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Excerpted from episode 32 of The Perfect Stool podcast, “What My Sciatica Has Taught Me about Gut Health.”

So by way of history, I’ve been going through a pretty awful bout of sciatica over the last 5 months, which had been, up until about a week ago, what felt like a slow and inexorable slide into disability. With each passing day, despite all my best efforts, I could see a little bit of loss of function over the previous day. And by the end of August, 2020, I was even finding it challenging to sit up straight, I couldn’t walk more than three steps without having to stop to stretch, so that my muscle spasms would let up, and my nights were spent writhing in pain until I could feed myself enough Ibuprofen, pharmaceuticals and melatonin to finally knock me out, only to wake up two hours later when my hip got sore from only sleeping on my right side. Then I’d have to spend an hour on the floor doing stretches to stop the muscle spasms and kill time, because there was no other comfortable position I could lie in. You’ll be glad to hear that things have finally started turning a corner, and I can now sit up easily and walk a bit but I’m still taking it easy as I heal. But during this time, I did a lot of thinking about gut health and how my journey with sciatica related to it. So here are some lessons I learned that I think may be useful to those of you who are struggling with a gut health, autoimmune or other mystery health issue.

1. Don’t wait too long to see a professional.

When I first started having back pain, I assumed that if I just kept doing the right stretches and used good posture, that my back pain would eventually go away as it had before. But the reality was, I was two years into pretty consistent back pain. If I could say something to the Lindsey of December 2019, or even July 2019, I would have said: “Go see your doctor! Get a referral for physical therapy! Take care of this before it gets worse!” I had no idea how bad it could get.

Similarly, if you’re having gut health problems and you’ve been trying to take care of it on your own, or only seeing traditional MDs, while you’ve been doing that your problem may be going from what Dr. Daniel Kalish calls a stage 1 gut problem involving some loss of gut diversity, to a stage 2 gut problem with compromised organ function that could impact your hydrochloric acid, enzyme or bile production and consequent damage to your gut lining and gut immunity, to a stage 3 problem in which you’ve acquired or your system has allowed the overgrowth of a pathogen because of the weakness of compromised organ function and lowered gut immunity. Left even longer, this can lead to autoimmune disease, increasing food intolerances, and Mast Cell Activation Syndrome, in which you quickly have what appears to be an allergic reaction to a whole slew of inputs, including many foods. The longer you wait, the harder, more expensive and the longer it will take for you to solve your problem, and honestly, the more you’ll suffer. Whatever concern I had in July or December of 2019 regarding spending the time or money to solve my problem, it pales in comparison to the amount of lost time, suffering that I could never have imagined, and money I have now spent on many modalities to try to solve my problem. Not to mention the opportunity cost of not spending time on my business while I’ve been trying to get well.

2. Don’t reject traditional modalities if they can bring you relief while you search for the root cause.

With my sciatica, I held out hope that the right kind of physical therapy with consistent follow-through, eating a super low inflammatory diet, taking the right supplements, and staying active would help me recover. However, my decline just continued. I waited way too long to see a doctor, and when I heard that the next likely step would be a hydrocortisone injection, I purposely delayed following up in hopes that things would get better and I could avoid the shot. As a result, I probably spent an additional 5 weeks of sleepless nights writhing in pain and got much worse before I finally had my first injection, which I don’t regret at all, no matter the potential side effects. I also tried for so long to avoid taking NSAIDS (Non-steroidal anti-inflammatory drugs) for pain, but finally realized that I was suffering a lot unnecessarily, and am now up to the maximum dose of ibuprofen each day, while protecting my stomach with DGL and shilijat. I sometimes hear from clients that they have refused certain treatments from their doctors (especially around autoimmune disease and biologic drugs) that might bring them relief. While I’m a strong advocate of finding and addressing the root cause of any problem, if you’re really suffering or your health is in serious danger, it’s okay to try traditional treatments for a time while looking for the root cause.

3. Don’t let the medical-industrial complex put you off from finding solutions.

One of the biggest roadblocks in getting to the root of my problem was my insurance wanting me to do at least a month of physical therapy before I got an MRI. But it was clear from almost the beginning of physical therapy that I was in too much pain to do most of the exercises I was being given, nothing was helping and I was going downhill. I finally resolved to just pay for the MRI myself because I felt it was important to have some insight into what was going on inside of me and they were clearly trying to make me jump through 1000 hoops to approve it. I didn’t want to have to pay for the test, but in the end, testing can give you real insight into root causes.

So if you’re hesitating to spend the money on gut testing that isn’t covered by your insurance and that your doctor doesn’t know about or won’t order, I’d urge you to reconsider. For gut health, there are two tests that I recommend to clients. They are the Organic Acids Test, which is $325, you can order it online yourself and it can enlighten you as to yeast and fungal overgrowths, bacterial overgrowth and dysbiosis, problems with carbohydrate, fatty acid and amino acid metabolism, detoxification issues, energy production issues and neurotransmitter problems. The other test I recommend, if problems are mostly confined to the gut, is a thorough gut health test like the Diagnostic Solutions GI Map or Doctor’s Data GI 360, which each run around $399, and you can order them yourself online. These tests will alert you to problems in your digestive system like a lack of hydrochloric acid, pancreatic enzymes or bile, indicating problems with fat metabolism, as well as test for specific pathogens, including pathogenic bacteria and parasites. It will also tell you how certain medications will work against those pathogens. It’s a rare insurance that would pay for these, although HSAs or FSAs might, but they’re worth their weight in gold for the information they will give you so that you’re not shooting in the dark. If that’s not financially possible, a less expensive option is doing a metagenomic sequencing of your gut through Sun Genomics. That’s only $147 if you go through my affiliate link, and if you look at the raw data, it will tell you everything that’s in your gut, if you know how to interpret that. So if you’re hesitating on testing, just think about how over time, you can waste a lot of money buying every supplement you hear someone recommending on a podcast or in a health summit, while building up a lovely supplement graveyard and getting no closer to a solution. Better to go around the medical-industrial complexes rules, order your own tests and get a functional medicine provider to help you understand the results.

4. Listen to anyone’s and everyone’s advice – you never know where your solution may come from.

As things got worse and even the checkout clerks at the grocery store knew about my sciatica, I started getting advice from them and everyone else who heard my story. I also joined a Facebook group on sciatica and frequently popped in there to commiserate and find advice. Some of the advice didn’t work out, but some was useful. And some of the most useful stuff was about the mental game. I had been working myself into a giant pity party in which I was focusing so many hours a day on my pain and helplessness that my mind was feeding into my problem rather than helping solve it. Someone in my sciatica Facebook group said she would meditate and picture her nerves flowing freely through her spine. This image has helped me go to sleep so many nights, as I used my mind to help calm my muscle spasms. And it was a health summit on toxic mold where I heard about a special modality of physical therapy and a machine that helps reduce inflammation that may be one of the key elements of my healing, in addition to the injections. Even my plumber showed me a stretch no one else had shown me that helped him with his sciatica. So don’t reject advice because of the source – give everything a good listen and if you’re not ready to try it, put it in your back pocket for later.

5. Don’t be afraid to ask for help.

As I was falling into disability, I realized that the more I was up and around, trying to cook, clean and do the things of everyday life, the more it was hurting me. The moment I had to tell my family that I really needed them to step up and help make my food and do my dishes, I couldn’t hold back the tears. I never considered myself one of those self-sacrificial people who always did for others and never asked for anything herself, but this was one of the hardest things I’ve ever done. But of course my husband stepped up and started filling in and got our boys to do more, and his kindness in this has really brought us closer. If you’re really suffering, let people help you. Don’t do things that will make you worse. It truly brings others joy to help, even if it forces us to humble ourselves, but there is growth in that humility. And also, don’t be afraid to reschedule or cancel things. People will understand. People have been very understanding with me when I’ve been honest with them. When you’re well again, you can pay it backward to those who helped you or forward to someone else who’s suffering.

6. Don’t keep it all inside. 

Chronic pain and illness is not just physically debilitating, it’s mentally debilitating. And sometimes you can feel very alone in your pain and suffering. I had moments in the middle of the night where I had spent over an hour trying to get the agonizing muscle spasm in my glutes to let up through stretches, exercises and using a massage wand. One night, after an hour, I was still in agony, lying on the floor and sobbing because I felt so sorry for myself. That night, I finally woke my husband up and asked for help. He told me that from then on, he didn’t want me suffering alone, but that I should wake him up. After I stopped worrying about waking him and started relying on his help, my nighttime suffering quickly decreased and he was able to help me settle back down to sleep sooner, and also started asking if I needed anything when he woke up at his usual 5 a.m. That helped me go back to sleep for several more hours. Even if you’re single, there is probably someone in your life you can lean on more if you’re suffering. Someone who would be happy to help you research treatments or doctors, someone who you can share your fear or tears with, someone who will make you a meal if you’re not up to it. Or friends who’d be willing to contribute to help fund your care. There’s actually a charity called efundyourhealth that matches up to $250 for functional medicine care if you can raise the rest. New campaigns are currently on hold while they’re updating their web site, but they’re still soliciting donors, so hopefully they’ll be up and running again soon. But back to the original message, don’t suffer alone. 

7. Find the gift in your pain and suffering.

When you’re deep in the midst of pain or suffering, it may be hard to find the positive, but doing so will leave you with a gift of wisdom that may help carry you through. For me, one of the biggest gifts will be the empathy I now have for people in chronic pain. I confess that before going through this, I assumed that anyone who had chronic back pain must have a terrible diet, or they didn’t exercise, use good posture, or try the right kind of physical therapy (speaking of which, if you’re dealing with chronic back pain, I’d highly recommend seeing a Mackenzie method practitioner). I looked down on people who got addicted to opiates because of their pain. After spending a desperate night in pain and like a crazy person rummaging through our medicine cabinet to find the two oxycodone’s left over from my husband’s dental surgery and washing one down without hesitation, I finally understood firsthand what drives people to desperation and addiction. I also know now how much a kind word helps. It may drive someone to tears, but it means so much to hear someone say “I’m so sorry about how much you’re suffering.” So if you’re the loved one of someone dealing with chronic pain or illness, you can’t ask how they’re doing or express your empathy enough. It’s like a balm on our wounds. So look for the good in your experience, the learning, the opportunity to grow as a person and then help others. It will make your situation just that much more bearable.

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

Over the course of my podcast (The Perfect Stool: Understanding and Healing the Gut Microbiome), I have done seven interviews with people who have had fecal microbiota transplants (FMT), some in clinics overseas, some self-administered, and I’ve also shared about my own ill-conceived  experience with DIY FMT. I also covered the research being done on a purified form of FMT for children with autism. As a result, I often hear from potential clients who are interested in trying FMT to heal their gut issues. Consequently, I decided to summarize the kinds of results that have been discussed in my interviews, and share my perspective on whether FMT is a good fit for various conditions and the practicalities of doing it, both in clinics and on your own.

