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

Lindsey:

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

Martha Carlin:

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

Lindsey:

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

Martha Carlin:

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

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

Lindsey:

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

Martha Carlin:

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

Lindsey:

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

Martha Carlin:

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

Lindsey:

Interesting. So it was like hardened concrete?

Martha Carlin:

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

Lindsey:

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

Martha Carlin:

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

Lindsey:

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

Martha Carlin:

Exactly!

Lindsey:

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

Martha Carlin:

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

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

Lindsey:

And what were these proteins related to Parkinson’s?

Martha Carlin:

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

Lindsey:

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

Martha Carlin:

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

Lindsey:

And so that probiotic, did that become a product?

Martha Carlin:

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

Lindsey:

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

Martha Carlin:

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

Lindsey:

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

Martha Carlin:

I think it was a 14% decline in HbA1c.

Lindsey:

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

Martha Carlin:

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

Lindsey:

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

Martha Carlin:

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

Lindsey:

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

Martha Carlin:

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

Lindsey:

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

Martha Carlin:

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

Lindsey:

And were there?

Martha Carlin:

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

Lindsey:

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

Martha Carlin:

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

Lindsey:

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

Martha Carlin:

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

Lindsey:

If they’re not organic?

Martha Carlin:

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

Lindsey:

And what’d they say?

Martha Carlin:

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

Lindsey:

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

Martha Carlin:

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

Lindsey:

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

Martha Carlin:

Yes, I believe so.

Lindsey:

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

Martha Carlin:

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

Lindsey:

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

Martha Carlin:

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

Lindsey:

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

Martha Carlin:

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

Lindsey:

So do you avoid those foods?

Martha Carlin:

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

Lindsey:

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

Martha Carlin:

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

Lindsey:

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

Martha Carlin:

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

Lindsey:

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

Martha Carlin:

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

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

Martha Carlin:

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

Lindsey:

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

Martha Carlin:

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

Lindsey:

Was it a Visbiome or a VSL#3?

Martha Carlin:

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

Lindsey:

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

Martha Carlin:

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

Lindsey:

Okay, so now how many formulations do you have?

Martha Carlin:

We have five and then the yogurt starter.

Lindsey:

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

Martha Carlin:

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

Lindsey:

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

Martha Carlin:

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

Lindsey:

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

Martha Carlin:

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

Lindsey:

And you can set the temperature on that one?

Martha Carlin:

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

Lindsey:

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

Martha Carlin:

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

Lindsey:

Any particular reuteri?

Martha Carlin:

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

Lindsey:

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

Martha Carlin:

We use one called PCR7 from Pure Cultures.

Lindsey:

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

Martha Carlin:

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

Lindsey:

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

Martha Carlin:

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

Lindsey:

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

Martha Carlin:

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

Lindsey:

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

Martha Carlin:

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

Lindsey:

Was it commercial coconut milk?

Martha Carlin:

I used organic Thai coconut milk.

Lindsey:

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

Martha Carlin:

Yes.

Lindsey:

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

Martha Carlin:

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

Lindsey:

Oh, wow.

Martha Carlin:

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

Lindsey:

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

Martha Carlin:

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

Lindsey:

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

Martha Carlin:

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

Lindsey:

Better diarrhea than constipation basically!

Martha Carlin:

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

Lindsey:

Right.

Martha Carlin:

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

Lindsey:

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

Martha Carlin:

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

Lindsey:

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

Martha Carlin:

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

Lindsey:

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

Martha Carlin:

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

Lindsey:

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

Martha Carlin:

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

Lindsey:

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

Martha Carlin:

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

Lindsey:

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

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

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

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

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

Yeah.

Dr. Katie Lee:

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

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

So Pg stands for…

Dr. Katie Lee:

Porphyromonas gingivalis.

Lindsey:

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

Dr. Katie Lee:

Yes, yeah, very similar.

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

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

Dr. Katie Lee:

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

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

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

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

Dr. Katie Lee:

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

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

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

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

Dr. Katie Lee:

Yeah, to treat the Fn infection?

Lindsey:

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

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

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

Lindsey:

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

Dr. Katie Lee:

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

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

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

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

Dr. Katie Lee:

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

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

Lindsey:

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

Dr. Katie Lee:

Did he get it on the internet?

Lindsey:

Yes.

Dr. Katie Lee:

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

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

Interesting.

Dr. Katie Lee:

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

Lindsey:

Wow. Okay. Sounds like serious business.

Dr. Katie Lee:

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

Lindsey:

Yeah. And snoring is a sign of it.

Dr. Katie Lee:

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

Lindsey:

Okay. Got it.

Dr. Katie Lee:

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

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

Interesting.

Dr. Katie Lee:

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

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

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

Dr. Katie Lee:

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

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

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

And that can take the place of it?

Dr. Katie Lee:

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

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

Yes.

Dr. Katie Lee:

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

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

As a probiotic?

Dr. Katie Lee:

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

Lindsey:

Okay.

Dr. Katie Lee:

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

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

Really?

Dr. Katie Lee:

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

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

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

Dr. Katie Lee:

Totally. Yeah, very, very common.

Lindsey:

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

Dr. Katie Lee:

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

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

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

Not just all processed foods, like eating real food.

Dr. Katie Lee:

Yeah, that’s great. Yeah.

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

Okay, cool.

Dr. Katie Lee:

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

Lindsey:

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

Dr. Katie Lee:

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

Lindsey:

Awesome, well, thank you so much.

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

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

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

Lindsey:  

Welcome to the podcast Damiana!

Dr. Damiana Corca: 

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

Lindsey:  

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

Dr. Damiana Corca: 

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

Lindsey:  

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

Dr. Damiana Corca: 

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

Lindsey:  

And those are clear now?

Dr. Damiana Corca: 

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

Lindsey:  

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

Dr. Damiana Corca: 

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

Lindsey:  

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

Dr. Damiana Corca: 

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

Lindsey:  

So that was the H Pylori.

Dr. Damiana Corca: 

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

Lindsey:  

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

Dr. Damiana Corca: 

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

Lindsey:  

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

Dr. Damiana Corca: 

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

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

Lindsey:  

Do you want to go into the other types?

Dr. Damiana Corca: 

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

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

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

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

Lindsey:  

And how are you testing neurotransmitters?

Dr. Damiana Corca: 

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

Lindsey Parsons 

Like a Dutch test or OAT?

Dr. Damiana Corca: 

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

Lindsey:  

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

Dr. Damiana Corca: 

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

Lindsey:  

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

Dr. Damiana Corca: 

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

Lindsey:  

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

Dr. Damiana Corca: 

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

Lindsey:  

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

Dr. Damiana Corca: 

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

Lindsey:  

Oh, yeah. Especially.

Dr. Damiana Corca: 

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

Lindsey:  

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

Dr. Damiana Corca: 

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

Lindsey:  

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

Dr. Damiana Corca: 

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

Lindsey:  

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

Dr. Damiana Corca: 

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

Lindsey:  

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

Dr. Damiana Corca: 

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

Lindsey:  

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

Dr. Damiana Corca: 

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

Lindsey:  

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

Dr. Damiana Corca: 

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

Lindsey:  

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

Dr. Damiana Corca: 

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

Lindsey:  

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

Dr. Damiana Corca: 

Of course, yeah. I can understand that.

Lindsey:  

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

Dr. Damiana Corca: 

Yes, I do.

Lindsey:  

Like tryptophan?

Dr. Damiana Corca: 

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

Lindsey:  

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

Dr. Damiana Corca: 

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

Lindsey:  

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

Dr. Damiana Corca: 

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

Lindsey:  

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

Dr. Damiana Corca: 

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

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

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

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

Lindsey:  

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

Dr. Damiana Corca: 

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

Lindsey:  

That’s an interesting technique.

Dr. Damiana Corca: 

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

Lindsey:  

Where you don’t allow yourself to nap.

Dr. Damiana Corca: 

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

Lindsey:  

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

Dr. Damiana Corca: 

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

Lindsey:  

I feel like I’ve heard three degrees.

Dr. Damiana Corca: 

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

Lindsey:  

So three would be a lot.

Dr. Damiana Corca: 

Exactly. It has to be less.

Lindsey:  

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

Dr. Damiana Corca: 

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

Lindsey:  

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

Dr. Damiana Corca: 

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

Lindsey:  

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

Dr. Damiana Corca: 

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

Lindsey:  

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

Dr. Damiana Corca: 

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

Lindsey:  

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

Dr. Damiana Corca: 

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

Lindsey:  

I haven’t.

Dr. Damiana Corca: 

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

Lindsey:  

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

Dr. Damiana Corca: 

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

Lindsey:  

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

Dr. Damiana Corca: 

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

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

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

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

Lindsey:  

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

Dr. Damiana Corca: 

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

Lindsey:  

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

Dr. Damiana Corca: 

Sleep supplement or sleep medication?

Lindsey:  

Medication, not prescription though.

Dr. Damiana Corca: 

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

Lindsey:  

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

Dr. Damiana Corca: 

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

Lindsey:  

I believe so, yeah.

Dr. Damiana Corca: 

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

Lindsey:  

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

Dr. Damiana Corca: 

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

Lindsey:  

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

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

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

Adapted from episode 120 of The Perfect Stool podcast with Jenn Trepeck, Optimal Health Coach and host of the podcast Salad with a Side of Fries, and Lindsey Parsons, EdD, and edited for readability.

Lindsey: 

So let’s start by talking about how stress can be at the root of gut health conditions and how that works.

Jenn Trepeck: 

Yeah! So I feel like taking a step back; we have to understand stress in the body. Not all stress is the problem. There’s eustress or quality stress, good stress. That’s what helps us get out of bed in the morning. That’s important. And then there’s the distress or the stress that really does impact our health in a variety of ways, and we could talk about that in a second. Because the other piece of stress, as a foundation to understand, is the difference between acute and chronic. Acute, like other times when we use acute and chronic with different conditions, right? Acute is short length, chronic is all the time. Now the body’s stress response, which many of us remember from growing up, is fight or flight; the fight or flight response of stress is designed to be 20 minutes.

So that age old story of being chased by a saber tooth tiger, right? I don’t know why that’s always the animal. But we’re being chased by the saber tooth tiger, cortisol rises, right? We have this increase in stress and fight or flight. So we run, maybe we hide somewhere, we watch the tiger run past us, our breathing comes back to normal. And now we move on with our lives. So that whole rise and fall of that stress response for survival is supposed to be 20 minutes. Our biology is still that primitive biology. The challenge now is that what causes us stress is not a saber tooth tiger, what causes us stress is our phone buzzing and the alarm clock going on. And an email coming in, or a conversation that we’re anticipating or a conversation that happened already that we’re replaying in our mind. And the challenge is that our biochemistry doesn’t identify the difference between an email and a saber tooth tiger.

And so this stress response that was designed to be 20 minutes, right, acute, is now chronic. Okay, so let’s also take a second to think about what happens in that stress response. Because in that caveman, primitive biology of the rise and fall of the cortisol for survival, because survival is the primary concern, any body function that does not contribute to survival in that moment essentially turns off. So what are those things? Well, our hair and our nails don’t grow, because who cares if you have hair or nails if you’re not going to live the next 10 minutes. Our reproductive system turns off, our metabolism turns off, and our digestive system turns off, which gets to the heart of what you talk about all the time, in terms of gut health. So while there are other systems and functions that turn off, the primary piece to understand here is that when we’re in that stress response, these other body systems turn off because they’re not critical to survival, which is fine if it’s 20 minutes. It’s not fine when it’s all the time.

Therein lies a lot of the things that people are probably experiencing related to stress. We have bloating, we have gastric upset, we have weight gain, we have all of these elements that can be really frustrating. We get that brain fog, because all of these things that would support those proper functions, even our immune system turns off, so maybe you’re getting sick all the time. Or you’re easily susceptible to that common cold or the flu going around. So a lot of these challenges that we don’t necessarily connect to stress really are connected to stress.

Lindsey: 

Yeah it got me thinking about a lot of things like, well so I schedule in my day, a time to check email each day. Well, on a Monday I schedule I think like an hour, on every other day I schedule in half an hour, and I try and make a point, unless I have to send an email, of not checking email in between. I imagine there’s a number of other tricks to keep yourself from getting stressed out about those sorts of things. Although, I have to say there is this panic when I look and I see 50 emails, of course, 45 of them are complete junk. And I can just delete, delete, delete, but I see the 50 emails and I don’t know what’s in there. And there’s this anxiety that immediately comes right.

Jenn Trepeck: 

And the truth is, if only it was just email, yeah, we could probably figure that out. Right? I mean, it’s every text message, every time the phone buzzes and there’s an alert. We don’t know what it is, that unknown in the brain creating possibilities of what it could be triggers the stress response, our alarm clock going off. For most of us the way an alarm clock goes off creates a stress response, versus the caveman biology of the increase in cortisol waking us up for the morning due to the natural increase in cortisol. The trick to all of it is to do some of the things. We can go through a bunch, similar to what you did, right, you created a structure to minimize those hits.

The other thing that we want to do is to create structure and systems that send signals to the body that the stressor has passed. We’ll go through those in a second. The other thing that I want to say on this is also to recognize that even when you don’t feel stressed, the body is having a physiological stress response, whether we realize it or not. And when we don’t do the things that actually complete the stress response, that bring us back down the mountain of that cortisol rise and fall, it’s almost like the body gets stuck at this peak. And then we’re building and building and building and every time something happens, it’s adding to this iceberg. I want you to remember that old motivational poster that had the iceberg and the water level. And it was like most of the iceberg is under the water level. Think of that water level as our perception of stress. Most of what’s happening in the body doesn’t even register to us as stress, yet by creating daily habits that help complete the stress response, that help minimize the body’s response, send signals to the body that the stressor has passed. If we can chip away at that iceberg and then bring the water level down. Does that make sense?

Lindsey: 

Yeah. So what kinds of practices are those?

Jenn Trepeck: 

I love your email example. It’s creating a set time so that even if we see something come in, we know when we’re going back to that, there’s a plan. It allows us to not ruminate. Regular relaxation exercises, that might be yoga. For me, yoga was never my thing. But you know what else works? Laughing right, laughing sends a signal to the body that it’s safe that the stressor has passed. Deep breathing sends a physiological signal to the body that the stressor has passed. So think about if we go back to that saber tooth tiger thing, when we’re running for the saber tooth tiger, our breath is in the chest, right? It’s pretty shallow; think about that panting when you’re running. And then when the tiger has passed, what happens, our breathing slows down, our heart rate slows down, the exhale becomes longer than the inhale. So if we can breathe in such a way that it slows down our heart rate, that it slows down our breath, where the exhale is longer than the inhale, it’s a chemical signal to the body that the stressor has passed, that we are safe, and that we’re good.

Similar to that, actually, gratitude. Complimenting someone else sends signals to the body that we’re safe. Because if we’re able to think about someone else and not focus on ourselves, that only happens when our lives are not in danger. If our life was in danger, we’d only be thinking about our own survival. So little things that we can do. Regular activity helps complete that stress cycle, we have that rise and then the fall. My old Pilates instructor, and old in every way, former and because she was an original student of Joseph Pilates, so she’s like, older than God, one of the things she told me and I don’t know if this is true, but she said it so I believe her, is that the phrase working out came from the idea that we were working the stress out of the body. Again, I don’t know if it’s true, but I like it. So I’m going with it. So any kind of activity that we can do to help the body physically move through that stress response is critically important. Building that into our day. Even if it’s a 10-minute walk. It’s helpful.

Lindsey: 

Yeah, I feel it. Like if I’m sitting, especially if I’m just sitting still all day, which I often am at the computer, like yesterday, and it’s cold out, right? Now I mean, it’s Tucson cold, so it’s not like really cold, like 40 to 50 degrees kind of cold.

Jenn Trepeck: 

Wait, but didn’t you guys have to like cover your plants recently? Like cover the trees?

Lindsey: 

Yeah, we did. I fortunately only have one plant like that in my yard at this point that needs covering. But anyway, yesterday, I just was like, I just got to get out and take a 10 minute walk. Like I knew I wasn’t going to go workout. So I was like, I’ve just got to move my body. And yeah, I felt much better afterwards.

Jenn Trepeck: 

Yea, and the trick is to do those things all the time, even if we don’t feel like it. Because again, remember, we have that iceberg. So the more these things are just built into the day, and we do them even when we don’t realize we’re stressed, we can chip away at that iceberg, because also our metabolism turns off because our immune system turns off, all very gut related. There’s a few things that we want to do. One is, I’m going to talk about the vagus nerve in a second, but the other is choosing carefully those snacks that we have. Because the high cortisol, the stress response is going to create cravings for sugar and caffeine and chocolate and all the things that actually are going to exacerbate all the symptoms. So the more that we could even make sure that we have edamame a some almonds, or a bag of carrots around, some quality snacks with nutrition, protein, fiber, quality fat, having those things around and making those things super easy, making those things easier than the sugar, chips, chocolate, candy. Shift what’s easy. And then again, we’re giving our body some of the things that help it handle this whole process. I mentioned the vagus nerve.

Lindsey: 

Yeah, let’s talk about that and how it relates to gut health and stress and all that.

Jenn Trepeck: 

Yeah. Okay. So vagus nerve is cranial nerve X. And it is the literal nerve that connects the gut and the brain. So what’s really interesting to me about the vagus nerve, so think about it like a five lane highway, three of the lanes go gut to brain, two lanes go brain to gut. So what that means is that we will never out think the chemistry of what we are feeding ourselves. Does that make sense? The more we can fuel with nutrition, the more we can manage the mental side of our mood and our emotions, the more we actually have balanced blood sugar, the more we can use the prefrontal cortex of the brain and not end up in the back of the brain that is all fight or flight. It’s also why it can feel nearly impossible to out think the cravings that we’re having. Vagus nerve, over time, loses its tone. So what we want to do is help stimulate or tone the vagus nerve to strengthen it. And then we’re strengthening that connection and that communication.

One of the best ways to do that is going back to that breathing thing. Any kind of conscious, slow breathing stimulates the vagus nerve. Humming, even talking, but humming even more than talking because it’s more constant than talking. But when you hum, that vibration of the vocal cords stimulates the vagus nerve, as it passes right by there. It’s called the valsalva maneuver, but nobody ever knows the name of it. But it’s the thing that you do when you travel on an aeroplane and your ears are plugged, where you sort of plug your nose, close your mouth, and  breathe out gently. We want to do that valsalva maneuver, that’s what it’s called, stimulates the vagus nerve. So you could do that a couple times. Exercise stimulates the vagus nerve, again, going back to why we want to build these things into our every day. The diving reflex. So this is when you would put your face in ice water for a few seconds. And then come up and take a breath. But you could do that a couple times . . .

Lindsey: 

. . . which is also a good way to boost your dopamine.

Jenn Trepeck: 

Exactly. Yes. And then the other one, and this might be my favorite, is human connection. Human connection lowers stress, right, human connection. Relationships is one of the things that all the blue zones have in common; the parts of the world where people live the longest, and why? Because human connection creates purpose and helps us manage stress. It’s why we like to vent to someone. You know that phrase, misery loves company? It’s actually human nature, we want to share it, sharing it can help us get rid of it. So maybe you’re sharing it with a journal just to get it out of your head. But for that vagus nerve activation, hugging someone really helpful. Having a conversation. Again, it almost goes back to what we were talking about as far as complimenting someone, if we can get out of ourselves, it helps us too. So there are all these tools that we can use. The trick is to have enough of them in your tool belts, and then have systems or things in place so that you actually do them.

Lindsey: 

As you talk about all these things. I just feel like maybe we need to jump back, to why is the vagus nerve relevant to gut health? Like what would be signs that our vagus nerve had lost its tone?

Jenn Trepeck: 

Yeah, it’s all of the same symptoms. It’s indigestion, inflammation, nervousness, sensitivities, digestive challenges and head discomfort or low energy. Maybe you feel like you’re sort of constantly worrying or you have that brain fog. There’s a combination of things, sometimes hard to decipher what’s stress and what’s vagus nerve, but if we’re always trying to mentally push our way through. And we recognize that the vagus nerve communication is primarily starting in the gut, it means that the gut discomfort is creating the mental stress, or contributing to or exacerbating that mental stress. And all the fatigue and the mental slowness or the poor judgment or the mood challenges that we often feel, that emotional eating sometimes, the beauty of all of this is that the solution for one thing is the same solution as the others. And that makes it a lot easier. We don’t have to say, oh, well, I have to do this thing for the vagus nerve, I have to do this thing for stress, it’s all going to be the same thing. Even the foods that we’re choosing to keep our blood sugar balanced, to keep our gut functioning, well, having fiber rich foods, right, your pre-, pro-, and peribiotics, all of that is contributing to the overall health.

And when we can turn on rest and digest rather than fight or flight, everything improves. So one of the key ways to build this into the day is figure out when we’re going to do it. So I love to do that deep breathing exercise. So breathing from the diaphragm, so your lungs expand like an accordion side to side with the inhale and the exhale. Breathing into the diaphragm is that the lungs expand like an accordion, slowing down the breath, having that exhale longer than the inhale. If we can do that before we eat anything, three deep breaths before we eat, turns off fight or flight, turns on rest and digest. Yeah, it allows us to build it into our day, and what better time than before we eat something to turn on rest and digest. And then we’re going to have that improved gut function. And if the fuel that we’re giving ourselves has nutrition, then we’re going to have improved blood sugar and improved immune health and improved vagus nerve function, improved cognitive function, because remember that communication is going to go to brain.

Lindsey: 

That’s one of my favorite tricks too, like sometimes you’re just running, running, running, and then you sit down the table and you’re just like, “Ah”, and then I’m like, “Okay, it’s time to do a couple of those.”

Jenn Trepeck: 

Exactly, like three of those. Exactly. If you can do the 10 minutes of walking after you eat. So we can use the habit stacking piece of attaching some of these things to an activity that already happens like eating. The other thing, I know, you we’re going ask a question, but the other thing I want to give everybody, to help make sure this happens, is I’m a big fan of a post it note. Okay, you might need a few copies of this post it note, okay? So on your post it note, maybe you’re writing down some of these vagus nerve exercises, maybe you’re writing down some of the things that you really enjoy doing that you feel like you never have time to do, maybe it’s read a book or listen to a certain song. Maybe there’s a song that when you hear it, you’re just you’re going to dance it out to that song. On your post it, write that song. So then we put a copy of the post it where we’re going to run into it in those moments of stress. So maybe there’s one on your computer screen at work, I used to have one in my coat pocket, I used to work in hedge funds. And when I left the office every day and I put my hands in my coat pockets, the post it would be there. And it would remind me of something I could do to get rid of the stress of the day. So even if I was just humming while I walk, it was helpful.

So we can have the post it remind us of the options of things that we can try to do when we’re feeling stressed. And even when we’re not necessarily noticing that we feel stressed. But then we run into the post it and it reminds us, because I think one of the challenges is to even remember these things in the moment. I have a client who actually put a post it on top of the pint of ice cream so that when she went to go reach for it, the post it could remind her of other things to do. I used to put one also on my coffee table so that when I would be tempted to maybe do something, the post it’s there, it’s going to remind me of options other than watching TV, which might stimulate the stress rather than deactivate it. I’m sorry, you were going to ask a question before.

Lindsey: 

Yeah, yeah, no problem. I’ve heard about studies where if your perception of stress is like “Oh, I’m so stressed out all the time. Everything stresses me out.” versus “These are stressors that help me work well and efficiently and I perform well under stress and I get a lot done,” that that whole perception completely changes whether that stress has a negative impact on you. Have you heard about those studies?

Jenn Trepeck: 

Yeah, for sure. And it’s true. It’s often about how we talk to ourselves in those moments. So if we say. “I got this,” it helps us physiologically handle that stress, which is very different than thinking, “Oh my god, this is terrible. This is the worst thing that’s ever happened,” right? How many people are like, “Oh, it’s a disaster.” Like, is it really a disaster? Actually calling it that creates more of a response in the body because the body says, “Oh disaster, life in danger,” versus “I got this, I can handle this.” You’re exactly right, we can actually change that physiological response because our perception creates the reality in the body.

Lindsey: 

I literally had a moment just like that today. I was I was trying to get something notarized, went to the bank, they said, their notary was too busy (dragging somebody else with me too). Then we go to a second bank (and they’d called ahead), they say they don’t have a notary there, even though we’d called ahead. And then I’m just like, “This is ridiculous.” Like, I’m starting to just get totally pissed off. And I’m like, “Okay, let’s see, this is maybe a delay of 20 minutes. It’s just 20 minutes, like, what are you worried about? You’ve got the time.” And I totally changed that narrative and how I felt about it, because I decided to stop right there.

Jenn Trepeck: 

Right, and notice, I would bet when that happened, and you talked yourself through, your heart rate came down.

Lindsey: 

I assume so.

Jenn Trepeck: 

Yeah. And instead of being so frustrated, and anxious, and sort of rushing, your whole being slowed down, you recognized that 20 minutes isn’t going to make or break my day, and I’m going to be fine. Yeah, that’s like that rise and fall the cortisol, of “Oh, my God, my life is in danger. Wait a minute. No, it’s not. I’m actually fine.” Yeah, I love that. Good point.

Lindsey: 

So moving on to another topic, weight loss. I know that lots of people struggling with weight loss turn to a ketogenic diet. And they also sometimes even go so far as carnivore, often because of gut health issues as well, or food sensitivities. So why do you think keto isn’t the answer, at least in the weight loss scenario?

Jenn Trepeck: 

Yeah, so I’m a big fan of doing things that will allow us to live that way forever. Keto is incredibly unforgiving. So the objective of keto is to put your body in a state of ketosis, where it is burning ketones, burning fat as fuel rather than carbohydrates. It’s not the kind of thing that’s easy to create in the body. So in order to create a state of ketosis, in the body, we absolutely have to be perfect. And I don’t know about you or anybody else, but I have lived enough of my life striving for perfection. And that didn’t work out so well for me. That created a whole lot of other stress. So it’s not something that allows for birthdays, doesn’t allow for enjoying some bread, because the way to put your body into a state of ketosis is to eliminate all these carbohydrates, essentially deprive your body of carbohydrates, its preferred fuel, and force your body to use fat. It is difficult to get into that state.

So you have to be consistent in that elimination of carbohydrates long enough to enter a state of ketosis. And by the way, once you have some carbohydrates, it’s going to knock you out. A lot of times, what happens is that people then start adding massive amounts of fat in an effort to enjoy some carbohydrates without knocking them out of ketosis. And a lot of those sources of fat are not our most helpful sources of fat, they’re also in quantities that then aren’t necessarily so helpful. For other systems, I also think keto and burning ketones creates a byproduct in the body that has to be detoxified. And so long term, we actually do see some challenges for people, like unless we’re using it to manage a disease state, which is what it was originally designed for, right? We don’t want to stay in a state of ketosis long term. It creates other challenges for the body. So I’m a big fan of removing the fat in a way that we can sustain and maintain. So if somebody was doing keto, and your plan is to be on keto forever, recognize that it’s incredibly unforgiving, and you’ll probably, at least in my experience, feel like you’re always starting over and you’re always flunking, rather than creating a plan that allows for burning fat as fuel without having to be in a state of ketosis. And that allows for birthdays and celebrations and holidays and all the things that we enjoy in life to help us find a little bit more of that balance.

