the brain turning up the volume on those sensations and distorting them. So what might feel like a little bit of bloating can feel like an intolerable amount of bloating. What might just be hunger cues could be pain or the feeling of digestion could also turn into pain or nausea. So there’s an amplification and distortion that’s occurring. And so you’ve got all these four elements happening. 

Lindsey:   

Yeah, in my list of podcasts, the most recent one I published was Ashok Gupta, The Gupta program, and that is a brain retraining program, specifically. And I’m doing the program because I have autoimmune SIBO, so I figured, why not give it a try? But it’s an interesting question, because I would also say, I don’t feel like I’m anxious about this. I feel like I’ve got it roughly under control. It flares up. I treat it. Yeah, I bloat a decent part of my meals, but I also overeat a decent part of my meals. So, you know, I’m curious, if you are somebody who doesn’t feel like you’re hypervigilant of your symptoms, would that be somebody who’s probably not such a good candidate for this kind of treatment, or not a necessary component?  

Dr. Ali Navidi:   

Not a necessarily the case. So people will differ in how they’re acting out these different variables. Like I said, there’s the hypervigilance, and there’s catastrophizing. But let’s not forget about our good friend, visceral hypersensitivity. And this is a tricky one, because most people have a very linear concept of how pain works in their body. It’s like something happens, the sensation of pain travels up to our brain, and we’re aware of the pain. When in actuality, it’s much more complex, and that sensation is processed in multiple areas of the brain in different ways. And the idea that our brain has this kind of tuning mechanism where it can turn up the volume, or it can even turn down the volume, and so it’s hard to say how much that is playing a role in somebody’s symptoms. And then there’s just this mind-body connection where there can be these feedback loops created, where what we expect to happen is being made to happen in some way. I’ve seen many patients that, you know, you talk to them, their self report and what you observe, you don’t see much hypervigilance. You don’t see much catastrophizing. They’re pretty level-headed people, so you believe them, just doesn’t seem to be the case, yet they still respond well to treatment.  

Lindsey:   

Yeah, I mean, to some extent, it really just shows the power of our brain to alter our physiology. Whether or not it was fully brain-caused, it can be brain-solved, right? 

Dr. Ali Navidi:   

Yeah, yeah. A lot of patients that I’ve had with functional dyspepsia, where they’ve got a lot of bloating, a lot of gas kind of decreases their appetite. It’s hard for them to eat big meals because it feels like it just kind of sits there. For example, when using hypnosis, a number of those patients, we’ve had experiences where they can literally feel the gas going away during the hypnosis session, and at the end of it, they’re like, “Wow, I feel hungry for the first time in however long.”  

Lindsey:   

That’s awesome. So if someone has GI issues, do you suggest they start with the gastroenterologist doing the full workup, or maybe starting with a psychological approach? 

Dr. Ali Navidi:   

Definitely want them to, at the very least, see their primary care. Often primary care, with a good history and a few simple tests, they don’t need a full workup. I think that’s what they’ve been finding more and more nowadays. They used to do a full workup on everybody, and they’re finding, I think, that that’s not really needed. With a good history and a few simple tests, they can usually figure out if it’s IBS or another of the DGBIs. So in case people don’t know, that’s a disorder of gut-brain interaction (DGBI), and it’s a class of maybe about 30 different disorders. So I would say definitely start with some sort of a physician, and then you can maybe come to us earlier, rather than later. What I think people do a lot of times is they’ll go to their doctor, doctor’s pretty sure it’s IBS. They do the few simple tests. They say, “Hey, it doesn’t look like there’s anything wrong with you.” And then the person responds with, “Yeah, but I’ve got all this pain, and you must have missed something.” So they want more. And so they complain enough that they’re going to get the endoscopy, they’re going to get the colonoscopy, they’re going to spend six months to a year chasing their tail before they end up seeing somebody like myself. 

Lindsey:   

Yeah, and so you mentioned a few simple tests. So I don’t see a lot of people getting anything related to GI from their primary. What simple tests are we talking about? 

Dr. Ali Navidi:   

I wish I remembered, because there are these certain kind of red flag things. 

Lindsey:   

Like fecal lactoferrin or calprotectin or things like that for checking for IBD? 

Dr. Ali Navidi:   

Yeah, exactly. They need to rule out IBD. At least rule out minimally IBD, they need to rule out something like Celiac. You probably know them. 

Lindsey:   

Yeah. Probably H. pylori, I would think, and then maybe occult blood, parasites, whatever, things like that. 

Dr. Ali Navidi:   

Yeah, and look at their blood and make sure there’s no indications that it’s maybe some kind of cancer or something like that. 

Lindsey:   

Right or maybe CRP to check for inflammation, things like that. Yeah, I do see all the time people who are like, “Yeah, they want to do a colonoscopy, and I’m young, and I think I can see the root cause of this, like I took a bunch of antibiotics,” or maybe they had food poisoning, something like that. And, “Do I really need to go get the colonoscopy?” and people wanting to avoid that. And I always sort of wonder, well, why don’t they just do a fecal lactoferrin? I mean, I don’t know how sensitive and specific it is for IBD, but there’s both calprotectin and fecal lactoferrin, if you do them both, then it seems like together, that would be a pretty good indication if you really need to do the colonoscopy. But I guess for a doctor who does colonoscopies every day, it’s probably like, no big deal for them, but for a person, you’re just like, “Oh my gosh, I’m going to have to drink this stuff, and then I’m going to have to go through this whole medical procedure, and it could be expensive” and yeah. 

Dr. Ali Navidi:   

And what you said reminded me there’s two main paths that you can develop these kinds of disorders. So IBS is the most well known of the DGBIs. Like I said, there’s a bunch of others. The two main paths are trauma, gut trauma, like they ate some bad sushi and they’re feeling sick, or they got a virus or they got a bacterial infection, and even though that has passed, their symptoms are remaining. And so the brain-gut has kind of learned a pattern, and now it’s just rolling with it. The other way this can happen is if they are going through something in their life, and it could be positive or negative stress. So if somebody’s getting married, somebody loses their job, they’re fighting with somebody in their family, like something that’s stressing them out, often is associated with the beginning of these. And then there’s certain classes of people that tend to be more vulnerable. So someone with an anxiety disorder, history of trauma, someone who’s on the autism spectrum or someone with a history of eating disorders. Those four groups, they all tend to be more vulnerable to developing these DGBIs. 

Lindsey:   

Interesting. Okay, so, yeah, tell me a bit more about the approach, about the hypnosis. 

Dr. Ali Navidi:   

So I’d say the majority of people may be listening to this, they hear hypnosis, and they’re immediately thinking of entertainment hypnosis. So what are they thinking of? They’re thinking of the movies with magic or mind control or a stage show. If we take all of that stuff, which is usually what most people know, and just put it to the side and say, “Okay, that’s entertainment hypnosis. What is clinical hypnosis?” Then you get something really interesting. What you get is a technique that has been studied for 40 years, for IBS, let’s say, if we just talk about IBS. It’s been studied for 40 years, and we’re talking about serious medical studies, randomized control trials, all that good stuff. It’s in the guidelines for the American College of Gastroenterology. In England, it’s kind of a standard of treatment, also. It’s really legitimate, and sadly, very few people with IBS would even think of it for their treatment. So what is it exactly? If it’s not entertainment hypnosis, it’s just deliberately teaching someone how to go into a state of trance. And trance is something that happens naturally, that everybody does. So I’m driving to my office. I drive the same way every time, and I’m listening my book on tape right now, and then I get there and I’m at the office. And how did I get there? I’m not sure what happened. I don’t know, but I know what happened in my book on tape. And that’s an example of trance. It’s happening all the time. 

Lindsey:   

Yeah. Or worse, you’re going somewhere else, but you still drive to your office. 

Dr. Ali Navidi:   

Yes, yes.  

Lindsey:   

Which is something I do a lot.  

Dr. Ali Navidi:   

Yeah. Or, like, you’re used to dropping your kids off and you drive to their school. So you’ve got this naturally occurring state, and so we’re just teaching people how to go into this state on purpose, rather than accidentally. And why do we care about trance? Well, it turns out that in trance, one of the things we can do is we can turn down that visceral hypersensitivity, turn that volume down. And there also seems to be more of an ability to access that brain-body connection in trance. So I’ll do a lot of work with patients with chronic pain. I’ll do a lot of work with patients with GI issues, also. Because in that trance, for whatever reason, they have a stronger ability to make shifts in that brain body connection. 

Lindsey:   

And then what about the cognitive behavioral therapy and how that plays in? 

Dr. Ali Navidi:   

Yes, so most people, I think, would have heard of cognitive behavioral therapy. For this kind of work, it’s not generic CBT. So CBT is cognitive behavioral therapy. It’s not generic CBT. It’s a more focused protocol, and I make that distinction, because a lot of patients get sent by their doctors, “Oh, you’ve got IBS, go get some CBT.” That’s a good instinct, but your standard CBT practitioner doesn’t know what to do with IBS. They don’t know what to do with functional dyspepsia or chronic functional nausea. They’ll treat the anxiety, they’ll treat the depression. But a lot of these patients will come back, and when we talk to them, we’ll say, “Okay, we’re going to use CBT in your treatment.” They’ll say, “Oh, yeah, I tried that. It didn’t work for me.” But what they tried was kind of general CBT, not those protocols that are specifically designed for GI problems.  

Lindsey:   

And what does that look like?  

Dr. Ali Navidi:   

Well, we want to address various components. So we want to address that habit of hypervigilance. We want to address the catastrophic thinking. We also want to address the various types of avoidance. You often will get avoidance of places and situations, like I don’t want to go on that car trip, or if I’m giving a talk at work, I’m worried that I’m going to have GI issues, so maybe I talk my way out of it or something. So there’s a lot of different kinds of avoidance that occur.  

And then there’s also avoidance of foods, right? And some of that is legitimate, and some of that actually is based on factors that are not related to the food. The poor food gets lumped in there with a bunch of other things. And then there’s actually what’s called interoceptive avoidance. So they develop a kind of anxiety that’s associated with their body and specifically the sensations in their gut. So we want to address those levels of avoidance. I usually like to save the food until the end because while people’s systems are hypersensitized, if you try to introduce the foods back in, they’re just going to have a bad reaction to it. So what you do is, once you desensitize the system, turn down the visceral hypersensitivity, reduce the hypervigilance, the catastrophizing, get the system calmed down, then you can go back and start trying to reintroduce foods, and you’ve got a better chance of doing it without them having a negative reaction. 

Lindsey:   

Yeah, I see a lot of people who are down to a very small list of foods, and in almost every case, they’ll say, “Well, I had that once, and I had this reaction.” And I think, “Well, I suspect that that wasn’t the only thing that was at the meal.” Right? I mean, it’s not usually that you did a one item trial. And you might have had something else going on, like it may not actually be that food. But yeah, slowly but surely, they just keep crossing things off the list or entire categories, say it’s histamines, oxalates, categorically eliminating foods until they’re down to a ridiculously small number of foods. 

Dr. Ali Navidi:   

And then we’re in the realm of ARFID, avoidant/restrictive food intake disorder. It’s a type of eating disorder where they’ve limited what they’ll eat to such an extent that it’s affecting them in life, socially, physically, mentally. Yeah, and exactly, you hit it right on the head, exactly what you just said. So they’re having a meal. Maybe they’re just having a bad day. They’ve got a higher background level of anxiety for whatever reason that day. So that’s feeding also into their system, so their stomach is more reactive. They eat their slice of pizza, or whatever it is they eat, and they have a bad reaction. Then they conclude, “Well, it seems like pizza is bad for me.” So then the next time they have pizza, they come into that pizza with the level of anxiety and fear, which, of course, is going to cause more symptoms, and then those symptoms are going to confirm that they’re right and pizza is bad, and that’s how pizza gets crossed off the list, right? 

Lindsey:   

Yeah, I do find it’s interesting, because obviously, when you work with someone, you’re not seeing them, at least I’m not, I might see them every two to three months. So I’m not able to monitor their diet and the minutia of what items they eat and don’t eat on a regular basis. And there are some types of clients that restrict and just stay restricted. They can live off of 12 foods, if that’s what makes them feel good, they’ll live off of 12 foods for the next 10 years. And then there’s others that just kind of keep going, “Well, can I reintroduce? Can I reintroduce?” And I’m like, “Yeah, yeah, definitely reintroduce.” Sometimes I forget to say, “Hey, are you trying now to reintroduce some of these things?” Because you’re more interested in making sure their symptoms are gone than you are in reintroducing foods. But of course, it’s much better if people are pushing and saying, “Hey, When can I start retrying these foods?” Just a note to people out there.  

Dr. Ali Navidi:   

Yeah, and you’re right, it’s so much easier for me also when they have that desire, that excitement about reintroducing and they even start testing on their own.  

Lindsey:   

Yes, yes.  

Dr. Ali Navidi:   

Versus those other people you’re talking about that they’re firmly lodged into, “Okay, this is safe, and things outside of that aren’t safe, and I want to stay safe,” and almost have a belief that they’re injuring themselves if they have the wrong food, like it’s doing harm to them. 

Lindsey:   

Yeah, that actually makes me think of a podcast I was listening to that was talking about just physical pain, and that you might have a physical pain in doing some type of action or sport or whatever. And if your belief is that that physical pain is injuring you and is hurting you, then it will seem worse, and then if somebody tells you, “No, it’s just a pain, it’s just your brain’s perception of it, but it’s not actually making you any worse.” Then all of a sudden they were like, “Oh okay, well, now I can walk or now I can play tennis.” 

Dr. Ali Navidi:   

Oh, my god, yeah, you’re opening up a subject that I love to talk about. I work with a lot of patients with chronic pain also, and that’s one of the fundamental concepts that people should understand is that not all pain equals harm. And there’s a really cool story about that. Have you ever heard the story of the two nails?  

Lindsey:   

No.  

Dr. Ali Navidi:   

It’s kind of classic in the pain literature. Essentially, somebody’s working in a construction site, and they jump down, and they accidentally jump on one of these long nails that were sticking up out of a board. Goes through their boot and it’s sticking up the other side. They look down. They freak out. Everyone around them freaks out. Pick him up, they carry him, the guy is screaming and yelling and he’s in all this pain. And then you get to the hospital and they give him a bunch of painkillers. It’s not helping. They’re losing it. They cut off the boot and the nail had gone right between the toes. There was no harm, but there was lots of very, very real pain, because when the brain thinks it’s been harmed, it’s going to take those sensations and again, amplify and distort. So this person believed he had been badly harmed, and so his brain gave him the pain that it expected to see.  