One of my most striking FMT stories was episode 23: “PANDAs, Autism, Anxiety and Depression: One Family’s Miraculous FMT Healing Story”, in which Mary talked about using FMT from a clinic in Australia to treat her daughter’s auditory and tactile hallucinations, her son’s autism symptoms, and her own anxiety and depression. About FMT in general, Mary shared, “This is like the golden elixir of life. If you have a very sick child, you are going to get over the ick factor very quickly because it’s just a miracle that we have such a beautiful, natural solution all along.” About changes to her daughter’s affect, Mary said, “[Before FMT], she just had a darkness pulling in, she had a fearfulness on her face, and a lack of affect, [and after FMT]… she’s off and running, she’s just doing beautifully.” About changes to her son’s affect, Mary said, “Whatever the interferences that autism causes, [after FMT] he’s just present, he’s looking you right in the eye, he’s listening to what you’re saying, he’s calm in his body, he wants to be part of the group instead of hiding from the group… He’s more friendly. He goes up to people and introduces himself… His desire for independence has just exploded.”

In episode 10 ““Designer Sh*t” – Coming Soon to a Theater Near You:
One Filmmaker’s Story of Overcoming Colitis”, I interviewed Saffron Cassady, a filmmaker in the process of making a film about FMT, including her own personal story of healing from colitis thanks to repeated FMTs from her boyfriend.

In episode 5, “DIY Fecal Transplants for Irritable Bowel Syndrome (IBS): One Patient’s 9 Experiences and the Urgent Need for High Quality Stool Donors” Michael described his nine experiences with DIY FMT to address IBS, irregular heartbeats and severe fatigue, the benefits and drawbacks of each experience, and the urgent need for healthy donors, which led him to collaborate on the formation of a donor/recipient connection tool, Microbioma.org. He also shared numerous resources including a sample donor questionnaire.

My very first episode “SIBO Recovery and Fecal Microbiota Transplantation (FMT)” was with Amy Hollencamp, a now-dietitian whose microbiome was decimated by antibiotics and an extended restricted diet used to treat SIBO, resulting in unwanted weight loss and continuing bowel issues. She chose the Taymount Clinic in the Bahamas for her FMT. After the procedure, she reported “better gut function mainly . . . less bloating . . . I felt like my bowel movements were a lot better.”

On my most recent episode (31), “How FMT Helped One Woman Read Emotions and Normalized Sound and Touch Sensitivities,” I interviewed Amanda, who sought out FMT at a clinic in Argentina for gut issues and psoriasis and benefitted from other unexpected benefits:  “[My constipation and diarrhea] got a lot better. My skin didn’t change at all. It completely did not change, which was weird. But everything else got way better: the social awkwardness got better, the sound sensitivity got way better, my energy level got better, my ability to connect words in my head got better… I could remember things from pop culture, I could remember the plot of a TV show and I could not do that before… Yeah, I mean everything except my skin, ironically, got better.”

In episode 12, “Healing Autism via Microbiota Transfer Therapy with Dr. James Adams” (whose title I realized subsequently was not the best choice and was offensive to many in the adult autism community), we learned about the amazing research using purified FMTs on children that Dr. Adams and his collaborators had conducted, resulting in a 47% decrease in symptoms of Autism Specturm Disorder three years post-FMT. The results were published in the prestigious journal Nature.

And finally, in episode 19, “How I Reversed My Autoimmune Diseases and Got Interested in Gut Health”, I shared my own health journey, my ill-conceived DIY FMT and some of my continuing personal opinions about FMT: “I definitely think there are a lot of mental health issues and things like autism, where fecal transplants can clearly help… To be perfectly honest, if I were a parent of a child with autism, I would not hesitate to try and give my child a fecal transplant because it’s going to jump start their development.” I also shared about FMT’s success in treating C. Difficile, “I think there are some conditions that we’re seeing, obviously C. Difficile, there’s a 92 percent success rate in some studies with the fecal transplant and it’s a shame, frankly, that [FMT] is still only essentially approved for C. Difficile that is recurrent and resistant to antibiotics, given that the antibiotic success rate is only in the 30 percent [range]. That’s the only use that you can get [FMT] for officially from a doctor in the U.S.”

So if you are you considering a fecal transplant, all these success stories might make you anxious to try it, but there are a lot of drawbacks. First of all, if you’re in the U.S. and can’t afford the ~$10,000 fee of doing it at a clinic overseas, you’ll need to find a donor and have the donor thoroughly tested. Of course you’ll have to have complete faith that the donor is honest in their questionnaire or well-known to you, as testing won’t reveal inactive viruses, such as Human Papillomavirus or Herpes Simplex Virus. If you don’t have your donor tested, you also risk catching a nasty bug from your donor that may not have caused them problems but will cause you problems if your microbiome is unstable and dysbiotic (like C. Difficile or H. Pylori). And if you’re lucky enough to find a potential donor who’s willing to give you 5- 10 samples (typical sequences of FMTs in a clinic run over the course of 5 days for C Diff and 10 days for conditions like IBS or colitis), thorough testing could be very expensive and most tests won’t be covered by anyone’s insurance. But at minimum to cover the microbiome end, you should run either a metagenomic sequencing of their gut microbiome and examine the raw data or do a test like the GI Map or Doctor’s Data GI 360. And clinics typically put patients on strong antibiotics like vancomycin for two weeks prior to FMT, so you’d need to get access to the same or use longer herbal protocols to properly prepare the terrain to receive new residents. The Power of Poop website is a great resource for all your FMT questions and lists other tests that should be done for a donor.  It includes instructions about How to Safely do a Fecal Transplant at Home and comprehensive information about Donor Registry Requirements.

But before you get your heart set on FMT, you should realize that FMT is not likely the quickest, easiest or least expensive way to solve your gut or other health issues. Most gut issues have at their root dysbiosis of some sort, be it an overgrowth of the wrong type of bacteria or an overgrowth of candida or other fungi, many of which take place in the small intestine, making it unlikely that FMT would reach the problem, unless you take it in crapsule format. However, herbal interventions following testing to determine the root cause of your problems, coinciding with dietary interventions and probiotics, followed by prebiotics, are likely to bring about substantial relief for most gut issues. And of course there are more complex interventions for more complex issues, like mold exposure, histamine intolerance or Mast Cell Activation Syndrome, that a good practitioner can guide you through.

So I’d encourage my listeners who are thinking of FMT as a first-line treatment to investigate other possibilities before taking the risk of using a donor who is not properly screened and a DIY fecal transplant. But if you are determined to move forward, please take as many precautions as you can afford in terms of donor selection and testing.

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

Excerpts from episode 30 (“Food for Thought: Mental Health and the Gut”) of my podcast, The Perfect Stool: Understanding and Healing the Gut Microbiome, edited for readability.

Relationship between Brain Activity and Gut Inflammation

One example of gut-brain dysfunction can begin with decreased brain activity. This could come from a brain injury, concussion or stress. Decreased activity can lead to a decrease in the activation of the vagus nerve, which is the main component of the parasympathetic nervous system (which is one arm of the enteric nervous system, or the two thin layers of more than 100 million nerve cells lining the gastrointestinal tract from the esophagus to the rectum, the other branch being the sympathetic nervous system, which controls the fight or flight response to a stressor). The parasympathetic nervous system oversees many crucial bodily functions, like digestion, control of mood, immune response and heart rate, specifically undoing the work of the sympathetic nervous system after a stressful situation and bringing your body into the rest and digest mode by decreasing respiration and heart rate and increasing digestion when you’re resting, relaxing or eating.

Returning to the vagus nerve – the vagus nerve connects the brain and the gastrointestinal tract and sends information about the state of the inner organs to the brain via fibers. Decreased activation of the vagus nerve then suppresses the intestinal immune system and decreases intestinal blood flow. This slows digestion and can cause increased growth in pathogenic yeast and bacteria, which then cause intestinal permeability or leaky gut. Leaky gut causes a state of chronic low grade inflammation. And then the inflammatory cytokines or chemical messengers produced in the gut travel through the blood and cross the blood-brain barrier, which activates the microglial cells, which are the immune cells of the brain, and the brain gets inflamed. That inflammation creates a leaky blood-brain barrier, also known as leaky brain. The blood-brain barrier is a single-layered lattice of cells joined by tight junctions that regulates which substances are allowed into the brain, not dissimilar to the way that the intestinal epithelial cells regulate what’s let in and out of the intestines. Generally, it keeps out toxins like heavy metals, pesticides and damaging proteins, while allowing in oxygen, hormones and nutrients. So this brain inflammation decreases nerve conductance, which in turn can cause depression and reduced activity of the vagus nerve, which controls mood, and we’re back where we began: caught in a vicious cycle, in which reduced activity in the brain causes gut inflammation, which inflames the brain, which leads to reduced brain activity.

It’s important to recognize that when gut symptoms persist even in the context of a healthy diet and lifestyle, this could be an indication of a gut-brain axis problem.

And likewise, the problem can also originate in the gut, with a poor diet lacking in fiber and high in sugar, simple carbohydrates, gluten, dairy or other common food allergens creating intestinal permeability, which then sets off the same series of events terminating in mental health issues.

Depression and the Microbiota

In a study published in the journal Nature Microbiology in 2019, researchers in Belgium sequenced the gut microbiome in 1,054 individuals, correlating their findings with measurements of both quality of life indicators and depression status of the participants. They found that those with lower levels of Bacteriodes enterotype 2 displayed lower measurements of quality of life and a higher prevalence of depression while those with higher quality of life indicators were consistently correlated with higher levels of Faecalibacterium and Coprococcus, which produce the short-chain fatty acid butyrate, which feeds gut epithelial cells and helps maintain a healthy gut barrier. They also found that a lack of Dialister and Coprococcus species also correlated with higher levels of depression. The researchers also looked at the genetics of these particular organisms and their role in manufacturing the neurotransmitters dopamine and GABA, which led to the suspicion that this may be another role that the microbiome is playing in mental illness. So overall, while we can’t say that precisely those organisms cause depression, what we do know for sure is that a healthy gut microbiome decreases inflammation, and the inverse, an unhealthy one increases it, and this has an impact on depression, which is at its core an inflammatory disorder.

Another study, which was a systematic review of studies on major depressive disorder and the gut microbiome, found that nine genera were higher in major depressive disorder (Anaerostipes, Blautia, Clostridium, Klebsiella, Lachnospiraceae incertae sedis, Parabacteroides, Parasutterella, Phascolarctobacterium and Streptococcus), six were lower (Bifidobacterium, Dialister, Escherichia/Shigella, Faecalibacterium and Ruminococcus), and six were divergent, meaning different results in different studies. What they suggested is that studying microbial functioning, or the function that any genera of microbes may play, may be more productive than a purely taxonomic approach, or singling out specific families, genera, phyla, etc. of bacteria to understanding the gut microbiome in depression.

