Today’s post is all about butyrate and tributyrin, which is the best absorbed form of butyrate. This is a supplement I recommend frequently to my clients and which some of my favorite gut health mentors like Dr. Daniel Kalish and Grace Liu, PharmD also recommend for certain gut issues. It’s particularly indicated for people with diarrhea, loose stool, IBS-D, hydrogen or hydrogen sulfide SIBO because it slows motility and leads to firmer stool. But before I launch in, I was to make a disclaimer that this should not be construed as medical advice and that you should see you own health care practitioner to make decisions about your own care.
Some of butyrate’s known health benefits are providing the primary energy source for the cells that line the colon, or colonocytes, improving the integrity of the gut barrier, aka reducing leaky gut or a leaky colon in particular and therefore, reducing inflammation and preventing the leakage of toxins into the bloodstream.
It has also been shown to enhance insulin sensitivity, which can reduce the risk of type 2 diabetes. It also has all-over body anti-inflammatory properties. And if that wasn’t enough, if you’re short on butyrate-producing microbes, which is associated with an increase in metabolic disease, type 2 diabetes, and obesity, butyrate may also be helpful. Supplemental butyrate has been shown to lower hemoglobin A1C and reduce blood-glucose spikes in type 2 diabetics, reduce insulin resistance, and reduce obesity-associated inflammation.
In addition, in animal models, when they purposely fed the mice high fat diets, which aren’t great for mice, butyrate prevented them from becoming obese and having the accompanying metabolic issues that accompany obesity. It was also shown to bring about weight loss in a randomized clinical trial of obesity in children. But in one study it did increase the weight of rats born to mothers fed butyrate, so I generally don’t recommend it for pregnant women, although Lucy Mailing, gut health expert and my guest from episode 25 of the podcast, made a good argument for using it even in during pregnancy in one of her office hour calls, and took it herself while pregnant. (See Episode 90 Show Notes for links to those studies).
Then tributyrin, which is formed of three molecules of butyric acid combined with one molecule of glycerol is a form of butyrate that is found in newer supplements, as opposed to sodium butyrate, potassium butyrate, magnesium butyrate or calcium butyrate forms, and has been found to be preferable to other forms of butyrate because it has a low odor and chemical stability, meaning it’s resistant to breakdown by gastric and pancreatic enzymes. This means that it can reach the large intestine intact. Tributyrin is also superior to other forms of butyrate for its ability to diffuse through biological membranes, releasing butyrate over time directly into cells as opposed to other forms of butyrate, which are metabolized rapidly as soon as they enter the cells lining the colon. Tributyrin has also been found to be more effective than other forms of butyrate in uses with animals, such as improving gut health in livestock and modulating immune function.
So now I’m going to focus in on the gut health benefits I’ve seen in myself and others of supplemental tributyrin, which are supported by the research.
So when you take antibiotics, your body’s ability to produce butyrate likely drops significantly. In animal models, the use of 3 days of oral antibiotics decimated the gut’s ability to produce butyrate from fiber and increased oxygen levels in the colon. Now the colon is supposed to be oxygen-free, also known as hypoxic. And a healthy, hypoxic colon supports both anaerobic bacteria, which can’t live in the prescence of oxygen, and facultative anaerobes, which can live with or without oxygen. But importantly, the anaerobes are the ones who produce butyrate to feed the colonocytes. Most butyrate producers belong to the Clostridium cluster of the phylum Firmicutes, such as Faecalibacterium, Roseburia, Eubacterium, Anaerostipes and Coprococcus, among others. So post antibiotics, when your gut becomes unable to produce butyrate, it will pull in oxygen as an alternate fuel source. This promotes the growth of facultative anaerobic bacteria, typically proteobacteria. In my experience, this leads to messy, loose stool, a poor mucus lining, and an inflamed and leaky colon. So supplementing with butyrate during and after antibiotics can reverse this cycle and help restore the healthy balance between anaerobic and facultative anaerobic bacteria. Lucy Mailing described this process in a great blog called “The oxygen-gut dysbiosis connection” and also spoke about it when she was on my podcast.