Lindsey: 

I’ve been keto for all of I think a month once and I think for that month, I was able to mostly stick to it. You know, sometimes my carbs went up a little higher, but I think I still stayed in the ketogenic state because I’m someone who needs a lot of carbs to fuel me in general, but . . .

Jenn Trepeck: 

. . . I think for some people a couple weeks, a couple times a year, okay maybe. But there’s a lot of people, I think this is one where you have to know yourself to, to say, am I going to come out of something that’s super restrictive in that way, and maybe boomerang the other direction? And if that’s our tendency, then I would say that’s maybe not our best choice, at least in this moment.

Lindsey: 

Yeah, well, then then you end up with sort of the worst possible diet, which is a diet that’s super high in saturated fats also has sugar and carbs. Like all that, together, adds up to something not dissimilar to the standard American diet, perhaps more heavily weighted towards saturated fat.

Jenn Trepeck: 

Exactly.

Lindsey: 

And there is certainly research showing that saturated fat promotes pathogenic gut bacteria. And so if you’re not in ketosis, where you’re getting these ketones that include short chain fatty acids, like I think beta-hydroxybutyrate is one of those that’s created through ketosis, as soon as you go out, then you’re just eating a lot of fat and not getting the short chain fatty acids.

Jenn Trepeck: 

Exactly, yeah.

Lindsey: 

And you’re not getting the fiber, which would feed the gut bacteria to create those short chain fatty acids.

Jenn Trepeck: 

And that’s where I always come back to, is there are certain pieces that are human, right? Protein, fiber, quality fat are human nutrient needs. If something is telling you to eliminate any one of those, let’s pause. Let’s think about it for a second. Because, you know, listen, like I always say the fundamentals are human, the specifics can be very individual. And so with those things being fundamentally human, when we remove those things, something else happens. And so just thinking, it can be sort of like shiny object syndrome, where we’re always trying that next thing, and we’re looking for that answer. I just caution everybody to say, don’t lose your common sense, right, you’re listening to this podcast, because you know the importance of gut health. And you know the importance from listening to Lindsey, you know the importance of fiber and gut health. So something that’s eliminating that, I don’t know, let’s pause, right.

Lindsey: 

And I know that a lot of people do end up on those types of diets, like keto and carnivore, because they’re having more and more food sensitivities, and just making a plug for the fact that eventually you want to get back off, and you want to open up to a wider diversity of foods. And if you are doing that, like especially carnivore, the real carnivore diet is not the diet of steak and chicken breast. It’s organ meat. Right? It’s heart, liver and kidneys, and all these things so that you’re getting all these other nutrients that are not in steak and chicken breast.

Jenn Trepeck: 

Right, exactly. And I want to highlight something that you just said, because I think it’s really important, is that a lot of these elimination diets that we can use to minimize symptoms and then repair the gut are not designed for forever, ether.

Lindsey: 

No. And they’re not treatment. They’re just minimizing symptoms.

Jenn Trepeck: 

Yes, exactly. And so the objective would be that while we minimize symptoms, we can repair and then strategically add things back in, which I think is really important, right? We don’t necessarily want to live our lives until infinity with three foods.

Lindsey: 

No, no. And then eventually, you will develop nutritional deficiencies, or you’ll have to take a ton of supplements, which is not exactly an ideal way to live. Exactly. So another topic I wanted to touch on was what you recommend to people regarding diet who have high cholesterol levels, in particular, high LDL-C, which is what we commonly measure here, even though there are better measurements like Apo B.

Jenn Trepeck: 

It’s interesting, a lot of times in the weight management space, a lot of people come to me after their doctor wants to put them on a statin drug, or they have a diabetes scare, things like that. And one of the most interesting things is that one of the big contributors to cholesterol challenges is blood sugar. And so when we can eat to keep our blood sugar balanced, so low glycemic impact foods, protein, fiber, quality fat, all of those things happening in combination, we actually see a dramatic improvement in cholesterol numbers. I want to preface, although I’ll just add, I guess it’s not a preface anymore, but like we are not diagnosing, treating, curing or preventing any disease. Always talk to your healthcare provider. And always talk to your pharmacist and I want you to start asking questions. So when it comes to medications, especially for some of these quote unquote conditions, for some of this blood work that comes back, especially when it comes to cholesterol, ask your doctor, “Does this medication decrease the likelihood of a cardiovascular event?” Because I will tell you that is not the question that was asked of the statin drugs. The statin drugs were passed asking the question of “Does that make the cholesterol numbers go down?” And while it does, there isn’t research to show that in a statistically significant way it’s decreasing the incidence of a cardiovascular event. The way that we can then use food and nutrition to manage cholesterol is in fiber, protein and quality fat. So fiber, in particular, soluble fiber can help carry some of that LDL out of the body.

Lindsey: 

And best sources of soluble fiber?

Jenn Trepeck: 

Just eat your vegetables, eat a variety of vegetables, I’m also a big fan of  chia seeds, they can be great. Even avocado has some fiber in there, too. That’s super helpful. But as long as you’re eating a variety of vegetables, and I caution going into specific lists of foods, because I see people go all in and overdo it. We want to have the variety; the body responds really well to variety. So if you think about eating a variety of fruits and vegetables, you’ll be fine. But load up on those vegetables to give your body the fiber to help carry the cholesterol out of the body. Recognize too for every body, the body produces cholesterol on its own, and the body tries to maintain about 50 grams of cholesterol at all times. So when we’ve been told, Oh, don’t eat that thing, it has a lot of cholesterol in it. It doesn’t really work that way. For some people, right? Some people are genetically better transporters of cholesterol, some people are better producers of cholesterol. But if we’re not eating, the body’s production of cholesterol is going to balance what we’re consuming. It’s not like our bodies are producing 50 grams of cholesterol at all times, no matter what. We don’t necessarily have to be afraid of egg yolks, what I would say is that a runny egg yolk is better for us than a solid egg yolk.

Lindsey: 

I’d never heard that.

Jenn Trepeck: 

Unsaturated fats are a liquid at room temperature. Saturated fats are solid at room temperature. When we cook that egg yolk, we turn it from a liquid into a solid. And then our body has to process it. So I’m big fan of runny egg yolks, you could certainly do egg whites, I grew up on egg whites because my dad was always on some sort of die, so now I don’t even have a taste for whole eggs . . .

Lindsey: 

 . . . but so many nutrients in the yolk . . .

Jenn Trepeck: 

Right there are, but again, like to your point, we want to balance that out and make sure that we’re getting other nutrients through a variety of food options. But so point being, I don’t know that people need to necessarily completely eliminate foods. And in fact, getting quality fat, like omega 3’s from avocado, from walnuts, from olive oil, we can then help the body improve the good cholesterol as well, which shifts that ratio, which is also sometimes a better indicator of what’s happening. Rather than just looking at any number in isolation.

The one thing I will caution some people with is a lot of the coconut products. So a lot of the coconut products, which again are in a lot of the keto things, they’re in a lot of the – especially if we’re looking at some of the plant based things, right – so coconut products have taken over by storm. And while coconut can be quality fat, it is a saturated fat. And the saturated fat can actually sit in the insulin receptor sites and create an increase in blood sugar, which for anybody who is looking at managing blood sugar, and for people looking at managing cholesterol, we want to keep an eye on that blood sugar because a lot of times it’s not so much the lipid that’s a challenge. It’s basically the sugar coated lipids in the blood. Because that sugar scuffs the lining of our arteries, and then that’s where the lipids can get stuck. And then we have the shrinking of the artery in terms of the area that blood can pass through. So if we can look at inflammation in the lining of our arteries, if we can look at managing blood sugar, if we can make sure that the lipids aren’t coated in sugar, right, which are some of those other blood tests that we can look at, then we’re in a better place to truly understand whether or not some of these other numbers are really cause for concern. Or, sometimes getting more granular and asking for more testing can be really helpful.

Lindsey: 

And you know what, back to the original point related to cholesterol and blood sugar, one of the first clients I had, who was seeing me for weight loss and also for autoimmune disease, for Hashimoto’s, she had high cholesterol and was quite worried about it. And you know, we were going to start by just dealing with diet and making changes related to that and maybe there was a supplement or two perhaps, but in any case, as soon as her sugar went down and sugar consumption went down, her cholesterol came right down. And it became sort of a non-issue. So that was a strong demo to me for the future.

Jenn Trepeck: 

Absolutely. And I see it all the time with my clients, right? We actually just did this with my dad, that we were able to bring both his cholesterol and his blood sugar numbers into, quote, unquote, normal ranges strictly through nutrition and activity.

Lindsey: 

I’m totally impressed that you managed to get your own father to change his diet, because I have had no success getting my parents to change their diet.

Jenn Trepeck: 

It’s been a process, right? We originally worked together in 2011, focused on weight management ahead of my sister’s wedding. And then over the years, it’s sort of been up and down. And then, because of conversations that we’ve had over the years, he was really resistant to the doctor wanting to put him on a statin. And then when his blood sugar ended up in that diabetic range, he was like, “I know, I know,” that’s when he really took it seriously. It was like, “Okay, I’m going to do something about this.”

Lindsey: 

Yeah, yeah, no, I think the problem is my parents are still pre-diabetic.

Jenn Trepeck: 

Yeah, there you go. Exactly. It hasn’t been enough of a scare yet. But the exercise piece of all of that, too, not just to help the body handle the food that we eat and the blood sugar, but I cannot recommend exercise, but specifically building muscle to improve metabolism and blood sugar balance, enough. It is critically important across the board.

Lindsey: 

I don’t know that people know that much about that. So talk a little bit more about how muscle and blood sugar interact.

Jenn Trepeck: 

Yeah, so muscle dictates metabolism. Muscle is metabolically active, muscle burns fuel, even when it’s not being used in the moment. So having more lean muscle mass on the body increases what we call the basal metabolic rate, the amount of fuel the body uses all the time, even at rest, laying on the couch all day, sleeping, great, your body is going to need more than if you had less muscle. The more muscle we have, the more fuel we’re burning, which is what’s going around through our blood vessels as blood sugar, essentially, for a basic way of thinking about it. So our body is going to use that fuel. And when our body uses all the carbohydrates as fuel, our body can then turn protein into fuel and can turn fat into fuel. So the more muscle mass we have, the better our overall health, and it sort of snowballs into all these other things that, we’ve talked about already. And now I will say there is such a thing as morbidly fit, where we have so much muscle and so little body fat, but most of us are fine, most of us aren’t going to get to that place. And most of us would be served by increasing our own lean muscle mass, which means pick up heavy things and put them back down, right? You can use your own body weight to build muscle. But muscle dictates metabolism. And the more muscle we have, the more fuel we’re burning. The more we’re using all of that fuel that we’re giving our body.

Lindsey: 

Yeah, I just want to put a pitch in for weightlifting. Because maybe earlier in my life, I did it for a little bit, but I wasn’t a member of a gym for many years. And then all the other avenues for exercise were depleted. Like it was winter. I couldn’t use my pool. I had sciatica, I could barely walk. So it was just like, the only thing I could do was go to the gym and swim. So I joined the gym, then I decided to start weightlifting because somebody offered me a free trainer for a month, a virtual trainer. And they were going to advertise on the podcast and never followed up with that. So anyway, I got the free routine started from this trainer. So it wouldn’t have been expensive if I’d hired a trainer to write a routine for me and I have been doing it ever since. And sure enough, after getting that weight routine going, I lost like five pounds that’s just stayed off. And it just feels so good to be stronger. Like I just feel great about, like now I’m going to pick up a bag, I’m like, “I’m strong, I can pick that up.” And it just feels really good. And you know, I’m 54 years old, and I’m stronger than I’ve ever been.

Jenn Trepeck: 

Exactly more energy. And I think it’s one of the things that especially when it comes to weight management is really confusing when we look at the scale. When we cut out whole food groups, dramatically cut calories, right, a lot of the things that we’ve typically been taught for how to quote unquote lose weight, it makes the number on the scale go down for a finite period of time, and then the scale stops moving and we get frustrated. And we go back to old eating habits and the pounds start to come back on, the scale starts to go back up.

What happens when we dramatically cut calories, when we abide by that eat less, move more, right? When we focus a lot on frankly, cardio exercise as our primary source of activity, and cut out all those food groups and do all those food things that aren’t sustainable, a lot of what the body is losing is water, muscle and bone. So the number on the scale goes down, but we’re losing that metabolically active muscle, we think we’re doing great because the number on the scale is moving in the direction that we want it to. But then it stops moving because our body starts to go “oop survival,” right, hold on a minute, then the food plan that we had wasn’t designed to be sustainable. And we’re frustrated because the scale stopped moving.

So we go back to old eating habits. Now we’re eating more and likely less nutritious food, and we have less muscle on the body to be burning that extra fuel, and we gain the weight back, but we gain it back as fat. So what can happen over time as we yoyo, anybody else in the diet world? We yoyo, we lose it as water, muscle and bone, gain it back as fat, lose it as water, muscle, bone, gain it back as fat. So over time, even if we end up at the same number on the scale as we’ve been before, by body composition, we can be fatter at that same number. If you walk away from this with nothing else, get a scale that measures body fat percentage, that’s the number that we want to improve. That’s the number that we want to decrease and the more muscle we have, the more that body fat percent will come down. Because that muscle is metabolically active, we want to increase the muscle mass and decrease the fat mass in the body.

Lindsey: 

We’re running out of time, but I just want to quickly ask, is there a division of macros that you recommend?

Jenn Trepeck: 

This is really very personal. I once did a diet a million years ago that was a 40 30 30, 40% carbs, 30% protein 30% fat. Personally, I am better with more protein, it’s really individual. The guidelines that I say to everybody is, instead of counting macros, because also my old diet days of counting anything makes me a little nutty. I’m not a big measuring person, I’ll use my hands. Every time where we eat, we’re having protein. And fiber, protein is clean, lean protein, whatever you want that to be, fiber is vegetables. And sometimes fruit. A serving of protein for a woman at a meal is like four to six ounces, a man is six to eight ounces, more than many of you have been eating. That’s your whole hand at a meal. And then a snack is like two to three ounces, so a little less than a palm of your hand. Serving of vegetables, it’s like a handful, and if it’s greens, I would do like two handfuls and we want eight to 12 of those a day. Quality fat, two to three a day. That’s the objective. And then within that range, right? It’s going to be a little bit different for people where those actual macro breakdowns are. But that formula is what I found for myself and for all of my clients to be most successful.

Lindsey: 

And where do carb foods fit into that, just from the vegetables?

Jenn Trepeck: 

Well, vegetables and fruit are a primary source of carbohydrates, so . .

Lindsey: 

. . . no grains?

Jenn Trepeck: 

So I recommend for people to go like six weeks without grains, because the average American eats more grain than an Olympic athlete is recommended to eat on race day. So by eliminating it for a period of time, we’re then able to add it back in in a proper proportion. So I like grains and starches more like a condiment. So things that are adding texture and interest rather than as a food group. To me, they’re kind of inefficient. In terms of sources of nutrition, other than some vitamins and minerals. If we’re looking for grains to be our source of macronutrients, they end up being inefficient. So we want to have them in balance. So they’re certainly in there. Sometimes it depends how much, depending on what phase of the process somebody is in, and what their health goals are and what their health challenges are.

Lindsey: 

Okay, so we better wrap it up now. But why don’t you tell me where people can find you?

Jenn Trepeck: 

Yes. First of all, thank you for having me. I love this conversation. I am on all social media at JennTrepeck. My podcast is Salad with a Side of Fries. So join us over there, wherever you’re listening now, my website is ASaladwithaSideoffries.com. And I’d love nothing more than hearing from you guys. So we’ll also make sure that you have a link for everybody who wants it to have a complimentary discovery call.

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

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

Adapted from episode 119 of The Perfect Stool podcast with Brian Kaufman, RN of Proliant Health & Biologicals and Lindsey Parsons, EdD, and edited for readability.

Lindsey: 

I wanted to start by obviously not burying the lead that I have just introduced a new supplement to complement my existing one, Tributyrin-Max, called Serum Bovine Immunoglobulin (SBI) Powder. And I invited Brian on this podcast because he is the SBI expert. So who better to explain what this product does and who it might be good for? So why don’t we start with the types of conditions that SBIs have been studied in, just so people know whether they should be interested in listening further, and then we can dig into the details later?

Brian Kaufman: 

Well, good stuff, Lindsey and thanks for having me on. First off, don’t even sweat about jumbling over serum-derived bovine immunoglobulin protein isolate. I mean, it’s a mouthful. So you’ll hear me I’d say hey, we’re the SBI guys, it’s SBI for short, bovine IGs, or serum IGs, whatever you want to call it. But it’s an absolutely amazing natural product that harnesses Immunoglobulin G, the most abundant most polyclonal, which means it bites and binds on to the most bacteria antigens possible. We’ve harnessed that and delivered it to patients to help reduce intestinal inflammation that can be brought on by various antigens or bacteria, fungi, things like that. But it’s fun, what it’s being studied in – I mean, that is such a broad question. If I sent you my Dropbox right now, you would literally . . . first you’d get super giddy, right? Because you’re like, Oh my God, there’s so much here. And then you’d get a little bit anxious because you’re like, where do I start? Because everything from broad-spectrum, diarrhea and IBS part D to Crohn’s and Ulcerative Colitis to cancer patients that are dealing with intestinal inflammation and digestive problems, either resulting from cancer itself, or from the chemotherapy treatment that we give them, malnutrition. We did an amazing study in Guatemala in the early 2000s, where we were really just trying to tackle malnourishment. Not only did we help their digestive problems, but we saw major increases in lean body mass and overall sense of wellbeing and the ability to thrive. Pediatric IBS, not any direct clinical data, but a very growing amount of data in the dermatology area. We all know that many dermatitis’s, plaque psoriasis, things like that, it starts with an inflammatory response, most of the time originating in the gut. And if we can just mitigate that inflammation, if we can just get in between that, we can probably mitigate a lot of the downstream effects that we feel, which is that diarrhea, bloating, flatulence, just not holding on to your protein and water. And then, of course, the mental aspect that comes from dealing with that type of a lifestyle.

Lindsey: 

So it’s a pretty wide gamut of things that it’s useful for.

Brian Kaufman: 

Hippocrates said disease begins in the gut. Now, I 100% have believed that but I like to flip it on its head, I believe that life begins in the gut. Gut health is mental health. Gut health is vascular health. Gut health is your entire integrity. A lot of people forget that your skin is the largest body organ you have. And one of the first signs of digestive problems is skin issues.

Lindsey: 

I definitely see that in clients and I do find that it’s often the trailing indicator of success in healing the gut, like everything else starts to get better and then finally, the skin does. What got you interested in serum bovine immunoglobulins?

Brian Kaufman: 

I started off as like an overall health nut, so to say and then kind of morphed into a total human optimization microbiome nerd. I grew up playing football in South Georgia and wrestling and stuff like that. And I wasn’t always the biggest, strongest, the fastest. But I have leadership skills. And I love to read and didn’t grow up with cable or a video game system. So I read. I read “Eat to Win” when I was in fifth grade, and started making my own versions of Gatorade, and cutting grass so I could buy vitamin D and creatine monohydrate and things like that when I was in middle school. I would do anything nationally to totally optimize my body. And then from there when I was in the army, I started and understood all of my soldiers, whenever we would have issues, whether it was an anxiety thing, or just being tired out in the field or whatever it was, a lot of manifested as digestive health problems. And then moving on from there into being a nurse. That is the common denominator for everything. And so when I’ve met practitioners that are really, really focused on nutrition and balancing the microbiome, in accordance with the other care plans, I saw people get better way faster. And so I said, you know, this is the key, Let food be thy medicine, right? It’s all of these universal old-school truths are still truth today. So that’s kind of how I got here. I am just infatuated with the human body and total human optimization and just living your best life.

Lindsey: 

So how long has ImmunoLin been around as a product (ImmunoLin being the ingredient in Serum Bovine Immunoglobulins, the patented ingredient)?

Brian Kaufman: 

So the ingredient has actually been around for a long time. It started off with another part of the business that I’m involved in where we fractionate plasma protein and use it for diagnostic kits, like various ELISA tests, pregnancy tests, COVID-19 tests, things like that. It’s used as a blocker. And so it’s kind of a commodity for those types of devices. But a byproduct of that is a concentrated IgG. And some really, really smart agricultural scientists here in Iowa, decided, hey, if we can lyophilize that, turn it into a powder, we can introduce it into animal feed to reduce mortality. At the time in the 80s the mortality for piglets was about 50%. So if the sow had a litter, they were going to lose 50% of that litter automatically. And if you’re trying to obviously meet the high demands of the American food population, you want to reduce mortality. And so they started introducing this super IgG rich powder into the food of these animals and reduced mortality by 90%. 90%!

So a very small group of scientists and people within the LGI family started taking this product just themselves. And eventually 10 years later, some more scientists got involved and said we can make this into a product. And they actually turned into a prescription medical food product indicated for IBS-D and Crohn’s, ulcerative colitis, called Enterogam and it’s available through gastroenterologists. And that was my first introduction to the product. I was working at the Medical College of Georgia. Interesting position where I was running the GI motility center a little bit and also selling broad spectrum antibiotics. And I saw this experimental immunoglobulin being introduced to a patient population and I was like, man, what sleazy drug rep talked to you into this? What is this? I got a quick rundown from the attendings and it just sounded so interesting.

And such a natural way to fight the inflammatory response, which is just to supplement the body with an IgG source that has the acquired immunity to bind and remove many of the antigens that set off the inflammatory response. And I use this analogy a ton. I get some funny looks all the time, I’d go: “If you had a rock in your shoe, how much Percocet would you take to make the pain go away?” And I have all these third or fourth year med students with their short coats looking at me like I just said something crazy, right? Of course you wouldn’t take Percocet, you’d take your shoe off and remove the rock right? Well, modern medicine has taught us to treat the symptoms, when we can just go to the underlying cause and remove that rock, which is that antigen, that bacteria, that fungi, that mold that sets off that inflammatory response and breaks down that gut barrier lining, and which is the true culprit to a lot of our digestive problems, which lead into other things like autoimmunity and Crohn’s disease, and malnutrition and things like that.

Lindsey: 

So maybe we should just back up a little bit and talk about what an antibody is, what IgG is, what the other antibody types are.

Brian Kaufman: 

There are lots of different antibody types. IgA is one of the most important ones secreted in your salivary glands, and begins your intrinsic immune response to things. The one that we concentrate on is actually IgG. And the reason why we concentrated on IgG is because it’s the most abundant one, easiest one to fractionate, easiest one to concentrate. And also from a broad spectrum person perspective, it’s also the most polyclonal, which means it’s tagged and taught, through acquired immunity, to bind on to the most bacteria, right? So you kind of get the most bang for your buck, so of say, in the IgG antibody game. And antibodies reach out and they seek out and bind on various antigens and remove them from the GI tract before they can set up an inflammatory response. Now, unfortunately, the more insults you have, the more IgG you’ve got to have. And if you’ve got an issue on one side of your body and you’re introduced to something else, or you’re immunosuppressed, you’re essentially the palace guards, right? That’s your antibodies that fight bacteria and stuff. These guys are down but you can supplement them and see major benefit. That’s what you have here with SBIs.

Lindsey:  

So what specific types of pathogens is SBI powder active against?

Brian Kaufman: 

That we know of right now there’s about 25/30+ pathogens. We’re always testing and that’s why we try to keep our thumb on the pulse of our practitioners and say, hey, tons of great diagnostic tests out there right, now if you come across something that you’re not sure about, let us know. We’ll try to test it here in our labs. But the most common one is going to be LPS, lipopolysaccharide, it actually makes up about 60% of the inflammatory antigens in your microbiome. So when you start supplementing with a serum, bovine IgG product, you’re already going to be harnessing and removing 60% of the bad guys. But again, that’s just the beginning.

Lindsey: 

And wait, before you go on that LPS is part of the cell wall of the gram negative bacteria and also produced by them, right?

Brian Kaufman: 

Absolutely. So the way that that antibody essentially clings on, it’s not just clinging on to, it obviously holds bacteria, but also pieces of bacteria, and also the very flagella, the thing that actually moves them through the microbiome. I always use this example when I’m counseling young patients. I’m like, hey, have you ever watched those crime movies where you see the bad guy running away and the police officer keeps trying to shoot the bad guy and you always say, oh, shoot the tire? Well, you get to shoot the tire with an SBI product. It’s  going to bind that flagellum, the very thing that moves it through.

So various gram negative rods, but one that kind of was my aha moment was C diff particles A and B. If you’re not familiar, C. diff is a just a debilitating, people don’t like to say the word superbug, but overexposure to broad spectrum antibiotics has definitely allowed this bacteria to flourish and wreak havoc on hospitals. But it’s a really, really nasty bug. You see it most often in immunosuppressed populations, especially in the hospital, especially post infectious, so after the use of antibiotics. It’s so debilitating, it’s so expensive to treat. The biggest thing is that mental factor, people can’t come in and visit. They’re on contact precautions;  you’ve got to put a NASA suit on to walk in the room to treat them. On average, it can cost about $10,000-12,000 a day to manage. I see the patients inpatient in the hospital. So anything that we can do to give some quality of life back, reduce hospital stay days, and get those patients out of the hospital, it was music to my ears.

So that was probably my biggest aha moment with what this product binds on to, but also various things like E coli, flagella, salmonella, all types of gram negative rods, all types of things that just cause that inflammatory response, which really put patients in this hamster wheel of low grade inflammation. And you put someone . . . I’m sure you’ve dealt with this, where someone says, oh, you know what, I’m here for you to manage this. But no, my gut health is pretty good. And of course, you make it a part of your care plan. They go mad, they never felt better. And what you actually did was healed that leaky gut.

Lindsey: 

And what about Candida?

Brian Kaufman: 

Oh, absolutely. So this is actually some new data, specifically to fungal components and mold and mycotoxins that we’ve done over the last 18 months. We knew that Candida is a big, big problem. And it’s growing, no pun intended there. But we’ve found that SBI specifically targets binds and removes Candida from the microbiome to allow that gut lining to heal and those tight junction proteins to express and come back together so that you can absorb all your water, your protein and your nutrients and reduce that bloating.

Lindsey: 

And what about parasites?

Brian Kaufman: 

So parasites are something that is growing right now. Obviously, harvesting parasites, bringing them into your specific lab with animal products, we’re a little hesitant on that, but we are looking at some specific protozoa and other parasites. Especially as we’ve seen anecdotal evidence from physicians internationally, but also most recently at the border, where we have lots of people coming over the Rio Grande, obviously they want to give care, digestive problems being the number one symptom, and utilizing Enterogam there, or one of our SBI products.