Going into a bit more detail on the role of specific gut bacteria in creating neurotransmitters, studies have shown that Lactobacillus and Bifidobacterium, typically genera in multistrain probiotics, synthesize GABA from monosodium glutamate which is notable because it’s hypothesized that depression may be caused by a deficit in GABA. Escherichia coli (aka E. coli), Bacillus and Saccharomyces produce norepinephrine (which you may know also as noradrenaline), whose general function is to mobilize the brain and body for action. Candida (a yeast, not a bacteria), Streptococcus, Escherichia and Enterococcus produce serotonin, which is the key hormone that stabilizes our mood, feelings of well-being and happiness and helps with sleeping, eating and digestion. And Bacillus and Serratia produce dopamine, which plays a role in how we feel pleasure. This is leading to research on a new class of drugs called “psychomicrobiotics” for the treatment of psychiatric disorders.

Another study that sheds some light on the mechanism by which the gut microbiome can cause depression was a controlled clinical trial on patients with major depressive disorders that helped validated the existence of an immune response to LPS or lipopolysaccharide, which is a component of the cell walls of gram negative bacteria. LPS is believed to also play a role in depression, along with inflammatory cytokines. The study looked at concentrations of the immune cells IgM and IgA against the LPS of 6 gram negative bacteria from the family Enterobacteria, which would indicate an immune response in the blood to bacteria. They found that the prevalence and median values for serum IgM and IgA against LPS of enterobacteria are significantly greater in patients with major depressive disorder than in normal volunteers, which led them to conclude that “. . . the results show that intestinal mucosal dysfunction characterized by an increased translocation of gram-negative bacteria (leaky gut) plays a role in the inflammatory pathophysiology of depression.” That means that the blood-based immune response indicates that this LPS is escaping the intestines and creating this immune response. They go on to suggest that patients with major depressive disorder should be checked for leaky gut by means of the IgM and IgA panel used in the study and be treated for it if found.

The Gut-Brain Axis and Anxiety

If you’ve ever had an experience that made you “feel nauseous” or had “butterflies” in your stomach before a public speaking event, you are probably clued into how your gut responds to anxiety-producing situations. Conversely, conditions in your gut can trigger various emotional responses in your brain, like anxiety, which studies have shown may affect up to a third of people at some point in their life. The enteric nervous system doesn’t just send messages to regulate the digestive system, it also receives information from the digestive system, creating thoughts in your brain. For a long time, researchers and clinicians thought that anxiety and depression contributed to conditions like IBS and other problems like constipation, diarrhea, bloating, pain and upset stomach. However, new research suggests the reverse is true too: that people suffering from IBS and other functional bowl problems are at much higher risk of developing depression and anxiety. As a result, you may find your gastroenterologist suggesting antidepressants to treat your IBS, not because they think the problem is in your head, but because these medications can calm symptoms by acting on nerve cells in the gut, as can cognitive brain training or other psychotherapies.

Looking at the research evidence on gut-based interventions for anxiety, a systematic review of 21 studies with 1503 people from 2019, examined the evidence from observational studies to support improvement of anxiety symptoms by regulating the intestinal microbiota. Of the 21 studies, 14 had probiotics as interventions to regulate the microbiota and 7 had non-probiotic interventions, like diet adjustments. Overall, 11 of the 21 studies showed a positive effect on anxiety symptoms by regulating gut microbes. Of the 14 studies that used probiotics, more than a third found them to be helpful in reducing anxiety symptoms, while 6 out of the 7 remaining studies that used others means found those to be effective. The researchers concluded that more studies are needed to clarify the conclusion that non-probiotic interventions are more effective that probiotic interventions in reducing anxiety, but overall, they did affirm that regulating intestinal flora is effective in alleviating anxiety symptoms.  

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

Episode 30 show notes

If you’re struggling to lose weight or successfully doing so but want a little boost or some help getting beyond a weight loss plateau, there are a number of foods and supplements that have good evidence behind them for supporting weight loss. In my experience, the number one issue for weight loss is reducing your carbohydrate intake, but we’ll focus on some more advanced strategies here.

Protein: When you’re trying to lose weight, you want to lose fat and preserve or increase muscle mass. In order to favor that balance, it’s important to eat sufficient protein, ideally spread throughout the day rather than primarily at dinner. In addition, protein requires more calories to digest it (20-30% of its calories) than fats (0-3%) and carbohydrates (5-10%), the other macronutrients. As a result, the net calories that you absorb from the protein you’re eating will be less than other foods. Megan Hall, Scientific Director at Nourish Balance Thrive recommends eating 1.8-2.2 grams of protein daily per kilogram of body weight if you’re trying to lose weight. This is probably a lot more meat than you’re used to eating: a 150 pound person would need to eat 123-150 grams of protein a day (FYI – 6 ounces of meat is around 50 grams of protein). Of course you can get your protein from non-meat sources as well like nuts, beans and legumes, but you will end up eating a really large (and complex and healthy) amount of carbohydrates at the same time. Vegetarians and vegans would likely benefit from the addition of protein powders to their dieting toolbox. For vegetarian food options, tofu is a good choice for a high protein to carb ratio.

Turmeric/Curcumin: Well known for its anti-inflammatory properties, curcumin (the active compound derived from turmeric), has been shown in mouse and human studies to enhance weight loss and increase body fat reduction. For the humans, the weight reduction of curcumin plus a weight loss program in 30 days (over just a weight loss program alone) went from 1.88% to 4.91%, while the increase in body fat reduction went from 0.70% to 8.43%.

Apple Cider Vinegar: Consumer Labs affirms that apple cider vinegar (ACV) may reduce or slow the rise in blood sugar after eating and may modestly help with weight loss. They recommend taking 1 tsp. to 1 tbsp. diluted in 1.5-8 ounces warm water before meals. They also recommend that you not let the vinegar linger in your mouth and to rinse afterwards, as it can erode tooth enamel. Note that they did not find ACV powder and pills to be an equally effective form for weight loss. They also caution against using ACV for diabetics without adequate blood sugar surveillance because of its alteration of blood sugar levels.

Probiotics: There is some evidence that probiotics may be helpful in weight loss due to their impact on the gut microbiome. In a placebo-controlled, double blind, 7-day study of Equilibrium Probiotic, 72% of participants reported a reduction in food cravings and mild weight loss.

Berberine: Used for centuries in Chinese medicine, this powerful compound found in many plants and known to help blood sugar regulation (perhaps even as well as Metformin), has been shown in several studies to help with weight loss. In one 2012 study, participants consuming 500 mg of Berberine three times a day lost an average of 5 pounds, while simultaneously improving their triglyceride and cholesterol levels. In another 2012 study, participants lost an average of 4 kilograms over those who consumed a placebo.

Fiber: While losing weight, it’s also important to consume foods with plenty of fiber, or supplement with additional fiber. Toxins are stored in fat cells, and if you have a higher toxic burden you may find yourself feeling unwell while losing weight unless you consume sufficient fiber to flush it out. One of my favorites fibers is psyllium husk, which can be mixed with a full glass of water or mixed in smoothies, ideally 1-2 tablespoons a day. It thickens up quickly so drink it down right after mixing if possible.

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

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Excerpts from episode 29 of my podcast The Perfect Stool: Understanding and Healing the Gut Microbiome with Dr. Nasha Winters, ND

LP: Lindsey Parsons, NW: Nasha Winters

LP: Do you still consider yourself a cancer patient? Or do you feel fully recovered and not in danger?

NW: That’s a really good question. I personally don’t believe that there is a cure for cancer. I believe cancer is in all of us and the studies and research support that fact. I believe that we have the ability to turn the signaling and those pathways off, or to keep them quiet and dormant, or we have the ability to set them on fire and turn them on wildly. So, I feel where I am today, per Western medical standards, I am not cancer free. However, per my standards, especially since about mid 2010, I’ve stopped “cancer-ing,” if that makes sense. Everything is stabilized, and my body is completely in harmony and balance with all of this. And I know how to check under the hood: to test, assess, and address my process. That’s what I’ve learned for myself, what I’ve taught other patients and now what I’m teaching other physicians: is exactly how to manage this disease process and really understand where it’s come from, why it’s so individualized, and how to best support the person through the process. One of the coolest key foundations for getting better outcomes is based on the health and diversity of the microbiome.

LP: Well, that’s exactly where I was heading. So let’s talk more about that.

NW: First of all, one of the things I love—and you being the poo goddess, microbiome diva that you are, I’m probably not saying anything that you are not aware of—but I love how we consider the microbiome today the “Forgotten Organ.” Let me explain. We’ve known since Ayurvedic medicine, which is the sort of great grandmother of medicine that we know of today—so we’re talking anywhere from 3000 to 5000 years old information—saying that our health is based on the health of our gut. We didn’t quite know what that exactly meant, but we know today, when we started really looking at studies in 2005, and really started placing more emphasis on our GI tract, we certainly were validating thousands of year-old ideology and theory. So that’s the one thing that even as a naturopathic doctor, since my medical school training in the mid 90s, we were like, “the gut, the gut, the gut,” and everyone just basically said, “you’re crazy,” and “standard of care.” Yet today, we’re investing so many of our resources for research and treatment. Until they could monetize [research on the gut microbiome], it didn’t mean anything. But once they were able to really monetize it, now we’re paying attention. That’s unfortunately the way it happens a lot in our medical system. But I just think this is really a powerful thing to think about: the Forgotten Organ always been there, we’ve always known it played a role, and now we are paying for the research to really explain why. The other cool thing specific to cancer and the microbiome is that it is estimated at 20 percent of all tumors worldwide are microbially-driven. Let that sink in.

LP: And would that be bacteria, fungi, viruses…?

NW: Yes, yes, yes, yes, yes.

LP: …and parasites!

NW: Yes. You’re nailing them all! You hit them all. And there’s a great quote that showed up in a cancer journal back in January 2019. The article was titled “Gut Microbiome and Cancer Immunotherapy.” This simple quote says, “a healthy body is inseparable from an integrated gut epithelium with specific function and gut microbiome, immune cells and mucosal barriers together that maintain epithelial homeostasis.” In short, what that says is that what those crazy Ayurvedic doctors have been saying for 5000 years was spot on: our health comes down to the function and flora of our microbiome. I just think it’s very interesting that it took us until 2019, to really state that fact with much more certainty in the standard of care model.

LP: So let me dig a little bit more into what you were saying about 20 percent of cancers having a microbial origin, is the implication there that the microbe is somehow setting off the tumor process?

NW: Yes, basically what we have learned is that the micro ecology of our microbiome, the changes there, are where—if you’re going in the wrong direction, that’s where we will rapidly proliferate rogue bacteria, or viruses, or parasites, and then those little creatures will then interact with the lining of our gut: the epithelial cells, and these other cells, which hold the structure of our inner world into a sort of matrix or into sort of a scaffolding, known as the stromal cells. What happens when that ecology gets tweaked in any way [is that] the epithelium and stromal cells are altered in their function and their chemical responses. Even more specifically, what’s happening is that rapid shift in the microbiome, and those specific cells result in what’s known as toxic metabolites that trigger off what we call carcinogenesis: new cancer cells that can grow anywhere in the body, not just in the gut. Then that happens even further, causing a cascade of things like inflammation and immunosuppression. In my mind, the trifecta today of cancer is: gut dysbiosis with inflammation and poor immune function. This is the perfect combination for a cancer storm.