There’s another example. So the second nail is another construction worker who, I guess, was holding a nail gun, and it kind of went off accidentally, and, like, bashed him in the face, the back of it. Then for about a week or so, it was just kind of hurting, it was a dull pain, not too bad. Eventually, he was like, “This isn’t going away. I should probably go the doctor.” But no urgency there. I think they did maybe an MRI or something, maybe an x-ray, and they saw that he had shot it, and I guess it had ricocheted and come back and lodged in his sinus, and it had been there for at least a week, maybe two, and very minimal pain, because just the way things had happened, his brain did not expect to be finding any pain or much pain at all, right? 

Lindsey:   

Yeah, that makes me think of a trick that I do every time they take blood. I pinch above the arm where they’re taking the blood on the inside real hard, just as they’re poking me, and half the time I literally don’t feel the needle going in, because your brain can only interpret so many signals at one time, especially on the same arm, right?  

Dr. Ali Navidi:   

Yes, yes. That’s an awesome trick. Everyone should listen to that. And I think that follows what’s called the gate control theory of pain. It’s why, also, if a kid hurts themselves, knocks into something, if you kind of rub around it and give them all this other stimulus, their brain will mask the pain and the pain will decrease. 

Lindsey:   

Yeah, that’s why I sometimes see dads like punching kids in the shoulder when they hurt themselves, because it’s like, “Yeah, get over it.” It’s just a distraction. 

Dr. Ali Navidi:   

And there’s good truth in that. It actually works! 

Lindsey:   

Yeah! Okay, so I’ve been playing with the Reverie app, and they have this thing where you look up and then close your eyes and then keep looking up as you close them. And that’s supposed to be a test for being hypnotizable. So I’m wondering first, is everyone hypnotizable? Because you did mention everybody can be in a trance state, and how do you test for it? Or how do you find out? 

Dr. Ali Navidi:   

Yeah, that’s a great question, and what they were doing is what’s called the eye roll. That’s been around for a really long time. And so hypnosis is interesting because it’s probably one of the most studied concepts within psychology. I mean, if you go on to PubMed and just type in hypnosis, you will see thousands of articles, studies, various things have been done with hypnosis. So you’re asking about hypnotizability. That’s been really well studied. And so they’ve done population studies using these concepts. And so what they’ve found is that it’s a bell curve. It’s essentially a bell curve. And so you’ve got a few people on the end who are just amazing at it, a few people at the other end who it’s like talking to a brick wall for them in hypnosis. And then most people are average. The vast majority of people are average. And what I say to people is, “We don’t need you to be amazing. We just need you to not be terrible for this kind of treatment to work.” And so the vast majority of the people it can be helpful if you’re wanting to do chronic pain work, if you’re wanting to do GI work, we just need you to be average or better, and it can be helpful for you.  

How do you test? There’s certain tests that have been developed over the years. The eye roll test is one of them. They’re kind of fun, actually. For example, there’s one called finger magnets, where you have them put their fingers out like this, and you give them some suggestions. And I’d say 95% of the time, the fingers come together, almost like they’re being pulled together by magnets. The thing to understand is that trance is natural, and it’s happening all the time. And how do people enter trance? Well, pretty much, you just need two things, focusing your attention and engaging your imagination, and that’ll usually do it. So for example, if you’re thinking deeply about all the different things you want to do today, and so you’ve focused your attention, and now you’re imagining your day, you’ll probably go into a light trance just doing that. If you’re reading a book, you’ve focused your attention, and maybe the story is really interesting, and you’re imagining the characters and all this stuff. You’re going to go into a trance just doing that. Does that answer your question?  

Lindsey:   

Yeah, yeah. I mean, I was curious too about the eye roll, because I don’t feel like I can do it. I mean, maybe I’m wrong, because, it seems like my eyes go down when I close my eyelids. 

Dr. Ali Navidi:   

Well, let me see, maybe it’s their instructions. Here’s how I do it, and it takes a little bit of practice. So what you do is, first you look up as if you’re looking through the top of your head, and then you slowly close your eyelids until you feel a flutter, while keeping, yep! Perfect, right there, yep! And then let your eyes relax. So that was it! 

Lindsey:   

Okay, yeah. I was wondering, because I didn’t do it super easily. But then there was a, “Are you hypnotizable?” little thing you could run through, and I did that, and one of the things was, “Your left arm is floating up, even though you’re not purposefully doing it.” And I’m just like, “I’m not going to just lift it, I’m not going to just lift it,” but I’m like, “I do feel like it’s being drawn up.”  

Dr. Ali Navidi:   

Nice! 

Lindsey:   

And then at the end, they tell you, you’re either a poet or, I don’t know, there were three people, you know, if you’re like a poet type. And I’m like, I am the least sort of poet-like person. I’m not very woo woo. So I just was sort of surprised that I was hypnotizable, because I thought, I’m not the kind of person I would expect to be. 

Dr. Ali Navidi:   

You do not need to be a woo woo poet person to be hypnotized. Absolutely not. We’ve worked with plenty of doctors and scientists and various medical professionals. I think the one factor they found to be really important is people’s ability for absorption. How good are you at getting absorbed in things that you do, the kind of person who could be working and then just lose track of time. 

Lindsey:   

Oh, yeah, that’s me. 

Dr. Ali Navidi:   

Right? Yeah, or, you know, you’re working for so long, and then you don’t even notice your body, and then you’re done, and you’re like, oh, and you’re like, all stiff and whatever, but you didn’t notice any of that stiffness, or any of that while you were working. That is the key. You don’t have to be woo woo, but if you have the ability to get absorbed in things, you’ll probably be pretty good at hypnosis. 

Lindsey:   

So are people who have ADHD, who are super distractible, are they not good candidates? 

Dr. Ali Navidi:   

Well, that is actually a misconception, because I think a lot of people with ADHD, they have this thing called ADHD hyperfocus.  

Lindsey:   

Right, right. But it’s usually on, like, computer games, isn’t it?  

Dr. Ali Navidi:   

Yeah! Well, it’s on things that they like, right? And that’s the problem with ADHD. They have real trouble getting focused on things that they don’t like, whereas people without ADHD can force themselves to lock in, whereas they have a lot of trouble doing that. But they can be amazing hypnotic subjects, because they really can get hyper focused if you can make the experience enjoyable for them. 

Lindsey:  

Yeah, so how long is a typical course of CBT hypnosis before a person will find resolution of their GI issues? 

Dr. Ali Navidi:   

Yeah, I don’t think I mentioned, so about four years ago, I responded to the fact that there was nobody out there that does this treatment. I think they did the numbers, and there’s like 500 in the world, right?  

Lindsey:   

Okay.  

Dr. Ali Navidi:   

Myself and another psychologist, we got together and created a bigger group practice called GI Psychology. And the idea of GI Psychology is that we were going to make this kind of treatment more accessible to people. We worked really hard to make it available. Now it’s available in all 50 states by telehealth. And so looking at the data from our practice, what we found is that, on average, people take about 10 sessions. That seems to be the average. To put in perspective, that’s a relatively short term treatment when you’re talking about behavioral health stuff. 

Lindsey:   

Yeah, for sure. And do you take insurance? Or is this all out of pocket? 

Dr. Ali Navidi:   

We’re out of network for insurance and our patients tend to get about half back. 

Lindsey:   

If they’ve got a non-HMO plan? 

Dr. Ali Navidi:   

Yeah, if they don’t have Kaiser or something like that.  

Lindsey:   

Right, right. Yeah.  

Dr. Ali Navidi:   

The other thing though, is that there’s something called a single case agreement. It’s also called a gap exception, and we help the patients get this. And basically you’re saying to the insurance company, “Hey, are there any other gut-brain therapists in network for you?” The answer is always no. And so when they grant that, and they grant it like 90% of time, then the patient gets reimbursed as if we’re in network for them. So they end up getting a lot more back. 

Lindsey:   

Okay, great! So I know that some people may have concerns about hypnosis, and maybe even more so if it might involve a child. So what would you say to reassure them about that?  

Dr. Ali Navidi:   

Yeah, I think that the concerns, for the most part, I think, rest in that category that we talked about at the beginning, which is entertainment hypnosis. If all I knew about hypnosis was the stuff I saw in movies and TV and stage shows, I would be concerned too! I wouldn’t want to do it! As long as they can understand that there’s a very big difference from what Hollywood is showing you about hypnosis and what it clinically is. So then we get common fears that you’re going to be under somebody’s control. Nobody would want that. But is that actually reasonable? When you’re daydreaming, you’re in a trance. Can somebody control you? Can somebody just suddenly tell you, like, “Hey, give me all your money!” No. Can you get stuck in a trance? If you’re watching a football game and you’re really into football, and you kind of zone everything else out, is somebody going to be able to control your mind, or are you going to get stuck in that state? No, of course not.  

What I’m saying is this is actually a very natural thing that we’re teaching people to do. And what I tell my patients is, when they’re learning this, instead of losing control, they’re actually gaining more control over themselves, because we want to teach our patients self hypnosis, also. And what that means is, then they have this skill that they can use to decrease pain, to reduce GI symptoms. It’s a great way to calm down if you’re feeling stressed or anxious. I mean, I’ve had patients come back 5-10 years later and say, you know, I’m still using self hypnosis. They’re just using it for other things. They’re using it, you know, if they’re stressed or they need to figure something out and they need to get away from everything. And you brought up children. It turns out, children are even better at hypnosis, especially between like 8 to 12 years old. When we look at the data, children are even better at hypnosis, and they respond better to the treatment. So for example, adults, 75% of the time, they’re going to reach their treatment goals. That’s a super effective treatment, but kids are even better. They’re like 80-85%, are going to reach their treatment goals. They’re even better candidates for this kind of treatment. 

Lindsey:   

Yeah, that’s great. One thing that surprised me in using the Reverie app is that the introduction to moving you into a state of hypnosis is very quick. It’s like, do the eye thing, you’re in, basically and practically. And is that really the case in the therapeutic setting? 

Dr. Ali Navidi:   

Yes. So there’s stages to hypnosis. There’s the pre-hypnosis stage, where you want to explain things to people. Then there’s what’s called an induction. All that is, is the transition between normal consciousness and a trance state. Then they have what’s called a deepening so that’s where you’re getting deeper into the experience of the trance and kind of letting go of that outside world. And then there’s the intervention, whatever that intervention is going to be. And then there’s the re-alerting phase. They’re going to shift you back into your regular state of consciousness. There’s thousands and thousands of different ways to do that induction. It sounds like what they’ve chosen to do is a pretty rapid one, and based on what you’re saying, I don’t know what they’re doing for a deepener. 

Lindsey:   

Well, it’s probably just part of what they’re saying after that. 

Dr. Ali Navidi:   

Yeah, that’s probably not the way I would go with someone who’s learning hypnosis. Because just like anything in life, there’s a learning phase to hypnosis, and people will get better at it with practice. And so when people first start, you want to give them time to make that transition. And you want to work with them, which is the difference between an app and a human working with you. I want to work with them to figure out what works best for them. What’s the type of language? What’s the type of imagery? What’s the style that’s going to work for them? Because, like I said, there’s thousands of ways to do it. And then once people have been working with me for a while, they can go into trance in like a minute, once they’ve learned and trained themselves. But at the beginning, I would opt for a longer period of transition, to give people time. 

Lindsey:   

Yeah, and so if somebody’s experiencing GI issues, when do you think it’s gone beyond, my kid, when he’s nervous, for example, or me, when I’m nervous, I have to run to the bathroom, versus like, this is actually an issue that requires intervention of this kind. 

Dr. Ali Navidi:   

That’s a good question. I would say that when you start adapting your life to the problem. If you’re just going along and you’ve got to run to the bathroom every once in a while, but it doesn’t actually cause you to do anything different in your life, and it doesn’t really cause you a lot of stress or anxiety, or you’re not up at night thinking about what might happen tomorrow, or your life is not getting influenced by this. Just kind of keep on, keeping on. But once you start shifting your life around this problem, I think it’s time to start thinking about getting it treated. Because these problems are so treatable that it’s almost to me, like a no brainer. It’s a short term treatment, they’re highly effective, and they last. So when they do studies longitudinally, the results stay. These patients are not having to come back to keep this up. For the most part, they’re good to go. Very occasionally, they might come back, and it usually takes like one session to remind them of some of the skills they learned, and then they’re off and running again. 

Lindsey:   

Yeah, so we were talking a lot about the functional GI disorders and IBS and such, but I assume that there is also a mental component, even to the ones that are autoimmune, even IBD. Is there a role for hypnosis or CBT in those types of conditions? 

Dr. Ali Navidi:   

Yeah, there recently was a protocol that came out for IBD also, a hypnosis protocol, and it found that it was helpful for IBD patients. Patients with IBD, it’s a different type of treatment, obviously, it’s a different disorder. But there is a lot of overlap. There’s dealing with chronic pain. If you can help people get better at dealing with chronic pain, they’re going to have better quality of life. We know that stress is a big component in almost all the autoimmune disorders.  

Lindsey:   

Absolutely. 

Dr. Ali Navidi:   

When people are stressed, it’s going to be worse on their immune system. So if we can reduce that stress, they’re going to tend to do better. There’s also, I forget the right name for it, but basically I think of it as like an overlap. So you might have IBD, and then at different points in your life you’ve had flares, and that’s when your GI system is really going to be causing you trouble, and then the flares go away, or the flares are treated and they’re gone. But what happens with a lot of IBD patients is, they have a flare, the flare is treated, but some of the symptoms don’t go away. And that’s usually because they’ve developed a DGBI on top of the IBD symptoms. And so there’s an autoimmune component, and then there’s also a brain-gut component. The final part is that with IBD, there’s a lot of comorbid anxiety and depression. Especially for us, we understand IBD, we know what’s going on, and so treating that anxiety or depression with somebody who’s already familiar with IBD, and some of the challenges that are involved there, just tends to go better. So we do work with a lot of IBD patients. In fact, we’re working on a joint project with the Crohn’s and Colitis Foundation right now. We’re developing a therapeutic group, which is another option. So patients can see us individually, but we also have groups where we’re trying to teach patients core skills that are going to be useful for helping their gut, and that’s a much more financially accessible option than individually. 