Lindsey: 

And if someone has an overgrowth of opportunistic bacteria like streptococcus, staphylococcus, do you think IgG would be useful against those overgrowths?

Brian Kaufman: 

Absolutely, those are two other ones. Like I said, there’s over 26 various pathogens that they bind on to,   and you’ll be able to get a breakdown of every single one of those. I’ll also make sure I furnish one of those cards to you, Lindsey, so that you can put that up on your website, so you know exactly every single one of the pathogens, especially as I know you’re a big fan of all the microbiome testing right now. That’s actually one of the things that I wanted to ask you about while I was on here. There’s been so many breakthroughs in microbiome testing lately. In accordance with your SBI product, what’s your care plan? Are there certain diagnostic tests that you’re doing first? Or last? Like when do you start SBI therapy for your patients?

Lindsey: 

I start most people out by doing testing on their microbiome, usually using either the GI Map or I’ve started using a new test called the US Biotek GI-Advanced Profile, and I will see on that whether they have elevated levels or on fire Secretory IgA or deficient Secretory IgA. In both cases, I will educate them about SBIs and suggest that maybe that’s something they want to try. The retesting is more spotty and  these tests are expensive. And paying for services like mine that’s not covered by insurance is expensive. So I don’t always get to retest people, but some people of course you do get to retest and honestly SBIs have come more into my practice I would say over the last four or five months, whereas maybe before I was thinking more about herbal anti-microbials. And especially, I’m thinking about them when I see someone who has low commensal bacteria, low levels firmicutes and bacteroidetes, low levels of all the commensals. And I think, the last thing I want to do – and sometimes nonexistent levels of things like Akkermansia muciniphila and Fecalibacterium prausnitzii – the last thing I want to do is give that person any more antimicrobials, you know, unless they have something that really looks like, gosh, that needs killing. So I think about SBIs as like, this is a way to preserve the microbiome, because correct me if I’m wrong, but it’s not going to attack beneficial bacteria.

Brian Kaufman: 

Absolutely. Specifically quoted with an acquired immunity from a bovine source to only bind and remove the specific bacteria and fungi and mold that it’s synced up to grab and bind on to. You’re not going to have to worry about any commensal bacteria or probiotics or anything like that. And that’s what one of the great parts about it is, that it’s all reward and no risk unless you have a beef allergy, which is less than a 10th of 1% of the American population. They’re out there, but as a practitioner, I never ran into any of them. That’s also one of the great parts about utilizing this is there’s no drug or food interactions. You don’t have to worry about any kind of polypharmacy or worry about it interacting with the other standard of care that you’ve already deployed. It’s the easy button, right? It’s got one job, go in there, grab the bad guys, get them out. And like you said, clean up the microbiome, allow that gut to heal. What people don’t realize is that it’s like having a cut on your arm, right? It’s never going to heal if it’s consistently being inflamed. And you’ve got to utilize changes in your diet and your stress, but also adding in something like a serum bovine immunoglobulin to grab onto that bacteria allow that gut to heal.

Lindsey: 

Yeah. And I think that really points to the question of leaky gut, where it’s been, you know, you look at social media, they make it out as if leaky gut is a thing in and of itself that has no causative factors. It’s just, you’ve got leaky gut, or you don’t have leaky gut. And it’s like, of course, there’s something causing the leaky gut, you have some kind of a gut infection. And so that’s, I assume, the mechanism of action that this addresses leaky gut, by killing whatever that problem is in the gut that you may or may not know the cause of.

Brian Kaufman: 

Absolutely, and again, it binds on to tons of different antigens, bacteria, fungi, mycotoxins, we know that mold is a big problem right now. So that’s what we’re doing with some extended research there so that you can’t live your best life. If you’re running on that hamster wheel of low grade inflammation, reduce your antigen uptake, allow the gut barrier heal, allow your body to absorb all the water, protein and nutrients and like I said, life begins in the gut, like Hippocrates says. You’ll see the benefit cognitively, in your physical performance. I mentor bodybuilders and athletes of all kinds. And step one is let’s figure it out. Because it doesn’t matter how much water and protein that you take in, it matters how much you can absorb. And a leaky, inflamed gut will not absorb that water, protein. It will just be shot in and out the other end. And we don’t want that right?

Lindsey: 

Yeah. So it makes a lot of sense for someone who’s had some weight loss, along with gut health issues.

Brian Kaufman: 

Oh, absolutely. Working with my immunosuppressed population, my elderly population, especially my elderly female population, where there’s a lot of issues with malnourishment, and especially calcium wasting and bone density problems and things like that. The first thing that I want to do is sort out their gut, get them to start absorbing more protein and water and start adding in more nutrient-dense foods. Even adding in creatine monohydrate. Tons of new data out there on the mental health benefits of creatine monohydrate, along with bone density, and water absorption and muscle mass and all that stuff.

Lindsey: 

It’s been on my list of supplements to start taking for so long, and I just haven’t gotten around to it because, well for one thing, I have to figure out how to get another powder into myself and I don’t eat smoothies, or have any sort of obvious thing to add it to. But beyond that, I just keep thinking, well when I get off of one of these 10,000 other things I’m taking, I’ll try that one.

Brian Kaufman: 

No ma’am. General creatine monohydrate, there’s about four different esters and fun marketing scientific names out there. Just get creatine monohydrate, five grams a day, you can do less, but if you want to hit five grams a day, it’s a great target for the most clinical efficacy and it’s flavorless. Add them into your SBI is what we usually do with my dad and my dad takes SBI and creatine monohydrate every morning, and he mixes it in with unflavored Greek yogurt.

Lindsey: 

Oh yeah, if I ate yogurt, that’d be easy. Tell me what the dosing and duration is recommended for SBIs.

Brian Kaufman:  

So the great thing about SBI is there’s no non-benefit to having even a little bit. Whether it’s five milligrams or five grams, there’s a benefit that will be sought. Now, the dosing depends a lot of times on the bacterial load. So essentially, how inflamed you believe or gut is or how much contact you’re coming in with various inflammatory antigens, and also your health history. If you regularly never have any GI issues, maybe you travel down south like I do, and have some have some of Nana’s country fried steak and you don’t sleep really well and things like that. You can take this acutely at around two grams a day for 10 days, and you’ll be perfectly fine.

But if this is a lifestyle for you, you’ve had diarrhea every day, five to six times a day, if that’s your norm, or if you’re binge purger, where do you go a day or two constipation, a day or two, diarrhea, that’s 100% a gut barrier dysfunction problem brought on by bacterial antigens that cause inflammation. And what we first need to do is we need to do a total gut reset. In that case, I recommend five grams a day for the first two weeks, and then we jump down to two grams a day after that, take that out to six to eight weeks. The reason why we want to take it out so long is depending on how your gut is, it may take longer to restore that gut barrier lining.

And we need to use higher doses of SBI to shield it from the bacteria so we can allow it to heal. Initial onset of action is usually around the three-week mark. And the reason why that is it takes at least 21 to 26 days for there to be turnover of new tissue in the gut lining, right? So I always say commit eight weeks to this or don’t do it. If you think you’re going to take a pill, it’d be fine the next day. Rome was not built in a day. And neither was your microbiome. Onset of action is usually around three to four weeks, keep that out to eight weeks and then reassess. Now what will happen is most people will go, “wow, this changed my life, I can’t believe that I lived that way before.” And they’ll be just fine. They’ll come off the product after about eight/ten weeks, they’ll be completely fine.

Now there will be a population that after a week, their symptoms come back. And what’s happening there is essentially your body doesn’t make antibodies to fight whatever bacteria or antigen that you’re coming in contact with. In which case you will see people take this product as part of a lifestyle. I managed a Crohn’s patient in the hospital on this product back in 2014. Before I came on with the company, I actually had this patient on 15 to 20 grams a day of this product for the first two or three weeks. She is great lady, she was admitted to the ER probably twice a year with flares; she was one of my frequent fliers. She is still on the product 10 years later. Now, obviously, she’s not taken 15-20 grams a day anymore. In fact, we only did that for about two weeks to get that total gut reset going. And then we were able to slowly wean her down. But she was one of those patients that it’s a lifestyle for her; she takes two grams every other day now.

Lindsey: 

And when you say two grams, you’re saying two grams resulting of the IgG or two grams of . . .

Brian Kaufman: 

. . . of the total weight product. Yeah, the total weight product, the composition of which is about 92% protein, so it is an isolate. So you will be adding a little bit of protein on there. It’s also got all of the, it’s a complete protein, so all of the BCAAs as well as the EAs, so you will see a protein benefit as well. And it also shows the cleanness of the protein being that it’s an isolate.

Lindsey: 

Okay, so people might not know these abbreviations, branched chain amino acids and essential amino acids I assume were the BCAAs and the EAs?

Brian Kaufman: 

Yes, that’s correct. Yeah, branched chain amino acids and essential amino acids. It changes the way that the protein is absorbed and taken into the body. It’s a complete protein. So that’s what you want. The overall concentration of IgG is over 50%. And then you have 1%, IgA, and then 5% IgM. And you have another really interesting protein in there, known as bovine serum albumin. Now, a lot of the health practitioners that are listening will understand how crucial and abundant albumin protein is in the body and how much we need it. It’s used to pull fluid and water into specific spaces in the body, and things like that. But what it also does in this instance, it also has an affinity to bind on to heavy metals, which as we know are a real issue in our diets right now and overall daily living, so not only are we learning now the benefits of the IgG in ImmunoLin as far as the binding and removing of inflammatory bacteria, but also the bovine serum albumin has the ability to remove heavy metals, so you see a benefit there.

Lindsey: 

Is there any other product on the market like ImmunoLin, or is this the only one?

Brian Kaufman: 

There are others. For instance, you’re probably familiar with colostrum.

Lindsey: 

Oh well, sure, sure. But that’s not straight IgG.

Brian Kaufman: 

No, it’s not straight IgG, it’s much different. It’s about 20% IgG. So less than half of the IgG concentration. It’s also coming from the first milking of the cow. And the other problem. So first let’s say the benefits because there’s some really good benefits, of course, because it can be a really good, valuable tool in your gut health toolbox. It’s very high in IgA, so there are absolutely benefits there. Unfortunately, many of your patient population that has issues with dairy and lactose won’t be able to take that product. Also, there are some issues with the quality and consistency of that product. Colostrum is one of those products that is consistently dinged in the market, as what’s on the label isn’t necessarily in the bottle. Yes, but it can be beneficial, if you find a really high quality source. It’s not going to be as beneficial as taking a serum-based IgG like ImmunoLin, like what you have in your product base, being that it’s half the IgG concentration, half the protein and of course, all the dairy and the lactose. Now there is one other option. And I would say that ImmunoLin is number one, that’s going to be your best source, your highest quality, then you’re going to have colostrum right there in the middle. And then kind of at the bottom, you’re going to have a product called IgY, which is a hyperimmunized egg immunoglobulin. Again, it’s an immunoglobulin source, it can have some benefit, but it’s going to be again less than half the protein concentration, less than half the IgG concentration. And it also that you actually get like 40% of your daily value of cholesterol in one serving. So that can be worrisome for some practitioners recommending as part of your protocol.

Lindsey: 

Yeah, I seriously considered whether I should formulate a product with IgY and I decided against it simply because there was so much research already on IgG and SBIs and I just thought I’d much rather go with a product that people knew about, understood, there was already the research there, than something that’s a little bit still unknown and unproven.

Brian Kaufman: 

So what’s interesting is actually, ImmunoLin is the newest of those three products. Yeah, I mean ImmunoLin has over 45 human clinical trials, previously only available by prescription. And we did something different, because this has only been available in dietary supplements since 2018, is that while many companies will lead with the marketing, and have one or two clinical trials to back them, we lead with the science first. We’re a biotech company, our brand partners are Merck and Janssen and stuff like that. And we have to lead with the science first before marketing. And so that’s the approach we took. And I think that’s a big part of why we’ve seen such success with this product, on top of the fact that it absolutely works. Go to the underlying cause, reduce intestinal inflammation and watch people get better in front of you.

Lindsey: 

Yeah. I meant to ask when we were back talking about the dosing and the duration, so I did see the study, I think there was a study specifically on IBS-D, where the dosing was five and 10 grams, and they compared it and the conclusions were that at the 10 gram dose, the bloating was reduced after six weeks, but not at the five gram dose, which is why I’ve been recommending 10 grams a day for people who have extreme bloating, which describes most of the people I’m dealing with.

Brian Kaufman: 

Right. And so here’s some history for you. So when we did that, one of our first IBS-D trials that we did, we concentrated on not just an acute reduction in symptoms like bloating, flatulence, diarrhea, abdominal pain, stuff like that,  but the total number of days that were reduced. And we saw reduction by 40 to 60%. I mean, that’s, gosh, if you could get six months of your life back, would you do it? I mean, of course you would, right? And so when we did that study, SIBO was still kind of, well IBS-D being an umbrella of diagnoses, right? The idea of small intestinal bacterial overgrowth was something that was still being kicked around. It wasn’t legitimized yet, and what I believe from my experience, I believe that that group of bloaters actually had SIBO and that by introducing a slightly higher amount of IgG, we were able to harness up all the yeast-loving bacteria that was migrating up large intestine into the small intestine to feast on sugar, and that’s where SIBO comes from, and that by using a slightly higher dose, we can actually corral that group in. Of course, I didn’t come to this conclusion until years later when we did the SIBO trial, and I saw some really, really good success there. And I was like, wow, I bet the arm of people in the original IBS-D study that we had, they actually had SIBO.

Lindsey: 

So tell me about the SIBO study.

Brian Kaufman: 

Okay. So an awesome gastroenterologist and Professor out of St. Louis University, big on Rifaximin (xifaxan), which is a broad-spectrum antibiotic that was launched specifically for SIBO. The problem is, is that it’s hard to get it covered by insurance, but more importantly, the number one side effects of the medication was diarrhea. You’re trying to fix diarrhea, but you’re giving diarrhea. And also, it’s an antibiotic, right? Antibiotics are amazing. They’ve allowed medicine to transmit leaps and bounds over the last century or two. But while you’re killing the bad guys, you’re also killing the good guys. And when you kill your commensal bacteria, you’re just opening up the gates for bacteria to just ravage you.

Essentially, this doctor who was not a believer in serum bovine immunoglobulin, he had he had an issue and 50% of the patients that he was given this product [Rifaximin] to, it wasn’t working. And then another large population, he couldn’t even get it. So I asked Dr. Weinstock, give me a chance, give me your three toughest patients, your train wrecks, the ones that you look on the schedule, and you’re like, “God, there’s nothing I can do for this person. I’m at my wit’s end,” give me that one. If I fix them, you got to try this more. And guess what? We fixed them. And then you know, he gave me three more, and we fixed them. And then he gave me three more, and we fixed them. And finally we did a study. And so we set it up that way. So the way we started it first is everyone got lactulose breath testing, diagnostic criteria for SIBO. If they were positive, they got standard of care, which is Rifaximin 550 three times a day. When they failed, they went straight to Enterogam, or serum bovine immunoglobulin at 10 grams a day for two weeks, then dropped down to five. If they were negative on lactulose breath tests, they got standard of care when they failed, and 50% of them did, and they went straight into the arm with the 10 grams of SBI for two weeks, then dropped down to five.

Lindsey: 

For what length of time, six weeks total?

Brian Kaufman: 

Total six weeks of therapy. We saw a 60 to 80% reduction in the bloating and abdominal pain and all the classical symptoms of SIBO.

Lindsey: 

And were these only hydrogen positive? Or was this also methane?

Brian Kaufman: 

These were both hydrogen and methane positive SIBO testing. And it was a game changer for him. And he was one of those. Obviously, he’s got to be a prudent professor and gastroenterologist. And but when he saw the results, he was like, I’ll never start anyone on a broad-spectrum antibiotic before I can use something that has no side effect profile and hurts no one. Wow. At the end of the day, if the antibody is not activated on bacteria, it’s just broken down into amino acids and absorbed as protein.

Lindsey: 

Yeah, so it’s no harm.

Brian Kaufman: 

No, you can’t you can’t take too much of it. I know. I tried. I took 100 grams of it one time. I won’t lie. I had some interesting flatulence. But other than that, no issues.

Lindsey: 

Okay. And what about trials in Crohn’s or ulcerative colitis?

Brian Kaufman: 

Yes, absolutely. Once we started cracking the IBS, we started having those same practitioners go, “Well, hey, if this works in the GI tract only, could it help with my Crohn’s and my also colitis patients? Half the gastroenterologist were like, “No, that doesn’t make sense. It’s not going to block the TNF alpha inflammatory response systemically.” And I was like woah, what if we use biologics to reduce the inflammatory response in a systemic space, and then we use the bovine IgG to reduce the inflammatory response inside the microbiome allowing that layer to heal? What we saw was a drastic reduction in recovery time, a reduction in the concentration of the biologic drugs that we had to give, a reduction in hospital stay days and more people staying in remission longer. So what that means is you throw a flare, and they start you on a biologic drug, you throw them on the serum, bovine immunoglobulin at the same time, you’re going to reduce your time to recovery by four to six weeks.

Lindsey: 

And are you doing the same sort of dosing, that 10 grams a day for two weeks, then five, or do you just continue on at that five gram dose if the person is still showing symptoms?

Brian Kaufman: 

We want to constantly wean people down because we also want to see where people’s antigen load is and where their healing process is. The beauty of it is, if you wean someone down to a gram a day, and they start to go, “Well, you know, I had diarrhea once over the last 72 hours or twice in the last 72 hours,” maybe we go back up to two grams, and you see what’s best for that patient. We also did a socioeconomic study. We also wanted to see because you know that obviously, hospital stay days are expensive, right? Hospitals are the last place you want to be if you’re really, really sick or really, really hurt, but it’s also the last place you want to be recovering from being sick or really, really hurt. And because we cordoned all the sick people into one place, right, so when you can reduce hospital stay days, you’re helping everyone. We actually saw a socioeconomic study that we did, we saw a reduction in hospital stay days that accumulated to a cost savings between 3000 and 9000 per patient. So saving money, reducing your time in the hospital, just by adding this on.

Lindsey: 

To be clear, what is in my SBI product and what is in Enterogam is identical.

Brian Kaufman: 

Absolutely, serum bovine immunoglobulin. Yep, absolutely.

Lindsey: 

Enterogam being the prescription medical food that people are getting in hospitals.

Brian Kaufman: 

So actually, you know, I’ll explain the difference: there is no difference. It’s a dosing difference. So think of it like Motrin, 800, right. 800 milligram ibuprofen by prescription behind the counter, or you can walk down the aisle and go pick up the 200 milligram capsules, same thing. You could go to your gastroenterologist and get a prescription or an order for Enterogam. Or you could just follow the link from your website and buy your product.

Lindsey: 

If your gastroenterologist hasn’t heard of Enterogam and doesn’t ever use it, then good luck getting it from him, right?

Brian Kaufman: 

Right.

Lindsey: 

Yeah. So obviously, there’s a lot of other gut health products on the market, like probiotics and prebiotics and herbal anti-microbials. So how does ImmunoLin relate to those other products?

Brian Kaufman:  

Oh, they’re all best friends. They’re all best friends. But here’s the thing. The best thing about friends in the story is the story has got to happen the right way. And if you’re familiar with the five R’s of gut health, the first R is Remove. And that’s why SBI should be initiated. First, we want to remove the bad guys, increase the microbial diversity so that the gut can heal and your commensal bacteria can actually function correctly. Where a lot of people go wrong on their gut health journeys and go “Oh, Good Morning America said I need to take probiotics.” So they go out and they buy a probiotic with 30 billion CFUs right? And they go, “Ah I took for a month, and that didn’t really help me.” Well, that’s because you just added more good guys to the fight; you didn’t remove any of the bad guys.

That’s why immunoglobulins are different. That’s why we’re the only manufacturer of this product in the world. And in a very, very short time it has become the most sought after gut health tool that you can bring into your practice, because it’s the only thing that’s going to go to the underlying cause and remove that bad bacteria. Now, once we remove the bad guys, let’s seed the garden. Now let’s add in your probiotics, right? Now let’s add in your NAC and things like that. Some other things that I’m also a fan of are glutamine. I’m a big fan of glutamine* as far as nursing the microbiome later. I like Epicor*, which is a postbiotic. The FDA and the International Probiotic Association still hasn’t quite figured out what the mechanism of action is for postbiotics or really where they fit in. But we know that there’s a benefit to the microbial diversity and I’ve had a lot of success using Epicor. Also Sunfiber*. As far as probiotics go, this is also an area where we’re still trying to get it right. Everyone’s gut health journey is different. I love spore-based probiotics*, but also know that they don’t work for everyone. I’m also a big fan of n-acetyl glucosamine (NAG)* and n-acetyl glucosamine interacts with the goblet cells and the epithelial lining of the gut and helps produce a little layer of mucus, right. So almost kind of like you get a cut on your arm, you maybe put a Band-Aid on it if you know if you’re going to be out in the elements or something like that. That mucosal layer that’s produced by the goblet cells that were fed by NAG can help with that a little bit, can get you into healing a little bit faster. Big fan of type II collagen*, its benefits transcend more to the skin than the joints and things like that. But they first have to be absorbed by the gut lining. And I’ve had a lot of success with those as well.

Lindsey: 

When you take herbal anti microbials or antibiotics, you can have die off or Herxheimer reactions. Does this happen with SBI powder?

Brian Kaufman: 

No, it doesn’t, it actually kind of helps with die off. We’ve figured this out by a lot of patients that said, I’m taking probiotics and it’s not helping but I’m going to keep taking them. And I’ll say, don’t stop taking them. Let’s add SBI there and the abdominal pain and some of the bloating they were experiencing was because of die off because there was no microbial diversity. You were just adding more good guys. We added in the SBI, controlled that microbial diversity, we saw some major benefits there.

Lindsey: 

So when I started researching what to put on my website about this product, I discovered that these benefits that I wasn’t familiar with, about leaky gut and then the uptake of nutrients and the preservation of lean body mass. So you mentioned that study in in Guatemala, was that the primary one that showed you that or was there another one?

Brian Kaufman: 

So that was what started it. We also have done various studies in geriatrics and immunosuppressed populations to include HIV. And what we found is when we were able to heal their gut and increase their protein utilization and uptake, they flourish. They put on lean body mass faster, in fact, no different than what I was telling you about the SIBO trial. I told Dr. Weinstock at St. Louis University I said, “Give me your train wreck man, give me the toughest one”, right and who’s more immunosuppressed than an HIV patient. And we were able to not only reduce their digestive problems and allow them to thrive and enjoy some quality of life, but they started to put on body weight. And then they also started to increase DD4 lymphocyte count and T cell count and things like that, that really, really showed that the body was responding to the standard of care that was being given to them. But a big kickstarter for that was shoring up the gut, reducing that intestinal inflammation, allowing you to absorb the water and the protein and the nutrients that you bring in. And in today’s society where our food is not as nutrient dense as it once was, we need all the other vitamins and protein we can get.

Lindsey: 

Yeah. So is it best to take this with food on an empty stomach or does it depend on the situation?

Brian Kaufman: 

There’s never a bad time to take it. I usually I’m all about compliance, right? Whatever’s going to ensure that you stay on therapy. And so what I tell people is take it with breakfast and take it with dinner. You’re not going to forget to eat breakfast, you’re not going to forget to eat dinner. If you know that, hey, I take my IgG at these times, you won’t forget. But there’s not a bad time. Anecdotally, I’ve have heard people, practitioners and patients telling them they like to take it at night before bed. Because they feel that because it dwells in the GI tract longer overnight, and it’s going to find more efficiently. I don’t have any clinical proof of that or anything like that. But I say whatever works for you.

Lindsey: 

Yeah, no, I think I put on my label to take it with food if you’re if you’re concerned about the incoming pathogens, take it on an empty stomach, if you’re just wanting to treat what’s already in there.

Brian Kaufman: 

Oh, good. I was going to ask you that. What do you tell patients to mix it in?

Lindsey: 

So I haven’t told anybody how to take it. I was taking it for a while and then I wanted to pay off my investment in the product before I start taking anything. So I have stopped taking it. But I was. I found that it was very easy. If I throw it on a salad and pour it on the dressing and mixed right in and you didn’t notice it at all. That was easy. Sometimes I was sprinkling it on my eggs in the morning but that became a little overwhelming, like it sort of took over, that entire scoop took over that egg.

Brian Kaufman: 

It’s flavorless. So it means you can mix it in, right, you can easily mix it in four ounces of water, 20-second, stir and take it down. And I will tell you for anyone that’s listening right now that tries this product, when you first mix it up, you’re going to go ooh, it’s not really going into solution immediately. That is by design. This is a hearty, dense, rich immunoglobulin protein, we want it to survive all the way through the GI tract, so that it can also bind and neutralize antigens, not just in the gut, but also in the large intestine all the way down through to the colon. So I will say give it 20 seconds, stir, and then just take it down. You can mix it in any of your flavored beverages that you like of your choice. If you have soft food issues, you can mix it in yogurt and pudding. That’s how I get my dad to take it; he mixes it is pudding.

Lindsey: 

Applesauce, probably.

Brian Kaufman: 

Applesauce is great as well. The only thing we tell you not to mix it in is carbonated beverages and alcohol. That’s, that’s about it.

Lindsey: 

Or hot things.

Brian Kaufman: 

Well, as long as it’s not over 150 degrees, you’re fine. We have lots of people that mix it in like a non-dairy almond creamer. And then once their coffee cools down, they pour it in there. As long as it’s not over 150 degrees, you won’t denature the proteins.

Lindsey: 

When I first started to formulate this, I was thinking that this came from colostrum. And it was just sort of some subset of colostrum. But now I understand serum-derived means it’s coming from plasma.

Brian Kaufman: 

Absolutely. It’s coming directly from plasma. And that’s one of the reasons why we have the ability to do something that no one else can, is in a pharmaceutical-grade GMP facility, extract plasma from the animal, fractionate it down in a closed loop system. So that it is clean and healthy and free of anything that you don’t want, while also having a super highly-concentrated, dense immunoglobulin, right?

Lindsey: 

So that’s why you can say this is dairy-free, because there is no dairy product in it.

Brian Kaufman: 

That is correct. Right.

Lindsey: 

Okay. The other study you mentioned was about Crohn’s exclusively. Was there another one on ulcerative colitis?

Brian Kaufman: 

Absolutely. Check out our web site. Like I said, there are over 45 human clinical trials, close to if not now over 100 manuscripts, either in human clinical research, animal research or bench top research that shows the safety and efficacy of serum bovine immunoglobulin.

Lindsey: 

Okay, awesome. Anything else you want to mention before we go?