LP: Okay, so, now, when you said “toxic metabolites,” is that the same as the endotoxins? Or LPS?

NW: Yes, all of those pieces. So, endotoxins that the individual organism can shed, but also a perforation to the lining, that LPS, that lipopolysaccharide coating that goes across our whole tube—I always tell people, “we’re just a tube with the body wrapped around it”—and so that piece happens. But, then, also we trigger—because you and your listeners obviously know that, depending on who you talk to, about 70 to 80 percent of our immune cells and our immune function is happening at the GI tract level, the microbiome level—we trigger a cascade of cellular responses such as: natural killer cells, cytokines, which are inflammatory molecules. We can create a little cacophony, a little orchestra, of all types of things that are triggered, that not only impact what’s happening at the tube level, but send out all kinds of signals throughout the rest of the body.

LP: And so they’re sending those signals, and as a result a tumor forms? I’m having trouble taking the one part and making it connect to the other part.

NW: Well, so, here’s the thing: your discomfort around really grappling with this is because we have [in Western medicine], frankly, blown smoke up people’s asses for 70 years with regards to what cancer is. So, what I’m talking about blows people’s minds because we sort of think of cancers as exogenous invaders that somehow enter us, from outside of us, and we have to then kill it or fully eradicate it. We’ve given [cancer] unbelievable power, [in believing] that it’s driven by our genetics, that it is a genetic disease, and that we’re sort of powerless and dealing with it. However, what we have learned in the last–well, what we’ve re-learned, let’s put it that way, because we knew this back in the early 1900s, but we took a little different turn when Watson and Crick came along with their focus on genetics and DNA–but what we’ve since learned is that really cancer is a metabolic disease. It’s a disease on the energies that we take into the body. It’s a disease at the mitochondrial level: on the little powerhouse cellular structures that each of our cells carry, the turning on or off energy performance throughout our tissues, throughout our organs, throughout our whole body. But [because cancer is a disease at the mitochondrial level, it is also a disease on] the signaling pathways that tell things to grow. Mitochondria tell things to die, they tell things to stall, to hold off, they tell things to regenerate, they tell things to increase inflammation when you need it, or to decrease inflammation when you need it. So basically, all of these cell pathways start to communicate to each other for the rest of the body, and, then, over time, on average, somewhere between seven and ten years, enough cells start to congregate and clump up, and hang out, based on the inflammation we talked about at the level of those epithelial cells that not only line our gut, but line our vasculature, and line our cells, and line our organs, [and] so, too, at the level of our stromal cells that offer structure–think of them as the sort of jungle gym that cells walk around on, like travel around on to migrate throughout, building and metastasizing. So when you said, “Okay, I’m trying to understand where the bridge comes together–that suddenly you have a tumor from this,” [my response is] it’s a long standing, ongoing process that can take years to solidify to be big enough and loud enough and clumped together in such a way that we recognize it as a tumor, or a cancer diagnosis. What I’m trying to help your listeners understand is that we have the power to turn this around way before it’s big enough and loud enough to capture our attention by changing things down at that cellular level, and preventing things from getting on the move, and congregating and clumping up to make what we know today as a tumor.

[…]

LP: What do you recommend–short of a fecal transplant–to replace that diversity [in the microbiome] as a preventive measure?

NW: I mean, first of all, we eat very differently than we do from our ancestors. We ate so many more diverse foods, and plants for millennia. And as I said, we’ve really mono cropped. So, you, then, have to take it upon yourself to branch out your diet and bring in foods you don’t normally eat. I tell people: start playing with things like Jerusalem artichoke, leeks, plantains, things that you would probably normally eat a little bit of in your diet that bring in the prebiotics and the insulin and the types of fibers that are the food and fuel for your microbiome. Then, diversify your portfolio with your pre-digested soil rich foods. Don’t be too clean with your foods. Grow your own. Eat the dirt off your carrot… And then also, in the West, we’re not really keen on our ferments, but most cultures have some type of ferment: like borscht, like the kvass, you know, in some parts of the world and, and the kimchi in others, or the sauerkraut in others, or pickled vegetables in others. It’s now becoming kind of hipster and cool in the U.S.: thanks to things like Portlandia: “you can pickle that!” But ultimately it’s about encouraging people to eat a fermented food on a daily basis. If you have really terrible things like FODMAPs or Small Intestine Bowel Overgrowth issues, even those foods can backfire. So you have to work with a trained professional to help get the inner garden more ready to accept those foods. So that’s a big one. Another big one is sugar. We’re a bunch of sugar junkies and sugar is really a beast and feeding these little wrong directional microbes and organisms in our gut. They will vie for that fuel and basically starve us of our other nutrients. And then fiber. We tend to have a very low fiber dietary intake in the West. We just don’t do our veggies. You know, we want to be telling our patients to take their 9-15 servings of vegetables in a day, which is what I have my patients do: above the ground, leafy green, low-carbohydrate rich foods, but ultimately, most people can barely get three servings in a day.

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

Pulled from my podcast The Perfect Stool: Understanding and Healing the Gut Microbiome

Prebiotics

Because their names are so similar and because they’re often combined in one supplement, people often confuse the terms probiotics and prebiotics. And you’ve probably heard a lot from me so far about probiotics, as I’m a fan, but today I’m going to be writing about prebiotics.

So the term prebiotic can be used officially as a food ingredient if you can scientifically demonstrate that it
• resists gastric acidity, (meaning your stomach acid doesn’t break it down), hydrolysis by mammalian enzymes (hydrolysis is any chemical reaction in which a molecule of water ruptures one or more chemical bonds), and absorption in the upper gastrointestinal tract;
• is fermented by the intestinal microflora; and
• selectively stimulates the growth and/or activity of intestinal bacteria potentially associated with health and well-being.
In other words, we can’t digest it and our good bacteria can.

The most widely accepted prebiotic supplements are the fermentable oligosaccharides fructoligosacrharides (FOS or fructans), inulin (a form of FOS), galactooliogosaccharides (GOS), xylooligosaccharides (XOS) and lactulose. Besides being found in supplements, these beneficial substances are handily located in something we all could stand to eat more of – fruits and vegetables, in particular legumes, as well as in whole grains, nuts and seeds. So the more of these foods you’re eating, in particular fruits and vegetables, and the greater the variety of them, the more and different types of prebiotics you are getting.

Some examples of particularly good food sources of prebiotics are: onions, leeks, radishes, carrots, coconut meat and coconut flour, flax and chia seeds, tomatoes, bananas, garlic, chicory root, dandelion greens, Jerusalem artichoke, jicama, asparagus, and yams.

Both prebiotics and probiotics nurture the good bacteria required by the digestive tract for proper health beginning in your mouth. And while probiotics are live, active, bacterial cultures capable of multiplying in numbers, prebiotics serve as the food source for the bacteria and do not grow or reproduce. As such, prebiotics are considered functional foods because they provide numerous health benefits and aid in the prevention and treatment of various health conditions and diseases.

Prebiotics have been shown to have many positive effects including:
• increasing the health of the intestinal mucous membrane, which improves digestion and gut health in general
• decreasing blood sugar and insulin levels, and consequently the risk of obesity and weight gain
• decreasing inflammation
• lowering cholesterol and the risk for cardiovascular disease
• lowering the stress response
• helping with hormonal balance
• modulating the immune system and helping manage autoimmune symptoms. In particular, prebiotic foods can result in significant changes in the composition of the gut microbiome that help improve immunity, shown by improvements in biomarkers and activities of the immune system, including reduced levels of certain cancer-promoting enzymes and bacterial metabolites in the gut (the byproducts of bacterial digestion).
• Other benefits include preventing traveler’s diarrhea and aiding in the digestion of lactose in those who are lactose intolerant, in particular with the prebiotic GOS.

So now that we’ve talked about some of the benefits, let’s get to some of the potential concerns, especially if we’re talking about supplementing with prebiotics, as opposed to getting them from food.

First, because you’re giving your gut bacteria a sudden, pure form of food, you’ll likely have some bloating from the gasses that the bacteria produce after eating this food, until the balance of bacteria in your intestines adjusts and more bacteria that consume that gas grow to accommodate it. So start slow and build up – either with a supplement or with a new prebiotic food you don’t normally consume (think gas with that occasional meal with beans – it’s because your system isn’t adjusted to their regular consumption).

In his great tome “Healthy Gut, Healthy You,” Dr. Michael Ruscio summarizes the research on prebiotics for various gut conditions.

For IBS (Irritable Bowel Syndrome) and SIBO (Small Intestinal Bacterial Overgrowth), the best evidence suggests prebiotics should be avoided and a low-prebiotic diet like the low-FODMAP diet should be adopted. FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols and it’s a huge list of foods including many fruits and vegetables, whole grains, dairy products and more. But keep in mind that this is a temporary diet and elimination and reintroduction process, not a permanent diet, until you’ve resolved your SIBO, dysbiosis or IBS. I’ve done the low FODMAPs diet on two different occasions and it’s very limiting – excluding two very common food ingredients – onion and garlic, including their powders – so imagine trying to go to a restaurant and not eating FODMAPs. And I actually had a funny thing happen to me during those two low FODMAP diets, and I’m curious if anyone else has experienced this. When I’m excluding FODMAPs, after a couple of days, everyone’s breath starts to smell like garlic to me, to the point that I can’t even kiss my husband. So it’s interesting how much our bacteria and its die-off (for lack of food) can influence our senses. So if you do try low FODMAPs, keep in mind it’s more about managing symptoms, rather than solving the problem. Typically you also need to take antimicrobials or other supplements to bring a dysbiotic gut or bacterial overgrowth into balance.

For IBD (an umbrella term used to describe disorders that involve chronic inflammation of your digestive tract, such as Crohn’s disease and ulcerative colitis), the best evidence suggests that people should avoid supplemental prebiotics as some trials have shown harm from using prebiotic supplementation in IBD.

While in a flared state, you should adopt a low-prebiotic diet like the low-FODMAPs diet or the Specific Carbohydrate Diet (SCD), which is a diet that eliminates all sources of grains and pseudograins like quinoa, even the white ones, all but long-fermented dairy, processed meats, most processed sugar, artificial sweeteners, sugar alcohols and all processed foods.

In terms of weight loss and gain, while a systematic review of twenty-six clinical trials concluded that prebiotics are effective in lowering blood sugar, many studies show prebiotic supplements have little to no effect on weight loss.

Finally, for celiac disease, there are no studies available, however, indirect evidence suggests avoiding prebiotics may be advisable, especially in those who do not fully respond to a gluten-free diet.

Synbiotics

Now on to another related topic. While I’m talking about prebiotics, I should also mention synbiotics, which are combination products of probiotics and larger amounts of prebiotics than the nominal amounts typically added to a lot of probiotics. One review published in 2014 concluded that the use of synbiotics may promote an increase in the number of bifidobacteria, glycemic (blood sugar) control, stimulation of the immune system, reduction of blood cholesterol and balancing the intestinal flora, which aids in reducing constipation and/or diarrhea and improves intestinal permeability. The study, linked above, has recommendations on dosages of certain prebiotics and probiotics in order to see benefits.