Lindsey:   

And if someone’s doing work with, say, someone like me working on their gut health from a microbiome standpoint, or working with a GI doctor, maybe they’re taking their immunotherapy or steroids, or whatever they may be getting from their regular doctor. Would you recommend that they do all that first before coming to see you, or do it simultaneously or in sequence? Or see you first? What’s the best order for these things?  

Dr. Ali Navidi:   

I think, for the most part, it works well in conjunction. What we say is we play well with others, meaning we’re often dealing with patients that have complex medical issues.  

Lindsey:   

Yeah. 

Dr. Ali Navidi:   

They don’t just necessarily have IBS. They might also have SIBO. They might also have fibromyalgia, POTS, chronic migraines, other musculoskeletal issues. So there might be a lot going on, and so we frequently work with other providers on the treatment team. For example, there’s a naturopathic physician who specializes in SIBO. We’ve kind of worked together really well for many years, because often he’ll treat the SIBO and there will still be symptoms. There’s always something to treat, usually. It can be pretty resistant. We might have to do multiple rounds. So he’ll continue that treatment while we start the brain-gut therapy. And there tends to be really good results, because there’s often a brain-gut component in a lot of these problems. 

Lindsey:   

Any final thoughts before you tell us where people can find you? 

Dr. Ali Navidi:   

Yeah, I think my final thought is, I was in private practice for years and years, and I started this bigger practice because I just felt it was just a terrible shame that people might have these disorders, and they’re so treatable, and we have so much good evidence showing that these treatments work. They might go their whole lives and never get this treatment, and I thought that was really just a terrible thing. My hope is that people will understand that these treatments are out there, and that they don’t have to live with these symptoms, and that if they have a loved one that is going through this, let them know! People should not have to go through this, because these treatments, they really work well. And to answer that final question, the clinic is called GI Psychology, and that’s the website also, and they can get a free phone consult. We have a clinically trained person, they can answer all their questions, see if it’s the right treatment for them. 

Lindsey:   

Perfect. Great, well this was really interesting and useful, and I’m sure there are heaps of people who can benefit from this that I’ve seen and that are listening. So thank you. 

Dr. Ali Navidi:   

Yeah, I appreciate you providing this opportunity. Like I said, you’ve got so many great topics on here, so I’m just privileged to be one of the many, so thank you. 

If you are struggling with bloating, gas, burping, nausea, constipation, diarrhea, soft stool, acid reflux, IBS, IBD, SIBO, candida overgrowth, fatigue or migraines and want to get to the bottom of it, that’s what I help my clients with. I see individual clients to help them resolve their digestive issues and you’re welcome to set up a free, 30-minute breakthrough session to see if you’d like to work with me. I also have my own two products, Tributyrin-Max, which is particularly helpful for loose stool and diarrhea as it slows your motility and firms up your stool, and SBI powder, which is an all around gut pathogen binder, which is super safe and won’t harm beneficial bacteria, and is usually the first line of treatment I educate my clients about in order to avoid stronger antimicrobial herbs.

Schedule a breakthrough session now

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

The Gut-Gene Axis: Unlocking your DNA to Solve Chronic Health Issues with Jenna Weeks, ND

The Gut-Gene Axis: Unlocking your DNA to Solve Chronic Health Issues with Jenna Weeks, ND

Adapted from episode 132 of The Perfect Stool podcast with Jenna Weeks, ND and Lindsey Parsons, EdD, and edited for readability.

Lindsey:

Thanks so much for being with us.

Dr. Jenna Weeks:

It is a gift and a pleasure to be here today.

Lindsey:

You’ve got a beautiful backdrop there of the nature, and I wish I were sitting outside as well, but I have too much traffic noise where I live.

Dr. Jenna Weeks:

I feel so blessed because this year, I finally have a home, and I have my very first garden, and I’m actually sitting in front of it. I’ve been sitting by it all day. Took the day off to recalibrate my soul back to what is good, right? And what better to do than sit beside your garden to figure that out?

Lindsey:

Awesome! Could you start us off by describing what DNA is and what it does?

Dr. Jenna Weeks:

Oh my goodness, that is such a huge, vast question and a wonderful question. Let me see if I can distill that down into something that’s going to be useful for any human on this planet. DNA is the instructions. So imagine having a factory, and imagine in the factory, there were no persons there that knew what to tell you to do, or how to do it, or when to do it or all of these different things. It would be kind of chaos, or chaotic. Your DNA is the thing that sends down governance from all the levels of your cells to tell you, tell your cells how they’re supposed to work and how they’re supposed to be and what they’re supposed to make, what they’re supposed to do. It’s kind of amazing. I think of it like Santa’s workshop and all the little elves working together to create harmony inside the body and to sustain life. It’s kind of amazing. Yeah, so that’s what DNA is, and what DNA does, as far as I’m concerned.

Lindsey:

Okay, so knowing that about DNA, now can you explain the difference between genetics and epigenetics?

Dr. Jenna Weeks:

That is also such a phenomenally interesting question that nobody knows the answer to yet, to be honest, and it keeps changing. It’s a moving target, and if anybody tells you that they know the answer to that question, they’re probably wrong. So long story short, the way that I look at it is kind of like a house, and your house has a foundation, and your foundation is your DNA and your DNA doesn’t really change. And then your epigenetics are kind of like the house above the foundation. You can change the curtains, you can change the blinds, you can change the color, so it can be different than what it already is. Where people get a little confused, though, is they think that by the word epigenetics, they mean that they can change their genetics. So a lot of times, you can’t actually change your genetics, necessarily. Kind of like a river going down stream, the river can become dammed up, and that dam is there, that DNA marker is there, but what we can do is we can circumnavigate around that dam so that we can still have the water flow to the other side as the outcome.

So for example, in your DNA, you are born with certain DNA markers. Those things can either be turned on or not turned on. It’s kind of like having a horizon, is what I usually tell my patients. And underneath the horizon, you can have light switches. Just because you were born with a light switch doesn’t necessarily mean it’s turned on, but maybe through your life, you may dip through deficit states, and then eventually the light switch can get turned on. And this is sort of where people go like, “Oh, I never really had that problem before, but now all of a sudden I do and I don’t know why.” So you have your DNA. It is yours, but there are ways to mitigate the problems that your DNA can cause. And there are also certain ways that you can influence your DNA. And where people kind of get a little bit confused, is going, “Well, can’t I influence my DNA by what I drink and what I eat and all these different things?” Yes, it does work that way, because DNA is what we call methylated.

Methylation, we go back to that reference of the factory, and imagine a conveyor belt. And imagine on that conveyor belt you have a Hot Wheels car, and you have a little house where you have a worker who’s going to pull the lever down, and that little Hot Wheels car is going to go through, and there’s another worker there that’s going to put either the windows, the doors, things on the car. And so there’s a reason why the conveyor belt needs to be turned on, and then maybe the Hot Wheels goes down a little further and it needs to be painted, and that conveyor belt needs to be turned off. The worker there represents methylation of your DNA, meaning methylation turns your DNA on and off. And there’s a reason for it to be on, there’s a reason for it to be off. Both are beneficial. Not – on is better, off is worse. Both are beneficial at different times. And so the way I like to describe it and how we can affect our genes is if we had a worker that’s there and they’re drunk, or they ate a bunch of crappy food and now their brain is really foggy, then that’s going to change how that lever gets pulled, turned on, turned off. And then that’s going to change everything that comes down the assembly line.

And eventually, if the person is really under it, drinking, smoking, crappy food, all that stuff, then that lever gets pulled at the wrong times, and now you have some messes in your cells, right? So this is how we can affect and change our DNA, by making sure that our worker is drinking a green smoothie, and they did yoga that morning, and so their body is primed and ready to do the job properly, to methylate the DNA, to make the DNA optimal, to make their bodies optimal. It’s my long winded way of explaining what DNA is, genetics are, epigenetics and how you can affect your genetics. It’s a complicated topic, so I try to do my best to give it to people in a way that they can hold it in their hands, use it and digest it and actually do something with it, right?

Lindsey:

Yeah. Well, now that we have that great analogy, tell me about what a SNP is and how they can influence your health.

Dr. Jenna Weeks:

Yeah. So a SNP is a single nucleotide polymorphism. The way that I like to talk about it with people is I usually get them to imagine a computer system, and behind the computer screen, inside of the software, there are zeros and ones, and the zeros and ones are kind of running the show. And behind the scenes, if you have a line of code, and if you have a zero where they’re supposed to be a one, you could have a little glitch, maybe another line of code, another glitch, another line of code, another glitch, in another area. And so depending on how many glitches you have in which different areas, that will determine how fragged your system shows up on the screen.

And so our body’s DNA, our SNPs are kind of like that. We could have an A, where there’s supposed to be a T, a C where there’s supposed to be a G in our DNA base pairs called adenine, cysteine, taurine and guanine. I usually just say red ball, blue ball, yellow ball, green ball. If you have a green ball where there’s supposed to be a red ball – glitch – yellow ball where there’s supposed to be a blue ball – glitch. And then when we take that whole thing, and put it in the framework of thinking about a giant Plinko board.

So remember The Price is Right? And we think about putting that Plinko chip in at the top of the board, and it filters down through and it falls down through a slot in the bottom, and you might get $500 you might get $1000 you might get nothing. Your body is like that too. You put food or drink in, drugs, alcohol, whatever it is, it filters down through pathways. And those pathways, out of them, you get certain things that get made. So the pathways are pathways for vitamin A, pathways for B vitamins, pathways for vitamins C, D, E, Zinc, feel-good brain chemicals, hormones and also your gut flora and your collagen. So if you have a little bumper representing a little glitch in any one of those pathways, then you can’t necessarily have made what you want to have made out of that pathway. And then that will have its own set of issues with it.

Just a real quick example of that, so people can have an idea. A lot of times I see patients in my practice that will have a bumper in the pathway of vitamin A. So that’s a SNP, a single nucleotide polymorphism, in your vitamin A. And what that means is that they don’t necessarily convert beta carotene into active retinol. And when that happens and you don’t have active retinol, well what’s active retinol’s job in Santa’s workshop? Active retinol’s job is to make sure that skin cell turnover happens. So if you don’t get skin cell turnover, then these are my people who have acne, psoriasis, dandruff, eczema, dry eyes, cracks in the corners of their mouth, cracks in their heels and their feet, and they will never, ever know it, unless we do this testing, find out and go, “Oh yeah, no wonder you have those issues. You don’t make your vitamin A properly.” So let’s look at supplying your body with what it’s been missing all along, in a safe, healthy way, through a practitioner and the right dose and the right kind, because vitamin A is also very dangerous at high doses for everyone listening. You don’t go supplementing with it willy-nilly. But then we can start to see changes that we’ve never been able to see in the body before, because we’re finally giving that individual the raw materials that their body’s been missing all along.

Lindsey:

And since you brought up the vitamin A example, and I know I actually have that SNP, so beta carotene comes from fruits and vegetables, right? Whereas the active form, like retinol palmitate, or whatever retinol forms there are come from meat, don’t they?

Dr. Jenna Weeks:

Yes, absolutely. Liver is the highest form of vitamin A, the active form of vitamin A, so that’s definitely where you would want to source that, or possibly through supplementation, because you’re right when you’re consuming carrots, that’s beta carotene, those orange foods. But if you don’t have the enzyme, because you have a little SNP, it doesn’t necessarily convert into that active form. So then you want to be consuming the active form again in right dose, because vitamin A can be toxic for the liver and can cause birth defects in childbearing women. So we just want to make sure we’re dosing it specifically, correctly. And anything said on this podcast today is for information purposes and never meant to diagnose or treat anyone.

Lindsey:

Got it. So can you tell us about some SNPs that could impact gut health?

Dr. Jenna Weeks:

This is my favorite topic of life, and the reason why I wanted to come on your podcast in the first place and shout this from the rooftops, because the amount of lives I’ve seen this change has been unprecedented. It’s been incredible. And I just wish that more people had this information in their hands so that they don’t have to suffer. Because when you go to your doctor, unfortunately, if you show up with a bunch of gut issues, they will give you a diagnosis of exclusion, which is IBS, usually. And they don’t know what that is, and they don’t know how to treat that, and that’s okay, because every aspect of medicine or anything has its limitations, even naturopathic medicine, right? So good on everybody for doing the best that they can where they’re at and your genetics, the two gene mutations that I would just love to talk about today, one of them is called a FUT2 gene mutation, FUT2, not Footloose, FUT2, have you ever heard of that one?

Lindsey:

Yeah, I was going to ask, because I’ve had my own DNA done by The DNA Company, and I’ll ask you about mine after you’re done describing it.

Dr. Jenna Weeks:

Awesome. Do you have a FUT2?

Lindsey:

I have AG.

Dr. Jenna Weeks:

Okay, so you’re an AG.

Lindsey:

So heterozygous.

Dr. Jenna Weeks:

Yeah. Okay. So yeah, generally, the one that I’m speaking about is an AA, a non-secretor. So what does that even mean? What I’m going to get everybody that is listening to imagine the wall of your intestine like one of those spongy bath mats that has those finger like projections that are really absorbent. That’s the side of your intestinal wall. And then just above that, usually I draw a picture, and I put these little microbes, and then just above that, in the sky, I put a little Pac Man. And that Pac Man is spitting out what I usually call glitter, but really what it is, is that little Pac Man is your red blood cell, and it’s spitting out a carbohydrate that’s meant to feed your gut flora. And if you don’t have a FUT2 AA non-secretor SNP, this is what happens. If you have a FUT2 AA non-secretor SNP and it is active, meaning that that light switch is triggered in you, and you’re having signs and symptoms of digestive disturbance, then what can happen is that red blood cell doesn’t necessarily make the carbohydrate to feed your good gut flora, which means that you don’t really have your good gut flora.