Brian Kaufman: 

Before we go, oh man, this is like my last send off right here? This is, all right, here we go. Number one. If you don’t cook it, it’s not good for you. Unfortunately. I have a cheat day. I love cheesecake and fried foods being born and raised in the south. But I know that if it’s processed, if I didn’t cook it, it’s not good for me. Concentrate on protein, chew your food and listen to your gut. And not just from an intuition perspective, but what you put into it. Utilize immunoglobulins to reduce bacteria, then feed that gut guard with probiotics and nutrient-dense foods. Get lots of sunlight and just enjoy life.

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

Learn more about The Perfect Stool brand Serum Bovine Immunoglobulin Powder.

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

Adapted from episode 118 of The Perfect Stool podcast with Bill Rawls, MD, Medical Director for Vital Plan* and Lindsey Parsons, EdD, and edited for readability.

Lindsey: 

So I understand that you have your own story of illness and healing that moved you from practicing obstetrics to what’s now a more holistic practice and a focus on herbs. So can you share about that with us?

Bill Rawls, MD: 

You know, I started my journey as a conventional physician, went into OB/GYN because it was more dealing with health and wellness. But at the same time, a small town practice, at that time, required me to be on hospital call every second to third day, and every second or third weekend. So if you can imagine most of my nights on call, I got very little sleep. And then, on top of that, balancing family and community, and I just went for 20 years without any sleep at all, hardly. And I crashed, and first identified with fibromyalgia because I had all the symptoms. But that’s kind of a nowhere diagnosis that really just gets you treatment of symptoms. And that’s about it. So like a lot of people, I kept searching. I finally found that I was carrying the microbes associated with Lyme disease. Now, I don’t really look at any of those things the same way that other people do. I think most illnesses have a microbe component. And Lyme disease. Yeah, that particular microbe is associated with a lot of other things. So the margins start to blur when you really get into it. But anyway, conventional therapy failed me, antibiotics made me sicker. And I finally turned to herbal therapy and became certified in holistic medicine and over about a five year period got my health back. And I was severely ill, you know, I had gut issues, heart issues, brain issues, neurological issues, everything, and got my health back completely. That’s been almost 20 years. I’m now 66 and in great health and really enjoying every minute of it. Now I spend most of my time really preaching that message and trying to get people to listen.

Lindsey: 

Right! Yeah, well, I got your book in the mail, the Cellular Wellness Solution. So I’ve been reading that and enjoying it and love your thinking and approach to herbs. I know that a lot of our pharmaceutical products are derived from plants and herbs. And of course, since I’m not an MD, I use herbs and nutraceuticals primarily, but can you explain the difference between pharmaceuticals and the herbs themselves?

Bill Rawls, MD: 

Well, yeah, it is true. I think we have this idea that our pharmaceutical scientists are these brilliant people that sit in a lab and develop these chemicals that have all these actions in the body. Quite frankly, we’re just not that good. Most everything that we use is pulled from nature. But the difference between what we’re using an herbal therapy, and what might end up being a plant, or a plant extract that ends up being made into a drug is that we’re using the synergy of the entire plant system of defense and protecting itself. So it’s hundreds of chemicals working in synergy. And typically, the things that I use for herbal therapy really don’t have drug like effects. They exert their actions by balancing systems in the body, protecting cells, suppressing microbes, and balancing the microbiome. Whereas most of our drugs actually come from plants that we would define as poisons. Very true. So when you get out on that spectrum, there are a lot of poisonous plants out there, actually, there are more plants that are good for you. And that will help you more than poisonous plants. But there are a few that are poisonous. And typically that’s where drugs come from. But it’s not the whole plant. It’s one chemical that they pull to do a specific targeted action, whether that’s an antibiotic or a heart drug, it all comes from just one specific chemical. So you lose that synergistic system that the plant is using to take care of itself. You don’t get that. You just get this targeted, potent action plant. Typically, then we take that chemical and we manipulate it in various ways to make it more potent.

Lindsey: 

And patentable, right? Well I guess you can probably pull one chemical and patent it.

Bill Rawls, MD: 

Right. Yeah, and that’s the other thing you can’t plant in a plant. You can patent a single chemical that’s been manipulated in some way. Not to say that drugs are bad. I think there is a very important purpose for every drug. But you have to understand that the drugs are restricted to affecting manifestations of illness. They are good for blocking symptoms or blocking abnormal hormone pathways. But they don’t address any causes. And they don’t affect things in a positive way at the cellular level. So most drugs really don’t actually promote healing, they can be important in acute phases of an illness to prevent someone from dying to block those really bad manifestations. But it’s unlikely that the drugs themselves or drugs alone are actually going to cause someone to heal.

Lindsey: 

An example that that I see a lot is that people will take antibiotics that just kill bacteria, and then they’ll have yeast overgrowth as a result of multiple courses of antibiotics. Whereas an herbal supplement that is antimicrobial tends to have a wide range of effects over both bacteria and yeast and fungi.

Bill Rawls, MD: 

It’s true, you know, all antibiotics come from a natural source. They either come from a bacteria, a plant or a fungus, and a lot of them come from a fungus. And then they manipulate those chemicals. So sometimes they’re far removed from the plant, but there’s always an origin. But it’s not that organism’s system of protecting itself. It’s a single chemical. And then they potentiate that chemical to kill a bacteria or a virus or a protozoa or whatever, in a very specific way. And because it’s so targeted, and so limited in its actions, bacteria find ways to get around it pretty rapidly. So we have bacterial resistance, but it’s not selective. I mean, it kills everything. And it tends to kill the fastest growing bacteria the quickest. So antibiotics are best for fast-growing, acute infections. Like if you develop a an acute pneumococcal pneumonia. Or if you’re on a battlefield, and someone has a wound that could potentially get infected in the wound, that’s an acute infection, those are fast growing bacteria. And as we know, antibiotics like penicillin back in World War II and beyond can be lifesaving in certain situations.

But anytime you’re talking about a chronic or prolonged infection of any kind, the problem with antibiotics is the longer you use them, the more you kill your normal flora, and your normal Flora are a very important part of your defense system, because they keep those rogue pathogens that we all have in our system from taking over, from flourishing and causing us harm. And you take antibiotics for any more than 10 days, and you start to kill off your normal flora enough that these pathogens can start flourishing, which can be a real problem. That’s a key element that makes herbal therapy very different. All herbs have antimicrobial properties against viruses, bacteria, protozoa, everything. It’s a broad spectrum, it affects a lot of different pathogens, but herbs don’t destroy normal flora. In fact, there are studies showing that while simultaneously suppressing pathogens, herbs have the effect of actually promoting the growth of normal flora, so they balance our microbiome, which is really cool. There’s just nothing else on earth that can do that for you.

Lindsey: 

Yeah, we’ll come back to that in a little bit. But I wanted to ask you about what a stealth microbiome is, and why we should worry about activating it.

Bill Rawls, MD: 

There are a lot of names for this idea that we have bacteria in our gut, you know, everybody knows that right? And on our skin and body openings, and we’re finding well, they kind of creep into other areas of the body too. But it turns out that in our internal pathways, our bloodstream, our tissues, it’s more like a freeway, things are constantly coming and going. So bacteria from the gut are constantly trickling across into the bloodstream, from our sinuses, from our skin, through all these reservoirs where we have bacteria that are technically outside of us, right. So part of our defense system is barriers, you know, we have skin to keep microbes out or keep microbes on the skin and not in the deeper tissues. We have the gut lining to keep the food, that foreign material and the bacteria that are are a part of it contained inside the gut. So we want to be separate from our bacteria. But things are constantly trickling across. And that’s part of our immune system’s job is to constantly stay on guard and mop these things up.

So it’s happening throughout our lives. Right now as we’re talking, there are bacteria that are part of us that are on our skin and in our gut and other places in our body that are trickling into our bloodstream. And most of the time, if you’re healthy, the immune system does a pretty good job of protecting you from those microbes, but also foreign microbes that try to enter your body too. But some of them get through. And this is a really interesting, a bit of science that is taking place only over the past five or 10 years that we’re realizing the extent of it, that bacteria, viruses, other things get through, they get past our defenses, and they enter our cells and invade our cells. And our cells aren’t defenseless. Our cells are part of our immune system. So if a cell is healthy, sometimes it can expel or kill invasive microbes. But another possibility, and it’s as a defense system that most microbes use very readily is they can just become dormant inside our cells. And studies are showing that healthy people, everybody, we have dormant bacteria inside our red blood cells. We have it throughout different tissues in our body, our brain has a microbiome. But most of these things, if we’re healthy, they’re dormant. They stay quiet. We don’t know that they’re there.

But go for 20 years with no sleep, and a bad diet and constant stress. And you stress your cells and you weaken your cells. And these things activate. And they start killing off the cells, you know, they basically use the cells for food, and then they start invading other cells. Well, at that point, the immune system looks at the thing and says, oh no, we’ve got all these bacteria emerging from the cells, and it starts attacking the cells. That’s what autoimmunity is. And it’s a key element of most any chronic illness where the microbes are emerging. What kinds of things you pick up has a greater bearing on what chronic illnesses you might end up with than anything else in your life. But if you keep your cells healthy, if you stay healthy through your whole life, that won’t happen, it’s really important to look at chronic illnesses from that point of view. It’s a really big incentive to have good health habits.

Lindsey: 

Yeah, no, I definitely see a lot of people whose illnesses started with a period of stress that obviously weakenek their immune system and started the cascade of poor health.

Bill Rawls, MD: 

Yeah, most people I talked to with a chronic illness, it’s a perfect storm of factors. And sometimes it’s acute, like they were in an automobile accident and ended up with a long hospitalization. But a lot of times, it was just things adding up and just getting worse over time to allow this reactivation. And then you know, once a thing starts boiling over, it’s hard to settle it back down.

Lindsey: 

Yeah. Are there particular herbs that you like using for gut health issues like SIBO or candida?

Bill Rawls, MD: 

I like herbs, but I think that there are a lot of really great herbs that we can use, or really any herbs are going to help balance the gut microbiome. There’s no doubt about that. But I think one of the first things is, let’s ask what the problem is, you know, what’s going on here. And when you look at virtually any gut dysfunction, most of the problem is rooted in slow motility. And that can can be associated with chronic stress. I had a lot of GI issues when I had so much stress. Also, diet, you know, these processed food diets that are high in carbohydrates and fat slow down motility. When you slow down motility, things get backed up. And you have to think about this thing. We have bacteria throughout our GI tract. We have bacteria in our stomach, not very many, the lowest concentration of anywhere in the GI tract, but they’re still there. And we have low concentrations of bacteria in our small bowel. Anything we eat is food for bacteria. And if you don’t keep things moving, you’re going to have bacterial overgrowth, bacteria grow as long as food is present. So it’s really important to keep things moving through our GI tract, because we’re going to keep growing bacteria and we need to get  them moving on down the track and out.

But when things are slow, when you have slow motility, you know in the stomach what that manifest as is you don’t empty your stomach and food just sits in there splashing around and it causes reflux,  it splashes up into the esophagus, but it’s also food for bacteria and just food sitting in there a long time starts to erode the protective barriers of the stomach. Well, bacteria like H Pylori, and others are just sitting there waiting. You know, when that stomach lining starts to erode, they start digging in. And so that’s where ulcers come from. So it’s not the H. Pylori as much as the H Pylori has an opportunity. So moving down to the small bowel SIBO, slow motility, when bacteria grow, they ferment. So you have overgrowth of bacteria, and that produces gas. Well in the small bowel, it can’t go back up. And it’s a long way for it to go all the way down and get out. So it gets stuck. So you get bloating, you get gas. But not only that, that overgrowth of bacteria starts to erode the lining, that protective mucus barrier that protects the cells in the gut. So you start to get a leaky gut and other kinds of problems. And it just works, it’s all the way down with irritable bowel syndrome and gut dysfunction and everything else.

So the first thing is addressing some of those issues of stress and diet, cutting out those processed foods, a more wholesome diet made of whole foods and fresh vegetables, the right kind of fibers, vegetable fiber, not whole grain fiber. Now some grains are okay, like rice is tolerated well by most people. But we tend to, if you have this going on, if you’ve got this irritation of the gut already, it really irritates the gut more. So you end up with issues of gluten intolerance and that sort of thing. Moving on to herbs and then we want to reduce the concentration of bacteria, we want to help things move through, and we want to protect the lining of the gut. So three herbs that I often use are slippery elm. Slippery Elm has a substance called mucilage. And it basically replaces that deficient mucus barrier that’s protecting the cells that the gut lining is made of, really important.

Berberine or berberine-containing herbs like golden seal and coptis and others. Berberine is exceptionally good, just exceptionally good for suppressing pathogens in the gut. Certain kinds of garlic preparations that can be good, ginger, wonderful for calming the stomach and suppressing some of those bacterial overgrowth. So those are just a few herbs. Dandelion is good for promoting liver function. But also it’s a really nice bitter so bitter herbs promote motility. So we want to restore that motility, we want to get that gut moving again because that’s the only way we’re going to get better. Bitter herbs like berberine, like dandelion. Another favorite herb is andrographis, we use andrographis for a lot of things. It’s got exceptionally good antiviral properties. It’s got some adaptogenic properties. But there was actually a study, there been a couple of studies actually, showing that andrographis works as well as drugs for managing ulcerative colitis. So even far down in the gut, andrographis is exceptionally good for protecting the liver and promoting bile function flow. So there’s just a few herbs that are just really nice herbs to have. There are many others, you know, peppermint, cardamom, others can just slow some of that. You want calm, some of that cramping and distress that can be associated with it. So all of those things are important.

Lindsey: 

Okay, thanks. So the dandelion, just curious, is that, I don’t know that I’ve ever seen pills of dandelion, is that used more like a tea or . . . ?

Bill Rawls, MD: 

You can do it either way. It comes as an extract, but you can also use dandelion teas.

Lindsey: 

I have heard concerns about certain herbs like oregano and berberine that they’re too strong and can impact beneficial microbes. And I’ve definitely seen clients who’ve taken many rounds of herbal antimicrobials and ended up depleting certain microbes like Akkermansia muciniphila. Any thoughts on that?

Bill Rawls, MD: 

I haven’t seen it as much with berberine. Now, oregano is an essential oil. Yes, it has some pretty strong properties. But you have to respect that there’s a difference between an essential oil like oregano oil, and an herb. So what you’re getting in an herb is chemicals that the plant is using to protect it cells and balancing chemical signaling agents and balance its microbiome and protected cells from various kinds of microbes. So that’s what you’re getting with an herb – a cell protectant. So what you’re getting with an essential oil are chemicals that the plant is producing as a deterrent. So typically, you’ll find these oils in leaves and stems in little vacuoles that the plant walls off, and it does that because they have a lot higher toxicity. So clove essential oil, any of your essential oils are going to have higher toxicity than herbs that can have similar properties. They have wonderful antimicrobial, anti-inflammatory properties, what they’re there for is to deter insects. So when an insect comes along and starts munching on the leaf, it releases these noxious chemicals and chases the insect away, you know, the plant is not using them to protect itself, particularly. So they do have a higher level of toxicity that must be respected. So you can use certain oils like oil of oregano in little gel caps in the GI tract, but it’s a lot stronger than most of your other herbs.

Lindsey: 

So I find that a lot of my clients are deficient in common minerals like magnesium and potassium, and often vitamins to like vitamin C, or the B vitamins, despite having ideal diets in terms of eating organic, grassfed, pasture-raised meats and eggs, or usually more like a paleo type diet, and good amounts of fruits and vegetables. So why would that be?

Bill Rawls, MD: 

Well, first of all, any testing you do is going to have issues. It’s really hard to measure vitamins and minerals very specifically. You have to remember that most of these things are inside cells. And typically they try to measure them in just the red blood cells, but they’re distributed throughout the body. So the only way to get an accurate measurement of those vitamins and minerals is to take multiple deep biopsies from tissues throughout the body, which just isn’t practical. So when we do a blood test, we’re getting an indirect sampling that may or may not be very accurate. I use testing a lot less than most physicians, I tend to listen to the patient, talk to the patient, look at symptoms, look at the profile of the patient, and I put a lot more weight in that then I do testing. We do a lot of testing and all of the testing, it has marginal accuracy. Yeah, we’re highly dependent on testing and some testing is very, very good. But the vast majority of it is not as good as you would hope for.

Lindsey: 

For the minerals, I guess probably for magnesium, I’ve seen RBC magnesium. And then I’ve seen hair tissue mineral analysis for the magnesium and the potassium.

Bill Rawls, MD: 

All of those have their own drawbacks.

Lindsey: 

Yeah. For the vitamin C or the B vitamins, these are usually organic acids I’m looking at. Yeah, so not not the typical test you’d get at your doctor’s. But in terms of terms of just deficiencies, whether tested or not, why would somebody eating a healthy diet still have nutritional deficiencies?

Bill Rawls, MD: 

Well, if they’re not absorbing these substances, you have to get them to cells. Correct. So if they’re in the diet, but they’re not being properly processed in the GI tract, then you may have some deficiencies there. And that’s why I do typically supplement in patients with chronic illness, with you know, vitamins, minerals, etc. And healthy people that are eating really good diet, I don’t know that they need it quite as much; there’s not very much evidence that it really changes outcomes. But chronic illness, I think having that extra is worthwhile. But again, it’s really hard to get accurate measurements, that’s tough.

And you have to define what is a nutrient doing. And a nutrient is basically raw materials that cells use to function. And so when you look at vitamins and minerals, those are cofactors, used for different cellular processes or mitochondrial processes. You know, if we’re loading in even a lot of supplements, if cells have a ready supply of those things, they can only use so much. The first thing I do is try to get good food in people. And as far as any person, I think, looking at gut function, which is what you’re doing there, is supremely important. Supplementing in early stages, especially to make sure they at least have an opportunity to get everything they need. And kind of going from there. I’ve done more of that pathway than testing. I went through a phase in my practice that I did a lot of testing and found it didn’t make as much difference as I thought it might. Sometimes I was just kind of chasing my tail with it.

Lindsey: 

In your book, you outlined some herbs that you think are great for just maintaining health and restoring vitality, shall we say, for someone who’s just maybe a little rundown? What are those herbs that you think the average person who’s in good health should be taking on a daily basis?

Bill Rawls, MD: 

Well, there are a lot of different herbs, but over the years I’ve cultivated my own personal list and these are herbs that I put in some primary products that I just think, you look at the evidence, and you look at the broad spectrum of what they do, they’re really valuable for anyone. So one of those herbs is rhodiola. Rhodiola is is defined as an adaptogen. So an adaptogen is an herb that has the effect of basically protecting our cells, protecting our systems. So it has this overall balancing, restorative effect, it helps balance stress hormones, so it’s a normalizer. It pulls us back into balance from wherever we are. So Rhodiola is really good for that. It’s been used in athletes to optimize performance. It’s known to improve oxygenation of tissues, so it’s used when people go to altitude, I’ve actually used it in skiing in Colorado to reduce my risk of altitude sickness because there’s some good data showing that. So rhodiola is a really nice herb.

Second to that, reishi mushrooms are mushrooms in our herbs or plants, but we kind of throw medicinal mushrooms in with the group because they have similar properties. And reishi mushroom has been studied in Japan, it has some of the most potent anti-cancer chemicals known. It’s a good immune modulator. It helps balance our immune system functions. Excellent cell protectant has some great anitviral properties. turmeric, everybody’s heard of that one, the yellow in curry and turmeric is really nice as an anti-inflammatory. It has some really wonderful properties for protecting the brain. It reduces inflammation, but unlike a drug like ibuprofen, that actually helps to heal ulcers instead of cause ulcers and it just really has this wonderful range of protective effects. It has some antimicrobial properties that are really nice.

Lindsey: 

I think I read it had action against H Pylori in your book is that right?

Bill Rawls, MD: 

It has some effects on H. Pylori, but a number of other microbes too. So just to tell a little story, our company, we have a product called joint care. It has turmeric, boswellia, which is another herb, some really nice things for joints. And you know, it’s a product that I put together years ago that’s helped a lot of people. My dog is now nine and when they get to a certain age, they start developing arthritis and that sort of thing. My last dog started doing that at seven, this dog hasn’t but I thought, it’s time we’ll go ahead and start giving it to him, so I gave him a couple of these joint care tablets in the morning. He’s really vital. But the problem he’s been having is his teeth, for several years. His teeth had been terrible, terrible bad breath, having to have his teeth cleaned every three months, bad plaque, all this mess in his teeth. We were really afraid that he was going to lose his teeth. About six months ago, I started doing this joint care for his joints, right? His breath cleared, his teeth cleared. And he has no dental problems now, it’s like wow. So what it was doing was balancing his whole microbiome, including his gingival microbiome.

Lindsey: 

Were you opening up the opening up the capsules and shaking them on to his food?

Bill Rawls, MD: 

Just stuffed two capsules down.

Lindsey: 

Interesting. Easier for a dog than a cat.

Bill Rawls, MD: 

Right before he eats to make sure it all goes down. So he’s done exceptionally well with it. So other herbs on my list: goto kola is really good as a brain protectant, it has some nice calming properties we all now need. Shilijat is an herb from the Himalayas. It is well known. It’s been used for 1000s of years. It’s plant matter that’s been compressed in the soil with bacteria. So it has substances called humic acid and fulvic acid that are really good for gut healing and helping to balance the gut microbiome. So that’s a nice herb.

Lindsey: 

Before you go past shilijat, just let me ask you about that. Because isn’t it one of those that has the California proposition 65 warning on it?

Bill Rawls, MD: 

Yeah, I think you do have to be somewhat careful with shilijat because it’s collected everywhere. And we use a special extract called PrimaVie that’s by a company that they spend a lot of time looking for the purest form of this substance. And they do a lot of testing to make sure there are no heavy metals and that sort of thing. So yes, buyer beware with that one; you do have to be careful. But if you get good stuff, it’s really amazing. And it’s not just from the Himalayas. This substance has been used in Alaska. I’m in Canada, a lot of the northern latitudes, they find it. Milk thistle, everybody knows that one for protecting your liver, and it actually can enhance regeneration of liver cells. And that’s really important because one of the reasons our cholesterol goes up and we started having more problems is because we replace our liver cells with fat. And as we’re doing that, we lose our ability to manage our blood sugar, to manage our cholesterol and to process toxins, really important. So this herb that can regenerate liver cells is really important. It sets up a condition in which it protects liver cells so that they can regenerate. Basically, I’ve been taking it for 15 years, my cholesterol is better than when I was in my 40s. And so it really has nice effects. But there are always surprises. I was researching milk thistle the other day, and I found that it protects osteocyte cells that rebuild our bone. So it’s actually found to be favorable for protecting against postmenopausal osteoporosis. So we may pick an herb because it has this known effect, but then you find out well, it’s protecting cells throughout the body, it doesn’t have a specific effect like a drug. So that one’s really nice. Hawthorn, really good for the vascular system. I put some of that in there. And pine bark, also is very good for the vascular system. So that kind of rounds out everything in the body.

Lindsey: 

I had heard of the pine bark extract, pycnogenol.

Bill Rawls, MD: 

Pycnogenol is a particular brand of that.

Lindsey: 

Okay. And I’d heard of that for migraines, in particular.

Bill Rawls, MD: 

Yes, because it’s protecting the vascular system. And we know that migraines do have a vascular component. So that’s where the herbs really work. Well, you know, instead of addressing the symptom, they’re addressing the underlying causes. And that’s really important if we want to promote wellness, instead of just suppressing symptoms.

Lindsey: 

Tell us about Vital Plan*.

Bill Rawls, MD: 

Oh, Vital Plan is a company I started about 10 years ago with my daughter, Braden. I was still in my practice, then. You know, I had to stop doing obstetrics because I couldn’t do the night call anymore. So I started a wellness practice that ended up being kind of like what you would know as a functional medicine practice. Now, I was using a lot of herbs in the practice. So everything I was using I was passing along to patients. I found that I just had a really hard time finding the level of extract, the purity, the potency, and the combinations of herbs. Because I was by then looking at it differently. So much of traditional herbology is observational; they didn’t have science to see how things are actually working in the body. They just made observations, you take those hundreds of years of observations, and you apply that to herbs that might be beneficial. And it works pretty darn well. But where I was going is taking that one step further to say, okay, how is the chemistry of this herb affecting things at the cellular and biochemical level? What were we achieving with it.

So it was coming up with different combinations, guided by newer science coming out over the past 20 and 30 years that was helping me make those choices. And a lot of times, I just wasn’t finding the level of product that I wanted to achieve the goals that I had in front of me. So I found that I could actually have products manufactured. And I started doing that to very specific specifications. And that grew into a pretty significant business. And finally, we carried it online to take it to a larger audience. The bigger the company got, it gave me more power to have more and more control over the extracts and manufacturing process and everything else. So we have been growing it ever since, so far with a focus more on chronic illnesses like Lyme disease and things like that. But there’s so many applications that apply to every person out there. We’re growing much beyond that.

Lindsey: 

With herbs, there’s a synergy that happens when you bring multiple herbs together versus say taking just one at a time. Right?

Bill Rawls, MD: 

Absolutely, yeah. And you know, you look at traditional herbal therapy, it’s formulas, it can be anywhere from five to 12 herbs together and you get a synergy; the analogy I use is a symphony orchestra. If you went down and sat down in the audience and you looked up on stage and there was one violin playing it would be nice, but you put two violins and then add in some other strings and the brass section and everything else and you suddenly start getting a sound that’s much bigger than any individual instruments. And that’s the way I think of the herbs working together. They’re each contributing in their own way. And you’ve got this complex defense system of a plant that synergizes with other plants. And nature’s really made to work together like that, then you come up with just this wonderful thing that can do extraordinary things for our health.

Lindsey: 

And how can you tell the difference when you’re looking at an herb, whether it’s a good quality extract, or if it’s just a cheaper version?

Bill Rawls, MD: 

Testing. Yeah, that’s what it takes. And a lot of companies don’t do the level of testing that you need, a lot of them do, probably about 50/50, I see a lot of products that I can tell they’re not doing testing. And typically, you find that if you look on the website, or look on the bottle, and they’ve just got a list of herbs under a proprietary blend, that’s a red flag right there. So what that tells me is they’re using the lowest grade preparation possible. And they’re going to put more of the least expensive herbs in there than anything else. And they’re going to try to wow you with marketing and scientific jargon to get you to buy that. To really make it work, you’ve got to have potent botanical extracts. So the extracts that we use in our products are typically 10 times more concentrated than what you’re going to find in average grade products. And you’re going to get the potency and purity. We do actually three levels of testing, when we get a certificate of analysis, when we purchase or wire an extract, which is from the supplier to say, okay, and it costs more to get something that has had a study, but then we take a sample of that and send it to our own labs, just to make sure it was really telling the truth. And then we test it during the manufacturing process to make sure that all those herbs are being blended properly. And again, there are other companies that do that level; it’s not the industry standard by any means.

Lindsey: 

Is Vital Plan on Fullscript by any chance?