In my personal experience, because I have post-infectious IBS leading to frequent hydrogen-dominant SIBO (or small intestine bacterial overgrowth), I often have periods of bloating and accompanying loose stool and sometimes diarrhea. Tributyrin has been my savior in these periods so that while I’m working on reducing the quantity of bacteria in my small intestine, I can still have firm stool and maintain a healthy mucus lining. I don’t know about you, but if you’re dealt with loose stool, when you have a good one, it just puts you in a great mood. The trick with using tributyrin in my experience is getting the dosing right, and that happens most easily by increasing the dose until you get firm stool, and then when it gets too firm, like rabbit pellets, decreasing the dose until it’s just right. Personally, I have found that I’d typically need something in the range of 900-1500 mg and at times even as much at 2000 mg/day to or more to start to achieve firm stool, but then I can decrease my dose after that. The nice thing about butyrate is it has very few known side effects, with even higher doses up to 2,000 mg/day, no short-term adverse reactions have been observed in studies. Of course I don’t recommend it to my clients with constipation because it does slow motility and constipation does increase your short-term risk of GI and other cancers.
And since I found that I needed such high doses to achieve the desired result, and because the available supplements in capsule or gel cap format were typically 300 to 500 mg each, I always felt bad telling clients about it and then telling them that in addition to the other 10 things they were taking they might likely need 3-4 additional pills of tributyrin once or twice a day to get the desired effect. So this is probably a good moment to mention that because I saw this obvious hole in the marketplace, I set out to solve the problem by making a higher dose tributyrin supplement. So this is actually the first time I’m announcing publicly that I have this new supplement available for sale called Tributyrin-Max, a 750 mg/capsule tributyrin supplement in a hydroxypropyl methyl cellulose capsule, which is an enteric coated capsule so that it makes it through the stomach acid and to the intestines. It is available on tributyrinmax.com (free shipping for 1-3 bottles and low cost after that) and on Amazon.
This is pretty exciting for me but I also do it with a little bit of trepidation. Up until now I have been very agnostic about supplements, meaning I don’t have loyalty to any particular brand and choose what I think is best for my clients. And because I’m a pretty skeptical person myself when I see health celebrities promoting their own products. I have to admit that it has made me question their integrity. The dilemma is that it’s really hard to make a living seeing clients the way I do, because I give them like 1-3 additional hours of prep and follow-up time for every hour they spend with me. So that only allows me to see 3 gut health clients per week in addition to all my other duties with the podcast and newsletter and answering client emails. But I spent a really long time thinking about what if anything I might sell as a supplement, and I only wanted to sell something I felt I could unequivocally recommend, that didn’t have really contradictory evidence, like probiotics, for instance, and for which there actually was a legitimate need in the marketplace.
So rest assured I wrestle with the ethical dimensions of selling my own supplements, I won’t unequivocally recommend them to anyone. Like even on the bottle I put that people with constipation or with a history of polyps in the colon shouldn’t take it, which no one else selling it warns against, because there is a little bit of evidence that because butyrate is a food for the colonocytes, it could be cancer-promoting for those with a history of polyps, although there is a much greater body of literature showing it’s preventative for colon cancer, prostate cancer, tongue cancer, breast cancer, lung cancer and neuroblastoma. I’ll link to the Lucy Mailing article called “SCFAs Part 2: The benefits of butyrate” that cites all that literature as well as the studies that show its potentially negative impact on colon cancer. In her article, she also cites additional benefits to the brain of butyrate, including increased neurogenesis, reduced oxidative stress, and improved recovery following ischemic brain injury as well as potential benefits for skin and bone health. And then in a following blog “SCFAs Part 3: Decrypting the butyrate paradox: can excess butyrate be toxic?” she talks about potential drawbacks, especially in the case of active and flaring ulcerative colitis, and about the importance of only taking physiologic doses, which she describes as 600-1200 mg/day of tributyrin.
Also, because of the capsule ingredients, because emulsifiers and other food additives have been shown to be harmful for people with inflammatory bowel disease, I might advise caution on that front as well. The studies I’ve seen are only on mice and concern something called carboxymethyl cellulose as a food additive, not hydroxypropyl methyl cellulose, which is actually used as a coating for capsules of IBD-targeted pharmaceuticals, but if you want to exercise an abundance of caution, there is one powdered tributyrin supplement called AuRx* that’s available in my Fullscript Dispensary instead, that has a delivery mechanism that makes it not gross to eat as a powder. It was actually designed for kids with autism in mind, because butyrate has been shown to be beneficial in autism. But reading through one of Lucy Mailing’s other blogs on butyrate, which is linked in the show notes, I think that butyrate may not be advisable in higher dose format for people with active and flaring Ulcerative Colitis, although I do have one client who has definitely benefitted from it.