It’s crazy when I say that I had one patient that was one of my very first patients ever, and she was trying to figure out the root cause of her MS, and she came to me and she had done a stool test, and her stool test showed no good gut flora, no bad gut flora, no flora. She was working with another doctor down the hall at the time, and they put her on a high dose probiotic and six months later, we tested her stool, no gut flora, no good, no bad. What? Okay, they put her on another round of soil probiotics, tested again, same thing, no gut flora. They put her on kimchi, sauerkraut, kefir, you name it, no gut flora. Three stool tests in, no good, no bad. She came to see me. We did her genetics. We found that she had a FUT2 SNP. It was like a holy hallelujah moment. Both of us cried in my office because we were like, “Wow, we finally understand why this is happening once we were able to see that, we were able to give her the specific nutrients that feed her gut flora and the specific probiota that she would be missing. And we tested after six months, and sure enough, finally, gut flora. It was a beautiful day.

This has had such an impact on so many of my patients, especially with IBS. I remember one man came to me and he said, “I’m 50 years old, and finally, I’m pooping the right way for the first time in my entire life, every day, two, three times a day.” He’s like, “That wasn’t ever a possibility for me.” He was somebody that went the other way and was five or six or seven times, and kind of diarrhea. And then my other patients, sometimes with this gene mutation will have constipation too. So it’s just a real blessing to learn about this one and assist it.

Lindsey:

Yeah. So as I mentioned, I have the AG, not the AA. So I have maybe one part of it that’s working right and one that’s not. And I have autoimmune SIBO, so I’m curious if this gene could have impacted my getting SIBO in the first place when I was exposed to food poisoning.

Dr. Jenna Weeks:

Yeah, let’s talk about this one. It’s been my experience that the root of SIBO, which is such a big statement to make, but I remember being in naturopathic medical school, like 10 years ago, and I remember SIBO being a really big, huge thing coming down the pipe and learning about it, and hearing that SIBO is really resistant in some patients, but not in others. And whenever I heard that, that was always a big red flag for me, and I’m very much a why person. Well, why is that? I want to know why. So I put my investigative cap on, and sure enough, somewhere down the line, I kind of figured it out. And what I learned is that the people, the patients that are resistant for SIBO treatment, where they’ve treated SIBO and it keeps coming back, they have what’s called a COL1A1 or 5A1 gene. Are you familiar with those ones?

Lindsey:

No!

Dr. Jenna Weeks:

Okay, put on your hat, we’re going to go for a journey that’s going to change your life! So, long story short, with a collagen gene mutation, what happens is we’re supposed to have collagen made in our body in a way in which it’s a strong cross-linking fiber. And if we have a collagen gene mutation, then what can happen is that cross-linking fiber can sort of have holes in the mesh of it. I figured this out about a year and a half ago, because I have these gene mutations myself, and I still had digestive issues, and I still could not figure out where they were coming from and why, why they wouldn’t just finally subside. And I went back to the drawing board, looked at my genes, and I dug deeper, and I found out, oh, I have this double collagen gene mutation.

Okay, well, where else is collagen in the body? We know it’s in the ligaments and tendons and joints, and we know it’s in the skin and the hair and the nails. Well, where else is it in the body? And I did some research, and found out that 98% of your intestinal wall is made up of collagen. Oh, how interesting. Okay, so theoretically, if I have a collagen gene mutation, I don’t make my collagen as well as I should, I probably have mesh in my intestines that has got holes in it. So, leaky gut – chronic, leaky gut. So then we can let bad bacteria in, and we can let good bacteria out and it just all becomes kind of a mess that we call SIBO. And these are the people that generally tend to be resistant to treatment, because the holes in the mesh never get addressed.

People think that the holes are caused by the SIBO and the bacteria being bad, and it’s causing leaky gut. But 9 times out of 10 my patients have collagen gene mutations underlying this and their net was leaking from the beginning. So if we can look at that, see that, pop that hood, find those collagen gene mutations, then we can address the root cause of the issue, which is a collagen synthesis issue, and support the body in making their collagen properly. Not just taking collagen supplements, but doing things to supercharge collagen production. Then things start to really change and take hold in a better, amazing way.

Lindsey:

Yes.

Dr. Jenna Weeks:

Life changing.

Lindsey:

So, I know vitamin C is one of the necessary ingredients for collagen production. What else is involved?

Dr. Jenna Weeks:

Glycine, proline. So generally speaking, I will use some combination of that, depending on the human, what their needs are, and what concomitant factors exist for them and what’s safe and what’s not for their body.

Lindsey:

And I know that there are different types of collagen. Is there a particular type of collagen that’s specific to the gut?

Dr. Jenna Weeks:

Yeah, so there’s collagen one through five, and collagen one, two and three are more specific to the gut. There is some collagen number five in there. There’s a little bit of four, but those other ones are the main, predominant ones to focus on. So if you’re looking for a collagen to support you in that way, then you would want to look in those areas, one, two and three.

Lindsey:

And if you’re just taking those basic collagen peptides, that would include all types, right?

Dr. Jenna Weeks:

Most of the time, yes, it’s usually collagen type one and type two.

Lindsey:

Okay yeah, I was just curious about that. And with glycine, this is something I’ve been sort of pondering of late, because both of my parents, I test them regularly, like once a year, they do their Metabolomix or NutrEval or whatever it is, and they’re always deficient in glycine. And glycine is one of the building blocks of glutathione. So I assume I probably got their genetics, and I’m probably deficient in glycine too. But now thinking, okay, if glycine is related to collagen, and we’re deficient in glycine, that might be sort of the triple whammy for our family.

Dr. Jenna Weeks:

Oh my gosh. I love conversing with people like you who can see the web of the big picture and understand how it’s all interconnected into a constellation that actually makes sense for your own self and also your whole family unit. That’s what I find to be the brilliance of genetics, is that it allows us that span of understanding, I guess. So you hit it right on the nail with glycine. My question for you is, how is your sleep?

Lindsey:

Not great. I wake up in the early morning, well, I also have hot flashes.

Dr. Jenna Weeks:

Let’s talk about it for just a second, because people will probably be helped by this. So imagine a bicycle that has a funnel on the front of it, and imagine a shelf next to you, and on the shelf you have collagen, vitamin C, glycine, proline, some B vitamins and different other things that make up what you need to make collagen. And so imagine you’re taking those ingredients off the shelf, putting it into the funnel, and you’re biking to spit out a ribbon behind you that’s supposed to be a nice solid ribbon of collagen, but your ribbon has a bunch of holes in it. So then you’re going to keep needing to take ingredients off the shelf and keep pouring it in the funnel, because it’s not really getting made properly, right? So eventually you’re using up your resources. When somebody walks into the room from another department and they say, “Hey, do you have any glycine in here? We need it for the sleep department.” Then the glycine isn’t available. So that’s actually what happens.

And this was a secondary discovery, when I figured this out, was that my patients who have a lot of sleep issues, that have these collagen gene mutations, their glycine is being used up by the collagen gene mutation so it’s not available to dampen their brain at night to make them go into a deep, restful sleep. And when I figure this out, they sleep like babies, most of them. It’s been a really wild and wonderful discovery that one.

And the other discovery that I made through this, was that this is the root cause of fibromyalgia, in my opinion. I know that’s a very huge, bold statement to make, but I have had so many patients come back after being on Gabapentin for 12 years, 5 years, 7 years, 3 years, and they’re no longer on their Gabapentin because they no longer have pain, because their gut is no longer leaking poo particles, which ignite their inflammation. And the body shoves that inflammation to the joint spaces, because that’s the safe place for it to go. They just no longer have those issues, right? And the same with arthritis, Rheumatoid Arthritis, we’ve been able to gain so much traction for those patients. And as well autoimmune thyroid conditions, because, again, poop particles roaming around in your system, roguely, will create inflammation in your whole body.

Lindsey:

Wow, that is interesting. And I know that SIBO is very much correlated with fibromyalgia and is often a precursor. So if you see this common root in collagen issues around both of them, that would make sense why they’re connected.

Dr. Jenna Weeks:

Oh, hallelujah, you get it!

Lindsey:

Yeah and I was going to say about the glycine was, I think one thing that often happens in the world of supplements is people, they go, “Oh, well, glycine is a great supplement for sleep, right? That helps sleep.” Well, it will help sleep if you were deficient in glycine, if you weren’t deficient in glycine, it probably won’t be a mover for you.

Dr. Jenna Weeks:

Yeah, absolutely, absolutely. And I mean, that’s where I have completely dedicated my life to understanding genetics. Because when I was in naturopathic medical school, it was so wild because they were like, “Curcumin, this is the number one thing. Everybody take curcumin! It’s so good!” And I would take it, and I would feel like absolute garbage. Or they would say this particular herb, valerian, or whatever it is, is for anxiety. And I would take it, and I would feel so anxious. And so I started going, I’m not made like everybody else. I need things that are individually for my own specific snowflake, make and model of body. And then I had to think, well, there must be other people out there. And so I thought, I can’t, in good conscience, prescribe to people things, knowing that maybe it’s not going to be the right fit for their body, unless I know what the right fit for their body is. So this is where genetics allows us to peek through that window for that specific make and model of body and give that specific make and model of body what it needs and understand its little recalls and the things that it needs extra support with, right?

Lindsey:

Yeah and so back to the collagen one. So you said COL1A1 or 5A1, is that what will appear if we have gotten our DNA done, or are we looking for specific letters or mutations on those two genes?

Dr. Jenna Weeks:

Generally speaking, the COL1A1, 5A1 should be enough information to tell you. I’m not really sure exactly what all of the companies are going to illustrate. I know for my own self, the way that I go about it, as I go through, usually Ancestry, 23andMe, and I take that raw data and I put it through my third party medical reporting software, which is called Pure Insight, and that’s where I gain all of the backstory on my patients, so I’m not really sure all of the different DNA sites out there will illustrate that.

Lindsey:

Yeah, I’ve I’ve taken people’s SNPs and put them through Genetic Genie, and what you get is, this ishomozygous, this is heterozygous. You get that kind of information. So I guess it would probably appear like that. One thing that I did find out when I did my DNA through The DNA Company, which was, with the Ancestry and the 23andMe, you can have group data, you can have mistakes, essentially, because they’re doing it en masse versus much smaller batch or individual. And I found out that when I put my 23andMe through Genetic Genie, I had APOE4/4, which is correlated with a higher risk for Alzheimer’s. And then when they did it through The DNA Company, I found out it was only a 3/4, so it was not quite as bad. And so I’m curious if there is something on there that’s kind of disturbing, do you send people for secondary testing, to confirm?

Dr. Jenna Weeks:

Yeah, generally speaking, I do. I don’t think any test, really, in the world is failsafe. Being realistic, we’re humans, we’re doing the best we can on this planet, so 9 times out of 10, I do feel like it really matches. Like 99.5% when I speak to my patients, they’re just like, “Yeah, this is so me to a T.” So in terms of discrepancies, I don’t really see a whole lot of them, at a clinical level.

Lindsey:

Okay, and so any other SNPs that specifically relate to gut health?

Dr. Jenna Weeks:

The ones that really surprised me, were B vitamin gene mutations. I had never learned anything, eight years of schooling, numerous days, hours of research and everything, and I had never heard anything about, necessarily, B vitamins playing a huge role in digestive health. And then, whenever I would treat the SNPs for B vitamin gene mutations in my patients, they would come back and say, “Wow, I used to be so constipated. I would go once every three days, and now I’m going three times a day. This has never happened in my life before.” And whenever we would do their genetics, I would always start them on one thing at a time. And so B vitamins are generally the thing I start people on first, because you need to kind of unkink the hose in the system. And from the moment they start the B vitamins, they’re like, “I really notice a difference in my bowels and my body in that way.” I’m like, “Yep, there it is. Okay.” And now there’s more research coming out that activated B vitamins play a really big role at the junction cells of the intestinal wall and helping to facilitate energy movement, peristalsis through the intestines, which is really kind of amazing.

Lindsey:

And so is this the famed MTHFR we’re talking about?

Dr. Jenna Weeks:

Yes, there is the MTHFR as part of that, which is never to be negated. It’s so important to know about the MTHFR gene mutation. What I’ve learned, though, is that generally speaking, when people have one or two MTHFR gene mutations, they’ll generally always also have a B12 gene mutation, maybe a couple of them, B6 gene mutation and also a choline gene mutation.

The way that I kind of make it make sense to my patients is I just say, “B9, imagine, kind of like a figure eight, and on the figure eight you’ve got B9 in one place, and B9 kind of makes B12 in the middle, and then B12 goes on to the other side to make B6 and B6 makes choline, and choline makes B12. And so they all kind of facilitate that infinity symbol of helping and making and facilitating each other. If you have a gene mutation in one of them, then you kind of have a gene mutation in all of them. And that whole cycle goes on to do methylation.

And that whole methylation thing that we were talking about, it’s such an important word for humans to know, learn, understand, have in their dialect, be able to speak about. That methylation, again, is that person standing there at the helm of your DNA, literally turning your DNA on and turning it off so that it works properly. This is why it’s so key to the function of your whole entire body to have that B vitamin cycle, that methylation cycle, working properly. And when we have gene mutations in there, that’s when things go kind of crazy and off kilter and haywire. And that whole B vitamin cycle goes off to make feel good, brain chemicals too. So when that doesn’t work, we’ll be deficient in serotonin and dopamine, and that’s where a lot of people think that they have anxiety, they have depression, they have ADD they have all these different things, and really they just have a B vitamin gene mutation, bunch of them, deficiency. And when we sort that out, those other issues, the volume on them turns down a lot, if that’s the root cause of what they’re dealing with.

Lindsey:

And what are the other genes that might show up on mutations related to B vitamins?

Dr. Jenna Weeks:

Those are the ones, B6, choline, B9, B12. I can talk a little bit about what they do. And if you have those gene mutations, what happens if they’re not working properly?

Lindsey:

Okay.

Dr. Jenna Weeks:

Let’s go with choline first. Choline, I’d lump it in with the B vitamins, because it kind of hangs out with them. But choline is so important to your liver function and metabolizing fats in your liver. A lot of my patients will go and they’ll get scans randomly because their intestines are doing something strange, and then inadvertently, they’ll find out that they have fatty liver. Then their doctor will say something along the lines of, “Well, it’s not really that bad, so we’re just going to wait and watch and monitor it and see what happens.” And if you do that, eventually it will get worse. When it gets worse, then it can actually turn into bad things. So I don’t know why that’s exactly the way we go about doing it, but that’s how it works.