Bill Rawls, MD: 

No, we’re not. And there is a reason for that. For the price that we wanted to charge, we had a choice, we can give a better quality product and take less margin, we can do a lower grade product and sell it through Fullscript at 50 to 70% off. Now we’re trying to figure out a way that we can actually do that and maintain the quality. But right now, we just haven’t quite gotten there. We do affiliate programs. But with the quality we’re trying to offer, we haven’t been able to have the margins to actually make the company work.

Lindsey: 

Yeah, no, I understand you have to sell a lot to make it, especially to go through them with the wholesale. Are you still seeing individuals or . . . ?

Bill Rawls, MD: 

What I’ve been doing for the past five years is doing consults that I really define as a high level health coaching. Because I don’t write prescriptions. I don’t manage medications, per se, I’ve been doing that. But I’m I’m taking a break from it right now to build a course that would teach people how to go through all those steps. So I’m taking everything that I’ve learned and building it into a stepwise course, that people would basically learn how to take care of themselves or learn how to recover from a chronic illness, and it would complement anything they’re doing with any other provider. But yeah, it’s so that’s kind of a labor of love that I’m in the middle of right now. To put together something that really takes that 20 years of knowledge and puts it in a form that everybody can use. The book, The Cellular Wellness Solution*, is kind of the backbone of it, that will be the handbook. But take people through that process of how you do the detective work or understanding why a person is having symptoms or why they’re ill. So often when we start with a patient, we start by focusing on the symptoms, because nobody likes to feel bad. Nobody enjoys their symptoms. As a society, as our medical system, we tend to focus more on symptoms than anything else. And how do we get rid of the symptoms? And what I want to know is why did the person become ill in the first place? Because illness doesn’t just happen. There’s always a reason. If you can define what’s going on, why that person became ill, then you have a pathway to start to reverse those things. So if I can create a course that can help people on that journey, we can get more people there and put people in a better place for how they think about their bodies.

Lindsey: 

And if they want to hear about your course when it’s ready, where would they find you?

Bill Rawls, MD: 

Oh, Vital Plan. Yeah. And so it’ll all be through that I probably got another month or two. I got a lot of other things going on.

Lindsey: 

But by the time this comes out, it may it may very well be out, because this will probably publish in a few months.

Bill Rawls, MD: 

Go look for it then. Yeah, it may already be there.

Lindsey: 

I signed up for the affiliate program through Vital Plan* (use code PerfectStool20 for 20% off your first Vital Plan order). And I noticed on the website that those five herbs that you think are like the great, maybe this is like the equivalent of an herbal multivitamin for you.

Bill Rawls, MD: 

The multivitamin industry has been so unbelievably successful convincing people that they need to take a multivitamin every day. And you know, half the population does it and they’ve been doing it for 70 some years. There’s not a lot of evidence, though. There’s a little bit of evidence that it’s a good idea, especially if you are struggling with some kind of chronic illness. But the power that you get from a multivitamin, yeah, pretty scant. It’s going to do very little to protect you from the kinds of illnesses that people have. Herbs, there’s so much evidence, there’s just so much evidence, and I detailed it in the book. It’s just overwhelmingly in favor of herbs that, yes, every person on the planet would be better if they were taking herbs every day. If every person took that assortment of herbs and a high grade supplement our risk of chronic illness would go down. I think the rate of cancer would go down, it would do some pretty remarkable things. And I know that because of the scientific evidence, but also just watching in action with 1000s and 1000s of people over the past decade of how much they’ve benefited just from these basic assortments of herbs. It’s good. It’s just truly powerful. So yeah, I’m trying to buck the norm and trying to get people to say, yeah, if you want to take that multivitamin, it is fine. It’s not going to hurt you. But if you really want to protect yourself, take a daily herbal of some kind.

Lindsey: 

And I noticed that there’s a product that has those five herbs, it was five, right, combined? What’s that one called?

Bill Rawls, MD: 

You know, because everybody needs a multivitamin. And because I couldn’t put everything I wanted in a bottle, we typically sell it as a pair. So there’s Daily Herbal, which has those five herbs. And then there’s Daily Multi that has the basic vitamins and minerals in a form that is best assimilated in the body, which isn’t what’s in most typical multivitamins. But that’s where I put the milk thistle and hawthorn and maritime pine bark and lutein for eyes and other kinds of things. So yeah, you know, it means taking a few capsules a day. But gosh, you get so much out of it.

Lindsey: 

Any final thoughts before we sign off?

Bill Rawls, MD: 

Well, that’s a lot of information right there. And I really appreciate the opportunity to talk to folks.

Lindsey: 

Yeah, well, thank you for being with us.

Bill Rawls, MD: 

Yeah, I encourage people to read my book*, if they get an opportunity. It’s a big book, don’t be intimidated. It’s like four books in one.

Lindsey: 

It’s more like a manual.

Bill Rawls, MD: 

Yeah, it’s like the first book is just looking at health at the cellular level. And everybody’s telling me it’s easy to read. The second is like an herbal primer to help people understand herbal therapy from a scientific point of view. The third is just all those things that we need to do with diet and lifestyle and everything else. And then the fourth section is applying those principles to specific problems like brain and gut and heart. Yeah, so there’s a lot of information in there.

Lindsey: 

You know, I’m really enjoying it. I wouldn’t say I get sent a lot of books, but I occasionally get sent books and sometimes I read them sometimes I don’t, but I was immediately pulled in when I started reading about your story and how herbs really just set you back on a path to health. So anyway, I’m enjoying it.

Bill Rawls, MD: 

Well, I’m very glad to hear that.

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

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

Adapted from episode 117 of The Perfect Stool podcast with Lindsey Parsons, EdD, and edited for readability.

My fellow bloating friends, if there’s anyone who can relate to bloating, it is most certainly me. Although I haven’t had SIBO my whole life, I have certainly dealt with bloating at least since my teens, when anytime I ate too much, I’d have a food baby and feel miserable. But once I got SIBO, it was on a whole other level, with the bloating happening before I even got up from the table, with almost any meal, and often continuing through to the morning, waking up bloated. Some clients don’t really know if they’re bloated, and I usually say, then you’re probably not, because it’s just a distinct feeling that is not like extra fat on your belly that’s soft and giggly, it’s like distension that’s tight and sort of hard and feels like you have a balloon inside you. At my worst I can easily pass for 6 months pregnant after eating.

So I’ll start with the most obvious causes of bloating just to get them out of the way, but this podcast is specifically about why you may be bloated if you don’t have one of these functional causes falling under the label of dysbiosis, or the wrong bugs in your gut. If you’ve already done functional stool and organic acids testing and nothing came up, you can jump down to the question: “Does low stomach acid cause bloating?” and continue reading from there.

So the most common cause of bloating is SIBO, or small intestine bacterial overgrowth, which is usually caused by stagnation in the small intestine due to a variety of causes, the principal being an episode of food poisoning in the past, and by that I mean it could have happened years before, as well as medications like PPIs, steroids and antibiotics. Any stagnation in the small intestine leads to a buildup of excess bacteria and general dysbiosis, or an overgrowth of the wrong types of bacteria. If you have mostly hydrogen producing bacteria, you’ll usually also have occasional diarrhea, usually soft or loose and messy stool, but sometimes you’ll have normal stool, depending on what you’ve eaten.

If your overgrowth is of hydrogen sulfide producing bacteria, then you’ll likely also have gas that smells like sulfur or rotten eggs and excessive belching and diarrhea or loose stool. I just did a whole episode on that, number 114 from early February 2024. Other possible signs of hydrogen sulfide SIBO include intolerance to sulfur-containing foods and supplements, weight loss, brain fog, exercise or stress intolerance, burning bladder syndrome, elevated heart rate, insomnia and low blood pressure after eating.

And then if you’re constipated and bloated, you may have IMO, or intestinal methanogen overgrowth, which used to be known as SIBO-C, or SIBO with constipation, which is an overgrowth of archaea (which are like bacteria but of a whole different domain) usually Methonobrevibacter smithii, which produce methane gas by metabolizing the hydrogen produced by bacteria fermenting carbohydrates. You’ll often have bloating and gas with a metallic smell when this happens, although often gas gets trapped with bad constipation so my IMO clients will often say they don’t have much gas or gas that smells.

Or if you have negative SIBO breath tests and are bloated, you can have an overgrowth of candida, or small intestine fungal overgrowth or SIFO. Candida is a normal resident of your gut but can overgrow and even become systemic in severe cases, and which can form hyphae or tail-like structures that go out between cells lining the small intestine. This can be caused by a diet high in sugar and starches, post-antibiotics, from estrogen dominance or supplementation through the pill or hormone replacement therapy or from low secretory IgA or stomach acid, which may result from chronic stress. Usually bloating after eating sweets or carbs, food sensitivities, skin issues and brain fog are signs of invasive candidiasis.

And finally, you can have parasites, which usually come with diarrhea or loose stool, anal itching, stomach pain or tenderness, nausea or vomiting, fatigue, abdominal pain or cramping, teeth grinding a night, or you may pass strange things in your stool like worms or flukes. Suspect that if you’ve recently come back from a trip to a developing country where they tell you not to drink the water and you didn’t realize that meant not to eat salads or washed fruit or brushing your teeth with the water. I’ve done podcasts on all of these things; see the show notes or you can scan back over old titles in your favorite podcast app.

Okay so on to the meat of the episode, other reasons for bloating.

Does low stomach acid cause bloating?

Let’s start with low stomach acid, which is the beginning of the digestive process. If you have bloating issues when eating meat or eggs or feel like meat just sits in your stomach and nothing moves, it may be low stomach acid or hypochlorhydria, which incidentally can lead to SIBO, because sitting food will breed bacteria. Other signs that hypochlorhydria may be at play are bad breath, no hunger in the mornings, feeling tired or nauseous after eating meat, indigestion, rotten egg smelling gas, acid reflux, hair loss in women, anemia which can be from low iron or B12 levels or hunger after eating. I actually experienced this a lot – I would feel what felt like hunger but sort of in the upper middle of my chest like mid-way up my esophagus, which was really a feeling of reflux, not hunger. Also, weak, peeling or cracked fingernails, stinky sweat, acne, and either constipation or diarrhea can be signs. There are also signs on your standard blood tests called the CMP, or comprehensive metabolic panel and CBC, or complete blood that you may have low stomach acid. So if you see one or more of these signs, you may want to test yourself: chloride levels under 100, high or low serum protein or serum globulin levels, low phosphorous levels, especially with a vitamin D deficiency, high BUN levels of 20 or more, abnormal MCV, MCH, MCHC or below normal Hematocrit or Hemoglobin, indicative of iron deficiency.

You can test yourself with a trial of Betaine HCl. Take one capsule of Betaine HCl (most of them are between 550 and 650 mg) halfway through a meal with 6 oz. of animal protein. If you feel burning or warmth in your chest, you probably have adequate stomach acid. You can always neutralize the acid with TUMS or a little baking soda in water if the burning is uncomfortable. But you should check at a few different meals to be sure. If you don’t, you can add another pill every couple days until you hit a max of 5 per meal with animal protein.

Another way to check is with the baking soda test, although I have no verification that this is actually a legitimate test. But it’s done by drinking a mixture of ¼ tsp of baking soda with 4 oz. of cold water first thing in the morning before drinking or eating anything. Time how long it takes for you to burp after drinking it. If it takes longer than 5 minutes, your body likely produces insufficient stomach acid. If you have immediate burping or you burp several times, it may be due to too much stomach acid. But just be careful you’re not having small burps from taking in air when you drink. Some possible causes of low stomach acid include chronic stress, an overgrowth of the bacteria H pylori, aging, zinc deficiency, food sensitivities, stomach cancer, autoimmune gastritis and allergy medications, specifically H2 blockers, which include Famotidine (Pepcid AC, Pepcid Oral, Zantac 360), Cimetidine (Tagamet, Tagamet HB), Nizatidine Capsules (Axid AR, Axid Capsules, Nizatidine Capsules) and Ranitidine (Zantac), which has been removed from the US market due to safety concerns.

Could low digestive enzymes be causing your bloating?

Another common reason for bloating is poor digestive enzyme production, which would be more suspect if you have issues eating vegetables, especially cruciferous ones, fruit and legumes. Signs beyond bloating that this may be the case are diarrhea or constipation, abdominal cramping, gas or poor tolerance to high fiber foods or high FODMAP foods. One possible way to test it is by eating a bowl of plain steamed broccoli and seeing how you do. You could also try digestive enzymes with a meal to see if you feel better. While many people with gut health issues have low digestive enzymes, there’s a more serious condition called exocrine pancreatic insufficiency or EPI that a doctor may diagnose you with. It may be diagnosed through a fecal elastase-1 or FE-1 test, which is also included in the stool tests I use like the GI Map* and my new favorite, the US Biotek Advanced-GI stool test*, which seems to combine the best of the GI Map and GI Effects and is in between the cost of those two. I’ve just added it to my Rupa Health Lab Shop* if you’re interested in looking at a sample report. Keep in mind, however, that low stomach acid is often at the root of low digestive enzyme production, because it’s the release of the stomach acid that triggers the release of enzymes from the pancreas. But causes of full blown EPI include chronic pancreatitis, pancreatic cancer, cystic fibrosis, nonalcoholic fatty pancreas disease, surgeries including pancreatic and gastric resections, short bowel syndrome, Crohn’s Disease, diabetes and obstruction of the pancreatic duct, celiac disease or Zolinger-Ellison syndrome. But SIBO and dysbiosis can also cause insufficient pancreatic enzymes, so that’s usually an area I support with digestive enzymes when helping people with SIBO and related gut issues. My favorites are the Pure Encapsulations Digestive Enzymes Ultra*, which are nice and small and come in big bottles at a reasonable price and there’s also ones with Betaine HCl included*, or Enzyme Science’s Critical Digestion*, which specifically have a lot of lactose and gluten digesting enzymes. And then there’s a formulation called FODMATE*, which is specifically designed for people with FODMAP issues, which are fermentable fibers found in grains and vegetables, and which would be especially relevant to someone with SIBO. And note that because food is not digested well with low pancreatic enzymes or EPI, it can also lead to SIBO.

Poor Bile Flow

Another reason for bloating is poor bile flow. Since bile’s role is to emulsify fat to prepare it for digestion, you’ll mostly likely experience this bloating and possibly stomach pain and nausea after fatty foods like pork belly, my personal downfall, and other fatty cuts of meat, cheese, high fat meals and deep fried foods. You may also have light-colored stool, greasy stools that may be foul smelling or float, diarrhea or erratic bowel movements, weight loss, stomach cramps, itchiness or jaundice, which is yellowed skin or eyes. Of course if you’ve had your gallbladder removed and aren’t supplementing with ox bile or bitters, you may need to address that. While the liver produces bile, the gallbladder stores it so it can send out a bolus when fat is detected in your duodenum. Low bile flow can also result from low stomach acid, which prompts the release of bile. Decreased secretion of bile can also come from certain drugs, sex hormones, inherited defects and ductal diseases like primary biliary cirrhosis and primary sclerosing cholangitis. There’s a long list of drugs that can cause liver damage and impact bile flow, including estrogens, NSAIDs, antibiotics, statins, metformin, antifungals and many more. I’ll link to an article on drug-induced cholestasis that lists them in a chart. And then bile ducts are most commonly blocked by gallstones, but could also be from cancers of the bile duct or pancreas, but usually you have severe abdominal pain either in the center or on the right side under your ribs, possibly spreading to your side or shoulder blade and lasting from 1-5 hours if that’s the case so the bloating won’t be your most obvious symptom. If you’re on a ketogenic diet and get this kind of pain, that’s a pretty good sign that it’s not for you, as some people’s bodies just can’t handle a high fat diet. Bitter herbs like arugula, dandelion and radicchio, lime or lemon water and rind, beets, artichokes, coffee and dandelion tea are great for promoting bile flow. Then supplements like gentian or bitters can promote bile flow and ox bile can supplement bile or you can try a Betaine HCl supplement that contains gentian like the Doctor’s Best one*. Note that low bile flow can also lead to SIBO.

Do food sensitivities cause bloating?

Food sensitivities and intolerances are another reason for bloating. While it’s not specifically a food sensitivity but rather an autoimmune disease, I’ll mention that celiac disease that’s undiagnosed and untreated through the avoidance of gluten can cause bloating, as can gluten sensitivity, dairy sensitivity, lactose intolerance or other food sensitivities. And it could take several days for other symptoms to manifest so sometimes it’s challenging figuring out what you’re sensitive too, but my general rule is, it’s usually what you eat the most of, because you won’t develop a sensitivity without eating something. Some of the other most common food sensitivities are to eggs, soy, sugar, corn and nuts. Personally, I know for sure I’m lactose intolerant. I used to just feel unwell after eating ice cream. My stomach would hurt and I’d just have a miserable, sick feeling, but it took a while to separate that from feeling sick from eating too much, which invariably I had done when eating ice cream as it was usually a dessert some insufficient amount of time after a meal. But once I targeted it through taking lactose digestant tablets or lactase enzymes and avoiding dairy, it became really obvious when I had dairy, as I would have painful, liquid, voluminous stool that burned as it came out and often had me having hot flashes and collapsing on the bathroom rug in pain. See if you are lactose intolerant and still eat dairy, you’ll still have some gut bugs that will help break it down, but when you give it up altogether and those gut bugs decrease or disappear, then eating is much worse. But when I stopped eating dairy, I also saw most of my issues with acid reflux disappear, my mucous production decrease significantly and a good amount of bloating decrease. The easiest way to test for lactose intolerance is just by taking cheap lactose digestant pills you can get at the drugstore or nicer ones like Enzymedica’s Lacto* that also has enzymes that target casein, a potentially problematic protein in dairy, while eating dairy and seeing if it changes your symptoms. The highest lactose foods are milk, ice cream and soft cheeses; hard cheeses, butter and yogurt or kefir have much less and ghee is lactose free.

And I’m sure you recall that I’ve mentioned that I don’t really put much weight into IgG food sensitivity testing because the things that tend to come up are basically everything you’ve been eating if you have a leaky gut, which dysbiosis can cause. However, there is one test I do think is valid, which is the Mediator Release blood test from Oxford Biomedical Technologies, which tests for all 7 types of food sensitivities at the cell level. One of my recent guests mentioned it and I thought I couldn’t get access to it, but then I was very excited to find out that I was able to establish an account and get training on it, so if you’re interested in that testing, you can contact me to get it at lindsey@highdeserthealthcoaching.com. They also create a LEAP food plan for eating the foods that will help you heal that’s very successful in helping people with digestive issues that aren’t otherwise identified.

There are three other food-related issues that may be causing bloating: fructose malabsorption and intolerances to inulin and sorbitol. For fructose, some people can only deal with a small amount of it, and then any unabsorbed leftovers are fermented by microbes, creating bloating. You may also see irregular motility, abdominal pain, gas or nausea. There are only small amounts of fructose in fruit, so usually this isn’t where you’d have an issue – a medium apple has about 10 grams of fructose. But a Coke has around 40 grams of high fructose corn syrup in a 12 oz. can. Foods that may impact you if this is your issue are sodas, dried fruit, added HFCS, foods with added sugar, sauces like ketchup, pasta sauce, honey, fruit juices and desserts. An easy test would be just drinking a can of soda alone. You can also use the Food Marble* to test, if you get their food intolerances kit. You may have heard of it – it’s an at-home SIBO testing device that you can use multiple times and test and retest yourself for SIBO and food intolerances. Some of the top SIBO doctors seem to be getting behind it and I have an account, so if you want to get one with the SIBO test kit and get a discount, you can find a link in the show notes to take a look and then email me at lindsey@highdeserthealthcoaching.com so I can submit a request for you. Its price is about the same as getting one commercial SIBO test, so I think it’s a great idea if you’re starting from ground zero or have recurrent SIBO or IMO issues so you can test and retest before and after treatment.

In the Food Marble webinar training, they said that 84% of those with IBS find that food triggers their symptoms. And while most of IBS is in fact SIBO or IMO, something like 60%, for the remainder of folks, it’s not, so finding out the specific foods you react to is important. You can test your reaction to individual foods using it, as well as getting the kit to test food intolerances. And for most people, while a low FODMAP diet may be great for reducing your symptoms, you may not in fact need to avoid all high FODMAP foods, as usually only one or two types of FODMAPs cause issues, and the Food Marble could help you identify those.

If you get the device, you can get a kit to test all four food intolerances: lactose, fructose, sorbitol and inulin. And interestingly, what they have found in their test results is that lactose, which most people think is the cause of their issues, has the lowest rate of intolerance at 36%, whereas sorbitol, which is in fruit and is used as a sweetener in various things, has the highest rate at 74%.

How can I tell if I’m intolerant to sorbitol?

Symptoms of sorbitol intolerance are bloating, gas, stomach pain, diarrhea and nausea. Fruits with the most sorbitol are the fresh stone fruit like peaches, cherries and plums and dried fruit, but there’s also sorbitol in apples and pears. It’s also found in juices and jams made from those fruit, most chewing gum, light or low-calorie packaged products and processed meats. Of course it’s easy enough to look at a label to find sorbitol in packaged products, but also look for the word sorbitan. It is also used in bread baking as a humectant and will be listed as E 420 on the label, if you get a label, but if bread is sold freely from a bakery, sorbitol doesn’t have to be declared. Of course even if you’re intolerant, you will probably still be able to deal with a small amount.

And the final food you can test for intolerance with the Food Marble is inulin, which is found in garlic, onions, wheat, bananas, leeks, artichokes and asparagus, among other foods. In the Food Marble testing, inulin has the second-highest positivity rate in every country in their dataset except Spain (where it has the third-highest positivity rate). You may not suspect inulin however, because it ferments more slowly, so you may not have digestive symptoms until later in the day or even the next day. And many foods high in gluten, like bread, also have inulin, so you may have issues with bread, but for a different reason than gluten. I’ll link to a blog from Food Marble on inulin intolerance that may be helpful.

Of course doing an elimination diet is also a great way to find out if you have common sensitivities. To do that, for 3 weeks take gluten, dairy, refined sugar, corn, soy, eggs, and if you really want to be thorough, all grains, vegetables oils, shellfish, tree nuts, legumes and nightshades, which are tomatoes, eggplant, peppers and potatoes and their derivate spices, out of your diet. Then add them back, one eliminated group at a time for 2-3 days to check for a reaction. If you react, stop eating that and move to another one, if you don’t, keep it in and add another. The hardest part of an elimination diet is after the 3 week deprivation to not just add everything back in at one time because you don’t seem that improved, but often you can’t tell how badly you react to something unless you’ve had time off of it and you can’t quite recall how bad you were feeling before you started. So keeping a symptom diary with how often and how severe your symptoms were is also helpful. But an elimination diet will be less useful for more uncommon food reactions.

What else can cause bloating?

Constipation

There are several other additional things that can cause bloating. First, constipation that isn’t from IMO but rather just from a poor diet with too little fiber, some physical issue impeding motility, lack of magnesium, insufficient water intake, insufficient movement, ileocecal valve dysfunction, vagus nerve dysfunction, or hypothyroidism can cause bloating. That backup of stool can block gas from exiting and cause bloating by itself, so if your intestines are full of stool, that may be your issue. Getting the bowels moving with vitamin C (and you can always start out with a Vitamin C cleanse to clean things out entirely and determine your best dose of C (Perque C Guard for cleanse*) and magnesium citrate. I like the Natural Vitality Calm powder* starting at ½ tsp. and increasing by ½ tsp. every two days before bed in water until things get moving – it’s magnesium carbonate but turns into citrate in water. Other forms of magnesium that help with motility are magnesium oxide, sulfate and chloride.

For vagus nerve dysfunction, you can check if that’s an issue by looking at your uvula in the mirror and saying “ah ah ah” and seeing if it pulls to one side or another or goes straight up and down. If it pulls to one side, you should check out the book Accessing the Healing Power of the Vagus Nerve by Stanley Rosenberg* for exercises to fix it.

Regarding ileocecal valve dysfunction, it’s the valve that goes between the ileum, the last part of the small intestine and the cecum, the first part of the large intestine, and it can get stuck. You’ll usually have constipation (but diarrhea is also possible) and pain in your pelvic region on the right side, if that’s the case. But you could also have flu symptoms, nausea, dizziness, fainting, lower back pain, heart pain, tinnitus, bad breath, a pale face, headaches or dark circles under your eyes. If you think this may be your issue, there’s a manoevre you can do yourself to unblock this value, which I’ll link to in the show notes.

Hypothyroidism

Another possible cause of bloating and constipation as mentioned above is hypothyroidism, so if you have other symptoms like hair loss, dry skin, weight gain, feeling cold all the time and tiredness, you should get your thyroid checked to see if that may be at the root of it. Ideally that would include a TSH, Free T3, Free T4, reverse T3 and both thyroid antibodies (that’s thyroglobulin and thyroid peroxidase antibodies) if you’re symptomatic.

Meal hygiene

Another reason you could have bloating, and this is more if it’s intermittent, not constant, is poor meal hygiene. This means eating while under stress and not in rest and digest mode, but while working, multitasking, watching TV or scrolling social media, eating too much at a meal, eating too quickly or not leaving enough time to digest and let your stomach empty between meals. Ideally you’ll spend at least 20 minutes eating a meal, chew each bite 25 times, pause between bites, limit water to small sips or drink most of your water away from meals, and focus just on eating. One trick is if you tend to arrive at the table full of stress, try taking 3 breaths before starting to eat – in for 5 hold for 5, out for 7. This will switch your body into a parasympathetic state and maximize your digestive processes. Then you should leave at least 3 but more ideally 4 to 6 hours between meals, and stop eating after dinner and at least 2 hours before bedtime.

Physical Issues

And of course there are physical reasons you may be bloated, so while most people I talk to get frustrated when they see a gastroenterologist because they may not be well versed on the functional reasons for bloating, they are best suited to diagnose physical reasons for bloating. Of course some you’d be aware of but others would require an endoscopy or colonoscopy to diagnose. So physical reasons include prior gastroesophageal surgery (such as fundoplication or bariatric procedures), gastric outlet obstruction, gastroparesis, ascites (which is fluid buildup in your abdomen, usually as the result of cirrhosis of the liver), a gastrointestinal or gynecologic malignancy, small intestine diverticulosis, chronic intestinal pseudo-obstruction (a rare disorder in which intestinal nerve or muscle problems prevent food, fluid, and air from moving through the stomach and intestines, which appears to be primarily an issue discovered in childhood), or an abnormal viscerosomatic reflex, which controls gas clearance through the contraction and relaxation of the diaphragm and the muscles in your abdominal walls. I always recommend people start with conventional doctors when they have gut health issues like bloating and once they’ve exhausted their arsenal, then you can come and see me or another functional medicine practitioner about what we call functional digestive issues.

What can I do about bloating for now?