But if that’s not your concern, the capsule is a plant-based capsule and okay for vegans or vegetarians. I would actually have used a gelatin capsule but the manufacturer told me there was a 1-year wait for those.
So to sum up, if you have loose stool, diarrhea, etc. and it’s from SIBO or dysbiosis that involves a likely dominance of proteobacteria, which is often the case in post-infectious IBS that causes SIBO and following heavy antibiotic usage, tributyrin is a good supplement for helping slow motility and firm up stool and reverse the cycle of an oxygenated gut. And of course, trying to bring more fiber into your regular diet so that the bacteria can ferment the fiber and produce butyrate naturally. So I’m talking about beans and lentils and psyllium husk fiber. Those things are all great for producing butyrate naturally. And if you have SIBO or other dysbiosis, you need to see an appropriate health care practitioner to deal with that and determine the reasons for it and address it as well. Which as you know is something I do with my clients, and you’re welcome to set up a free, 30 minute conversation with me to find out if I can help you.
And if you’re interested in trying my new butyrate supplement, Tributyrin-Max, I’m offering a 15% off discount code for your first order, which is INTRO15.
So, I heard you speaking on the Chris Kresser podcast, and I immediately went out and got some tocotrienols to try. And so I was really excited when you were able to come on the podcast. Why don’t we just start with talking about what tocotrienols are and how they differ from tocopherols, which are the typical form of vitamin E contained in most multivitamin formulas.
Barrie Tan, PhD:
Yes. Vitamin A has two groups of compounds called tocopherols and tocotrienols. The tocopherols are more known, and you can see them on your cereal box, and tocotrienols are less known. The plant makes these two compounds, when the protection in the plant is more serious, then the plant likes to make tocorienols. So you intuitively know that it’s probably more potent, and otherwise, if it’s normal ones that use tocopherol. So, in the US diet, most of our vitamin E are tocopherols with a few exceptions than the tocotrienols, so the last 30 years of my life has been spent looking for the active form of vitamin E.
Lindsey:
Okay, so the tocotrienols are the active form, whereas, the tocopherols are inactive? Is that-
Barrie Tan, PhD:
Not inactive – less active, the tocopherols and the tocotrienols are active enough that about this book, you can see from the title of the book, “Tocotrienols: Vitamin E Beyond Tocopherols.” Tocopherol is the only E people know and tocotrienols people know less. You see, I was one of the authors so it’s more an academic book, so I don’t tell people much about it. This is a more consumer book, I wrote it as a labor of love and people can download on your website free of charge: “The Truth about Vitamin E,” is the book and they can download it from here.
So I started my career as a University of Massachusetts professor in 1982. And then I started to study vegetable oil. So intuitively, if vegetable oil is where you find vitamin E, the plant makes vitamin E to protect the oil from going rancid. So that is like that. So I know we are all to some extent very self-centered, somehow the plant makes things for us. The plant never makes things for humans. We ought to be grateful that they make things that are helpful to human health like that. They make it to protect themselves and for their own survival. Plants typically don’t make a lot of fat, but when they do have a lot of fat like corn oil, soy oil – actually corn and soy is not a huge huge amount of fat, but when they take the meal out and feed the animal or make tofu, left behind would be the vegetable oil and then the vitamin E goes there to protect it. When you think of a human being we typically have anywhere from a 20%, which would be exceedingly lean, to 40% is on the obese side. If you average a person of 30% fat, so in general, a human person has more fat than the plant ever would have. From there you can tell if we carry on average of 30% fat, then this fat needs to be protected. So that’s where I study Vitamin E to find out how it can protect us from oxidative damage.
Lindsey:
Okay. So, I understand that the tocotrienols that you work with are sourced from the annatto plant, so tell me how you came across this source of tocotrienols.
Barrie Tan, PhD:
Yeah, I discovered the three major sources of tocotrienols from plants which I had said earlier are difficult to find compared to tocopherols. The first one I found was in palm – palm oil. And people have questioned about taking palm oil, saturated fat and all that, but palm oil has a fair bit of tocotrienols. And then rice bran – the brown part of the rice bran, also has tocotrienols. It’s kind of like an open secret. When you eat Japanese tempura, they deep fry it with rice bran oil and rice bran oil is stable because of the tocotrienols in it, otherwise the oil will go rancid even faster; however, rice and palm contain about 25 to 50% tocopherols. Now, I’ll come back to that later.