And so what I really want people to know about there is that often what will happen is that there’s an underlying gene mutation, or two of them in your choline genes. So these are MTHFD1 and PEMT2. If you have a gene mutation in either of those, then what can happen is, the way I describe it is like this, if you had a cold slab and above it you had a screen, and that screen was warm, and on the screen there was a chunk of butter, and through the screen, little droplets of butter were dropping through and landing on the cold slab below. This is what happens in our liver when fat passes through it, and choline is the nutrient to heat up that slab below to allow the fat to keep rolling through your liver. But if you don’t have the choline, that slab doesn’t get heated, it doesn’t get metabolized, those fats don’t get emulsified, and then they just build up in your liver. And so then that’s what’s causing the fatty liver.

But when you go to the conventional medical system and you’re not really drinking a lot of alcohol and you’re not really eating a lot of fatty foods, they’re like, “Well, it’s non-alcoholic fatty liver disease, and we have no idea why it happens.” Well, actually, it’s a choline gene mutation, and when you know this, you can do something about it. I had a patient who came and they had an 80% fatty liver, age 27, and it was causing their brain to have so much brain fog that they could hardly function or work. Once I saw their genes, once I realized what we were dealing with, we were able to give their body what it had been missing all along and with, in the right dose, right form, right kind, right timing and right combination of choline and other factors. Within three months, I thought it was going to take nine months, maybe a year, for this to happen, but within three months, they went in for another scan. No more fatty liver. From an 80% fatty liver.

Lindsey:

Wow!

Dr. Jenna Weeks:

Tell me that’s not wild.

Lindsey:

Yeah, would somebody who has fatty liver because they’re doing the bad stuff like drinking and eating sugar, could they take choline or other cofactors and help with it?

Dr. Jenna Weeks:

Are they going to?

Lindsey:

Well, maybe! Maybe they’re willing to take a pill, maybe they’re not willing to stop eating sugar, but they’re willing to take a pill.

Dr. Jenna Weeks:

In good conscience, I can’t really say that, because my take on life is don’t put yourself in that position to begin with. Yes, maybe the cards are stacked against you and yes, maybe there are things that you can do to support your body better, but one of the best things you can do to support your body if you do have fatty liver, is to not drink alcohol and not eat sugar.

Lindsey:

Sure, sure. But say my 80 year old parents, they made it this far. They don’t have cancer, they don’t have heart disease. They’re drinking their two drinks a day, and that’s going to happen. They’re going to be eating desserts a few times a week. That’s going to happen. That’s never going to change. They’re in their 80s. They made it this far. So would choline be a good supplement for somebody who, I mean, I don’t know that they have any fatty liver, but I’m just curious, in that sort of scenario.

Dr. Jenna Weeks:

That one’s crossing an ethical boundary in me.

Lindsey:

Okay, that’s fine, you don’t have to answer!

Dr. Jenna Weeks:

The reason I say that is because a patient of mine the other day said something along those lines, where they they went to their doctor and they were eating a bunch of ice cream and a lot of Lay’s potato chips, and the doctor put them on a statin, which totally depletes your nutrients and is actually really not a healthy substance. Some drugs are not mean, and some are. Anyways, this is a mean drug, a statin. And the doctor just said, “Well, eat your chips, eat your ice cream. Just take the statin. It’s all good.” In my soul, I cringed, and I just said, “No, don’t eat the chips. Don’t do the thing to your body.” And I get that the parents are old, they made it to 80, so maybe they just eat whatever they want, do whatever they want, and that’s their prerogative!

Lindsey:

Yeah, no. I mean, I also am sympathetic to the fact that there are some people really have binge eating disorders. They have really complex issues around trauma and ACEs and everything else, such that it’s not even within their conscious to control not to eat the wrong things. Like some people have fatty liver and may always have fatty livers. You got to work with people who are imperfect.

Dr. Jenna Weeks:

Yeah, with that kind of a case, then maybe, yeah, for sure. That’s a good topic to explore, really. Thank you.

Lindsey:

Yeah. You mentioned what we were just talking about, choline, how about the other B vitamins you were talking about?

Dr. Jenna Weeks:

Oh my gosh, pick one! Which one do you want to know about?

Lindsey:

Folate! Let’s talk about folate.

Dr. Jenna Weeks:

Oh, wait. Okay, so that’s your MTHFR gene mutation, methyl tetrahydrofolate reductase. Okay. So what does this mean? Why do we care? Usually, what I tell people is that Clark Kent needs a phone booth to turn into Superman, so that Superman can take the Riff Raff out make the hearts of people happy, keep people happy so they can keep reproducing properly in your body. Your folate, just plain old folate needs an enzyme inside of your body to work, which is a reductase, methyltetrahydrafolate reductase enzyme in order to work in order to turn into, so Clark Kent needs the phone booth to turn into Superman. Your folate needs the enzyme to work in order to turn into activated folate to then take and bind to excess hormones, excess heavy metals, excess plastics, toxins, pesticides, you name it. So if it can’t do that, then those things can roam around our body and create havoc. That whole methylation cycle, again, goes on to methylate our DNA. So that’s part of it.

Methylfolate makes a lot of the methyl groups that go on to methylate DNA. And then it makes, like I said, your feel-good brain chemicals serotonin and dopamine. And then the other thing it does is it makes the cells on your cervix divide and grow properly. So women who have abnormal paps, a lot of times will have B12 and B9 gene mutations and not ever know that this is actually part of the root cause of why they’re having their abnormal paps in the first place, because you need activated B vitamins to turn that cellular turnover on the cervix the same as you do to make a baby. And so women with MTHFR gene mutations as well sometimes will have a history of miscarriage or premature birth or abnormal births. The way that I describe that to people is, if you are making a cake, you need resources to make the cake. If you don’t have enough resources, then sometimes the cake has to come out of the oven sooner, right? So premature birth, or sometimes the cake just doesn’t work. And so that can be the miscarriage, right, if we don’t have enough of those proper resources. But again, if we can find out that this is what’s going on, then we can mitigate this before women ever go into their birthing era and facilitate there being more healthful births as well.

B vitamins play a crucial role in energy metabolism, just making energy. And so I have a lot of women who will have gone through giving birth, and they’ll say, I’ve just never been the same since I just have not gained my energy back. And this will be 10 or 12 years later, and they just feel flat like a pancake. In the morning, they can’t get out of bed. And then at 10 in the morning, their energy is sort of okay. And then two, three in the afternoon, it dips. And then 8, 9, 10 at night, they’re really tired. But then 11, 12, at night, they start to wake up again. And this is called a reverse curve on your adrenals, and your B vitamins are intimately connected to your adrenals. And so this comes back to these women having underlying B vitamin gene mutations and never knowing it. And when they go to make a baby, they use all their B vitamins to resource making that baby. And then once that’s done, they’ve got nothing left inside their body to replenish with. So then they are low on energy going forward, just the way it is. We give these women the things that they’ve been missing all along, they start to literally feel like someone turn the lights back on in their body and they’re coming back to life, and they have energy, and they’re finally sleeping again, and they actually have a zest and a joy for life again, as opposed to just dragging themselves barely through the day. Those B vitamins are huge, right?

Lindsey:

And then, of course, they put folic acid in most of the prenatal vitamins, which is not the active form.

Dr. Jenna Weeks:

I mean, yeah, that is something for everybody to be very aware of that the statistic on it is that about 44-47% of the population has an MTHFR gene mutation, that’s not taking into consideration as well the other B vitamin gene mutations. So in my experience, it’s somewhere closer to around 70% of people may have one or more B vitamin gene mutations, which means that they’re working at a deficit for resources, for energy.

Lindsey:

Yeah, and so most people need to be looking for B vitamins that have methylated folate of some sort, yeah?

Dr. Jenna Weeks:

So here’s my little rule of thumb. This is how I find a B complex on the shelf, which is really hard to do to find a good one. But everybody knows what B12 is, right? Like, just B12. Yeah? I know B12. No, B12. Okay, cool. So the way that I describe it is the ABCD rule. So I will tell if a product has integrity, integrity, meaning that it has activated forms of things, if it follows the ABC rule. So you get an A if you look for B12, right on the back of the bottle, look for B12, and if next to it you see a C word D, don’t do it. So that C word will be cyanocobalamin, and that’s the non active form. You want to see any other word next to B12. You want to see, the real word is methylcobalamin. And then you go and look at your folate. And if it’s just a simple word, folate, folic acid, simple word. No complicated word next to it, don’t do it. You want a complicated word, you want L5 MTHF or L5 calciummethylfolate, or one big, complicated word.

Lindsey:

Okay, is there one like Metafolin or. . .

Dr. Jenna Weeks:

Yeah? Metafolin is a trademark name that a company uses, so, yeah, something like that.

Lindsey:

It’s also methylated.

Dr. Jenna Weeks:

Yeah, absolutely, okay.

Lindsey:

And does it matter if the B6 is P5P?

Dr. Jenna Weeks:

I prefer if the B6 is P5P, that’ll be the activated form of B6 as well. But I also prefer to know if people have a B6 gene mutation before they take a B complex. Because if they don’t have a B6 gene mutation, I won’t leave my patients on B complex longer than one bottle to rebolster their body, because B6 actually can build up in the nerve to shoot and cause numbness and tingling in the hands and feet if it’s not needed.

Lindsey:

Yeah, I’ve come across many clients who have to use B complexes without B6 because they’re deficient in other things. And what’s the name of that gene for B6?

Dr. Jenna Weeks:

There’s two of them that I know and work with intimately, and one of them is called NBPF3, and the other one is called CBS, cystathione beta synthase. Those are two different kind of things. One is you have a problem just even making or having enough B6 around NBPF3, and then CBS uses B6 So if it’s going too fast, then you can use up your B6 too quickly.

Lindsey:

Isn’t there a fast and slow CBS?

Dr. Jenna Weeks:

Yeah, there is. It’s really weird. But in my experience, most of the time it’s going fast, but most of the research that’s out there is on the slow ones. In terms of percentages, I would say 12% of my patients have the slow one, and the rest of them have the fast one, and the fast one, then is generating too much ammonia in their body. And that just for anybody listening, if you go to the doctor and you have panic attacks, they will basically tell you, and the literature tells you that there is no real, known cause for panic attacks. Nobody knows why they happen. If anyone’s ever had a panic attack, I really haven’t, but I’ve seen people have them. It looks like the worst, most terrifying, the most horrible thing on the face of the planet. And then to not have an answer or a conclusion as to why that’s happening would also be horrifically terrifying. So this is why I want to share this. I would say 88% of my patients who have panic attacks have a CBS mutation in which their CBS gene is making too much ammonia, and that ammonia crosses the blood brain barrier and acts like a poison in the brain, and then that sends off signals to the body to dilate blood vessels, make heart race, make breath shorter, brain fog, vertigo, dizziness, digestive issues, brain racing towards all the problems that you can see, because that’s what happens when our fight or flight gets ignited. And these people, really what’s going on with them is that they’re having an overdose of ammonia in their body. And we can figure that out. We can change that, change their diet, remove the sulfur foods that are spurring on ammonia. Because we know that that gene mutation is there for them, that it literally changes their panic attacks. I don’t have one patient that doesn’t have panic attacks that no longer has them once we figured this out.

Lindsey:

And so the sulfur foods, are we talking like garlic, onions, cruciferous vegetables or like meat?

Dr. Jenna Weeks:

So the whole situation with the CBS is that essentially, what’s happening is that you’re supposed to be able to convert sulfur through cystathione beta synthase into active glutathione. With this gene mutation, what happens, instead of it going to glutathione, instead it gets shunted over and turns into ammonia. And so the idea is to put in less sulfurous foods to make less ammonia. So your sulfur foods, the highest concentrations are going to be your onions, your garlic, your broccoli, cabbage, cauliflower, kale, Brussels sprouts, green onions. So those are the highest amount. What I then tell my patients is to try to avoid those ones. And then I give them a list of all of the foods that contain sulfur, and I just ask them not to 2x, 3x, 4x or 5x them all at the same time if they’re going to eat them. So they can still eat the meat, they can still eat the cheese, they can still eat the cashews and the almonds that all have sulfur in it, and the eggs, but just not eat them all in combination to overload the system and push that ammonia.

Lindsey:

So there’s more sulfur in garlic and onions than there is in meat? I mean, because I’m just thinking, you might have a clove of garlic in your food, but you’re eating four ounces of meat, I’m just curious, like, proportionally, it really . . .

Dr. Jenna Weeks:

The potency of the medicine of garlic is stronger.

Lindsey:

Okay, got it. Interesting. Yeah, yeah, I actually had something with the CBS mutation relatively early on in my coaching, and amazingly, figured this out. I don’t know how I did. I ran his DNA, and this thing popped up, and I started just Googling everything, and then I was like, this guy’s got too much ammonia. Well, I knew he had too much ammonia because I’d done an Organic Acids Test, and so I was already working on clearing his ammonia, but then we figured out that the mutation was a part of it.

Dr. Jenna Weeks:

And you knew why?

Lindsey:

Yeah. I mean, I think I found an incredible post by Dr. Jockers that explained the whole thing and I’m like, okay.

Dr. Jenna Weeks:

Dr. Jockers is amazing for the CBS for sure.

Lindsey:

I wanted to ask quickly about SNPs that might influence autoimmunity.

Dr. Jenna Weeks:

Oh, yeah. Okay, so snips that may influence autoimmunity, the ones that come to mind first are actually IL6, interleukin 6, interleukin 17, IL4 as well, TNF alpha. When I see this in a patient’s report, I’ll ask them, Are you experiencing autoimmune conditions? Is this part of your picture? The collagen gene mutations are very much a foundation for this. Because, again, if you have poop particles leaking around through your body, your body’s immune system is going to be ignited continuously. It’s like that bouncer that’s just always on and like, “What? What? What’s wrong?” Never gets a chance to sit down and not be on. So they’re hypervigilant.

And then with the IL6 and the TNF alpha, these sorts of things, what happens is you have a TH1 immunity. And the way I like to describe this to my patients is imagining a wall and imagining green blobs on one side and blue blobs on the other. Your green blobs represent TH1 troops. They fight things kind of outside of your body, like cold viruses, all that fun stuff. The TH2 are like the blue blobs inside, and they fight things inside of the body. And sometimes, sometimes they can fight your own tissues, so you don’t really want too many of them around in case they kind of misfire or hit something wrong. So we want more green guys than blue guys. And essentially, what can happen is the green ones can jump over the wall and turn into blue and then you have too many on the blue team raging havoc inside of your body.