If you just need some immediate relief from bloating, you can take 2 to 3 capsules of activated charcoal* in between meals – wait at least an hour after eating or other supplements and another hour before eating again to relieve bloating. But note that activated charcoal can suck up nutrients so not something you want to take in the long-term to deal with bloating, and it can also cause constipation. So better to find the root cause.

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

Adapted from episode 116 of The Perfect Stool podcast with Lara Frendjian, Registered Holistic Nutritionist, and edited for readability.

Lindsey:

So let’s start with your story, because I know you went through a period of uncontrollable bloating and weight gain in your 40s that you dealt with sort of indirectly. I think this is an approach that I don’t often consider for my clients. So let’s hear about that.

Lara Frendjian:

Okay, sure. So I was a practicing nutritionist. Nutrition is my second career, I started off in finance and accounting; I was a comptroller for many years. And nutrition was just a passion of mine. So I started to practice, I was practicing for a number of years, I was feeling great energy, everything was working really, really well. Until I started to approach my 40s. And things just suddenly seemed to shift. And it felt like a little bit overnight. But if I think back, I know that there were signs that things were starting to shift. So you know, my cycles were changing. For instance, after my second daughter, who I had in my early 30s, my periods were just closer together. And then they suddenly became really close together and a little bit erratic. But I didn’t think much of it because it was just sporadically that it would happen. It’d be like 26 days, and then I would miss a period. And I’d be like, “Oh, I wonder what happened?” And then it would continue. So I didn’t think much of it. And this happened for a number of years. And then suddenly, everything shifted, meaning I started to not feel like myself anymore. I started to notice that I was putting on weight, especially in my midsection. I noticed that my energy was lower than it used to be, like I feel like I need a nap. Now I would push through it. But I felt like I needed a nap. And I hadn’t felt like that since my kids were little and I was up with them all night. And what got me the most is that my mental health was not good. I was feeling anxious and irritable and just wanted to cry and didn’t know why. And of course I was bloated and everything was uncomfortable. My clothes didn’t fit me the way they would. And I developed eczema. I’ve never had eczema before and all of this just felt like overnight, which of course it wasn’t. Now if I think back, there was something that tipped me off. But I went to my doctor, I explained what was happening. She checked some of my labs, and she said everything is okay. It’s perimenopause. If you want, you can go on the birth control pill, there’s really nothing else that I can do for you. And that was the first that I really thought about perimenopause. Because I was a nutritionist that was helping just generally people, I was focused on gut health, actually. And all of this was happening to me. And internally, I felt like a fraud, because here I was helping other people and my body felt like it was falling apart. And that’s when everything shifted. And I shifted my focus. And I started to study other things and learn other things. And I realized that I was doing some wrong things that were impacting my body in a negative way. And I needed to do things a little bit differently now that I was in this phase of life. And here I am, fast forward a number of years. And yeah, all of that has gone, behind me. And now my health isn’t perfect. I know my hormones are still shifting, but I don’t have any of the symptoms that I was experiencing before, even though things are still changing. So we are going to go through changes. It’s just we can thrive through the changes or really struggle through the changes. And I want to get people on the other side of thriving versus the struggling.

Lindsey:

Yeah. And how what turned it around for you?

Lara Frendjian:

Okay, well, so I understood first what was happening in my body. So I recognized that there were hormonal shifts that were happening, and that I needed to address them. And the crux of it for me was stress, lifestyle stressors. I had traveled to Cambodia with a colleague and we had done work there. And when I came back, and I thought I picked up a bug or something there. And we were so cautious and careful. Now, in retrospect, I realized that it was not a bug. It was just the travel; the things that I experienced there were extremely stressful. And I know me and I realized back then that it was stressful, but I didn’t realize the implications that it would have on my body. Because my body was already under stress with all the hormone shifts that it was starting to go through or that I had been going through for a number of years. But that kind of just tripped things up. So that’s one, I recognized the importance of stress management, because we can’t get rid of stress. I recognize the importance of nutrients. So I was supplementing with some of the generic things that we think of, like, zinc let’s say for example to boost your immune system and vitamin C in the form of ascorbic acid. And what I didn’t realize is that these were causing other nutritional imbalances. So what I learned was, it’s very detrimental to just supplement with just generic stuff that you hear. So what I learned was that there’s a real connection between minerals, and hormones, and understanding what is happening to your body is really important and supplementing with the things that your body needs is really important. So I studied these things, I delved into it, I studied, I researched, I came under other people and learned from them. And I learned how to read the hair tissue tests and blood work in terms of understanding your nutrient status and things like that. And then I’ve moved away from fully plant based. So I was eating a plant-forward diet, which I still do, but I integrated animal proteins, and I integrated animal fats back into my diet, because my body needed it, and everything shifted. So those were the three main things that I did.

Lindsey:

 I do find that a lot of clients who were vegan or vegetarian will eventually realize their body’s not getting as much protein as they need on that system, or even more specifically, people who are on vegan or vegetarian diets, or who end up with some type of a methane SIBO or IMO presentation. And that diet is just not working for them, because they’re eating the things that are feeding them. They are fueling that growth.

Lara Frendjian:

Yeah, yeah, for sure. And, it’s really important to listen to the . . . like if I were to go back, it’s important to listen to the whispers that the body gives you before it starts yelling, because they are there. I just was choosing not to hear them out.

Lindsey:

Yeah. It’s very easy to underdo protein, because we sort of been told, oh, animal protein is bad for you. I don’t object to people having a vegetarian diet if they can somehow pull it off. But you probably are going to need some protein powders, because you’re just going to have to eat so many carbohydrates to get the protein you need. Then what do you think of as a minimum amount of protein?

Lara Frendjian:

Right now I’ve moved towards higher at the end of protein. So I’d say 25% minimum. Thirty-five percent is where I’d like to see it.

Lindsey:

Of calories?

Lara Frendjian:

Of calories. Yeah.

Lindsey:

So how do you start working with clients who have got health issues like bloating?

Lara Frendjian:

So the first thing is I do an intake; I understand what’s happening to their hormones. So I understand if they have histamine issues, if they have cortisol issues, if they’ve gotten any diagnosed diseases related to their gut. So I approach it from a different angle. Where I used to attack the gut, specifically, I approach it from an overall, and only if we need to address the gut directly do I go there. Because the women that I’m working with aren’t necessarily coming to me because they have Crohn’s or colitis or SIBO. They’re just not feeling well. And it’s just that they’re tired or they’re gaining weight. A lot of the things that I described that I was experiencing, those are the women that I’m seeing. Usually nine out of 10 times when we address all the other stuff, we reduce the stress, we work on the minerals, we replenish the nutrients, we balanced the iron, etc., reduce the histamine load, estrogens. Once that happens, usually nine out of 10 times I’m able to help them with it. And where I can’t, that’s when we go deeper into the gut health. So I ask them to run panels/bloodwork through their doctor. I do run a hair tissue test through the services that I provide. They send it into hair tissue analysis, and then that, in addition to their lifestyle intake, gives me a really good picture of what’s happening. If we need to, we do the Dutch hormone test. But because I’ve worked with so many, based on their symptoms, I’m able to decipher what’s happening with their hormones. And only if the situation is really stubborn and we can’t deal with it do we do the Dutch hormone tests, just to save them money really is why I put off some of the lab work. So when you had bloating and then when your clients do who are not coming specifically about gut, but bloating is part of the picture, is this more bloating associated with their cycle or is this bloating like every time they eat? Every time they eat. Yeah.

Lindsey:

And that resolves from a hormonal perspective then?

Lara Frendjian:

Yes, yeah. It’s often related to cortisol, right? Stress causes an impact on your gut bacteria. But so do our shifting hormones, especially in our early 40s. Up until menopause, what’s happening is estrogen is declining. But progesterone is declining even faster. What happens is we have this estrogen dominance picture, so we have more estrogen in relationship to progesterone. And this estrogen dominant person will have more histamines in their body, their histamine load; they won’t be able to clear the histamines. So there’s a real correlation between histamines and estrogen. And once we’re able to increase their progesterone in terms of the ratio, that histamine generally goes away. And once we’re able to balance the cortisol levels and bring them down, their histamine load will go down, and they won’t have those reactions that they used to.

Lindsey:

And so are you starting from addressing cortisol imbalances when you’re dealing with estrogen?

Lara Frendjian:

Yes, that’s where we’re starting. So we work on it hand in hand. So I take them through this process of understanding what is happening to their body from a hormonal perspective, reducing their stress load. It’s multifaceted. Okay so when I say reducing their stress load, I’m talking about eating the right food.  Ninety percent of the women that are coming to me, they’re like, I eat healthy, most of them are undereating. Most of them have a predominantly carbohydrate rich diet. So just shifting that around and having a balanced meal and eating enough, well, their cortisol levels come down, their energy levels go up, and they feel better. And they’re able to move more; it’s just this snowball effect of these shifts. And I was going to say tiny shifts, but for most of us, they are quite big shifts because just to wrap your head around . . . you know, I’ll talk about carbohydrates. Everybody thinks of bread, right? Bread and grains. No. All our fruits and vegetables, all of them are carbohydrates, and understanding the differences in the carbohydrates, and s ome of them are low, etc. Yeah, just doing that, the nutritional stuff, adding a little bit of movement, getting sunshine, getting access to red light, breathing, having a healthier mindset, right? I get a lot of chronic dieters who are in or out, 100% in their dieting, or they’re not at all. So just shifting these mindsets reduces our stress load. So what I do is multifaceted, and I have a program that I run them through. But everyone’s starting point is a little bit different. And everyone’s focus could be a little bit different, because someone can have a really healthy mindset and they’re not dieters. It’s just where I was, the body just did what it did, because of some things that happened in their life. So my starting point would be different than your starting point, because I have different issues than you.

Lindsey:

Yeah, of course. Everyone’s so unique. Yeah, I always find it funny when people say I’ve got a healthy diet. And mind you, I don’t see a lot of people like this because by the time they found me, they’ve done everything diet wise a human being can do, they’ve gone through the paleo, they’ve gone through the keto, some of them have gotten to carnivore; whatever they can do to reduce their gut symptoms. But that being said, occasionally you do happen upon a person who’s like “I’ve got a healthy diet”, but they’ve really had no interaction with functional medicine; they found my podcast because they were looking for gut problems. And you’re like, “Okay, what’s your diet?” Bagel for breakfast, then I have a sandwich for lunch. And maybe I have a meat and veg and grain for dinner of some sort. And then whatever they may add on to that, snack-wise. And you’re like, “yeah, that’s not actually healthy diet.” That’s a healthy diet compared to going to McDonald’s every day, but that’s far from healthy.

Lara Frendjian:

Yeah, yeah, it’s true.

Lindsey:

But what I should just ask is: ‘What do you do for grains and carbohydrates?’. Like that’s the big question because that’s always where the crux of the problem was. And then of course when you pull those out, it’s now fill it back in with the stuff you’re supposed to be eating, the protein and the fruits and vegetables and the healthier grains and such that has some nutrients,  nutrient-dense foods right? That’s the key.

Lara Frendjian:

Yeah. And then there are nutrients. Like one of the things I do is I get them to track their meals. And I’m not just looking at their proteins and carbs and their macros, I’m looking at their micronutrients. So suddenly, their potassium levels like skyrocket when they start to replace their bread with this sweet potato or squash or something, their nutrients just skyrocket.

Lindsey:

Yeah, everybody I test is low on potassium, everybody.

Lara Frendjian:

Yeah, I know. It’s quite exciting when it happens. Yeah, it’s really hard to get the level of potassium that you need, unless you’re eating the rainbow and eating a range of foods and reducing your grain, your pasta and your bagel and your sandwich.

Lindsey:

Yeah, I think the only person I had who tested high in potassium was somebody who was using one of those potassium salts that you use when you’re on a keto diet. That was the way. Are the folks that you’re seeing also having issues with their moods or their emotions and things like that as they head into perimenopause?

Lara Frendjian:

Absolutely, yeah. That’s one of the things because a lot of us can handle, let’s say, the weight gain, right? We can deal with it. And we find our old thing that we used to do; we find our thing. I find that the issue that gets most of my clients is the mood changes, the depression, the anxiety, the irritability, the place where I was, where I felt like I was losing my mind. Like, I went to my doctor, and I’m like, I don’t know what’s happening to my brain. I just feel crazy. Like I just didn’t know how else to describe it. I just was losing my mind. And nobody else knew, right? I wasn’t even talking about it to my family. But internally, I felt like if someone put another to-do on my desk, my reaction would be like to just burst out into tears. I had nothing left. And I don’t know, like if a deadline moved up, it would be like the end of the world. It was really strange. So yes, absolutely.

Lindsey:

Yeah. That’s funny. I never went through any of that in perimenopause. And perimenopause was like a non-thing for me. I just went straight to menopause. And then it was just hot flashes that were insufferable. So I ended up, I started with hormone creams to see if that would be enough for me and to help with hot flashes. But ultimately, I had to go for the estrogen patch. And for the progesterone pills, which I believe are all bioidentical. I hope I’m doing it the right way, so my doctor said. So I’m curious, do you use creams at all? Or do you get at estrogen and progesterone indirectly?

Lara Frendjian:

I don’t start off there. So I’ll start off with progesterone-boosting foods and estrogen-balancing foods. So we’re we’re focusing on things that are going to help clients’ liver and help the body clear estrogens better, like lemon, ginger, turmeric, rosemary, beets, beet greens, carrots, raw carrots. So these are all clearing foods. Flax seeds I do like to include because they do have some researched benefits to helping with estrogen levels. Whether they’re high or low, they do help them. And then progesterone-boosting foods, like all your potassium-, magnesium-rich foods. And of course, some supplementation. Everybody needs magnesium in their diet either through food, topically, depending on your gut status, and/or supplemental magnesium. So this is where I start and it looks a little bit different for everybody and some people will need other nutrients but that’s where I start. Ultimately with some, myself included, I do progesterone cream over the counter, or a bioidentical, very small dose, supplemental progesterone cream, which is extracted from wild yam. There’s one company that I love and I do use theirs. And I find it’s very low dose.  So yes, progesterone creams and progesterone drops, they’re very low dose, especially when you look at the prescription and generally that truly does it. If their blood work is still coming back wonky or their symptoms are still existing, then they work with their doctor because I can’t prescribe, I’m a holistic nutritionist. So then they work with their doctor in order to get bioidentical progesterone or estrogen. Ninety percent of them don’t have to go there. Once their lifestyle and diet is dealt with. And then that’s not something we have to deal with. But some of them still do. Some people still do and that’s okay. As long as they’re bioidentical and you’ve got both the estrogen and progesterone together, because that’s where we are in our research right now, is that when the two are together, then it’s safer.

Lindsey:

Yeah, safer because you don’t want the lining of the uterus getting too thick.  And so what kind of interventions do you use for unbalanced cortisol and DHEA?

Lara Frendjian:

So the lifestyle will help. Potassium, sodium, magnesium are your friends for cortisol, balancing your cortisol, and lifestyles shifts for the ones that we can’t, or are having a hard time or they’re having these reactions, these cortisol spikes. So we will do some saliva testing through the Dutch hormone test. And for some of them are spiking, cortisol spikes, and then it spikes further and that’s not supposed to happen. It’s supposed to come down through the day. So often changing our lifestyle will help. It’s like looking at what is your morning look like? What are you doing? Are you having coffee on an empty stomach? Are doing a HIIT workout first thing in the morning?

Lindsey:

High Intensity Interval Training?

Lara Frendjian:

Exactly. Thank you. Are you staying up late at night watching TV or scrolling on your phone and you’ve got this blue light infiltration in your life? Truly I find these lifestyle interventions, they it sounds like oh whatever, I’m not stressed. They have a profound impact on our lives. They have a profound impact on how we sleep, how we feel, how our digestion functions. The way that we live today is the most abnormal way of living, in the walls with heat and without sunlight, without stepping outside. We can go on for days now. A lot of us work from home; many of us don’t, but I work from home, my husband still works from home since the pandemic and this is our life. So we don’t necessarily have to step outdoors. But we need access to air and natural light and all of that. So it’s really being aware of your day and shifting things around. And it sounds very simple. It’s very hard to do. But once we do it, I find cortisol, DHEA – they all behave and we don’t need to do anything further. I do work with the adrenals and adrenal tonics and maybe some herbs that we introduced to the body, but bang for your buck, the best place to start is to look at your lifestyle. And just think back to if this was 150 years ago: What would I be doing? What would my day look like? We’d wake up with the chickens. We’d go outside, we’d feed our animals, we’d collect some eggs, we were forced to move first of all, and to go outdoors. It was just part of our lives. And we didn’t think about it and our lifestyle was very different.

Lindsey:

Yeah, so you recommend getting out in the sunlight first thing in the morning or doing some HIIT training?

Lara Frendjian:

Yeah, don’t look at your phone. First thing, for the first hour of every day.

Lindsey:

But isn’t that the same kind of blue light that wakes you up?

Lara Frendjian:

No, what should be waking us up is red light. So the sunrise is red light. So getting access if you can to that.

Lindsey:

I can’t remember the last time I’ve seen the sunrise.

Lara Frendjian:

Well and now we have red light machines that we can turn on to mimic that.

Lindsey:

I used to have a sunrise clock and it didn’t have a red light but it slowly got light because I couldn’t bear waking up before the sun rose. I felt it was so unnatural.

Lara Frendjian:

Yeah, it isn’t natural. And I don’t necessarily do that. I just don’t turn on my phone in the morning. It’s not on for the first hour, and I step outdoors. As soon as I wake up, I turn on my red light machine, it’s my best friend. It’s in my bedroom, I turn it on at night, as we’re getting ready for bed. It’s mimics basically sunrise and sunset.

Lindsey:

And is it a special thing? Or can you just buy a red bulb?

Lara Frendjian:

I think there are different wavelengths. And so there are companies, it’s still cheap, it’s $30, you could go by a red bulb and stick it in, turn it on in the morning, turn it on at night, before bed, and they’ve done some sleep studies and it improves the quality of your sleep. So I actually always start with the night before. So what are you doing before you go to sleep, because if we can improve the quality of our sleep, we improve all of our hormones, and a lot of women are coming to me for weight loss. If you improve the quality of your sleep, you will improve your metabolic rate. They’ve researched this, your detox pathways are clear at night. And there’s cancer-fighting cells that are scavenging during your sleep. So if you’re not getting good quality sleep, you’re really setting yourself up for things down the road, which you don’t want. We start at night. So don’t scroll on your phone, put the red light on, read, do some deep breathing, meditate, pray, whatever you do to calm down your nervous system, don’t have your TV in your room. Just keep your room cooler. And put the covers on. There’s research that starting with sleep is a really important piece. And then how are you starting your morning? If we could just get those two right, things function better during the day. Our mental health is better.

Lindsey:

I have a lot of folks who tell me, and I am a bit familiar with this myself, that they have trouble with waking up, maybe not so much in the middle of the night, but that’s also a situation, but waking up maybe just a little bit too early and not being able to get back to sleep. What do you recommend for people in that situation who’ve already done all the sleep hygiene things?

Lara Frendjian:

Looking during the day to make sure that they’re getting enough sodium, potassium, magnesium. Okay, that’s really important because if you’re waking up and you can’t fall back asleep, it doesn’t matter when, right? Three, between three and five I think in Chinese medicine is the liver hour when the liver is most active. And from a hormonal perspective, cortisol is just spiking when it shouldn’t or spiking a little bit too early. So is that what you normally see, when people are waking up between three and five?

Lindsey:

Yeah, I would say so.

Lara Frendjian:

Yeah. So cortisol is spiking too early. And what you want to do is make sure that you’re doing the other stuff, right, that lifestyle stuff that we talked about: changing your morning. The morning dictates what happens to cortisol later on in the day. What happens to cortisol and melatonin later on in the day. If you fixed up your night and you’re still waking up in a panic, going on your phone, checking your email, getting access to this nice blue light first thing in the morning, which is not nice, right? If the morning is messed up, that will impact you. Okay, so let’s say we clean up the morning. We’ve got a nice relaxed morning, we’re doing our thing, we’ve got a rhythm, you go outside, you’re walking or some breathing and red light and all of that. So it’s a nice calm morning, and a nice calm evening, then we look to see what’s happening during the day. Is your stress crazy during the day? Do you have any coping mechanisms, stopping, breathing, etc.? And then we look at the nutrients. Are you getting enough of the minerals that I just talked about? That usually does it, so if it doesn’t, then progesterone cream would definitely help. Because it could be progesterone and cortisol. And when progesterone is low, you feel a lot of the anxiety that we talked about before. And it’s really stressful on the body when progesterone is really low. So cortisol naturally spikes. And if that’s not helpful, then putting in maybe a magnesium bath, foot soaks, taurine. Taurine is a mineral that helps with relaxation, and it also helps with magnesium absorption. We have to be careful with it because some people are really reactive if their other minerals are out of balance. Basically magnesium moves way quickly and the taurine causes more heart palpitations and anxiety. So if you’re going to experiment with taurine, I would start with a little tiny amount. And I would try it in the morning to see if your body reacts well to it. If it does, then you can test it out at night.

Lindsey:

That’s good to know. And since you do the hair tissue mineral analysis, do you find that a lot of people are low on sodium?

Lara Frendjian:

Yeah, definitely, sodium and potassium are usually low. Magnesium, it’s a toss up, a toss up between being really low or they’re leechers, meaning it’s through the roof high. Calcium, magnesium is really high. And that means they’re just not . . .  magnesium is supposed to be inside the cell, intracellular, and it’s just leaching outside. So we have to do other things in order to help the body absorb the calcium and the magnesium. But yeah, so to answer questions, yes, usually nine out of 10 times sodium and potassium are both really low.

Lindsey:

And why would somebody not be absorbing magnesium?

Lara Frendjian:

Usually potassium. So all of our minerals work hand in hand. So if potassium is low, then their magnesium absorption rates are going to go down. And because of the deficiencies in our food, not only magnesium, but potassium, boron. Boron is a cofactor for magnesium absorption and taurine is a cofactor for magnesium absorption. So all of these things really work together, hand in hand. And then we see like nail breakage, nails not growing, osteoporosis, hair not growing and breaking and things like that.

Lindsey:

Okay, you brought up a topic that I’ve been struggling with for forever. My nails are terrible. I shouldn’t even admit this because this is like the one problem I can’t solve. I’ve solved every problem, but this one and I have tried every nutrient that I could possibly imagine to try and get them, well actually I haven’t really ever tried that hard on potassium. What do you think could be at the root of this? It’s not iron.My TSH is totally normal. But I do have Hashimoto’s but never had to medicate for it. Tried collagen, tried biotin, multivitamins, they just break and they’ve got lines, and they’re terrible.

Lara Frendjian:

So what I normally see helping with that is enough magnesium in the body. So enough magnesium supplementation.

Lindsey:

Taking 340 mg a day.

Lara Frendjian:

Okay, of what form?

Lindsey:

Glycinate.

Lara Frendjian:

Glycinate. Good. Next would be boron. So you would need some boron. And then finally taurine and possibly some vitamin K, have you done a hair tissue test?

Lindsey:

I did.

Lara Frendjian:

You did? Okay, how was your calcium?

Lindsey:

It was high.

Lara Frendjian:

It was – like through the roof high or?

Lindsey:

It was – I’ll open it up, and I’ll tell you. Might as well. Calcium: I was at 1190 on a reference interval of 300 to 1200.

Lara Frendjian:

1190. Okay, so you were just at the high end. So you weren’t through the roof, right? Like it wasn’t off the charts. Okay. That’s still too high. Right?

Lindsey:

Yeah. I cut back on the supplementation. Since I didn’t eat dairy, I was supplementing several times a day, so I dropped to once a day more or less.

Lara Frendjian:

You were supplementing. Okay. Okay. Unless I see calcium shell like through the roof high. . . Have you done it again? Have you repeated it?

Lindsey:

No, I haven’t.

Lara Frendjian:

Okay. So I’m very careful. I hardly ever recommend calcium supplementation, because I do know that once we balance the other nutrients, calcium behaves just fine. So vitamin K?

Lindsey:

I take K.

Lara Frendjian:

You do?

Lindsey:

I take K regularly. Boron was actually was sort of on the low-ish end of the scale, it was .25-1.5 and I was .38

Lara Frendjian:

Okay. Yeah.

Lindsey:

Magnesium was right in the middle of the range. Potassium was sort of on the low end, 8-75 and I was 20. Yeah, I was hoping that this was going to be the something was going to help me with my nails. So this whole thing and nothing really came out other than that my iodine was high and my iron was low, but this isn’t a good way to measure iron, right?

Lara Frendjian:

No, for sure.

Lindsey:

Hair tissue mineral analysis is not the ideal way to measure iron.

Lara Frendjian:

Neither is it for the other things, so I don’t rely very heavily on it for anything outside of the four electrolytes: sodium, potassium, magnesium, calcium. So those show up really well on the hair tissue test. Everything outside of the heavy metal, I’m not really looking at it. I’m just looking at it as, okay, is everything high? Or is everything really low? And generally, everything is low. So what I would focus on for you is making sure that you have the boron, maybe upping the magnesium and trying another form of magnesium. I know that it’s good to have different forms through supplementation.

Lindsey:

Like a threonate or a malate

Lara Frendjian:

I like malate and I like taurate. So those are the two that I like.

Lindsey:

I guess that would get you some taurine.

Lara Frendjian:

Yeah, some extra taurine. And then so I would start there. And then see if that’s enough taurine. I’m surprised. I wonder which K – yeah, we could talk offline. I could give you the vitamin K that I like.

Lindsey:

I’ve done the K2mk7 for a while and now mk4 is really the one I try and get.

Lara Frendjian:

Okay. So, okay, I’ll share a company that I like.

Lindsey:

You can share it online. I mention brands.

Lara Frendjian:

Yeah Lifeblud. I love Lifeblud products. They have got great products. My mom has osteoporosis. She’s extremely tiny. We are just very small-framed women in my family. And so osteoporosis is prevalent. We were doing the magnesium, we were doing the boron and then I finally put her K, and we’ve done vitamin K from other brands before and nothing helped. She is on some calcium supplements, very low dose. But I put her on the Lifeblud vitamin K, the drops, 10 drops, they’ve got two different forms. Her nails used to split. So they would just grow to a certain length and then just split down the middle in two; they no longer split. Every time she comes over she shows me her nails that are now growing. She’s in her 70s.

Lindsey:

So how many micrograms is that at 10 drops?

Lara Frendjian:

I don’t know. I’m not sure. I just follow the dosage that he recommends, which is 10 drops. And she’s actually not even taking it every day. I think she keeps forgetting but she at least three to four times a week she’s doing 10 drops. And she’s seeing the benefits. And with the boron though it did help the lines diminish on her nails and she’d show me you could see through her nails. But they would still split. Once we introduced the K, they no longer split.

Lindsey:

And is this boron doses like you would get in a multivitamin? Or is this like extra-physiological doses?

Lara Frendjian:

Three milligrams, you can start with three milligrams. Yeah.