Fiber Supplements

Another related topic is fiber supplements. So while all prebiotics are dietary fibers, not all dietary fibers are prebiotics.

But first, a little bit about what fiber actually is and why it’s important: fiber is the part of plant-based foods—fruits, vegetables, nuts, seeds, legumes—that give the food its structure. There are many types of fiber, but we’ve separated it into two major types: soluble fiber and insoluble fiber. Soluble fiber dissolves in water and gastrointestinal fluids when it enters the stomach and intestines and then is transformed into a gel-like substance, which helps to positively slow absorption of nutrients during digestion. Insoluble fiber passes through the body and becomes the bulking agent to take up and help eliminate any by-products of metabolic processes, such as bacteria that need to be cleared, excess estrogen, and excess waste. Both soluble and insoluble fiber play an important role in digestion and the health of the microbiome. While soluble fiber feeds the bacteria in the gut, insoluble fiber ensures that nothing harmful lingers too long and creates a state of putrefaction or dysbiosis. You can find soluble fiber in supplements like Metamucil (or its simplest form without additives, psyllium husk), Citrucel (which is methylcellulose) and FiberCon, Fiber Lax, Equalactin, and Mitrolan, which are polycarbophil. You can find insoluble fiber in foods like beans, barley, corn, rice, bran, whole wheat, vegetables and apple and pear skins.

Other supplemental fibers you may want to consider include Sunfiber, which is made from the guar plant and is actually a low FODMAP fiber, glucomannan (made from Konjac root), acacia, pectin and inulin. In foods, you’ll find some of these same and other fibers as well, including cellulose, found in legumes, nuts, and bran; inulin, found in bananas, garlic, onions, asparagus, wheat, barley and rye; pectins, found in apples, strawberries, citrus fruits, carrots, and potatoes, and in smaller amounts in legumes and nuts; beta glucans, found in oats, barley, shiitake mushrooms, and reishi mushrooms; and lignin, found in whole grain foods, legumes, green beans, cauliflower, zucchini, avocado, unripe bananas, and nuts and seeds.

So you’ve probably heard that we all need more fiber and you’ve likely heard of the Recommended Daily Allowance of fiber, which is is 30 to 38 grams a day for men, 25 grams a day for women between 18 and 50 years old, and 21 grams a day if a woman is 51 and older. Or generally, you should get 14 grams of fiber for every 1,000 calories in your diet. But it’s important to remember that, while fiber can help some and probably most people feel better, especially if you’re currently eating a standard American diet, it can make others feel worse, especially those with inflammatory bowel disease during a flare. But for anyone considering supplementing with fiber, it’s a great first step in trying to solve lower level bowel issues like constipation, but be sure to do it with a full glass of water or other liquids.

Resistant Starch

Another related topic is resistant starch, which is like fiber, in that it feeds your healthy gut bacteria. It’s called resistant because it resists digestion by us but not by our bacteria. Resistant starch is naturally found in foods like green bananas and their flour; banana skins; cooked and then cooled potatoes, rice and pasta; beans and legumes; raw potato starch; hi-maize flour and oats. And I like to think of resistant starch as free food because the amazing thing is that by cooking and cooling and then optionally reheating to no more than 130 degrees foods like potatoes and rice, you can save yourself many calories but eat the same foods. This is because the starches convert into resistant starches, so we don’t absorb the calories! They also promote feelings of fullness so you end up eating less. One study showed that men who had a meal with resistant starch versus a placebo ate 90 fewer calories. One great trick I learned is that if you buy organic bananas and use them in smoothies, leave the skin on and you’ll get a nice serving of resistant starch and it will fill you up a lot more without adding calories. I also tend to make my rice ahead of time and reheat it throughout the week as I eat it, but of course that’s primarily because no one else in my house will eat any whole grain rice so I have to make it for myself while they make white rice.

Benefits of Fiber

In terms of the research on the benefits of fiber, Michael Ruscio also sums it up in his book. In terms of digestive-tract cancers, the overall impact of supplemental fiber, including resistant starch, on colorectal-cancer risk appears minimal at best. Most of the data shows no positive impact.

For IBD, randomized controlled trials have shown fiber to be helpful for IBD, but again, fiber is best used when IBD is in remission. Low-fiber diets have been shown to be helpful for active or flaring IBD.

For IBS, fiber has been shown to help IBS symptoms, including stool frequency and consistency and quality of life. However, high-fiber intake can be problematic for some IBS patients. You may have heard that something like 80% of IBS is believed to be caused by small intestine bacterial overgrowth (SIBO), so as you can imagine, if your small intestine bacteria is overgrown, adding more fuel to the fire wouldn’t be ideal. As a result, low-fiber diets like low FODMAPs have also been shown to be helpful in IBS, at least until the SIBO is cleared, if that’s your underlying cause. And in general, fiber has the most benefit for those with IBS-C or constipation, although I have to say that I have tended more toward the IBS-D and found that supplementing with psyllium husk gave me much better quality stool as it absorbed some of the excess water in my colon.

For celiac disease, there is no quality data available for supplemental fiber’s impact.

For type 2 diabetes, high-level science shows supplemental fiber can help lower fasting blood glucose by about thirty-five points and hemoglobin A1C by about 1% in patients with type 2 diabetes. But the healthier your blood sugar already is, the less effect supplemental fiber will have.

For heart health, supplemental fiber may cause a small decrease in blood pressure and cholesterol levels. However, there does not appear to be a clear benefit for heart disease from fiber supplementation.

For obesity and weight loss, a review paper showed that the average weight loss from fiber supplementation was around 4.2 pounds. Viscous fibers (gel forming) might be best for weight loss but also may carry the highest risk of digestive side effects. Overall, supplemental fiber does not appear to be hugely effective for weight loss.

Now I’m going to mention a study from 2018 that seems to have gone virtually unnoticed but definitely didn’t escape my notice. Researchers at the University of Toledo found a link between refined dietary fiber, gut bacteria, and liver cancer, at least in mice. The study challenges conventional wisdom that dietary fiber is good no matter how you get it. Chicory root is used as a source of inulin to fortify a lot of processed foods with fiber. In the study, the mice were given chicory root inulin and they developed liver cancer. And the ones that developed liver cancer had altered and elevated gut bacteria, or dysbiosis. Interestingly, the researchers observed no evidence of liver cancer in inulin-fed mice that were treated with broad-spectrum antibiotics to deplete gut bacteria. So given this was on mice and was just one study, probably the biggest takeaway is that fortifying processed foods with refined, soluble fiber may not be safe or advisable for people with SIBO or dysbiosis, whose abnormal fermentation of this fiber could potentially increase their susceptibility to liver cancer.

On the other hand, there are studies supporting the positive effects of fiber, in particular in kidney disease. A 12-week, single-blind study published in 2014 in the Journal of Renal Nutrition found that supplemental inulin was beneficial, in particular with increasing stool frequency. Many people with chronic kidney disease don’t get enough fiber, because many fiber sources are too high in potassium and phosphorus, so if you do have kidney disease and try to get more fiber, be sure to do it carefully and with your doctor’s advice and support.

Speaking of stool frequency, in case you weren’t sure, ideal stool frequency is around 1-2 bowel movements a day, so it’s beneficial to keep the gastrointestinal tract moving. This also helps prevent diverticulosis or pockets inside the colon, which can become diverticulitis when they become inflamed or infected. This is a very painful condition and can lead to bowel surgery, so keeping those bowels moving regularly is very important.

Now you may be asking what to do with all this information if you’re just an average person? Well, my general approach to fiber and prebiotics has been to get it from my diet rather than trying to supplement, although I will say that prior to solving all my bowel issues, I did have success with a tablespoon of psyllium husk in my smoothies, and I now get it in my keto bread. I hear that Jason Hawrelak, a Naturopath, probiotic researcher and university lecturer, recommends aiming for 40 different whole plant foods week. So next time you’re shopping, pick one new fruit or vegetable you’ve never tried, and incorporate it into your diet. Then add another one the following week. Just because you like broccoli and have finally gotten your kids to eat it, don’t just buy broccoli every week – switch it up, get something different, try new recipes. And you can find some of my favorite vegetable recipes at the bottom of my podcast show notes.

If you’re someone with IBD and you’re flaring, switch to a low fiber diet, but once your flare is over, slowly increase your fiber again to protect yourself from future flares.

If you’re considering investing in a prebiotic or synbiotic supplement, look for research to support its effectiveness. But don’t be like these folks I’ve seen in some Facebook groups who are selectively supplementing with certain prebiotics in hopes of increasing specific gut bacteria. We really don’t know enough about individual gut bacteria to be targeting them. Rather, think more about how well your gut is functioning overall.

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

Links in the article to products are Amazon affiliate links for which I receive a small commission.

From my podcast interview with Dr. Drew Sinatra, edited for readability.

What is the relationship between the gut and autoimmunity?

There are three things that I tend to look for. First you need to have a genetic predisposition. So, for example, with celiac disease, you must have either one or two of the HLA-DQ2 or HLA-DQ8 genes. Number two would be there has to be an exposure to an environmental trigger that will instigate an immune response. And gluten is a classic example of that. That’s the trigger that creates all this inflammation. And then, thirdly, there has to be intestinal hyper-permeability in the intestinal lining, which will obviously allow substances to go from the gut lumen into the bloodstream, and the immune system will become activated and that will set off a sort of systemic inflammatory type reaction. So, generally speaking, that’s kind of how I look at the development of autoimmune diseases.

And also you can use those three parameters for treatment as well. If you want to remove the trigger, which today we’ll talk about some triggers for autoimmunity in the gut. And what I found, doing a lot of research into this is that, unfortunately, there’s no unified theme when it comes to certain bacteria or certain phyla that might be increased or decreased, or looking at byproducts like short chain fatty acids, whether those are increased or decreased. It seems like there’s huge variability all across the board. Let’s say a condition like rheumatoid arthritis might have an elevation in prevotella, but in MS, you might have a decrease in prevotella species. So, I was hoping for more of a concrete unifying theme around these parameters, but I didn’t necessarily find it. And so that’s why I still come back to treating those three parameters in terms of development of autoimmune disease and also using them as treatment.

And so how important do you think gluten is for most autoimmune conditions?

I’m so happy you asked that. I take every single autoimmune patient that I see off gluten, and the reason I do that is because I’m sure you’ve read up on a lot of Alessio Fasano’s work in regards to zonulin. But gluten is one compound that can elevate and increase the production of zonulin, which then leads to the disassembly of tight junctions, which therefore sets the stage for leaky gut. And that happens regardless if you have celiac disease or if you have non-celiac gluten sensitivity or if you don’t even have any sensitivity or allergy to gluten. It happens in everyone. There’s this increase in zonulin that’s temporary after consuming gluten. You need to have the intestinal hyper-permeability present for autoimmune disease. That’s why I always take every single patient off of gluten that has an autoimmune condition. And I will say this too, out of all the treatments I’ve done over the last 12 years in private practice—this is including supplements, medications, dietary changes—gluten removal has been the most profound in terms of changes. . .