And sometimes that is needed when there are triggers like those particles kind of roaming around. So again, it’s removing the insult. But we can also apply things like plant sterols to help facilitate the blue ones jumping back over and turning into green. So that’s also part of the possibility, and as well as antioxidants, because if the antioxidants are not working, for example, your SOD2, or your GSTP, your glutathione, or your NQ01, those are your main janitors of your body. And if they’re not working properly, the way I describe it is you’re supposed to have ushers to take people to their seats, but if the ushers aren’t there, maybe the bouncers get involved. But the bouncers, that’s not their job. So then maybe they start getting like rowdy or feisty, or think that somebody’s causing a problem when they’re really not that kind of thing. So if we can put the right things in the right place to do the right jobs, meaning the antioxidants are just taken care of, the poo particles flying around, or any other insulting, inflammatory things going on, then the immune system doesn’t necessarily have to get involved.

Lindsey:

Yeah, well, I’m sure there’s way more detail than we can possibly cover in this hour-long podcast, but let me just ask you where people can find you. And you do virtual consultations, right?

Dr. Jenna Weeks:

Yeah, I do. I work out of New Brunswick, Canada, but I do work online and I just have people sign a waiver form, basically absolving any liability, because, again, insurance only covers so far of the world, so as long as people are okay with that, then I’m okay to work with them. You can find me online @dr.jenna.nd on Instagram, and also you can find me on Facebook and all of my contact info is there. You can also find me a little bit in YouTube. And if you are in Canada and you have Bell TV, you can watch me on TV, because we have a TV show out called Health Your Home that I singlehandedly spearheaded to help people understand what things they’re doing in their homes that may be sabotaging their health. It’s shameless self promotion. Hopefully this year, around Christmas time, my book called The You Code, meaning the code of you, your DNA, will be out and will be a more deep dive into all of the things we’ve touched on today with more dilution oriented focus.

Lindsey:

Awesome. Well, I’m really looking forward to seeing that, so I hope I’m on your list to get the notice when that comes up.

Dr. Jenna Weeks:

Yeah, if you want to be on my early readers list, we can totally do that.

Lindsey:

Awesome, awesome. Thank you so much for sharing all this really interesting information with us. I appreciate it. You’re so welcome.

Dr. Jenna Weeks:

I hope that it helps any human on this planet feel better because we don’t need to struggle so hard.

If you are struggling with bloating, gas, burping, nausea, constipation, diarrhea, soft stool, acid reflux, IBS, IBD, SIBO, candida overgrowth, fatigue or migraines and want to get to the bottom of it, that’s what I help my clients with. I see individual clients to help them resolve their digestive issues and you’re welcome to set up a free, 30-minute breakthrough session to see if you’d like to work with me. I also have my own two products, Tributyrin-Max, which is particularly helpful for loose stool and diarrhea as it slows your motility and firms up your stool, and SBI powder, which is an all around gut pathogen binder, which is super safe and won’t harm beneficial bacteria, and is usually the first line of treatment I educate my clients about in order to avoid stronger antimicrobial herbs.

Schedule a breakthrough session now

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SIBO/IMO vs. Dysbiosis: Choosing the Best Test for your Symptoms

SIBO/IMO vs. Dysbiosis: Choosing the Best Test for your Symptoms

Adapted from episode 131 of The Perfect Stool podcast with Lindsey Parsons, EdD, and edited for readability.

I have covered SIBO and IBS several times on the podcast, but in this episode, I want to distinguish between SIBO and dysbiosis. The two are different and usually involve somewhat different symptoms, causes, tests and treatments, although I know there are some people who would argue that all SIBO should be considered dysbiosis and that SIBO isn’t really a thing, but I’m convinced it is. If you’re interested in my other episodes on SIBO, see Episode 36 on IBS Treatment, Episode 83 on Recurrent SIBO and Episode 114 on hydrogen sulfide SIBO

But let’s start with the basics. SIBO, for those listeners who may or may not know, stands for Small Intestinal Bacterial Overgrowth and it occurs when there is an abnormal increase in the bacteria in the small intestine, which occurs most of the time because of an episode of food poisoning, but can have lots of other root causes, which I’ll get more into later, but things as diverse as Ehlers Danlos Syndrome, a traumatic brain injury, long-term PPI use, GLP-1 drugs or hypothyroidism. But for the SIBO that stems from food poisoning, you may have the initial signs of food poisoning, like vomiting, cramping, diarrhea, maybe fever, which you’ll usually get over in a day or two, but then maybe a few days to one to several weeks afterwards, things don’t quite get back to normal. You will end up with loose stool, what we liked to call multi-wipers in my house, or maybe even recurrent diarrhea, which may include urgent trips to the bathroom or histamine reactions like allergic symptoms when you eat certain foods. This is particularly the case with hydrogen sulfide species which produce histamines. But most SIBO is caused by an overgrowth of hydrogen-producing bacteria in the small intestine, which Dr. Marc Pimentel from Cedars-Sinai, the main SIBO researcher, has pinpointed as strains of Klebsiella pneumoniae and E Coli, primarily. They will end up fermenting the food you eat, in particular foods high in prebiotic fibers known as FODMAPs, and creating lots of gas, which is why the absolute most common and determinative symptom of SIBO for me, without which I look to other causes, is bloating. For some people it tends to increase throughout the day with dinner being the worst meal, usually because it’s the largest, but some people say that they end up bloated even from drinking water. But unless you’ve severely restricted your diet, with SIBO, the bloating is ever-present, at almost all meals. 

Other common symptoms of SIBO include getting full fast, having a smaller appetite, alternating constipation and loose stool, which can happen if you have IMO, intestinal methanogen overgrowth and SIBO, excessive burping, abdominal discomfort or cramps, food sensitivities, deficiencies in B12 and iron, or signs of that on blood tests, and fat malabsorption. If left unaddressed, SIBO can potentially lead to more serious conditions like autoimmune disorders, mental health issues, skin issues or systemic diseases like fibromyalgia or chronic fatigue syndrome. 

They used to delineate SIBO into SIBO-D for diarrhea, SIBO-M for mixed type (meaning diarrhea and constipation) and SIBO-C for constipation, but now they’ve renamed SIBO-C IMO, intestinal methanogen overgrowth, because methanogens can be overgrown in the small or large intestine and cause similar symptoms, and because methanogens aren’t bacteria, they are archaea. And they have also just renamed hydrogen sulfide SIBO (H2S SIBO) Intestinal Sulfide Overproduction or ISO, because it can also be present in the large intestine as well. And SIBO-M or mixed would now get you two diagnoses amongst the three, IMO, SIBO or ISO, depending on what the symptoms were and the actual bacteria causing it. 

So IMO is a different beast because it is characterized by an overgrowth of specifically methane-producing organisms called methanogens in the intestines, which are from the kingdom archaea. Archaea are single-celled organisms that differ from bacteria enough to warrant their own kingdom. The singular of archaea is archaeon, and archaea are known for their ability to survive in extreme environments like hot springs, hydrothermal vents and our digestive tracts. Unlike bacteria, archaea aren’t susceptible to most types of antibiotics, which is why people who’ve taken lots of antibiotics may end up with an overgrowth of methanogens. Methanobrevibacter smithii is the best-known methanogen and primarily responsible for IMO. IMO always presents with constipation and lots of painful bloating and distention as well, although not everyone with bloating has IMO or SIBO for that matter. Some people are just so constipated and backed up that they’re bloating because gas is simply getting stuck in their systems and once cleared out, the bloating clears. In theory you might smell methane gas, which is a more metallic smelling gas, in IMO, but in my experience, people will sometimes have smelly gas with it and sometimes not, and often it depends on what they’re eating. IMO is definitely more common in people on a more plant-based or vegan diet, because methanogens like carbs, and for that reason, also hard to get rid of for people who want to stick to that diet. 

Then the final type, hydrogen sulfide SIBO, now called ISO, can be present in the small intestine, usually due to an overgrowth of Desulfovibrio, Fusobacterium or Proteus Mirabilis, the latter in particular in the small intestine, but also in the large intestine. I’ve heard Bilophila Wadsworthia as another hydrogen sulfide producer, which it is, but don’t see it mentioned in Dr. Pimentel’s most recent work as a likely culprit in ISO. Dr. Pimentel’s group has experimented with giving Desulfovibrio and Fusobacterium species to rats and has successfully provoked diarrhea in them, which is the most common presentation of ISO, but not the only one! I have seen cases of ISO that present as constipation, which can happen when the overgrowth is in the colon, not the small intestine, and also when it co-occurs with IMO. This often presents as someone who is constipated most of the time, but occasionally has a bout of bad diarrhea. But it’s usually diarrhea in the case of ISO that has a sulfury, rotten egg smell, at least some of the time. Along with diarrhea, ISO sufferers will often mention a painful, gurgling gut, known as increased visceral sensitivity, of course bloating, excessive burping, urinary urgency, a burning bladder or interstitial cystitis, systemic inflammation, rampant food intolerances and often histamine reactions after eating. You might also see weight loss, postprandial hypotension, meaning low blood pressure after meals, an elevated heart rate, exercise intolerance, brain fog or insomnia. And I did a whole episode on Hydrogen Sulfide SIBO or ISO, it was Episode 114, so do check that one out if you want to dig more in on that topic.

Then there’s also the possibility of an autoimmune component to SIBO or ISO, but much less common in IMO, although I have seen it. I did a whole episode on recurrent SIBO that details how that happens, but suffice it to say, if your SIBO or ISO goes away after antibiotics for SIBO like Rifaximin or herbal antimicrobials but then comes back after 2-4 weeks, then you likely have the autoimmune kind. If your IMO comes back or never goes away after treatment, you likely just need a stronger or longer course of treatment.  

As I mentioned before, there are numerous potential root causes of SIBO/IMO/ISO. Beyond food poisoning, some of these causes stem from impaired digestion, such as low stomach acid or hypochlorhydria, which is crucial for breaking down proteins into amino acids. There may also be a deficiency in pancreatic or brush border enzymes, which can result from conditions like Celiac disease. Enzymes play a key role in breaking down all types of food, so when food isn’t properly digested, it can fuel bacterial overgrowth. Other root causes include low secretory IgA, a key component of the gut’s immune defense (often depleted by chronic stress), or poor bile flow, which is essential for fat digestion and also for killing pathogens. So, if you’ve had your gallbladder removed, which stores bile produced by the liver, it’s likely that there is a bile insufficiency. In addition, certain medications, such as opiates, antidepressants, proton pump inhibitors, cholestyramine, GLP-1 agonists, antibiotics, narcotics and antispasmodics, can trigger SIBO or IBS-like symptoms or SIBO itself even once you stop them. Physical conditions like Ehlers-Danlos Syndrome which is associated with extreme flexibility, adhesions from abdominal surgeries, endometriosis or ileocecal valve dysfunction can contribute to SIBO as well. Environmental factors like mold toxicity or underlying health issues such as diabetes, prediabetes, hypothyroidism and even traumatic brain injuries, may also be at the root of SIBO. But the most common trigger is autoimmune dysfunction caused by a bout of food poisoning, which disrupts the migrating motor complex. 

Now that we have a basic understanding of SIBO, IMO and ISO, we can differentiate between those disorders and dysbiosis. Dysbiosis refers to an imbalance or disruption in the normal composition of the gut microbiome. It occurs when harmful bacteria, fungi, parasites, viruses or other microorganisms outnumber beneficial ones, leading to various digestive and systemic health issues. Unlike SIBO, IMO and ISO, which are more specific conditions involving bacterial and methanogen overgrowth, which we’ve now targeted to specific bacteria and methanogens, and that people often can have for years without getting treatment, dysbiosis is a broader term that encompasses any microbial imbalance in the stomach or intestines, some of which may necessitate more urgent treatment. 

Symptoms of dysbiosis can include bloating, gas, diarrhea, loose stool, constipation, reflux, stomach pain, abdominal pain and more systemic issues like fatigue, mood changes, skin issues or weight changes. Dysbiosis often overlaps with conditions like SIBO, IMO and ISO, but is a more general term for a disrupted gut environment.

Dysbiosis can be caused by multiple factors, oftentimes distinct from those root causes of SIBO and friends (which I’m going to use to refer to SIBO, IMO and ISO from here forward). Single organism bacterial infections, for example, can cause dysbiosis in the gut. The presence of harmful pathogens like Clostridium difficile (abbreviated as C. diff) or Campylobacter can lead to an imbalanced GI system, especially when there are predisposing weaknesses in the digestive process, like low secretory IgA, your gut immune defense system, or few beneficial microbes due to poor diet or the use of antibiotics. C. diff is a bacterium that causes diarrhea and colitis (inflammation of the colon) and explosive all-day diarrhea, which causes about 30,000 deaths in the US annually. C. diff germs spread via stool, but can also be found in the environment, living on surfaces or in soil. People with already weak immune systems or people who are taking antibiotics are more likely to become sick after ingesting C. diff spores and are therefore more likely to develop a dysbiosis in the gut. Campylobacter is another bacterial diarrheal illness, but is often spread from animal to human as chickens, cows and other animals can carry it without becoming sick. Humans can contract Campylobacter by eating raw or undercooked meat or seafood, drinking untreated water or touching certain infected animals. After coming into contact with Campylobacter there is a risk of becoming sick and developing a dysbiotic gut. And there are a number of other single-organism bacterial infections that are not dissimilar to C. Diff and Campylobacter, including Enterohemorrhagic E. coli, E. coli O157, Enteroinvasive E. coli/Shigella, Enterotoxigenic E. coli LT/ST, Shiga-like Toxin E. coli, Salmonella, Vibrio cholerae and Yersinia enterocolitica. 

Other infections, like those caused by parasites, can also attack a healthy gut creating dysbiosis. One example is giardia, a protozoan parasite that lives in the intestines and is often contracted through contaminated water or food. Other protozoan parasitic infections include Cryptosporidium, Entamoeba histolytica and certain subtypes of Blastocystis hominis. Other parasites are worms called helminths. These include parasitic worms like tapeworms, roundworms and hookworms, which can infect the intestines, causing symptoms like diarrhea, abdominal pain, malnutrition and weight loss. And the worms can be contracted through undercooked meat or contaminated soil. Although you may have heard that some people are using helminths as a therapy to treat an overactive immune system manifesting in allergies, autoimmunity and/or migraines. I’ve been trying to get someone on the podcast to discuss helminth therapy for ages, but an expert on this keeps eluding me. And then there are of course viral illnesses that can manifest in GI symptoms, like norovirus, rotavirus, adenovirus, astrovirus, picobirnavirus, cytomegalovirus and even COVID-19, which has even been found to cause gastric ulcers in a small number of cases. In any case, all these organisms can contribute to dysbiosis, and their presence may make other infections or dysbiosis appear or get worse. 