Lindsey:

Yeah. Okay. I’ll try that. I’m like, if I could just solve the nails, everything would be. . . That’s probably an exaggeration. There’s always those tiny little things we just can’t quite fix in our health, even as we manage to help others.

Lara Frendjian:

No, I know. For sure. You know what, and we’re human. Right? These are human bodies that are imperfect. It’s okay. I say that. Because sometimes as practitioners, we feel this, we have expectations of our bodies to be perfect. And they’re not. But they are getting better and better and better. And that’s versus the opposite – 90% of the population is getting worse and worse and worse. 99%, right? As we age, we should expect things to get worse. That’s what the world tells us. But you’re not, right? You’re improving your health. And kudos to you. Yeah, Hashimoto’s . . .

Lindsey:

Yeah. So I think people find us because we’ve had the kinds of things that they are feeling or experiencing and they want to find somebody who’s experienced what they’ve experienced. Because it’s not just about how can we fix your problems, but how can we empathize with your problems as well.

Lara Frendjian:

Yeah, for sure, yeah, absolutely. It makes us better practitioners.

Lindsey:

Yeah. Okay, any final thoughts about your work with clients and all that and then tell us how people can find you?

Lara Frendjian:

Sure, I guess final thoughts is, I guess if you’re listening to this, you know, that you don’t give up on your health. And you don’t want to throw in the towel. I just want to encourage people that there is hope. I find the body is like holding its breath, giving you all these signals for help. And it’s like holding its breath just waiting for you to give it what it needs. And then once you do, it starts to thrive, and I work with women in their 40s. And a lot of people feel like as things shift and are getting worse and we’re told that, oh, we’re just going to grow old and it’s downhill from here. It’s really not. I’m 47. And I feel better than I did even in my 20s. I can honestly say that I have more energy and more vitality, I have a more positive mindset. So there’s just hope. And it just takes a little bit of time and a little bit of guidance from the right people. And it’s trusting that your body can heal, and trusting the practitioner that you’re working with, that they can guide you down the right path.

Lindsey:

Okay, and where can people find you and your work? Do you work with people one on one?

Lara Frendjian:

So I work with people in a one-on-one setting. I have also courses that they can go through on their own. So different ranges of products, depending on where your budget is, and where your time is. They can reach me on my website, nutritionherway.com, as well as on Instagram and Facebook. And I do offer free weekly trainings on where to get started every Thursday, from 1-2 p.m. Eastern Time and it’s just to help you get started on your health wherever you are on your journey.

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

Adapted from episode 115 of The Perfect Stool podcast with Reed Davis, HHP, CNT, Founder of Functional Diagnostic Nutrition® (FDN), and edited for readability.

Lindsey: 

So why don’t we start with, what is Functional Diagnostic Nutrition?

Reed Davis: 

Well, it’s a name I gave something I had been doing for 10 years. When I first started teaching again, after spending 10 years in a clinic, I put a course together finally, by popular demand, and had to call it something, so I just dreamed it up. Functional: is very functional, it’s all about how we function. We use a lot of lab testing for function, how are things working, etc. And then diagnostic in nature, but never medical diagnosis. So that’s a bit weird, but functional and diagnostic in nature. Because we’re using data, we’re running lab work. And then nutrition because I was a nutritionist, nutritional therapist. And nutrition is included in our protocols, although it’s not all of our protocols. So it’s more like nurturing, but that would have sounded even weirder.

Lindsey: 

Okay. But the program is called Functional Diagnostic Nutrition and people can get certified in that?

Reed Davis: 

Yeah, we’re popularly known as FDN. And there’s a lot of FDNers or the practitioners really all over the world now. And again, I started teaching in 2008, I just needed a name, and now we’re stuck with it.

Lindsey: 

And is this in addition to studying something else, then people add on this certification? Or is this the entire course? Can you do this course?

Reed Davis: 

That’s a good question. So most of the graduates, it takes 10 months, I can teach you what I learned in 10 years, took me 10 years to learn, in about 10 months. It’s self-paced, so you could do less, but you know,  anyone could do it. And it’s the kind of thing that most people do have a college degree but not all, and you don’t have to. Some have a certificate or two or three or four in something, whether it’s nutrition or personal fitness and the things that go along with those certifications; people get more. And then this is kind of the coup d’état. You know, it’s an upleveling in every way.

Lindsey: 

Great. That sounds like a cool program. So we talked about maybe talking a little bit about stress and how stress can start the downward spiral of health that often terminates in gut health issues. Can you talk a bit about that?

Reed Davis: 

Sure. Yeah, it’s very popular and common to say, all disease begins in the gut. I think even Hippocrates, Muhammad, a lot of people said that, but I found that it actually begins with some stress, or some possibly hidden stressor, possibly the stress doesn’t exist anymore. But it has started this downward spiral that circles around to the gut so often. That’s why we think disease begins in the gut. But I can show you on paper, you know, with the lab test, how stress in its various forms causes breakdown, causes what we consider a catabolic condition. So it throws us out of balance, and the body starts to break down. And I can show you a progression, various of these downward spirals, again, on paper with the lab testing, and it does circle around the gut, the immune system and digestion and things like that. So we get a lot of symptoms and disease processes are going in that area. But when we get out of balance from anabolic to mostly catabolic, then that’s when the body starts to break down.

Lindsey: 

And can you dig more into the actual details biochemically of what’s going on?

Reed Davis: 

Yeah, well, for 25 years I’ve been using, we just call it a Stress and Hormone panel, because it looks at the major stress hormones, cortisol and DHEA. And these are both made in the adrenal glands and they counterpose each other, one is a kind of counter balancer to the other. Well you need both, so your body’s supposed to break down and rebuild. That’s how we get rid of old cells and get new ones. So there’s catabolism, which breaks down, that’s measured by cortisol. So if your cortisol is elevated, you may be in a catabolic state, unless you have enough DHEA, which again, is counter regulatory, which will be building you up. So you’re breaking down, building up, breaking down, building up. And so it’s cortisol and DHEA. When we see those out of balance, and especially in cortisol dominance, well, we know that you’re breaking down and guess what the people who come to us for testing feel like? They’re breaking down. So it totally correlates. We call that clinical correlation. And it’s very, very important in our world, Lindsey never to treat the paper. It’s not about the paper. That just tells us something about a person, and it’s about that person. And so from there, there’s lots of downward spirals that can occur. One that’s obvious and by the way, we measure on the same test, which is saliva, which is done at home in the convenience and safety and you know, it’s not expensive and things like that. A lot of what we try to use are self-tests. So this easy to use, not expensive saliva test gives us a catabolic to anabolic, but also will show us the sex hormones, the progesterone and estrogen, of course, the testosterone, and so on. You can bring it down as far as you want, but those three alone are pretty good markers. And they’re out of balance, in many, many cases, and guess what? Very high clinical correlation with how people are feeling. So finally, from a test result, people find that instead of a typical standard medical bloodwork, oh, nothing’s wrong with you, or your bloodwork looks normal, we actually see the subtle changes in the saliva, which is a bioavailable marker, or analyte, and we do it on every single person. And from there, you get into the other tests, there’s urine and there’s stool, and there’s finger stick, blood testing for all kinds of other functions that we would consider downstream from those that are kind of a measurement of stress.

Lindsey: 

So I have a question that I’ve been curious about for a while. I have done these tests, saliva, cortisol, you get the four spits, it’s like what 9:00, 12:00, 3:00, and something like that anyway. So there’s four spits, and then the DHEA-S. And what I’m wondering about is, what kind of test retest reliability is there? Like, if we did that the next day, are we going to find the same thing? Or what if they just happened to have a stressful day that evening, and then their cortisol is elevated?

Reed Davis: 

Well, there are instructions along with the tests to try to mitigate that potential. So you know, you will take an ordinary day, if there’s such a thing, not a day, when you have a wedding, and not a day after you got kicked out of your house, you know, some godforsaken thing. So you take a typical day, and there are patterns that are fairly reliable. But regardless of that consideration that you just mentioned, one day to the next, everything’s relative. So we don’t measure the tests in a vacuum. We measure them relative to a person and what was going on that day? So we might see a high afternoon cortisol, for instance. Well, if that’s going on every day, it would really tell us something important, like you’re eating something at lunch that you’re sensitive to, and your body’s reacting to it. Or your blood sugar is low; you’re eating the wrong food; your insulin is spiking and crashing and your blood sugar, cortisol kicks in to try to raise your blood sugar. These are the things that we know about. Because again, for 25 years, we’ve been studying the use of these labs, clinically; they’re not done in a vacuum. And you can’t say because one person had this, it means the same thing in the next person. You have to go back to the person and get clinical correlation. So while there are some variations, that’s a great consideration, Lindsey, very smart question. The answer is the test results are interpreted relative to that person that day. And I’ll say this, to summarize, everything, every client is a study of one. There’s no courts. There’s no lineup 10 people and that’s fine. There’s you and your test results. And does it relate? Does it tell us anything about you? And so that’s why we use it, saliva, because it’s bioavailable in the moment.

Lindsey: 

So will you typically ask someone to record anything about their day that they do that test? Because I often send people off to do tests and then I don’t see them for six weeks. So by the time the test comes around, they don’t remember what they did or didn’t do that day.

Reed Davis: 

Well, likely, you want that person to jot down some things. As a matter of fact, some of our tests, we do even have journals. They ask you those questions. So yeah, they include a questionnaire, we have our own questionnaires. And so it would be appropriate to do that. It isn’t always done. Six weeks is a long time. We’re looking at usually to get all of our labs back in about three weeks, sometimes four, because we don’t run just one test on anybody; that just wouldn’t tell you enough.

Lindsey: 

So we talked about then the DHEA and the cortisol, so say that gets dysregulated, how does that then lead to gut health issues?

Reed Davis: 

Oh, it’s quite interesting how that works. So when you’re catabolic, you’re likely going to start losing the mucosal barrier. So matter of fact, cortisol suppresses secretory IgA, that is the main immunoglobulin, main defense element in the gut. It’s very abundant; it’s there to protect you. And that layer, we call it the mucosal barrier, gets very thin and it loses its ability to fight against those things that we want to fight against. And so yeah, you measure that actually on the same lab test. So the secretory IgA is included in our saliva test. These are tests we developed over the years that we asked labs to do for us. Say we want the secretory IgA on there. We also want melatonin on there, which is another hormone that comes into play, all these things are in play to some degree or other. Remember, this is really important as us we’re not looking for a medical diagnosis; we think people have had enough of those. And so instead, we want to find out just what are the healing opportunities? What are the opportunities? What can we do together with our clients to improve things? So these are not, they don’t reach the threshold of a medical diagnosis. And again, many people are told you don’t have one, you’re not a medical case. And I might add, yet.

Lindsey: 

So what is the name of the test then that you do and whose test is it?

Reed Davis: 

So we use Fluids IQ, we just call it the Stress and Hormone Panel. Fluids IQ is the name of the lab out of Canada. They ship their kids everywhere. They have catered to us to some degree with adding markers, adding analytes that I think are very important in all my experience.

Lindsey: 

The Fluids IQ Stress and Hormone panel. And does that include sex hormones, as well?

Reed Davis: 

Oh, yeah, cortisol, DHEA, testosterone, progesterone, estrogen, secretory IgA (sIgA), melatonin, all on one easy-to-do, at-home lab test kit tells us a lot about you. Does it tell us everything we want to know? No, the idea is to run tests that cover an entire constellation of healing opportunities. Because again, you’ll run up to people who, “Oh I ran a test like that, I ran it”. And you’ve worked on that one thing, but it didn’t work. Because the way stress works, it’s multi causal, multifactorial, and these multi causal factors weigh upstream, sometimes, sometimes really far upstream, happened a long time ago. And all of these causal factors are having an effect on each other. And that’s not even measurable, sometimes not singly. And so you have to get the whole constellation. So hormones, yeah, for sure. The immune system. Yeah, we talked about sIgA. But there are other immune system markers. And those are on the other tests. So hormone, immune, digestion, detoxification, and some other things, we want to get as many healing opportunities as possible and sorted all out, give people the things they can do at home, an epigenetic lifestyle program that will make improvements to every cell,, tissue organ, system in the body. Why single one thing out? We know that certain diagnoses: “Oh, I found your problem”. Yeah, right. You know, you found a problem, you think a marker that’s out of place, and you can treat the paper if you want to, the person might even feel better for a little while. But if you don’t address all of it, which is our job, then likely those same symptoms will come back. You have to increase dosage on the medications and different things, the symptoms will come back, or new symptoms will appear. And that’s just another endless cycle. So we want to end the cycle of trial and error by getting a very comprehensive outlook.

Lindsey: 

So when you see that decreased Secretory IgA are you approaching that by starting with addressing the adrenals? Or are you dealing with that directly? How do you how do you handle that?

Reed Davis: 

Well, our protocols address every cell, tissue, organ, system at once. And so it just gets swept up in the lifestyle and epigenetic program. But that, in particular, if it’s low, what does that mean? Well, it means your mucosal barrier likely is worn thin, and you don’t have the same immune system you used to. But what if it’s high? Ah, different problems, more like a current infection, something it’s responding appropriately to some offender, some overgrowth, bacteria, parasite, something, and it’s actually responding quite appropriately. So high or low tells us different things about that person, and indicates a certain course of action. Where that person could self-treat, we hope, or sometimes we send people right back to their physicians. Say, hey, you doctor missed this. So let’s go see what that doctor says about it. And if they recommend something, we might concur. Might want to go more natural. Who knows? It’s all up to the person.

Lindsey: 

Yeah. So what kinds of other tests then do you like to do with your patients?

Reed Davis: 

To get the entire or not the entire, but a big picture, the constellation? If I showed you two stars and said “What constellation is it?” You’d say “I don’t know. It depends. Where’s the other stars?” So we want to get as many as possible so we can actually look at hormone, immune, digestion, detox. You’ve got a lot of room for improvement here; we identified numerous healing opportunities. And now we can set forth on a path that would correct all of it. As long as there’s no downward spiral that’s really contracted, which is where doctors fit into the picture. So they fit in very nicely. If the downward spiral is really contracted, if there’s time, then we expect your body will heal. It wants to; there’s an innate intelligence, and we would play to that let’s coach up function, while we cut down contributors to what I call metabolic chaos.

Lindsey: 

So which specific tests do you order?

Reed Davis: 

There’s the Mucosal Barrier Assessment, the Metabolic Wellness Panel, and there’s a GI Map stool test*. And there’s a food sensitivity test. And along with this Stress and Hormone Panel, that’s five really good panels. And you know, it’s an investment in the lab work, we can’t help with that cost. We work with good labs who have reasonable prices, we think, and no one makes money on lab work, not us, we simply charge you for the interpretation on top of that.

Lindsey: 

Right, whose test is the Metabolic Wellness Panel.

Reed Davis: 

So for that, we use Fluids IQ as well. And that’s a urine test. So it’s got three main markers on it, urinary bile acid, sulfates, it’s 8OHdG, which is eight hydroxy deoxyguanosine. There’s a mouthful; that’s why we call it 8OHdG. So and then indican, which is a really good old test. And when I say indican to some practitioners, they go, “Wow, I forgot about that test.” So I learned it in school and we never run it. While your doctors could all run it in their office if they wanted to. It’s a simple urine test. I don’t know, when I was a kid, we used to give the doctor some urine and they do it in in-office testing. Now there’s none of that; it’s all farmed out, you know. So it’s pretty interesting. Well, there’s not as much of it as it used to be anyway. And they don’t do anything anymore. That tells you if you’re breaking down protein or not to bacterial action, in order to break down, absorb protein, whatever you’re eating, the protein needs to be broken down by bacteria, in addition to the pepsin and the hydrochloric acid in the stomach. Going into the small intestine, you need this bacteria breakdown to get proper absorption of protein, and protein is where you get your amino acids from. And by the way, that’s what makes neurotransmitters. You know what neurotransmitters are made for. So there’s a whole long, again, downward spiral or chain of events, list of symptoms that can occur just from having positive indican. And it’s great, it could indicate dysbiosis; you don’t have enough good bacteria to get proper digestion. So that’s remember I said hormone, immune, digestion. And by the way, that tells you there’s something going on with your immune system too, because now you don’t have enough good bacteria. And you have an abundance probably of the unwanted bionts. And then from there it just goes worse if you don’t find it up and do something about

Lindsey: 

Oh, sorry, I was just going to ask what the name of the immune test was.

Reed Davis: 

Well, the secretory IgA is a really good marker that’s in the saliva test. So now you’ve got it. You got a couple of markers now with the indican. Now you add the 8OHdG. That’s a measurement of oxidative stress. There’s lots of things going to be oxidizing; lipid peroxides would tell you if you have oxidization of cell membranes, which is never a good thing. Then there’s also on that test urinary bile acids. Now if those are in excess, you likely have spillover from the liver of the bile acids, telling you you’ve got a congested liver. Haha, now we’re looking at detoxification problems. So you’ve looked at hormone immune, digestion, detoxification, and you can we do it on every person. It’s a little finger stick. So you just prick your finger and you drip some blood to a blotter. It dries, you send it into the labs, not expensive. And that will tell us. We look at the zonulin, we look at histamine and the diamine oxidase or DAO, and the histamine to DAO ratio is very important. So this tells us more about that mucosal barrier. So we’re looking at stress, looking at ooh, that’s your immune system sliding down. That’s affecting digestion and the liver is getting congested, especially if you have that high zonulin and leaky gut kind of a thing. And the mucosal barrier is further breaking down in that your villi are atrophying or the crypts are becoming swollen. We call it crypt hyperplasia. So you get an unhealthy situation, lots and lots of healing opportunities. And that’s just three simple tests one saliva, one urine and one finger stick.

Lindsey: 

What’s the finger stick test called?

Reed Davis: 

Mucosal Barrier Assessment.

Lindsey: 

Okay, is that also a Fluids IQ test?

Reed Davis: 

That’s Fluids and that’s the three Fluids tests we use. They’re a good foundation to find out what’s really wrong so that you can go about fixing it.

Lindsey: 

Okay, and then there was a GI Map, which I’m well familiar with. And then what was the last one called?

Reed Davis: 

The Mediator Release Test or MRT for food sensitivities, just for 172 foods. So why would you run that? Well, because you’ll never heal the gut, and reduce your stress markers back to normal, which by the way, regulates blood sugar, and a lot of things, insulin levels and things. So there’s a lot of connectors, we care much more about connecting the dots than the dots, we don’t single one or two or three out and say, oh, here, take this for that and take this for this.  No, it requires looking at it in concert. It just works. It outperforms every other system. It’s why it’s so popular. So those three tests tell you what’s wrong. The other two, that GI Map tells you what else is going on inside the gut microbiome and you can find parasites, bacteria, funguses, even test for a couple of viruses. And then the microbiome itself, the balance between certain families of bacteria need to be highly balanced. So that the dysbiosis you found on the urine test is actually identified, further speciated to some degree with the GI Map, which is a stool test. So far, we haven’t had to go for a blood draw and get our veins poked. And then the food sensitivity test, the really good one does require a blood draw. But there’s all these drive by vampires, I mean phlebotomists, who do the at-home blood testing, come out and help you get the kit done.

Lindsey: 

Yeah. So I had heard of the MRT. And I’ve never used it with anyone. I’m curious, are you at all concerned if somebody is doing this testing initially, that if they have a leaky gut, they’re just going to have everything they eat show up on it?

Reed Davis: 

No, it’s really surprising. That’s true with certain tests that they’re IgG or IgA or something like IgM, might be elevated to an awful lot of things that aren’t really a problem. There’s all these cross-reactivity possibilities. The MRT is a completely different form of measurement. So Mediator Release Tests aren’t as dependent on that as some of the other tests. That’s why we prefer it. There’s always green foods. So that’s the good ones. There’s green, yellow, and red. You avoid the yellows and reds, but we try to get our clients to focus more looking on the green. There’s green vegetables, there’s green fruits, there’s green forms of produce, and it even measures condiments and spices and things and it’s really valuable. I’ve seen people completely turn around. And I would attribute a lot of it to that one test. I mean, talking about almost miracle, I can’t use the word cure and don’t want to, but turnarounds, kids, oh my goodness, so much. And by the way, you say it can change a bit, and as you get heals, you may have a few less sensitivities to answer your question a bit. And I’ve tested people who are on immunosuppressants, you know, for joint, skin, and other problems, and it will throw the test off, certain tests. It’ll look like you don’t have a lot of sensitivity because your immune system is being suppressed. So that’s another reason we like to use MRT; it’s not as affected by those kind of medications.

Lindsey: 

I think one of the things maybe my hesitancy in ever using it was that it was, I think it was pretty expensive compared to some of the other ones, which I also don’t use, IgG tests, but also that I think you have to go through a dietitian or somebody who’s . . .

Reed Davis: 

It’s expensive if you go the retail route, but the lab fee for practitioners actually, I think is reasonable. You know, I always say to people, if you think getting well is expensive, try staying sick. Because the loss of work and the unhappy –  having no joy in one’s life – to me is way too much of a price to pay.

Lindsey: 

Yeah, I often say this to my parents who I test and advise yearly on what to do and not to do as they’re in their early 80s. And I keep getting push back because they’re so used to the regular medical model that they followed their entire life, especially for my father, and he’s like, “I don’t want to take any more than seven pills at any one meal.” You know, it’s like “Yeah, okay, but how about stop smoking a cigar a day, drinking three drinks a day?” You know, you might have to take some pills to make up for the lifestyle habits you’re insisting on continuing.

Reed Davis: 

With you 100%, I used to work with my parents, my father passed away at 85; but my mom is 93 and still living well. And I say, well, she’s the one that listened to me most.

Lindsey: 

Well, that’s what I say. I say, how much is your life worth? And it’s amazing that you’ll still get pushback like, well, if I have to live like this, it’s not . . . I’m like, “Really? Really? Like swallowing two swallowfuls . . . “, cause he can toss down four or five pills at once, like “two handfuls of pills is not worth a year of your life?”

Reed Davis: 

Yes. And, you know, if you eat really good food and supplements, you can really supercharge the process, the healing process and the maintenance, you know, there’s just not enough nutrition in food anymore. The food is grown in depleted soils so you’re not getting  – you need vitamins, minerals, essential fatty acids, antioxidants, phytonutrients, trace elements, and whatever else is in there. And that’s a mouthful there. It’s not in the food. So you can only supplement, you get all that. And by the way, if you’ve done the lab work, you have a much better idea of what would be helpful, right?

Lindsey: 

Right. Of course. No, I’ve heard that said a lot. I mean, I listen to all sorts of health podcasts and I have a little bit of a push back in my head, which is okay, but what if you’re buying the best quality, organic foods? Is the soil depleted there too? Aren’t they composting? Aren’t they doing what you’re supposed to do?

Reed Davis: 

It’s hard to figure, if you know, the farmer, you know, that’s one thing. But the reason we buy organic food in the grocery store is mostly to avoid the herbicides and pesticides and the bad things. So if for no other reason buying organic, you’re avoiding the chemicals. And that alone is worth paying the extra to buy organic. But are you getting much more nutrition? It’s pretty hard to say because we don’t know who the farmers really are. We know that they can’t use the poisons. And that’s good thing. But is it enough? I don’t think so. I mean, I eat organic. Just every time. I mean, my wife and I are very meticulous. we will not eat the food if we think it has poison on it. But also, even you can take that to a step further, like seed oils and things. We have a problem with labeling. Sometimes on some of our products, especially in restaurants, you can’t figure out what they’re using to cook with and things that are not very good for you. So can I give your listeners a tip? It’s an app, I have it on my phone right here. It’s called Seed Oil Scout or SOS. It’s in the app store. There’s a free version. And it will tell you, you can punch in your favorite restaurant and it will grade it in terms of seed oil. Why do you care about that? Because we’re eating way too much Omega 6 in this country, versus the Omega 3s. And this 6 to 3 ratio is critical for long-term longevity. It’s not going to show up tomorrow or the next day, or even this year. But year after year, you start getting the cardiovascular disease and other problems. So that long list of other long-term markers on top of what I just told you about the more immediate need healing opportunity markers are very critical in our world.

Lindsey: 

Yeah. So talk a little bit about Omega 6s. So I run on a lot of people Metabolomix or NutrEvals. And so I see their omega 3s and Omega 6s and I have noticed this phenomenon over and over where at some point they went on omega 3s maybe, or maybe I see that they are short on omega 3s. And I suggest that might be a supplement they try. And so they do that for a bit. Then they take the test. And then I see the Omega 3s are way high. And now the Omega 6s have gotten pushed down because they’re trying to do everything perfectly. They’re staying away from the seed oils, they’re eating nothing but extra virgin olive oil and eating avocados or maybe avocado oil. And then all of a sudden their Omega 6s have tanked. So what’s the balance? What’s the perfect ratio for the person who’s just trying to eat healthy, who is not like severely impacted? Like what is the right balance?

Reed Davis: 

Yeah, the right balance will be less than four to one ratio of omega 6 to 3. So these are fatty acids that are essential. You have to have the polyunsaturated fatty acids or PUFAs. And the ratio again, you just take the six divided by the three and that’s your ratio. So if you had a four to one or three to one ratio of 6 to 3 you’re in good shape. People in America walk around with 10, 20, 30 to 1 ratios; this is not good. They say the Western diet’s approximately 15 to one. And we have seen much worse because of the processed foods, which are rich in these vegetable and seed oils. And so testing that can lower your risk for a lot of chronic diseases, but very high prevalence of cardiovascular disease, even cancer, all kinds of inflammatory and autoimmune things. You can reduce your omega 6s by eating less seed oil. But you can’t avoid them completely, because they are in food.

Lindsey: 

Right, they’re in meat.

Reed Davis: 

So you’ve got to increase your omega 3s and you could do that through fish, seafood or supplementation. I think everyone, and I take two capsules every single morning, little pearls. And I just want to make sure my omega threes are up there.

Lindsey: 

So I like the Nordic Naturals ProOmega 2000*. So each one is basically 1000 mg of EPA and DHA in one pill – pretty well balanced. And I find though if people are on two of those a day, that their Omega 6s start getting pushed down. And mind you these are not people who are eating a lot of processed foods, like by the time they find me, these people are already on almost the perfect diet. Most of the people I see they’re already eating all unprocessed food, they’re not . . . you know if they’re going to restaurants, it’s probably higher quality restaurants, or not often. So they’re not eating the processed food, the standard American diet. So I’m trying to figure out what’s the . . . and then I’m telling them okay, if I first see them, I say yeah, so avoid the seed oils. But then it gets to a point where I’m thinking they actually need some more omega 6s. So it’s like, well, should you cook with canola oil every fourth day or you know, what’s the balance?