So I was looking for a source that is very rich in tocotrienols, then the year was 1994. There was a professor at Harvard. Her name was Joanna Seddon and she discovered that on the back of the retina of the eye, they’re laden with zeaxanthin lenses to filter out the blue light. If you fast forward to today, everybody knows that if you take lutein and zeaxanthin, it’s good to prevent macular degeneration, but this was back in 1994. It wasn’t long ago. So now I know that in South America, in Peru, there would be a huge, giant marigold plant. I went there to look for marigold petals to extract lutein from the petal that it will be good for the eye. But then, by this time I was already studying tocotrienols. Then fate has it literally 20 feet away from me, I saw the annatto plant. You will have heard of the annatto plant because we use the color for coloring cheeses, Dorito chips and macaroni and cheese. If you touch it like I pretend to do here, it will stain (the plant). I intuitively knew something was unusual. By the way, the color is also a carotene, like lutein and zeaxanthin. Except it’s very unusual. If you look at this fruit, it doesn’t have a fleshy part, like fruit has. If you think of any fruit you eat, it has the fleshy part, but this just has the seed and then this stamen. Because I was a carotenoid chemist, I thought of something. If you think of a carrot, you have to cook the carrot to get the beta carotene out. You’ve got to cook a tomato for a long time in oil to get it out if you do Italian sauce. I knew that carotenes are so unstable; they are protected inside the cell of the cytoplasm. And even in lobster and crustaceans you have to cook them and then they deprotonate. And suddenly the yucky green or blue color becomes an orange or red color. Like you come to New England to eat a lobster.
Now when I explain it, it sounds so trivial like that, but it’s in my DNA, I kind of know this thing. But when you touch this guy here, it is not bound to anything. Notice that? You just stained your finger. So, I intuitively thought, “It must be a powerful antioxidant to protect the carotene from oxidative damage.” It was only a figment of my guess. I thought that it would be a polyphenol, which will happen a lot in nature. Surprisingly, it wasn’t. And more surprisingly, it is a vitamin E molecule. And most surprisingly, it is a vitamin E molecule that only contains tocotrienol and not tocopherols. So that would be my third attempt. Palm and rice contain 25 to 50% tocopherols. Annatto tocotrienols are completely free of tocopherols. By this time, I had already been studying tocotrienols for some 2025 years. I immediately called my professor friend. At the time he was at University of Wisconsin, Madison, and asked him, “What do you think?” I remember he told me, “Barry, if tocotrienols were to mitigate human chronic conditions, this tocotrienol better be, otherwise, you and I are completely a lost cause for our desire to bring this to bear.” So the last 25 years, I’ve been committed to do a chronic condition with this sort of vitamin E. And happily, they work on many chronic conditions that we study.
Lindsey:
Interesting, and we will talk about that. But I did just want to mention I lived in Costa Rica for a year and a half. And I learned how to make a few dishes there and one of them, Arroz con Pollo, uses annatto as a spice and they come in tubs in the grocery store. They’re just bright red, orange sort of tubs that you can take a chunk out of and it was like a refrigerated margarine, about that consistency.
Barrie Tan, PhD:
Wow.
Lindsey:
Not like the pebbly stuff that you find here in the spice aisles. And of course it tastes terrible if you eat it straight but it adds a subtle flavor and of course an obvious color to the whole dish when you add like a teaspoon or two. I bought a couple of tubs years ago and I still keep it in the fridge and of course it doesn’t seem to go bad at all which is because of obviously the protection that it has.
Barrie Tan, PhD:
Yes and if you could sometime, you have my email, send me that you said the Spanish word. I will try to look for dishes. I know they’re not classically American dishes. South Americans use it for a lot of their food. I was able to track, even the Inca Indians use it for their food in Peru and other places. Here it’s a very sterilized use, like we put it in cheese, but besides that it’s not used in any food dimension that I’m aware of. And curiously, I thought of this one time. It is not known to the Asian context. I’m Asian. With the exception of Filipino, and then I was able to track it because the Spanish that went to South America also were in the Philippines for 400 years. Sometimes when I tell my American colleagues, it’s hard for them to put their heads together. The Spaniards were in the Philippines for 400 years, as long as they were in South America. So not surprisingly, many of my Filipino friends, they have Hispanic names, and they look like me. They’ve been there for a long time. A lot of Filipino foods also use annato. Isn’t that interesting? So they brought the flavor and the seeds and they grow it in the Philippines. So a lot of Filipino empanadas – and that’s a Spanish word, but if you ask any Filipino, they know empanadas. And then they make this little reddish looking and then they put this annatto in. But otherwise the other part of Asia or Southeast Asia it’s an unknown spice; they don’t use it at all.