We talked about the diet piece, the autoimmune paleo, or anti-inflammatory diets – where I like to start. I always add on vitamin D if there’s overarching inflammation in the body. I’ll typically do like a tumeric or a boswellia or an artemisinin supplement to calm down inflammation.

I’m a huge fan of CBD. I don’t know if you’ve dug into CBD at all, but big fan of CBD . . . And you know what you’ve got to do is really talk to the company and figure out what they’re doing that is special, and make sure that their products are organic and they’re not overly processed. And then you need to experiment on yourself to figure out which one actually helps you feel different or better. That’s how we settled on it. I finally settled on one, it’s called Sana Botanicals. I love that company. They have such amazing products that work well, and I tell you, people come back and they’re sleeping better, they have less anxiety, they feel just calmer in their body, and it also helps with pain and inflammation.

. . . And then I also like to recommend LDN, low dose naltrexone. And it’s never good as a monotherapy, but when you combine it with everything that we’re talking about today, I do find it’s helpful across the board for autoimmune conditions. And the reason for that is it’s really helping upregulate T regulatory cells, which can really calm down a part of your immune system that’s overactive. And side effect profile-wise . . . people might have some insomnia the first couple of nights or some vivid dreams, but then that tends to go away, especially if you start off with a low dose and work them up.

I like, obviously probiotics, which you talked about, prebiotics getting mainly from food are really going to support the gut lining and work on inflammation. And then something like a GI Revive or something that has glutamine in it or DGL or aloe or marshmallow root, slippery elm, zinc carnosine, all these different nutrients to help calm down inflammation and help heal the gut.

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

When it comes to gut health problems, it’s not bad enough you can have gas that people might smell, bloating that makes you look pregnant, debilitating cramping and pain, frequent trips to the bathroom that can leave you exhausted mentally and physically, unpredictable bowel movements that can cause accidents and an inability to follow through on plans, but on top of all that, because of the nature of your issues, it can also cause stigma.

Stigma is when society labels an individual as abnormal. Stigma can be something you experience, perceive, or internalize.

If you’re experiencing stigma, it’s when you’re receiving concrete signs or actions of bias or prejudice against you from someone else. If you’re perceiving it, you may be sensing discrimination against yourself from others but the signs are subtle enough that you can’t be 100% sure. But when it’s internalized that’s really the worst because then you’ve absorbed and now believe certain stereotypes about yourself because of your condition, like I’m weak or I’m unreliable or I’m always in bad health and always will be or I’m not a good (fill in the blank: worker, friend, mother, father, girlfriend, boyfriend, husband, wife, etc.), or the mother of all internalized self-criticism, I’m not enough.

I’d like to undo some of that stigma and programming to help you see yourself as whole, healthy, healable, strong, and good enough in and of yourself and in relationship to others.

For starters, I want you to know that you’re not alone.

A 2013 Fox News Survey showed 74 percent of Americans are living with digestive symptoms like diarrhea, gas, bloating and abdominal pain. And whether a given individual has those symptoms now, everyone has had them at some time and knows what it’s like to have gas, constipation or diarrhea. Literally everyone, except maybe small children, has had those at one time or another.

In terms of actual diagnoses, as of 2015, it’s estimated that 1.3% of US adults (3 million) had been diagnosed with Irritable Bowel Disease (IBD), which is either Crohn’s disease or ulcerative colitis.

In terms of Irritable Bowel Syndrome (IBS) studies have estimated that between 10% and 15% of the entire U.S. population has it. That’s more than 1 out of every 7 people. So if you’re at a party with 10 people, someone else probably has IBS besides you. A party with 30 people? 3 more besides you. You’re not alone. That being said, in one study, more than half of people with IBS believed that they were treated differently because of their IBS.

How about gastritis? In the U.S., it’s estimated to affect 25-35% of the entire population!

And in my experience talking to clients (many of whom aren’t coming to me for gastrointestinal issues) I have yet to meet more than 2 people who think they have no GI issues at all: no pain, no constipation, no bloating, no soft stool or diarrhea, perfect Bristol Stool chart #3 or 4 stools with a clean wipe. That’s almost non-existent, because we’ve all taken antibiotics, we’ve all eaten a standard American diet, we’ve all taken NSAIDS or other prescriptions meds, we’ve all been subjected to a medical system that doesn’t focus on root causes. So if you take nothing else from this article, please take the information that almost everyone has gut issues of some sort, so if you’re experiencing stigma, much of it may be perceived and internalized but may not be experienced.

But I don’t want to underplay experienced stigma, as experienced stigma is real. So let’s talk a bit about it.

One study on IBS found that co-workers and employers were the greatest source of stigmatization, followed by health care providers and friends.

Stigma can result from

• Being reluctant to tell others that you have a gastrointestinal condition.
• Being unable to fulfill your expected role in a relationship.
• Being unable to fully participate in daily life, work and social activities.
• Lack of awareness and knowledge about your condition in the general public.
• Lack of awareness or even belief in your condition among allopathic, or traditional medical doctors (particularly with conditions like SIBO, candida or dysbiosis).
• A perception that your condition isn’t taken seriously, which is much more prevalent with conditions like IBS where there’s no physical evidence of a problem than with conditions like IBD.
• And finally, stigma can come from other people’s perceptions that your condition is self-inflicted or all in your head or being used as an excuse to get out of doing things, which is again the case more with IBS than IBD.

It’s important to identify and address stigma, because the research on perceived stigma in IBS and IBD shows that it negatively impacts clinical outcomes, including increased depression and anxiety, lower quality of life, and reduced self-esteem and reduced self-efficacy (or the ability to advocate for yourself). Internalized stigma in both conditions is associated with an increase in health care utilization and reductions in health-related quality of life, psychological functioning, and perception of health competence. And again, perceived stigma is greater with IBS, with IBS patients showing more perceived stigma from their health care providers than patients with IBD. As a result, 40% of people with IBS reported choosing self-care after being dissatisfied with their health care provider, which is a shame because often working with a functional medicine provider in conjunction with your allopathic provider can give you access to tests and drugs that can be paid for by insurance and may be quicker or more effective in treating your condition.

And if you’re someone who doesn’t have a gastrointestinal condition and you don’t fully realize how debilitating it can be, read this:

• In a global survey of 1,966 individuals who suffer from IBS, on average patients surveyed said they would give up 15 years of their life to live symptom free.
• In another multi-continent survey involving a little over 500 people who suffer from IBS, 11% agreed that when their symptoms were at their peak, they often wished that they were dead.

Let’s talk about the different domains where gastrointestinal issues can cause stigma. As I mentioned, one study on IBS found that most patients felt most stigmatized by their employers and co-workers, followed by their doctors and friends.

Work

If you have been struggling at work, it’s best to have an honest, straightforward conversation with your supervisor or HR department about your condition and see if there are accommodations they can give you, like the ability to work from home when having a flare. It’s better to be honest about your condition than have them think you’re unreliable.

If your workplace has 15 or more employees, you have a diagnosed illness like IBD or IBS and your symptoms significantly impact on a major life ability, your condition should be a covered disability under the Americans with Disabilities Act (ADA). The ADA requires your employer to provide you all the usual work-related opportunities including hiring, promotions, salary, raises and training opportunities and to make “reasonable accommodations” to the limitations of the disabled individual, as long as these accommodations do not result in “undue hardship”. You can look at the ADA legislation to understand more what reasonable accommodations are.

If finances have been an obstacle in getting the care you need from a functional medicine provider, you might ask your employer for assistance in covering the costs of tests or special care, because they’re already paying a lot if your condition is causing you to miss work or meetings or spend a lot of time in the bathroom. It might help to be armed with statistics for your condition, like the ones I found on IBS – that at least one third of employees with IBS miss an average of one day of work per month due to their IBS symptoms and they have 15-21% greater loss in work productivity because of gastrointestinal symptoms than employees without IBS. Also, IBS is the second leading cause, behind the common cold, of workplace absenteeism. So getting you the help you need to is in their best interests.

Also, there is something called EFundYourHealth that will match any money you raise to cover the cost of your functional or alternative medicine care. Your medical provider will have to set up a fundraiser for you and give you a code to get in, then you can ask friends and family to help contribute and they will match up to $250. I have an account set up with them and can give you a code to get started if you’re working with me.

Doctors

If you feel like you’re being stigmatized by your doctor because of your condition or your reaction to your care, it may not be about you. It may be about the fact that your doctor doesn’t have a solution for your problem and that makes them self-conscious or insecure about their inability to help you. I’ve heard from doctor friends that gastroenterologists would love to pawn off their IBS cases on someone like me because they don’t know what to do with them.

Second, I can tell you that it is important to advocate for yourself with healthcare providers, but I myself know what it’s like to be in a doctor’s office these days. Your provider has about 7 minutes to spend with you and most don’t want to take the time to talk in depth about your situation or hear about what you’ve heard in a podcast or on the internet. And you probably don’t want to sound like a crazy person asking about something that isn’t evidence-based or isn’t the “standard of care”. And honestly, your allopathic doctor isn’t really free, from a liability standpoint, to give you anything that doesn’t fit in with the standard of care. Plus, most doctors won’t order a test whose results they don’t know what to do with. So keep that in mind if you’re requesting microbiome stool sequencing or Organic Acids Testing, for example, from a doctor who’s never seen those tests before. To some extent, you have to understand the limits that an allopathic doctor’s knowledge and scope of practice impose on them. If you want to take a non-pharmaceutical and functional medicine approach to your treatment, you will likely need to seek out a functional medicine provider, which includes functional medicine MDs, naturopaths, a chiropractor who practices in gut health as well, a functional nutritionist or a health coach like me who specializes in gut health.

These types of practitioners don’t typically take insurance (although some people are able to pay with their FSA or HSA) but they will be able to spend much more time with you, will not stigmatize you for your condition, will take your complaints and ideas seriously and will offer natural methods of healing, including changes to diet, lifestyle and the use of herbal medicines.

But an allopathic physician can be a good partner in ordering tests like nutrient deficiency tests, for example, that are usually covered by insurance. And depending on your policy, you may have some out of network coverage for other lab tests if ordered by an MD, so it’s always worth checking whether your doctor will order the test for another practitioner to interpret. My approach with my own gut and autoimmune health is to find a general practitioner who’s willing to order tests for me if I know what to do about the results.

But in the end, you know your illness better than anyone and if you don’t advocate for yourself, no one will. You have to take responsibility for finding solutions or possible solutions to your problem. If your provider isn’t solving your problem and isn’t open to tests or medications you suggest (or even can provide peer-reviewed evidence to support), and/or you feel stigmatized by your provider, it may be time to transfer your medical care elsewhere. I used NextDoor.com to ask neighbors about providers that are open to integrative or alternative medicine. You can also choose, at your own expense of course, to talk with the doctor for the length of an appointment about their approach to medicine and their willingness to order tests for you or try non-traditional approaches. Or talking to a nursing assistant over the phone may also be a way to find out more about the doctor. But you shouldn’t have to put up with stigma at the doctor’s office.