Reed Davis: 

You can get tested, we don’t guess, we test, right? So there’s a good place if you’re having trouble. It’s called Sunbasket.com. And anyone can go to Sunbasket.com and they ship you the food in little bags. You make it yourself.  Meals can take 20 minutes or up to half an hour because you still, if it comes with an onion, you still have to chop it. But it’s everything in balance. And it’s all fresh, and it’s all organic. And it’s all pretty balanced in terms of these, no cheap seed oils and things like that – these things go rancid by the way. And they’re just very good. So they’re paleo. You can also get the vegetarian or gluten-free, keto-friendly, Mediterranean-friendly; you can get the pescetarian version and only eat fish if you want. Personally, I like a full broad spectrum of foods and it’s all fresh. So you can get it down to about five bucks a serving. So if you’re cooking it for a family of four, you can have really good meals. The order, remember it comes fresh, not frozen. But they ship it right to your door. You get two or three days’ worth, four days’ worth, five days. You can cook it all at once. And of course cooked food lasts a lot longer in the fridge.

Lindsey: 

Cool. hadn’t heard of that one.

Reed Davis: 

Your kids can be pulling it out of the fridge in your little containers. We use glass. It’s got a plastic top but it’s glass and you can pop that right in your little micro – we don’t use microwave in our house but we put it in the little oven thing.

Lindsey: 

Do they recollect to those glass containers from you or?

Reed Davis: 

No, no, it comes in plastic. It comes in bags.

Lindsey: 

Oh, you reheat it in glass?

Reed Davis: 

What I’m saying is we’re preparing two or three days in a row on say a Sunday. You cook Monday, Tuesday, Wednesday’s meals and you put them in glass and you put them in the fridge and you can pull them out. The kids could if you’ve pre-prepared it, come home from school and eat really good, nutritious food instead of whatever else they might be wanting to eat. You teach them. And plus, they can participate in the making of food. It’s actually pretty meditative. You know, it’s good for you feel like you’ve accomplished something.

Lindsey: 

Oh, yeah, I’ve taught my children how to cook. My youngest was making meals for the whole family by I think 13 or 14. He would do one meal a week.

Reed Davis: 

Wonderful. Yep. You just need to have seven kids so that you never have to cook!

Lindsey: 

Well, we had a down to a science. Well, we had four meals, each of us did one meal a week and then we would go out probably once a week and then leftovers and maybe at a friend’s or something. So it worked out.

Reed Davis: 

Yeah, I know. We eat out a little bit more often, but not much.

Lindsey: 

Yeah. So if somebody does have a co promised mucosal barrier, from what you can tell, what kind of supplements or approaches would you recommend?

Reed Davis: 

Yeah, so we have what we call a DRESS for Health Success System. Matter of fact, I think we could give all your listeners a free booklet on the DRESS for Health Success System if they want. DRESS stands for diet, rest, exercise, stress reduction, and supplementation, DRESS. So if you eat right, the right diet for your type, we have a way of figuring it out, diet, and you rest, you know not just sleep, but during the day, if you need to rest your emotions, your mind, whatever you need to do, we teach you some techniques for midday. You know in Italy, they do siestas, because it’s good for your soul, not just because you got up too early. And so diet, rest, and exercise goes without saying. And then the last the two S’s are stress reduction and supplementation. Stress reduction is too big to go into. Now, I’d love to spend a whole show on it sometime. Because it’s so ubiquitous, there’s so many different kinds of stress. And the body doesn’t care what kind, it responds with the stress response, whether it was a mental, emotional, psychospiritual, whether it was bad food, or you got punched in the face, or a car accident, or these chemical stressors like new furniture or something. So you got all these stressors, and you got to handle them, learn about how to sort them out. So you got diet, rest, exercise, stress reduction, finally, then supplements would actually have a good chance of helping you when you’re doing other things, right? If you’re trying to supplement your way to health, it’s not going to work. If you try to supplement, you have a bad habit. In other words, well, yeah, I like to eat gluten, you know, I’m allergic to it. But I’m going to take my Gluten-ease – it doesn’t work. So supplements are applied intelligently for the nutritional needs, but also to support for maybe a short period of time, certain systems or organs, or to stimulate, like, if you’re going on a trip, take some immune support with you. Because you’re going to get exposed to bacteria your body might be a little sensitive to. So you can substitute for what’s not in the food anymore. You can stimulate like the immune system, you can support your adrenals or your digestive system. And you can even self-treat with, they’re not really supplements, but they’re available in the same store, self-treatment for parasites or bacteria or fungus or these kinds of things. So there’s four reasons to take supplements.

Lindsey: 

And so supplements for a leaky gut? Oh, yeah.

Reed Davis: 

So we want to coach to up function. So the gut needs a lot of circulation, it needs some immune support, it needs some soothing, and things. So we want to support the proper function. So there’s all kinds of ingredients for that. I use a product from Biomatrix called Support Mucosa*. What a name, think of that. And it soothes and helps the healing process. But you also need something and maybe coach down the bugs and dysbiosis and the biofilms that might occur. So it just depends what we see in the test results. So Coach up function, coach down the contributors to metabolic chaos, and you’d be in pretty good shape with anything that you’re looking at. We don’t like the word treatment; we like to say support, you know, coach up function. When it comes to the gut, you got to run a test and get rid of the bad foods, they’re irritating. So if you’re going to keep eating the same way, your supplements aren’t going to be as effective. Diet is really a key there. And so is exercise or reduce exercise. People exercise too much, believe it or not. And so there’s lots of ways to look at DRESS, regardless of what the main complaint is, like leaky gut or irritable bowel or migraines or psoriasis, or ADD in kids. I had a kid once, I’ll just tell you a quick story. So with the lady, he comes in the office, and she says “Reed I’m just curious, do you work with children?” I raised four kids, I’ve been coaching football for 15 years, and I work with kids. And she goes no, I mean they’re trying to send my kid home from school if I don’t put him on drugs. They say, back then it was Ritalin, was the drug of choice for bad behavior. And this kid was poking the other kids and disrupting the class and hey, put this kid on drugs. The first thing I said really was, well, was this a medical person at the school, nurse at least? No, just the teachers and principal are diagnosing and recommending treatment to a mom, which I thought was pretty not very good. But I said I don’t know if I could help her out. Let’s run a couple of tests and see. After we got the results, changed some things, by the way this kid was nine, they wanted to drug a nine year old. And the parents were about to do it. Yes, the thing is, well, what do you do? So, you know, they’re desperate. And within three weeks, I’m telling you within three weeks, I got a call, the principal of the school tracked me down and said, you know, Mr. Davis, tracked me down with through the Mom, “this is a different kid”. He’s paying attention. He’s not poking around the other kids. He’s not disrupting classes. He’s actually paying attention. And then he said, “What did you put him on?” We were not getting anywhere with this guy. He just wanted to know what’s the magic pill.

Lindsey: 

And what were the big movers for him?

Reed Davis: 

The big movers were the food colorings. Some of these foods and food colorings and the sugar and all the crap, the chemicals and preservatives, were neurotoxins to this boy, exciting his nervous system, and he couldn’t come out of sympathetic dominance. For one thing. He also had other irritation, again, the nervous system acts where there’s probably some inflammation and things going on, and some gut issues and stuff like that. We also got him going to bed on time, you know, some disciplinary things. But in three weeks, I got a call “What did we put him on?” I said we’re putting him on a better lifestyle. And he didn’t “well that doesn’t . . .”

Lindsey: 

. . . didn’t want to hear about that. Yeah, well, you’ll love this. What I used to do, my previous job, I started a nonprofit in Montgomery County, Maryland, outside of DC, and one of the largest and most prestigious school systems in the country, in order to change the school food, it was called Real Food for Kids – Montgomery. And we got them to remove all the artificial colors from the school food.

Reed Davis: 

Oh, my goodness, yeah. Well, good for you. And that is a step in the right direction for sure. Hopefully, they got rid of the sugar too.

Lindsey: 

Oh, I tried so hard on the sugar, let me tell you, but until the USDA, or the FDA, well, until they change the labels, which they finally did. Now they show the added sugar on labels. That was a key mover because you have to be able to somehow actually track what’s added vs. naturally occurring sugars in order to then say, okay, we want you to limit. But what was happening was, if you added it all up, the kids were getting something like 10 teaspoons of sugar in a typical school breakfast. So like on a bad day, maybe where they served, of course, they served juice, but it had to be all natural juice. So only naturally occurring sugars there, but they would serve of course the flavored milks with added sugar, chocolate and strawberry typically. And then cinnamon roll, and then a pack of Craisins that by itself had five and a quarter teaspoons of added sugar. So that combo. And so they’d already had more than the maximum recommended daily allowance of sugar in their school breakfast already.

Reed Davis: 

You know, I totally get it and you’re doing fantastic work. And just another quick one. I had a patient coming into our office who was a principal of five Montessori schools, so five private schools for kids. And she went to one each day that week. And she started sitting in on the disciplinary meetings between parent, teacher and kid. And she just started asking one question of the kid. And the question was, what did you have for breakfast? These were disciplinary, like bad kids, you know, kids doing this or that or whatever, call the parents and try to correct the behavior. And what did you have for breakfast? What percentage do you think was sugary cereal?

Lindsey: 

Oh, probably 95%.

Reed Davis: 

100%. They’re eating Pop Tarts or Cocoa Puffs or, you know, whatever they’re eating today. I don’t know. But it’s bad. And actually, that was 20 years ago. So isn’t going away, this problem. And if you ask my 93 year old mom, what’s your secret to longevity? She goes, no sugar.

Lindsey: 

Good for her. I can’t get my parents to listen to that one.

Reed Davis: 

Well, she says that, but then I see a box of chocolates in the freezer.

Lindsey: 

Hopefully it’s 70% at least.

Reed Davis: 

Yes, she knows about that. She’s still drives for gosh sake. Yeah, she’s funny.

Lindsey: 

Okay, one more gut health question. So do you take an anti-microbial approach or something more conservative when it comes to things like SIBO or IMO?

Reed Davis: 

It’s just blown up dysbiosis and there’s questions about the source, how’d you get it? But it’s not a test where there’s any kind of speciation whatsoever. They don’t know what the bugs are just plenty of bugs, you know, bacterial overgrowth. So I think it’s really important to dive in little deeper, and you can self-treat, you can, remember what I said, coach up function while you coach down the contributors to metabolic chaos. So, like overgrowth, bacterial, fungal or parasitic and these things, biofilms occur. They develop over time where they all kind of get together in a big orgy and move up and down around inside your small intestines. And they also produce toxins, so lipopolysaccharides, you know, so they’re toxic. And so you have a lot going on. And so to say, what’s the one remedy? No, but coaching down bugs, we call them generally, is a good thing. Chase away the bad guys, while you support the element, the good things in this, the mucosal barrier, the structure and condition of the villi, and in between the little villi, the crypts are called. And there are tests that can tell you how those things are going before, during and after treatment. And as I said, if you’re not eliminating the food sensitivities, you’re missing out on a big opportunity for improvement.

Lindsey: 

So tell people where they can find you and find the program?

Reed Davis: 

Yes, sure. So well, you know that what we do is called FDN, Functional Diagnostic Nutrition. And so we have a website, it’s FDNtraining.com. So if you go to FDMtraining.com/theperfectstool that’s named after your program, then you would get a free booklet. And if they don’t give you a free book, hopefully it gives you something. Okay, we want everyone to learn about the DRESS for Health Success Program, simple steps for health success. Yeah. So you can you can get that book, download it for free.

Lindsey: 

And what about you? Do you practice virtually? Or are you in a one set location?

Reed Davis: 

No, I have a few hundred people I’ve trained to refer to. So I do that mostly. And I don’t see any one to one anymore. Although, if somebody got a hold of me, I’d give my best shot. The problem is that without the labs, there isn’t much to talk about. From the point of, yeah, there’s just not much to say.

Lindsey: 

So if they want to find an FDN practitioner, would they go to that FDNtraining.com?

Reed Davis: 

We’re about to add a list. But if they go to that URL, and sign up for the free book, and then follow up to that email, hit reply and say, “Hey, I’m really interested in in hiring an FDN in my area.” And really, we’re in 50 countries, we’re in every state, and at least every time zone and plenty of people to choose from. Right? And they’ll actually try to hook you up with someone whose work . . . so we have FDNs who are personal trainers, say young men 25 to 35, who work in the gym, and they help people get more fit and improve performance. That might not be the same FDN that a postmenopausal woman with weight gain and fatigue and irritable bowel would want to talk to. So we’ll help you pick somebody.

Lindsey: 

Yeah. Great. Well, thank you so much for your time. I really appreciate it.

Reed Davis: 

A pleasure. Good to be here, Lindsey and if there’s anything I can do for you, let me know, we’re always willing to come back and talk some more.

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

Adapted from episode 114 of The Perfect Stool podcast and edited for readability.

I’ve done multiple other podcasts on SIBO and IBS, so do see episode 36: IBS Treatment: Addressing an Irritable Bowel Naturally and Episode 83: Recurrent SIBO: Symptoms, Causes, Testing and Treatment for an in-depth treatment of all types of SIBO and IBS, but today, I’m going to focus on hydrogen sulfide SIBO (H₂S SIBO).

You know how when you learn a new word, all of a sudden you hear it being used all the time? That’s kind of going on right now with me and hydrogen sulfide SIBO. It kind of feels like everyone I’ve seen lately has suspected or diagnosed hydrogen sulfide SIBO. And it’s funny because before now, it wasn’t that common in my experience.

But I’m starting to recognize the type, and if I had to say one thing that tells me that someone might have hydrogen sulfide SIBO, other than a positive breath test or a stool test showing elevated levels of hydrogen sulfide producers or what are called sulfate reducing bacteria, it’s how miserable they are. From a painful, gurgling gut, known as increased visceral sensitivity, to bloating and distension, to excessive burping, to urinary urgency, a burning bladder or interstitial cystitis, to systemic inflammation, rampant food intolerances and often histamine reactions, my hydrogen sulfide clients are just some of the worst suffering. Other symptoms you might see include weight loss, post-prandial hypotension, meaning low blood pressure after meals, weight loss, an elevated heart rate, exercise intolerance, brain fog or insomnia.

Hydrogen sulfide overgrowth is also associated with ulcerative colitis, Crohn’s Disease, colorectal cancer and Parkinson’s Disease, so definitely not something you want to let fester.

And what I’m finding, surprisingly, is that some of my toughest cases of what I though was an overgrowth of methanogens, is in fact an overgrowth of hydrogen sulfide alone or in combination with methanogens. This is because while the overwhelmingly common presentation of hydrogen sulfide is diarrhea or loose stool, it can also present with constipation if there’s an overgrowth in the large intestine or if you have a simultaneous overgrowth of methanogens, which pretty much always causes constipation. The classic example of this is someone with a mixed type IBS where constipation is the usual presentation, but then occasionally there will be bouts of attacks where they have diarrhea and often all-over body pain or extreme abdominal pain, often requiring a trip to the emergency room.

And what a lot of these clients have had in common, if they have constipation, is that they have slowly but surely stopped eating everything besides meat or meat and a limited number of vegetables and maybe a very limited quantity of rice. And they often have histamine intolerance or signs of sulfur intolerance, like the inability to stand cruciferous vegetables or alliums, like onions, garlic, shallots, chives and leaks, which have sulfur. A few have noticed they don’t tolerate red meat, which is particularly high in sulfur. Ironically, all of this may actually stem from a deficit of sulfur, which is a new theory I’m testing out, so I’ll get back to you on that, but this is theorized because of the impact of glyphosate on food, which impairs a pathway in gut microbes called the shikimate pathway. This pathway produces the very important amino acids l-tryptophan, our serotonin precursor, and l-phenylalanine and l-tyrosine, our dopamine precursors, as well as other nutrients. And it’s been shown that glyphosate also impedes sulfur production by causing a deficiency in molybdenum, a cofactor for the enzyme sulfite oxidase, which produces sulfate. Then if you have homozygous copies of the CBS (cystathionine beta-synthase) enzyme, which drives the recycling of sulfur-containing compounds, you may have too much unusable sulfur in your body, which can lead to sensitivities, while simultaneously having a deficiency.

But suffice it to say that hydrogen sulfide is very important in the human body, playing roles in inflammatory, neuromodulatory, immune, endocrine, vascular and respiratory actions. However, at high levels it becomes toxic to cells, inhibiting cytochrome oxidase, a hemeprotein which an important enzyme in the electron transport chain in our mitochondria, which is the way we produce energy in the cells. It also damages the intestinal mucosa and inhibits the oxidation or use of butyrate to feed the colonocytes or cells lining the colon. So upregulating hydrogen sulfide production in the gut may be a compensatory mechanism, but I’ll have to get back to you on my experiments with that.

Which bacteria produce hydrogen sulfide?

So lots of common genuses of gut bacteria produce hydrogen sulfide it turns out, including Escherichia as in E coli, which is not just the pathogenic E coli you’ve heard of, but also includes many commensal species, klebsiella, which is known as the big histamine producer, proteus species and Citrobacter freundii (but not all citrobacters), all of which are part of the family Enterobacteriaceae, some of which are hydrogen sulfide producers. Also the genuses streptococcus and staphylococcus, which I see elevated on virtually every GI Map I see, pseudomonas, H pylori, salmonella, some Clostridium, and Yersinia Enterocolitica. But the two that have been most highlighted as potentially overgrown and relevant to the hydrogen sulfide SIBO picture are Desulfovibrio species and Bilophila wadsworthia.

The interesting thing is that hydrogen sulfide producers come from a number of different phyla, including Deltaproteobacteria, Proteobacteria, Pseudomonadota, Thermodesulfobacteriota, Fusobacteriota and one genus from the phylum Euryarchaeota called Archaeoglubus. And while most are gram negative, one genus, Desulfotomaculum is gram positive and is a spore former. But the majority of the sulfate reducing bacteria are from the genus Desulfovibrio, around 66%, hence why you see those species listed separately on the new version of the GI Map under the heading Commensal Overgrowth Microbes, right above Methanobacteriaceae, the methanogens responsible for intestinal methanogen overgrowth (IMO). And then Bilophila Wadsworthia is in the class Desulfovibrionia and the order Desulfovibrionales but a different genus. And can I just say, bacteria nomenclature is really confusing, even for me? And then finally, Fusobacteria, which is from the phylum Fusobacteriota and the family Fusobacteriaceae, is another one that’s well known to be a problematic one in hydrogen sulfide SIBO, including Fusobacterium nucleatum, known to be responsible for periodontal disease and all sort of other mischief.

What do hydrogen sulfide producers eat?

So the next thing you might want to know about H₂S producers is that most of them use hydrogen (H₂) as a fuel source, through a process called oxidation. The hydrogen is coming from other gut bacteria that produce hydrogen, which you will certainly be familiar with as the more common type of SIBO. And while hydrogen gas is odorless, hydrogen sulfide gas is smelly like rotten eggs. But again, one of the difficulties in recognizing hydrogen sulfide overgrowth is that many people with it will not say they have gas, smelly gas, or gas that smells like rotten eggs. Or they’ll only occasionally have gas like that, like after they’ve had a meal heavy in animal fat.

But other sulfate reducers use different fuel sources or multiple fuel sources. So for example, Bilophila wadsworthia metabolizes the amino acid taurine. Fusobacterium, Desulfovibrio, E coli and Klebsiella metabolize the amino acids cysteine and methionine. Which makes finding food to eat much more complicated (e.g., protein), but I’ll get to that in a minute.

The other thing you might want to know is that methanogens also use hydrogen as a fuel source. So although you may be negative in a breath test for hydrogen, if you have methanogens and/or hydrogen sulfide producers overgrown, if you kill them off, you may end up with a hydrogen overgrowth. So don’t think that it’s likely to be a one and done program to get rid of these pathogens; sometimes it requires several rounds of treatment with testing in between to see where you are.

How do you test for Hydrogen Sulfide SIBO?

So there is only one breath test out there that tests for all three possible gases in SIBO/IMO, including hydrogen sulfide, and it’s called the triosmart test or order from my Rupa Health Lab Shop*. But stool tests, like the GI Map or GI Effects, can also point to the presence of H₂S SIBO in conjunction with symptoms, when you see elevated bacterial markers for H₂S producers. You can find all these tests in my Rupa Health Lab Shop*. Although I have been partial to the GI Map in working with clients, I’m beginning to think that the triosmart might make more sense for clients who are constipated, both because you can differentiate between the rarer H₂S overgrowth or find out if it’s present alongside IMO, and because then you can track the level of methanogens and determine exactly how bad the overgrowth of methanogens is and have some sense of how long a treatment protocol someone might need. With the GI Map, you’re just seeing stool levels, which isn’t necessarily indicative of small intestine levels. But if you happen to have taken a SIBO breath test that only included hydrogen and methane, the sign that you might have a hydrogen sulfide issue is that you have a flat line or no growth on either of those gases.

I’ve also heard that you can use sulfite urine testing strips* to test for the presence of free sulfites, which may help you diagnose H₂S SIBO, but I don’t know the details of how to use the strips in this way.

How do you treat hydrogen sulfide SIBO?

So the bad news for those of you who are on a paleo or carnivore type diet is that the diet for hydrogen sulfide SIBO is actually a plant-based diet. To start with, you want to reduce your animal fat completely, and ideally your animal protein as well, other than fermented dairy, which seems to be helpful in reducing levels of Bilophila wadsworthia, per two studies, one on probiotic yogurt consumption and the other on consumption of a fermented milk product. There may also be benefits for yogurt and kefir consumption in the reduction of Fusobacteria, as an in vitro study found they inhibited its growth. But no animal foods ideally for 3-4 weeks, then you can start reintroducing those foods one by one, starting with the lowest fat types.

But otherwise, you’ll want to decrease fat entirely for 2-3 weeks, definitely avoiding butter and tallow and lard and fatty cuts of meat. Coconut oil and coconut milk in moderation are okay after your initial low fat period. And small amounts of olive oil or omega 3’s are the best choice for fat throughout. MCT oil may also be okay in that initial period and after as it doesn’t require bile for absorption. You also want to avoid simple sugars or high fructose and focus on whole foods with lots of fiber. And then avoid animal protein as much as possible. So basically, you’ll have to incorporate sources of protein that are not animal based, but not including soybeans or quinoa if you have overgrowths of Fusobacterium, Desulfovibrio, E. coli or Klebsiella, as those two foods are high in cysteine. You’ll want to sustain this diet until such time as you are feeling better.

And if the sulfur-containing vegetables like garlic, leeks, onions, scallions, and shallots and cruciferous vegetables bother you, you should limit those as well.

Now if you are one of the unlucky ones who has both a hydrogen sulfide overgrowth and a methane overgrowth and a high level of constipation, you may be asking, what can I eat, especially if that coincides with histamine issues and food intolerances. In those circumstances, I tend to recommend a diet that’s more in between, with a limited quantity of low-fat sources of animal protein like skinless chicken breasts, white fish and shrimp, with low-fat, fermented dairy, nuts, seeds, and any high fiber carbohydrate foods you don’t react to, like lentils, chick peas or beans, starting with small quantities and working your way up, as well as fruits and veggies you can tolerate. Another option of course is doing an elemental diet, which consists of just a liquid diet for 2-3 weeks, which mostly likely you’d want to combine with antimicrobial supplements in order to help it along. I did a podcast on elemental diets, which is episode 100, called Give Your Gut a Break.

This may seem like a scary idea if you have had trouble keeping on weight, but in fact, my guests from that episode, Debbie and Roy Steinbock, maintained that people maintain or gain weight if they have had trouble putting on weight while on the diet. But people wanting to lose weight simultaneously lost weight. So it’s good for any weight circumstances. Or you may just use the elemental diet “shakes” as a supplement to the food you’re eating in order to make sure you’re not losing weight, or to replace 1-2 meals a day. You can find the Physicians Elemental Diet* powder in my Fullscript Dispensary.

What supplements to avoid with hydrogen sulfide SIBO?

So as you’re decreasing sulfur in your diet, you’re also going to want to avoid supplements with sulfur or bile. This includes ox bile, bitters, bile stimulating herbs, carrageenan and additives with sulfur, glucosamine and chondroitin sulfate. You should avoid protein powders with high levels of sulfur amino acids like taurine, cysteine and methionine, although collagen is okay.  And then of course avoid NAC (n-acetyl cysteine), glutathione and anything with a -thiol or sulfur group, including alpha lipoic acid. Thiamin or B1 and Biotin also have sulfur, so avoiding high doses of those might be a good idea. Also, certain probiotics are known to produce hydrogen sulfide, so best to avoid those, including Lactobacillus reuteri BR11, Lactobacillus delbeueckii ATC4797 and possibly Bacillus subtilis. There are a couple of others that produce H₂S, L plantarum 299v and L rhamnosus GG, but I’ve heard recommendations and studies in which foods or supplements with those strains were helpful in H₂S SIBO, so the jury may be out on that.

What supplements are helpful for H₂S SIBO?

So what is helpful to take for H₂S SIBO? First, there are several herbs that are helpful, including gymnostemma, codonopsis and Korean ginseng, which is panax ginseng*. Then minerals may be deficient that are necessary for repairing bodily processes that aren’t working properly, in particular molybdenum*, 50-150 mcg per dose but no more than 500 mcg/day, or a multi-mineral supplement. I like the Jigsaw Essential Blend Multimineral* as it has zinc, copper, selenium and molybdenum in it at good doses, all of which are recommended for H₂S SIBO. Hydroxocobalamin*, a form of B12, is also recommended, as opposed to methylcobalamin, a form I recommend to most clients because of the prevalence of MTHFR SNPs. Then beyond that, butyrate is important (although go easy on it if there’s constipation, only taking one 300-500 mg pill every 3 days if you’re constipated to start). If you’re not constipated, you could use my Tributryin-Max, 1-3 daily, decreasing if you get constipated, or any other tributyrin or CoreBiome based product, although you’ll need more of a lower-dosed butyrate supplement.

Then the prebiotic FOS* is also helpful, 2 grams a day with meals if you don’t react to that. Be careful not to choose one with inulin though as many people with SIBO are reactive to that. And finally, something I’m recommending to most people these days, serum bovine immunoglobulins*, which help bind to and remove gut pathogens without impacting commensal bacteria. The dose that’s been studied is 5 grams a day, which is recommend in two doses of 2.5 grams on an empty stomach, usually first thing in the morning and last thing before bed.

And let me not fail to mention good old Pepto Bismol* or a generic equivalent* or a supplement containing bismuth. MDs will use 500 mg of bismuth three to four times a day with H₂S SIBO in addition to Rifaximin, the antibiotic for SIBO. There’s only one product in Fullscript with bismuth that isn’t full of dyes and additives you might want to avoid, which is called Biofilm Phase-2 Advanced*, and has 200 mg of bismuth in two of them, along with some other stuff though that may not be great in H₂S SIBO, like alpha lipoic acid. I’m just beginning to experiment with this product, so I’ll let you know how it works out in a subsequent podcast.

And also, I shouldn’t fail to mention that exercise and stress management are also important in managing H₂S SIBO.

Well I hope this helps some of you get to the bottom of your gut health or all over body suffering and find a way out.

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