Lindsey:
Yeah, well, I’ve got two recipes, I think, that call for it: the Arroz con Pollo which is chicken and rice, and then one another is a chicken dish. I will send you both those recipes and I’ll post them in the show notes. So I’m wondering, are tocopherols harmful to take as a supplement?
Barrie Tan, PhD:
Not harmful unless you take them in high amounts. If you remember, the late 90s into the 2000s, all the published work on Vitamin E was negative, even women who take it, Harvard Women’s Health Study, and some of the women have higher incidence of breast cancer and men who took it had prostate cancer. I think that the reason is because of all the eight Vitamin Es (four tocopherols and four tocotrienols), alpha tocopherol is the only one that has a transport protein. That means that when they cross the cell membrane, they have a right of passage. They have a protein that takes them in. Only alpha tocopherol has it, the other ones just go in by diffusion. Diffusion simply is an engineering phrase: “low concentration, high concentration.” You will move from the high concentration to the low concentration. Just like if you put sugar in a glass of water, and the sugar first sinks to the bottom. Over time, you see some wiggly thing, it will move from the high concentration as the sugar dissolves into the low concentration. That is a process of diffusion. And that’s how Vitamin E would work with the exception of alpha tocopherol. Because they have a transport protein that helps. So in those studies, when they use alpha tocopherol, they use 400 ones and 1000 milligrams. So a lot of this vitamin E goes in, it had no place to go. And I think that they are not good for you. However, if we were to eat a normal diet containing 10 to 15 milligrams (15 milligrams is 100% of the recommended daily allowance), that would be fine. However supplemented, people will have 10-20, even 30 times higher concentration of alpha tocopherols. That’s a problem. But we did not find that to be a problem with tocotrienols.
Lindsey:
And so what conditions has the research shown that tocotrienols can benefit?
Barrie Tan, PhD:
Okay, how about I tell you some of the conditions we’ve studied, and then we can fractionate them? We did a lot of studies in the last 20 years on chronic conditions. And I think that for the audience to appreciate this, right, we’re not talking about a drug. We’re talking about supplements. and this is almost my entire lifetime studying this. So this is, if I weren’t here, I doubt a very large company would put this kind of money and time and effort and energy to do it. So we did probably about 15 to 20 clinical trials. And the kinds of studies we were involved in, chronic conditions we initially studied were dyslipidemia: high cholesterol, high triglycerides; insulin resistance; people who are prediabetic (but not yet diabetic) and finally we studied a group of people who are diabetic. And now we have committed to have a huge amount of resources to study fatty liver disease.
Now if the audience is having any of these conditions, you would understand. For the audience members that do not have these conditions, you’re blessed, but just to give you some numbers. People who are prediabetic are about 90 million Americans. People who are diabetic, 35. And about another 100 million people who have fatty liver disease. Of course, some of these things overlap. So therefore, huge numbers of the American population has this kind of problem. Most recently, we are studying people beyond overweight. They are obese – men and women in Texas. So in the studies that we are doing, people with prediabetes and dyslipidemia, our study calls for anywhere from 100 to 250 mg. Say you round it up 100 to 200 mg. For people who are diabetic, the studies were about 250 to 350 mg. For fatty liver disease, (remember, the liver is a larger solid organ), we actually did three studies on this, Lindsey. We did a three-month study, a six-month study and a 12-month study. We already were convinced 600 mg was needed for this. We didn’t change the amount, we just did the time, because I wasn’t sure that after three months, if we were to be successful, that it would continue to be so in six months. So therefore, it’s not a dose-dependent study, but instead a time-dependent study. So we stayed with the same dose. We studied different things at three months. We studied stress enzymes and the stress enzymes come down and drop.