Personal Relationships

A study done in 2014 found that more than half of the participants with IBS felt that they were treated differently by peers, family, friends and colleagues due to their diagnosis.

While this article is not just about IBS, for people with IBS in particular, whether it’s been diagnosed or not, because there aren’t physical signs of disease in your intestines, stigma may come from loved ones or peers who think it’s all in your head or being used as an excuse to get out of activities and events. And the reality is that IBS is linked to a dysfunction between the brain and the intestinal nervous system, so in some sense, it is in your head, but that doesn’t mean it’s any less real and that’s not the same as it being psychosomatic. And as a result of the connection between the gut and the brain via the vagus nerve, stress can manifest in your gut and gut issues may be caused by your brain. And if you didn’t listen to my podcast #20 with Corey Deacon, you should listen to that episode because he talks a lot about the gut brain connection, how it’s measured, and how to fix gut problems that originate in the brain due to incorrect electrical signals.

Again, talking about your gut condition with friends and family may help to reduce psychological stress and improve relationships, because it will help people understand why you may have to be absent from activities, may be less reliable that you’d like, and it may lessen your feelings of isolation. And who knows, someone you tell may have gut issues of their own. Positive relationships can be hugely helpful when it comes to managing symptoms and helping you out when you’re having a flare with transportation, child care or errands, or for a colleague, covering for you at work.

But if you find that the person you’re sharing with does not take you seriously or treat you with kindness, that may not be a person that’s good for you right now. You have a right to be taken seriously, believed, and be treated with kindness and compassion.

So if you’re a loved one of a person with gut issues – here are some key pointers for you:

• Let your friend, romantic partner or family member know that you think they’re brave for confiding in you. It takes a lot of guts to talk about this kind of stuff.
• If they’re in pain, ask them if there’s anything you can get for them, or offer to leave so that they can rest.
• Tell them that they have nothing to be embarrassed about and what they’re going through is not their fault.
• Ask them if it’s okay to share about their condition with other people before doing so.
• If you hear or see someone else making jokes at their expense (like for spending a long time in the rest room for example), defend them. Let the person know that their comments are inappropriate and that your friend/family member/colleague suffers from a gastrointestinal disorder and those types of comments are not acceptable (if they gave you permission to share about it).
• Offer to go with them to a doctor’s appointment if they have been feeling like they are not being heard by their physician and be a moral support.
• Encourage them to confide in you when they’re feeling down; the psychological impact of having IBS or other gastrointestinal issues are real.
• Help to educate other people in your life about their condition, especially mutual friends or colleagues who may not know what it is.
• If they’re unable to follow through on plans due to a flare, don’t pressure them to come and don’t make them feel guilty. They probably already feel bad about cancelling. Just let them know that you understand, and offer your support if they need anything.
• If you are planning to go out, make sure there are bathrooms available.
• Gut health issues are often lifelong battles with periods where you loved one is better and periods where they are worse. Don’t blame or insult them for being in a worse period or going down rabbit holes or trying anything, including a million different supplements to solve their problem; if you had a similar problem, you’d do the same.
• Don’t tell them it’s all in their head or psychosomatic. This feels condescending. If you suspect their condition is related to stress, rather, point them to stress management techniques that may be useful. But ask more questions, give fewer answers.
• It’s not your responsibility to solve their problem. If they ask for your help, give it, but otherwise, just listen compassionately, reflect their pain and emotions back to them (“I hear you, you’re feeling really down right now because you can’t make it to the party”), but don’t try to troubleshoot their problem unless they’ve asked for your help.
• Support their dietary restrictions – this is what helps them avoid flares. Don’t tempt them with foods that cause a flare. Talk to them about their greatest temptations and if there are foods they really don’t want eaten around them that are too tempting to resist but will cause a flare.

Finally, talking to a new romantic partner may be the most tricky, so here’s some advice:

• Take it in baby steps, this can happen over multiple conversations.
• Explain to them about your condition and how it affects your life.
• You don’t have to tell them all the gory details of your symptoms and toilet habits when you’re just getting to know one another.
• Share how it makes you feel (not sexy, bloated, nauseous, needing to be near a bathroom).
• If you’re intimately involved, share how it can impact your libido (not feeling sexy, pain, need to use the toilet, fear of accidents) and if there are better times of day to be romantic – like first thing in the morning rather than after dinner.
• Make sure your partner’s ego isn’t impacted (people’s egos are tightly tied to their feeling sexually desirable) by explaining that it isn’t about them and is just that you’re having a flare. Make sure they know you still find them sexy and desirable but just aren’t in a physical place yourself to be intimate.

In sum, life is messy, being honest and open is more likely to lead to closeness and intimacy than hiding. You deserve a romantic partner who shows you compassion and support for your condition, so don’t settle for less.

And some pointers on stigma around food and special or restricted diets:

• If you’re eating out (when that becomes possible again) or ordering take out, pick the restaurant if possible.
• Check the menu and call ahead to the chef to make sure they understand how serious your diet issues are.
• If you’re cooking/eating at home, you can make bulk quantities of gluten-free or non-grain side dishes (like pasta, quinoa, rice, riced cauliflower, etc.). If another person cooking doesn’t want to eat gluten-free, they can just pull out some of your pre-cooked side dishes or base starch, then add the other ingredients to it for you.
• Batch-cooking and freezing meals so you can eat your own thing can also be helpful.

I hope that those pointers for dealing with stigma with others are helpful.

So finally let’s talk about internalized stigma you may be experiencing. Think for a second about these questions:

What are the messages you send yourself about your condition?

What are the words you tell yourself about your health, your ability to participate in work and activities, your future prospects?

Now imagine a child who’s totally innocent and has the same condition. What would you say to that child? Are you being as kind yourself as you would be to that child? Because you should be, you should give yourself the same kind kindness and compassion, even if you messed up and ate something you shouldn’t have, for example, as you would that child.

Are you taking time to care for yourself or are you still trying to put everyone else’s needs first? It’s like the oxygen mask: you have to put your own on before taking care of others’. That means you have to take the time to practice self-care, which may mean exercise, relaxation activities, meditation, yoga, and practices that reduce stress because stress is a real, concrete factor in bowel issues, and research shows that exercise and stress reduction are essential components of healing.

And stop feeling like you’re a bother. You have to speak up and advocate for your own needs, in your relationships, at work, at the doctor’s office, you can’t let the opinions of others keep you from living your best life and getting better.

And finally remember, what you’re going through now is not going to last forever. Five years from now, if you keep searching, keep trying and keep advocating for yourself, most likely this will all be a distant memory. So don’t lose hope. There is always a path to healing and you will find it. You are enough, and you are good, and you need to love yourself through this challenging experience.

And if you want help with your gut issues, you can make a free, 1-hour Breakthrough Session appointment with me to talk about it.

My last podcast with Lucy Mailing, PhD shed light on a new theory to describe the process of gut dysbiosis that may be responsible for many different symptoms and diagnoses in the gut. This has impacted the education I am sharing with my clients in helping them heal their guts. Read excerpts of our interview below (edited for readability).

So let’s get to the main topic, the oxygen-gut dysbiosis theory. Tell me about the theory and the research today that supports it.

So first I saw a talk done by Dr. Sean Colgan at Experimental Biology Conference and essentially learned that butyrate is essential for the gut barrier. Most people know that, but it actually also helps to maintain hypoxia or a very low oxygen environment in the gut. So a healthy colon, large intestine, is virtually devoid of oxygen. It’s a very low oxygen environment, also known as anaerobic. And what happens is that anaerobic environments select for certain healthy bacteria. And what happens when we have gut inflammation is that the epithelial cells, the cells that line the gut, start to become inflamed and they start to leak oxygen into the gut. And when this happens, a lot of opportunistic pathogens like E. Coli, Salmonella and Enterococcus really like that oxygen, and they can use it to outcompete some of the beneficial microbes. So that oxygen leakage is really what is driving the dysbiosis.

And in fact, we do see this pattern across different chronic diseases: the most common pattern among all the dysbiosis that’s been observed is that there’s this overgrowth of facultative anaerobes, meaning microbes that can use oxygen when it’s present, and they do this at the expense of the beneficial microbes, including a lot of those butyrate producers that are so important for maintaining the gut barrier.

And what are some of those species or genera or phyla of beneficial butyrate producers?

I can name a few: Lachnospiraceae is one, Clostridia, a number of different Clostridia produce butyrate, Eubacterium, Roseburia. So there’s a number of different genera and families of butyrate producing bacteria, and essentially these are crucial to maintaining the health of that gut barrier because we if don’t have those butyrate producers, then we’re not getting an abundance of butyrate to fuel the epithelial cells and maintain them in a healthy state.

And so what is the result of that oxygenation and then the increase in these facultative anaerobes?

So just generally the facultative anaerobes tend to be much more inflammatory, so they tend to stress the gut, cause inflammation, intestinal permeability, and are also directly inflaming the gut epithelium. And what’s really interesting is that their inflaming the gut epithelium then leads to more oxygen produced in the gut. So it’s almost like these pathogens can hack our gut metabolism to feed themselves the substrates that they need to survive. And then it becomes a vicious cycle and they start to expand.

Right. And these are all typically from the phylum proteobacteria?

Yeah, most of them are in the phylum proteobacteria; that’s the most common that’s seen. And particularly the family Enterobacteriaceae is the most common to expand in this condition of increased oxygen leakage.

And more from our conversation on gut stool testing using metagenomics:

There’s a couple: Onegevity and Sun Genomics are two that I’ve explored. I’m liking Onegevity the best right now because they also allow you to download the raw data and then you can kind of parse through that as well. So that’s what I’m using currently. I was using uBiome, which was really great for 16s [a different form of gut microbiome testing] and you know, a lot less expensive. They’re totally gone now, so it’s not an option. So I haven’t found another 16s that I feel is reliable. So I’ve typically recently gone to the metagenomics instead . . . metagenomics is taking all of the genes in the sample and sequencing all of them and then matching them back up to databases so we can get down to the genus species and strain level and typically do so with a greater degree of accuracy.

And will Onegevity tell you your breakdown of these big phyla?

Yeah. Onegevity does show the phyla breakdown. They also show your butyrate-producing capacity, which is pretty cool. And they do have a brief pathogen screening profile. I’m hoping that they’re going to be expanding that soon.

And do they include fungi?

They do include fungi, yeah. At least in the raw data. I’m not sure how much they report in the visual reports at the moment.

And parasites or viruses or anything like that?

So they will detect them with the metagenomics, whether some of them will pop up on the visualization report that they give you. Some of them you might have to find in the raw data. So for example, things like Blastocystis hominis that are a little bit more, is it parasite, is it not, will be in the raw data, but wouldn’t necessarily show on what they choose to report at the moment, at least.

So let’s go back to my ridiculous potential overabundance of proteobacteria. And if I look at some of these great anaerobic butyrate producers, and in my reports, I got none of them. So other than doing a fecal transplant, is there any way I can get them back into my system?