And if overgrown bacteria and parasites weren’t enough, you can also have fungal overgrowth contributing to dysbiosis, and often present in biofilms with bacteria. SIFO is an umbrella term that refers to small intestine fungal overgrowth, which is caused by candida and other fungi, and there are different species of candida that can overgrow. Candida naturally lives on your body: in your mouth, on your skin and in your intestines, but can become unhealthy when overgrown, often caused by the use of antibiotics, which deplete beneficial bacteria, allowing yeast and harmful bacteria to thrive. And then also, of course, a poor diet of processed foods, sugars and additives can also contribute to dysbiosis (and you can learn more about additives and preservatives in Episode 128, which covers those in detail). So when candida becomes overgrown in the gut or even extending into the bloodstream or other organs, it’s called systemic candidiasis. Candida is also the cause of oral thrush, which you can see when you have a thick yellow or white coating on your tongue in the morning, and vaginal yeast infections, which cause itching, redness, pain with intercourse or urination and a cottage cheese like or off-color discharge from the vagina. I often suspect candidiasis if there have been lots of antibiotics plus one of these other types of bodily candida, including fungus in the toenails, and in people who tend to run cold or have cold hands and feet, as candida thrives in a cooler environment.

And sometimes dysbiosis isn’t caused by any one single pathogen, but just shows up on a stool test as a gut that’s depleted of most of the keystone beneficial species, but enriched in one or more of the opportunistic bacteria or genuses of bacteria that aren’t problematic unless they overgrow, like certain Bacillus species, Enterococcus faecalis, Enterococcus faecium, Morganella species, Pseudomonas species, Pseudomonas aeruginosa, Staphylococcus species and Staphylococcus aureus, in particular, and then Streptococcus species. Although I have to say I see very few guts that don’t have at least one of those overgrown. And there are also opportunistic bacteria that are associated with autoimmunity that can overgrow, including Citrobacter species, Citrobacter freundii in particular and Klebsiella species, M. avium subspecies paratuberculosis, which is associated with Crohn’s disease, Proteus species, and Proteus mirabilis, in particular. However, these dysbiotic bacteria may not present with bloating and are usually overgrown in the colon, or at least that’s where the sampling is taking place when you do a stool test, and where I’m seeing them. And Dr. Pimentel’s work on SIBO shows that what’s going on in the small intestine in SIBO, as measured by an aspirate of the contents of the small intestine, is completely different from what’s found in the stool, which better represents the colon’s contents. 

And I think it’s worth distinguishing between SIBO and friends and dysbiosis, because although they may present similarly in the body, they are distinct, with different causes, testing and treatments.

Breath tests are recommended as the first line of testing for SIBO, ISO and IMO because they are the only way to access what’s going on in the small intestine. Patients will take a sugar solution and their breath is analyzed at 15 or 20-minute regular intervals for 2-3 hours to measure hydrogen and methane levels. Lactulose and fructose are the best two substrates to use for the sugar solution for testing, at least according to Dr. Jason Hawrelak’s work, but glucose has been used historically, and lactulose is only available by prescription in the US. Currently, I think the best choice for breath testing if you suspect hydrogen or methane is the FoodMarble device you can buy and reuse (which I did a deep dive on in the last episode) and the trio-smart Test, which is the only test that includes hydrogen sulfide currently. I have had issues with breath tests and clients though, as many times the testing returns invalid results for some of the specimens sent in, which seems to happen a good bit on the trio-smart. I think probably because it’s a very sensitive testing for hydrogen sulfide. And I often get negative results but the symptoms are so specific to SIBO and then the client responds to SIBO treatment, so I assume the test was wrong. And you also have to be careful that you’re instructed to take the correct amount of substrate. Since I only recently started using the FoodMarble with clients (normally I would just send them to do the test and how it was done was not something I was that concerned with), I only recently started doing more research on how much of these sugars to take before the test. As I described in my last podcast, I got the Aerodiagnostics test and did the FoodMarble at the same time, but the Aerodiagnostics test had come in the mail because my doctor’s office had sent in an order, and they sent a pack of glucose with instructions to take a certain amount based on my body weight. So I ended up taking 22 grams of glucose, only to learn later that the consensus on the amount of glucose to take is 75 grams – not 25 or 22! So no wonder I got a negative result. The consensus for fructose is 25 grams and lactulose is 10 grams. All are mixed in one cup of water. But apparently fructose catches a lot more cases of SIBO, so I’m now instructing my clients to take fructose as their substrate unless they live somewhere where they can access lactulose easily (it’s only by prescription in the U.S.). 

And I should also mention that testing for the elevations in antibodies to the bacteria that cause SIBO called cytolethal distending toxin B or CdtB, and to the protein in your body responsible for the migrating motor complex, that resembles that bacteria, vinculin, is not only another way to test for SIBO but also to test for whether you have autoimmune SIBO or officially called post-infectious IBS. The first test of this kind was developed by Dr. Pimentel’s group and it’s called the ibs-smart Test, although there is at least one copycat test out there. I knew I had recurrent SIBO for years, but it was only when I saw that my vinculin antibodies were elevated on this test that I knew officially why my SIBO kept recurring. Apparently the Pimentel group is studying something to bring down these antibodies and ultimately cure SIBO, I’m not sure what, but I think my next personal experiment will be to try LDN or low dose naltrexone, which I suspect is what they’re testing, a prescription drug you can get with an online doctor, which has been successful in lots of other types of autoimmunity for bringing down antibodies. 

Anyway, despite current recommendations, I sometimes prefer a stool test like the GI Map, US Biotek GI-Advanced Profile, GI Effects or Tiny Health PRO if I suspect hydrogen sulfide or methane overgrowths, that is, ISO or IMO. And sometimes I think it’s best to order both the SIBO breath test or the FoodMarble (email Lindsey to request a FoodMarble invitation) and the stool test, if I suspect multiple pathogens. Stool tests have PCR or metagenomic shotgun sequencing data that will tell me the levels of specific pathogens like Desulfibrio piger, Bilophila Wadsworthia, Proteus Mirabilis, Fusobacterium and Methanobrevibacter smithii that can point me to the likely cause of someone’s distress. And then of course if you want to test for candidiasis, you need to order an organic acids test, preferably with the marker Arabinitol or D-Arabinitol, the most validated marker of candidiasis, as candida rarely shows up as positive on a stool test. I also like that the stool tests I just mentioned include markers of intestinal health, which gives me an idea of whether someone’s digestion is impaired, if they have sufficient pancreatic enzymes, fat in the stool, sufficient secretory IgA, elevated markers of inflammatory bowel disease like calprotectin or lactoferrin or low levels of short chain fatty acids like butyrate. Most tests also have at least one marker of gluten sensitivity, which when discovered can really turn things around for some people. 

So to finish up, I wanted to share a case study of one of my clients who had a few different types of dysbiosis without having SIBO, IMO or ISO, because there are a few good lessons to learn related to why testing is so important before being treated. So he came to me with diagnosed gastritis, which is inflammation of the stomach, GERD or reflux manifesting as spitting up after a meal, constipation, a white coating on his tongue, shortness of breath, tightness in his jaw, pain between his shoulder blades, cramping in his hands and shooting pain down the arm that came after eating, headaches, dark urine, a funny body smell, dizziness, low blood pressure overall, but episodes of high blood pressure, tinnitus, insomnia and internal hemorrhoids, and diverticula found during a colonoscopy, which are small pouches that form in the colon’s muscular wall that can get infected causing diverticulitis, plus undesired weight loss. He didn’t describe bloating as an important symptom, so I chose the route of a stool test and we did the US Biotek GI-Advanced Profile, which is one of my new favorites because it includes zonulin, a marker of leaky gut, and the short chain fatty acids, and H pylori and its virulence factors, which tells you whether the H. pylori could cause an ulcer or stomach cancer, and its price is in between that of the GI map and the GI Effects, but it has more markers than both of those tests.   

So what showed up on his test was whipworm, which is a parasite, high Streptococcus species, high Fusobacterium species, which I really don’t like people to have much of, because one member of that species, Fusobacterium nucleatum, is associated with cardiovascular disease, rheumatoid arthritis, respiratory tract infections, Alzheimer’s disease, colorectal cancer, pancreatic cancer and inflammatory bowel disease. And most of his commensal bacteria levels were low, but he had high Clostridium species (but not C Diff), which can constipate. In terms of digestive health markers, he had low butyrate despite being constipated, high calprotectin, a marker of inflammatory bowel disease (although that wasn’t diagnosed on his recent colonoscopy, so I assumed that was not in this case showing inflammatory bowel disease), high zonulin, meaning a leaky gut, low pancreatic elastase, meaning not enough enzymes being produced by his pancreas to digest his food, and high beta glucuronidase, which can put you at risk for colorectal cancer and for women, breast cancer. 

And I want to pause a moment and say, if you have high beta glucuronidase on a stool test and have a history of breast cancer or colon cancer, this is marker that says that your gut is dysbiotic and has too many of the wrong bacteria that are producing this molecule that will untag estrogens and toxins from your bile and send them back into circulation. These toxic forms of estrogen are what causes some breast cancers, so thank your lucky stars that you took the stool test and you know what’s going on, but take it very seriously if you want to prevent a recurrence of breast cancer. I have a client who was in this very situation and I recommended interventions, including a vegetarian, low-fat diet, to help turn it around and educated her on the supplements to prevent recurrence and to bring down that beta glucuronidase and change her gut microbiome, but I then didn’t see any of them purchased on Fullscript, maybe she found them elsewhere, I don’t know, but she didn’t respond to any of my follow-up emails. Who knows where she was in the disease process at the time I saw her, but she contacted me about 10 months later, diagnosed with a stage 4 metastatic uterine cancer. So please everyone if you get a high level of beta glucuronidase on a stool test, take it seriously, see someone who understands the marker, follow their instructions and retest after doing interventions. I had a little bit elevated beta glucuronidase on my last stool test and I markedly decreased my meat and saturated fat intake and went on 4 different supplements to counteract it. 

Sorry for that interlude but sometimes gut stuff can be a signal for much more important things, so I don’t want you to blow off gut-related recommendations. Anyway, back to my original client. We also did a NutrEval test because of the all over body complaints, weight loss and to check on candida, because of the white coating on his tongue. I won’t go into all the details of everything we found, but he did have high Arabinitol on the NutrEval, which means he had systemic candida. 

So one of the first things I taught this client about was SBI powder, because that’s safe to start with even before you know what’s going on. So he opted to get on that right off the bat, which helped him feel much better, even before we got back his test results. It works by adhering to gut pathogens of various types and ushering them out in the stool. Then my usual go to’s for constipation are magnesium citrate and vitamin C, so he opted to take those to get his bowels flowing better. He ended up getting antiparasitic medication from his doctor to treat the whipworm, which is usually easier as prescription worm treatments in my experience are just a 1 or 2 pills for a few days. 

Then I educated him on how a multivitamin and vitamin D/K would help in bringing up his own immune system to fight infections. With Vitamin D, I always recommend testing 6 months later then adjusting to hit optimal levels and I always recommend taking D with K, preferably mk4, as it’s the form our body makes, in order to direct the calcium the D will help you absorb to your bones and not your arteries. An optimal level of vitamin D is 50 or 60 to 80 ng/mL, so after testing you can adjust your dose. Most people settle on a dose of 3000-5000 IU/day to maintain that optimal level, but usually start around 5000 IU/day, just to bring it back up.

Then I taught him about digestive enzymes to help when pancreatic elastase isn’t great, and most importantly, suggested a high-fiber, vegetarian diet and calcium d-glucarate for high beta glucuronidase. I also educated him on how Iberogast can help with reflux after meals and slippery elm can help with healing the lining the digestive tract and my favorite all-around probiotic, Seed Synbiotic*, which can help bring up commensal bacteria levels and better shape the microbiome to reduce beta glucuronidase. But keep in mind, most probiotic species are transient and don’t settle in the gut, but pass through making your microbiome healthier as they go. Given his low butyrate levels, but constipation, I also taught him about how a one pill of a low-dose butyrate or tributyrin supplement every 1-3 days can help heal the lining of the colon. This is a situation where I don’t recommend my own tributyrin supplement, Tributyrin-Max, but rather another tributyrin supplement in the 300-500 mg range and usually starting every 3 days and up to once a day, because it does have a constipating effect.  And then perhaps the most important part, along with a high fiber diet, is a gut shake that I shamelessly stole and adapted from Marc Hyman’s recipe to bring up commensal bacteria. In this client’s case, his shake included Dr. Formulated fiber, pomegranate powder, cranberry powder, matcha powder (these are all good polyphenols that help promote healthy bacteria), l-glutamine, collagen peptides, continuing on the SBI Powder to keep the pathogens at bay and added Nutraflora FOS, a prebiotic that helps bring up beneficial bacteria in order to bring down beta glucuronidase, and freshly ground flaxseed, which may have related to specific bacteria we wanted to bring up, and then add frozen fruit and water and your favorite milk and voila! He told me he loved the smoothie. I also taught him about how adding creatine and branch chain amino acids could help with building muscle, which was based on his test results, which didn’t indicate general amino acid deficiencies. 

Now one particularly interesting thing about his case was that after he was feeling way better from all this and most of his symptoms were gone or improved, he took a trip to Costa Rica and Panama and got food poisoning from some seafood. Now I did suggest he take some SBI powder and sprinkle it on all his meals to try to avoid traveler’s diarrhea, which he did, but sometimes the pathogens are stronger than the amount of IgG you can throw on it. So he and his companion did have one day of diarrhea, but it did not continue. So when he came back, he was retested, incidentally after a round of antibiotics for an unrelated thing (and I’ll get back to why these antibiotics were ill-timed in a minute). So on the retest, his butyrate was high now, pancreatic elastase was almost to optimal levels, his zonulin was normal now, so no more leaky gut, his beta glucuronidase was normal, but he had a new marker that was high, steatocrit, which is indicative of fat in the stool, which was likely coming from the Enterohemorrhagic E. coli that was highly elevated on his test, which must have been the source of the food poisoning. Now back to why the antibiotics were ill-timed but fortunately didn’t have a bad effect in his case. When you have Enterohemorrhagic E. coli, taking antibiotics can destroy that bacteria causing a release of even more toxins, which can cause something called hemolytic uremic syndrome, which is from the toxins damaging and inflaming the small blood vessels throughout the body, which can cause clots to form in the blood vessels, which can damage the kidneys and other organs, and in the worst cases, can lead to kidney failure and be life-threatening. Bloody diarrhea, abdominal pain and cramping, fever, vomiting, loss of color in the skin, easy bruising or bleeding, swelling in the hands, feet or ankles and high blood pressure are some signs of hemolytic uremic syndrome. Do get help immediately if you’re having those symptoms. Now fortunately, in his case, he was taking the SBI powder the whole time, so he was protected from these toxins, as the SBI powder binds to them, and it’s a great thing for continuing to fight off the E coli even after that, so he just chose to stay the course on SBI powder. So if you are planning a trip to a developing country that doesn’t have great water or food sanitation, I can’t recommend SBI powder enough as a preventative measure and as a possible treatment if you do get sick. And then not just taking antibiotics without knowing what you’re treating, because of the possible danger of hemolytic uremic syndrome. If you have a diarrheal illness, getting liquids and electrolytes and letting your body fight it is the best plan, if you don’t have something on hand to deal with it and can’t get tested. But if it doesn’t subside after several days, getting tested before treating it is recommended.  

Other things to note on the retesting were that his Staph species were back to normal and his Fusobacterium species were now at normal levels (they had been at 30 x 104 now at 1.33 x 104). An interesting thing to note, even though he still had the Enterohemorrhagic E. coli elevated at the time of testing, he had returned to being constipated, which is interesting for a diarrheal illness, right? But it  was likely because the levels had come down a lot from the original infection and his Clostridium species were high, which can be constipating. So it wasn’t a perfect resolution quite yet, but I like this case as a demonstration of the fact that 1. Diarrhea can come from all sorts of different sources that aren’t SIBO and you need to know what you’re treating to treat it safely, unless you’re going to choose something super safe and harmless like SBI powder; 2. Constipation can be present for many reasons from a magnesium deficiency to high levels of constipating bacteria that aren’t methane producers to typical IMO, which he had none of in his gut, by the way; and 3. You never know when you’re going to find a parasite, although honestly, I would say I have only seen parasites show up on about 5% of all the gut tests I’ve done. Now some people will argue that they’re lodged in the digestive tract or under biofilms or otherwise hiding and we all have them, and maybe that’s the case, I’m not sure, but in terms of testing results, that’s what I’ve found. So if you do try everything to deal with digestive symptoms and aren’t having any luck, aren’t seeing any SIBO or other dysbiosis, there’s no mold in your background or other potential problems, and even if you don’t see parasites on a stool test, you may want to try taking some anti-parasitics. And for this I’m a fan of the CellCore Biosciences Para 1 and Para 2 products (use patient direct code to access their products: I0rdLMOm). 

So that’s all for today. If you’re suffering with any of the symptoms I’ve mentioned in this podcast, I see individual clients to help them resolve their digestive issues and you’re welcome to set up a free, 30-minute breakthrough session to see if you’d like to work with me. I also have my own two products, Tributyrin-Max, which is particularly helpful for loose stool and diarrhea as it slows your motility and firms up your stool, and SBI powder, which is an all around gut pathogen binder, which is super safe and won’t harm beneficial bacteria, and is usually the first line of treatment I educate my clients about in order to avoid stronger antimicrobial herbs.

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Conquering SIBO and IMO with At-Home Breath Testing

Conquering SIBO and IMO with At-Home Breath Testing

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

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

Okay, and are the med versions the medical ones?

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

Okay? And what kinds of food intolerances?

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

Absolutely, yeah.

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

And why so long after a meal?

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

Typically, yes.

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

Absolutely.

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

Instead of glucose?

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

After you’ve conceivably taken a breath, right?

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

Oh, perfect. Yeah, yeah.

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

Yeah, yeah.

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

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

Absolutely.

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

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

What, dysbiosis and SIBO?

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

Lindsey: 

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

Ricky Harrison: 

Anything. Yeah, absolutely.

Lindsey: 

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

Ricky Harrison: 

Okay, no problem.

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

Yeah. It has a green icon, yeah.

Lindsey: 

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

Ricky Harrison: 

Correct.

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

Yeah, correct.

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

Yeah, so that was your practice breath.

Lindsey: 

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

Ricky Harrison: 

You can, yeah, yeah.

Lindsey: 

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

Ricky Harrison: 

It’s zero.

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

You have to send that to them.

Lindsey: 

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

Ricky Harrison: 

Correct.

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

Okay.

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

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

Lindsey: 

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

Ricky Harrison: 

Yeah, for sure.

Lindsey: 

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

Ricky Harrison: 

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

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

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Transforming Health Through Mindset: The Power of Stress Management for Gut Health with Brooke Herbert

Transforming Health Through Mindset: The Power of Stress Management for Gut Health with Brooke Herbert

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

Lindsey:  

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

Brooke Herbert:  

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

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

Lindsey:  

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

Brooke Herbert:  

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

Lindsey:  

Yeah. And so what was your diagnosis, ultimately? 

Brooke Herbert:  

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

Lindsey:  

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

Brooke Herbert:  

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

Lindsey: 

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

Brooke Herbert:  

Absolutely, yep.  

Lindsey:  

Yeah. And stress can bring that on. 

Brooke Herbert:  

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

Lindsey: 

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

Brooke Herbert: 

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

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

Lindsey:  

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

Brooke Herbert:  

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

Lindsey:  

Yep, I’ve read it.  

Brooke Herbert:  

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

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

Lindsey:  

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

Brooke Herbert:  

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

Lindsey:  

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

Brooke Herbert:  

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

Lindsey:  

Oh really, wow! 

Brooke Herbert:  

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

Lindsey:  

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

Brooke Herbert:  

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

Lindsey:  

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

Brooke Herbert:  

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

Lindsey:  

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

Brooke Herbert:  

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

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

Lindsey:  

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

Brooke Herbert:  

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

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

Lindsey:  

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

Brooke Herbert:  

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

Lindsey:  

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

Brooke Herbert:  

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

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

Lindsey:  

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

Brooke Herbert:  

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

Lindsey:  

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

Brooke Herbert:  

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

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

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

Lindsey:  

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

Brooke Herbert:  

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

Lindsey:  

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

Brooke Herbert:  

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

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

Lindsey:  

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

Brooke Herbert: 

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

Lindsey:  

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

Brooke Herbert:  

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

Lindsey:  

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

Brooke Herbert:  

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

Lindsey:  

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

Brooke Herbert:  

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

Lindsey:  

Oh I see, okay!  

Brooke Herbert:  

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

Lindsey:  

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

Brooke Herbert:  

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

Lindsey:  

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

Brooke Herbert:  

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

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

Lindsey:  

And what’s it called?  

Brooke Herbert:  

It’s called Ivy Unleashed.  

Lindsey: 

Great! And where can people find you?  

Brooke Herbert: 

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

Lindsey:  

Any parting words?  

Brooke Herbert:  

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

Lindsey: 

Great! Thank you so much. 

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

Schedule a breakthrough session now

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

The Hidden Impact of Food Additives on Your Gut Microbiome

The Hidden Impact of Food Additives on Your Gut Microbiome

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Schedule a breakthrough session now

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

Healing Chronic Illness through Brain Retraining with Ashok Gupta

Healing Chronic Illness Through Brain Retraining with Ashok Gupta

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

Lindsey:   

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

Ashok Gupta:   

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

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

Lindsey:   

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

Ashok Gupta:   

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

Lindsey:   

Okay, so this is like inflammation of the brain? 

Ashok Gupta:   

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

Lindsey:   

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

Ashok Gupta:   

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

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

Lindsey:   

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

Ashok Gupta:   

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

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

Lindsey:   

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

Ashok Gupta:   

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

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

Lindsey:   

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

Ashok Gupta:   

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

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

Lindsey:   

I do have some saliva.  

Ashok Gupta:   

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

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

Lindsey:   

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

Ashok Gupta:   

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

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

Lindsey:   

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

Ashok Gupta:   

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

Lindsey:   

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

Ashok Gupta:   

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

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

Lindsey:   

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

Ashok Gupta:   

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

Lindsey:   

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

Ashok Gupta:   

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

Lindsey:   

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

Ashok Gupta:   

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

Lindsey:   

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

Ashok Gupta:   

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

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

Lindsey:   

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

Ashok Gupta:   

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

Lindsey:   

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

Ashok Gupta:   

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

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

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

Lindsey:   

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

Ashok Gupta: 

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

Lindsey:   

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

Ashok Gupta:   

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

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

Lindsey:   

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

Ashok Gupta:   

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

Lindsey:   

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

Ashok Gupta:   

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

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

Lindsey:   

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

Ashok Gupta:   

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

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

Lindsey:   

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

Ashok Gupta:   

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

Lindsey:   

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

Ashok Gupta:   

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

Lindsey:   

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

Ashok Gupta:   

Thank you so much. 

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A New Option in Infant and Mother Microbiome Testing with Cheryl Sew Hoy of Tiny Health

A New Option in Infant and mother Microbiome Testing with Cheryl Sew Hoy of Tiny Health

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

Lindsey:

Welcome to the podcast Cheryl!

Cheryl Sew Hoy:

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

Lindsey:

Why’s that?

Cheryl Sew Hoy:

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

Lindsey:

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

Cheryl Sew Hoy:

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

Lindsey:

That’s ambitious!

Cheryl Sew Hoy:

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

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

Lindsey:

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

Cheryl Sew Hoy:

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

Lindsey:

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

Cheryl Sew Hoy:

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

Lindsey:

Awesome.

Cheryl Sew Hoy:

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

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

Lindsey:

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

Cheryl Sew Hoy:

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

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

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

Lindsey:

It’s overreactive?

Cherry Sew Hoy:

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

Lindsey:

All opportunistic bacteria that at higher levels are pathogenic.

Cheryl Sew Hoy:

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

Lindsey:

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

Cheryl Sew Hoy:

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

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

Lindsey:

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

Cheryl Sew Hoy:

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

Lindsey:

I did not buy any HMOs yet.

Cheryl Sew Hoy:

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

Lindsey:

For the rest of my life?

Cheryl Sew Hoy:

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

Lindsey:

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

Cheryl Sew Hoy:

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

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

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

Lindsey:

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

Cherly Sew Hoy:

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

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

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

Lindsey:

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

Cheryl Sew Hoy:

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

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

Lindsey:

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

Cherly Sew Hoy:

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

Lindsey: 

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

Cherly Sew Hoy:

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

Lindsey:

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

Cheryl Sew Hoy:

Yeah. You could even say leaky skin…

Lindsey:

Leaky skin, right.

Cheryl Sew Hoy:

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

Lindsey:

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

Cherly Sew Hoy:

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

Lindsey:

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

Cherly Sew Hoy:

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

Lindsey:

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

Cherly Sew Hoy:

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

Lindsey:

But they’re not using fecal material?

Cheryl Sew Hoy:

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

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

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

Lindsey:

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

Cheryl Sew Hoy:

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

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

Lindsey: 

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

Cheryl Sew Hoy:

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

Lindsey:

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

Cheryl Sew Hoy:

They have to order it through their practitioner.

Lindsey:

Okay. They have to know the practitioner themselves?

Cheryl Sew Hoy:

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

Lindsey:

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

Cheryl Sew Hoy:

Yep. It’s called shotgun metagenomics.

Lindsey:

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

Cheryl Sew Hoy:

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

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

Lindsey:

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

Cheryl Sew Hoy:

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

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

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

Lindsey:

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

Cheryl Sew Hoy:

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

Lindsey:

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

Cheryl Sew Hoy:

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

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

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

Lindsey:

I actually sell one!

Cheryl Sew Hoy:

Oh, you do?

Lindsey:

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

Cheryl Sew Hoy:

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

Lindsey:

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

Cheryl Sew Hoy:

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

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

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

Lindsey:

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

Cheryl Sew Hoy:

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

Lindsey:

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

Cheryl Sew Hoy:

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

Lindsey:

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

Cheryl Sew Hoy:

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

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

Lindsey:

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

Cheryl Sew Hoy:

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

Lindsey:

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

Cheryl Sew Hoy:

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

Lindsey:

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

Cheryl Sew Hoy:

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

Lindsey:

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

Cheryl Sew Hoy:

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

Lindsey:

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

Cheryl Sew Hoy:

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

Lindsey:

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

Cheryl Sew Hoy:

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

Lindsey:

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

Cheryl Sew Hoy:

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

Lindsey:

Yeah, the HMOs.

Cheryl Sew Hoy:

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

Lindsey:

I have been eating sourdough bread.

Cheryl Sew Hoy:

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

Lindsey:

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

Cheryl Sew Hoy:

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

Lindsey:

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

Cheryl Sew Hoy:

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

Lindsey:

And what is Shannon diversity?

Cheryl Sew Hoy:

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

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

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

Lindsey:

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

Cheryl Sew Hoy:

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

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

Cheryl Sew Hoy:

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

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

Cheryl Sew Hoy:

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

Lindsey:

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

Cheryl Sew Hoy:

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

Lindsey:

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

Cheryl Sew Hoy:

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

Lindsey:

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

Cheryl Sew Hoy:

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

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

Lindsey:

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

Cheryl Sew Hoy:

Perfect.

Lindsey:

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

Cheryl Sew Hoy:

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

Lindsey:

Okay, awesome! Thank you so much!

Cheryl Sew Hoy:

Thank you!

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

Schedule a breakthrough session now

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

Natural Remedies for Heartburn and GERD

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

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

Can children have GERD?

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

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

Why are more young people suffering from GERD or heartburn?

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

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

What are the physiological causes of GERD?

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

What dietary changes help reduce GERD?

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

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

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

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

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

Can proper meal hygiene help with GERD?

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

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

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

What other factors might influence GERD symptoms?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Conclusion

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

Schedule a breakthrough session now

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