So the question is, do you actually not have them or are they just at such low abundance that they weren’t detected by 16s? And I would guess since you’re relatively healthy and talking to me, my guess is that they’re there. They’re just not at as high of abundance as they could be or are maybe even not high enough abundance to be detected with 16s, especially if it was skewing with the proteobacteria. Some of the butyrate producers may have also come back lower than they should have, but essentially, you know, there’s a number of things that you can do too even if the bacteria have gone down to really low abundance. Improving the health of your gut and your diet will essentially help them to reflourish.

So the gut really is quite resilient. There are certainly instances where your butyrate producers could go completely extinct. And in that instance, the only way to get them back would be to do a fecal microbiota transplant. But for most people, if you’ve got low butyrate producers, it is possible to shift the ecosystem back to just allow those to flourish and become more abundant.

And how do you do that?

So I think the, the first step is really just to make sure you have the basic health behaviors in place. We can talk about all kinds of advanced gut interventions, but if you don’t have the basic, you know, healthy diet, exercise, sleep and stress management cupboard, then all the fancy gut treatments, advanced therapies are not going to move the needle nearly as much as any of those things. So that’s kind of the first step. And honestly, that will shift the microbiome quite a bit back in the right direction.

Any particular aspect of a healthy diet, since obviously so many people define that differently?

Yeah. I think the truth is we don’t exactly know what the best diet is for the gut microbiome, and I don’t think that there is one best diet for the gut microbiome. Everyone’s microbiome is different, and some people, you know, may respond really well to a ketogenic diet, whereas other people might do better with a diet that includes more plant foods. So generally I just talk about focusing on whole foods and making sure that you’re getting processed foods and refined sugars out of your diet for sure.

After that, it really is personal experimentation. And if your gut is really inflamed, then it might be beneficial, like I said earlier, to do a short term more hypoallergenic diet, like the autoimmune protocol, to remove some of those more inflammatory foods, at least for a time to facilitate that healing. Because healing, bringing down inflammation, is going to essentially stop that oxygen leakage, which is driving the dysbiosis.

And what about the role of fiber in there?

Yeah, so fiber can be really beneficial for some people, but for other people it’s just going to exacerbate inflammation. So it’s kind of nuanced. Again, fiber does seem to be important in some people and is a good way to increase production of butyrate. But something we haven’t really touched on yet is that in a ketogenic diet, even if you’re not getting quite as much fiber, you are getting beta hydroxybutyrate, which is one of the primary ketone bodies produced in the liver, and it can actually eat into the same pathway in the gut that fulfills.

So what if you had this typical overabundance of proteobacteria and oxygen dysbiosis thing going on? What would be the typical symptoms of that?

It really can manifest in a lot of different ways. So we’ve seen that basically this microbial signature of high proteobacteria and low butyrate producers is found across a wide range of different diseases: inflammatory bowel disease, irritable bowel syndrome, colorectal cancer. But even type 2 diabetes, obesity, psoriasis.

Okay, so you wouldn’t necessarily say, well, people like this typically tend towards diarrhea or less formed stool versus constipation?

No, not necessarily. Although I will say that I see it a lot in my clients that have persistent bloating and abdominal distension. That’s a very common one that I see, but it’s also probably skewed based on my client population.

And so in your article that you wrote about all this, you suggested the supplemental butyrate might be something that would turn around this state of dysbiosis. Can you talk a little bit about that?

Yeah, definitely. And I should say, I don’t think that supplemental butyrate alone will necessarily be able to overcome this dysbiosis. So I outlined a number of different things, both diet and lifestyle factors, and  supplemental things that could be useful in trying to prevent oxygen leakage into the gut and kind of shift back to a state of homeostasis, butyrate being one of those things though that’s really important. So essentially what’s going on is the oxygen leakage is happening partly because the epithelial cells that line your gut are starved for energy. And when they’re starved for energy, they’re not metabolizing butyrate if they don’t have it. So what they do instead is pull glucose from the bloodstream, and essentially this ferments to lactate, and that lactate leaks into the gut, in addition to the oxygen that is normally used through the metabolism of butyrate. So it’s really the fact that there’s not butyrate present, and that’s what means that the oxygen that’s flowing into epithelial cells from the blood doesn’t get used. And that’s when it ends up spilling out into the gut lumen and feeding the pathogens.

So essentially providing supplemental butyrate will mean that you’re providing the energy that the epithelial cells prefer. They’ll use more oxygen as part of their metabolism of that butyrate and won’t need to do this, essentially, anaerobic glucose fermentation. That’s going to produce lactate and end up not using up the oxygen, meaning that oxygen and lactate will leak into the gut and feed Salmonella, Enterobacteriaceae, and a number of those different proteobacteria. . . But when we’re talking about things like supplemental butyrate, or I even talked about in my article, the use of mesalamine, which is actually a pharmaceutical treatment for inflammatory bowel disease that I could think could be beneficial in some cases of severe dysbiosis. I’m certainly not recommending that to the average person trying to improve their gut health. I’m really recommending that when we’ve gone beyond the typical interventions.

Well I know we are running out of time, but I have one last question because you’ve mentioned glutamine, so is L-glutamine something you frequently supplement with or suggest people supplement with?

Occasionally. It really depends on the case. It has been shown to be beneficial in IBS, in randomized control trials. Typically that’s a dose of five grams given two, three times a day. So in some people, yes. I am a little bit more cautious in people who might have autoimmunity, because glutamine can stimulate the immune system, so it really is more of a case by case basis, whether I’ll recommend glutamine. And of course there’s plenty of ways to get glutamine from our diet. If you tolerate bone broth, broth is a great source of glutamine, as are a lot of those other messy animal parts.

And I didn’t ask about this, but what kind of dosages are you thinking about with the butyrate supplementation?

With butyrate, I think it’s really important to be using a dose that is more of a physiologic concentration. So a lot of butyrate salts out there, sodium butyrate, calcium butyrate, magnesium butyrate, you can buy are suggesting like a five gram dose. I prefer to use smaller doses and those that are more targeted to the colon. Again, I’m not a licensed practitioner, but in the evidence in reviewing the literature, it seems that lower doses of butyrate can be beneficial for healing the mucosa, whereas large, massive doses of butyrate might actually inhibit STEM cell proliferation in the gut and prevent wound healing. So I think butyrate supplementation is great in a lot of different conditions, but it needs to be done in a way that’s more mimicking the concentrations of butyrate that we would be getting if we had a healthy microbiome that was producing butyrate.

Listen to the whole podcast on your favorite app.

If you’re suffering from gut health issues and traditional routes have not yet brought you relief, I offer free, 1-hour Health Restoration Breakthrough Sessions to share about your struggles and learn how health coaching with me could help.

I know this is a scary time for lots of people who are concerned about their health or concerned about loved ones who are older, immunocompromised or in otherwise fragile health. My parents are in their late 70’s and I’m definitely concerned for them.

To help alleviate my concern and give all of our bodies some tools for preventing and fighting viral infections, I ordered myself and my parents these herbal medications. I wanted to share them with all of you too so you could protect yourselves and your loved ones.

If you’d like to see the white papers describing the scientific evidence backing up the Biocidin/Olivirex products, I can send you those – just send me an email. Here are a couple of studies on monolaurin, the active ingredient in Lauricidin: In Vitro Effects of Monolaurin Compounds on Enveloped RNA And DNA Viruses and Effect of antimicrobial factors in human milk on rhinoviruses and milk-borne cytomegalovirus in vitro.

Disclaimer: None of the statements below have been evaluated by the FDA; some of the links are to my affiliate accounts for these products/Fullscript dispensary for which I receive affiliate commissions.

Antiviral Throat and Nose Spray Options (prevention while going out or also for use if infected)

Biocidin Throat Spray (available in my Fullscript Dispensary – you have to set up an account to order – or buy from Bio-Botanical Research directly but do compare prices!) A great throat spray to stop sore throats in their tracks, kill viruses and bacteria and increase secretory IgA (your antibodies in mucus-lined parts of your body that kill invading pathogens).

Beekeeper’s Naturals Propolis Throat Spray – an alternative throat spray option. This is the antiviral, antibacterial and antifungal substance bees make and use to line the interior of their hives.

Biocidin Nasal Spray – you have to make this yourself using Biocidin Broad Spectrum Liquid Formula or Biocidin LSF Liposomal Formula Liquid available from my Fullscript Dispensary. Add 8-12 drops of Biocidin Broad Spectrum Liquid or 1-2 pumps Biocidin LSF to a 1 oz bottle prepared saline solution nasal spray (some common drugstore brands have removable tops or you can pry the top off with pliers). Use several times a day until improvement is seen or as a preventative/post-contamination or while going out. Good for sinus infections too and sinus infections post dental surgery on upper teeth.

Immune Supportive and Antiviral Supplements

Biocidin LSF Liposomal Formula Liquid – antiviral herbal combo supplement  – available from my Fullscript Dispensary.  If you’re well now, titrate up slowly per the instructions included and stop if you have any die-off (Herxheimer) reactions until they’ve passed (sudden flu-like symptoms). Don’t increase your dose during die-off reactions. [You can also use GI Detox (also available on Fullscript) or activated charcoal to help absorb die-off by products. Take 2 hours after taking this medication.] Titrating up slowly will prepare your body to be able to handle it when you need it. When you get to the maximum dose and can tolerate it, stop and hold onto the liquid until you actually need it. If you’re already sick, titrate up slowly per instructions. If you’re acutely sick, consult with your doctor before taking and/or if you have an acute reaction. It can also be used to shorten the duration or severity of other viruses like colds and flu.  

Olivirex – olive leaf extract combo herbal antiviral supplement – available from my Fullscript Dispensary. If you’re well now, titrate up slowly per the instructions included and stop if you have any die-off (Herxheimer) reactions until they’ve passed (sudden flu-like symptoms). Don’t increase your dose during die-off reactions. [You can also use GI Detox (also available on Fullscript) or activated charcoal to help absorb die-off by products. Take 2 hours after taking this medication.] Titrating up slowly will prepare your body to be able to handle it when you need it. When you get to the maximum dose and can tolerate it, stop and hold onto the capsules until you actually need them. I’d get 2-3 bottles to store until needed. It can also be used to shorten the duration or severity of other viruses like colds and flu. If you’re already sick, titrate up slowly per instructions. If you’re acutely sick, consult with your doctor before taking and/or if you have an acute reaction.

Lauricidin – highest dosage monolaurin supplement available – antiviral, antifungal and immune supportive. If you’re well now, titrate up slowly per the instructions included and stop if you have any die-off (Herxheimer) reactions until they’ve passed (sudden flu-like symptoms). Don’t increase your dose during die-off reactions. This will prepare your body to be able to handle it when you need it. When you get to the dose of 1 scoop 3 times/day and can tolerate it, stop and hold onto it until you need it, or continue taking as an immune system support. One bottle lasts around one month. If you’re already sick, titrate up slowly per instructions. If you’re acutely sick, consult with your doctor before taking and/or if you have an acute reaction.

You can email me if you have any questions about purchasing or using these products. I’m happy to help.

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