And the second study, we studied steatosis, which is fat in the liver. We used our ultrasound to map it like you use ultrasound to look for a baby in a mother. We were able to see the fat egress from it in a six-month study. In the 12 month study, we decided to go for gold. We decided that I have to go beyond getting consumers to be interested, or a primary physician to be interested. I have to convince the specialist to be interested, which means that these are liver specialists. So we decided to do CAT scans. And we saw that the fibrosis score is reduced the steatosis also is reduced. When the fat stays in the liver for too long, it forms a scar. So the doctors call it fibrosis. And that’s kind of like considered not reversible. So now we can clearly confirm that fat is reduced. Inflammation is reduced, liver enzyme is reduced, steatosis and fibrosis.
But there is something I will keep last to tell because I’m initially very skittish to talk about this. We noticed this in the three months. I was not very convinced. So in the six months, we saw it again. And my science director, says, Barry did you notice this?” I saw this, but I’m hesitant to make a comment on this. How about we do a 12-month study? And we repeated it. The shorthand is, the people who have fatty liver are already generally overweight; they lost weight. And in our clinical trials, we did not have that as a primary outcome. See, when you design a trial, you have to make a hypothesis. What are you looking for? We did not look for weight loss, but then they lost about 10 to 15 pounds consistently in three months, six months and 12 months. So I asked, “How are we going to report this? Factually it is true.” Can you imagine that? Most people will do the opposite. They just say weight loss and then they go sell a heck of a lot of product. I’m doing the opposite. You know why I was worried Lindsey? When when you say the word weight loss, people expect a weight loss in two to four weeks. Well, I never had data at one month. My shortest data was three months, even so you saw weight loss at three, six and 12 months and just say that. If people say, “Would I see weight loss in one month?” No, we don’t have data on that, but you can say that we saw the weight loss. So now we can consistently see sustainable weight loss on the largest organ in the body that at three, six and 12 months. I think tocotrienol is not intrinsically a weight loss product. Instead, it helps people’s metabolism out of kilter to come back to balance and the inflammation drops, the stress to the liver drops, and as a consequence of that, their weight also comes back to normality.
Lindsey:
Interesting. So does it matter whether the fatty liver is non alcoholic or could it be alcoholic fatty liver too that this would impact?
Barrie Tan, PhD:
This is a brilliant question. We only studies non alcoholic fatty liver. But the reason this disease was called non alcoholic fatty liver disease – It was discovered by the Mayo Clinic in 1984. Not so long ago. I don’t know if you know this story. This is a cute story. Well, it wasn’t cute when it happened. There was this guy. He went to see the doctor. And the doctor looked at the numbers came back and said (I just made up his name), “Mr. Jones. Do you drink alcohol?” Mr. Jones says, “No, I don’t drink alcohol.” So the doctor went back to the lab and came back again. And now a little bit more accusatory tone. He spoke with Mr. Jones and said, “Are you sure you don’t drink alcohol?” See, with that kind of intonation, Mr. Jones is upset. He says, “I told you I don’t drink alcohol!” So that was the reason because Mr. Jones’ liver looked like a cirrhotic liver from somebody who drinks alcohol. It wasn’t. So all this to say that when we take in a lot of carbohydrates and fat, we can make the liver almost look like someone who drinks alcohol. So a short way to answer your question is we believe that people who have a cirrhotic liver caused by alcohol also would benefit from tocotrienols because their liver looks the same, which is why awkwardly this disease is NAFLD. After NAFLD, they become NASH – non alcoholic steatohepatitis. So the liver looks like a person with hepatitis A, B and C. Hep A, B and C are different because they are caused by a virus. And by the way, this tocotrienol worked positively for people with hep C virus, totally different mechanism.
And that was done, sorry I to have to tell so many stories, but when we designed this study, Lindsey, the investigator and I decided that if you have people with Hep C, you have to recruit people. He said we have to exclude people with Hep C, if they have alcoholic liver, we have to exclude them, otherwise, we have all the “monkey on my back.” I cannot interpret my data. That’s how you randomize a study. He was fine with that. When he was recruiting the 100 older patients, about 12 to 15 of them had hepatitis C. So he had to exclude them. But what he didn’t tell me was curious. He separately gave them a tocotrienol. It was not in the study, it was excluded. He didn’t tell me. A few years later, I found an answer “Barrie, did you see this? Our tocotrienol is used on people with Hep C. It actually worked to reduce the viral titre in the people.” Then it tracked back to the author, and the author is the same one that did the NAFLD. So he excluded it. It also helped people with that. So we did not continue that study because Hepatitis C is a different direction; it is caused by a virus but it probably, I think, any damage to the liver, whatever the reason might be, at minimum, tocotrienols would help the liver.
In animal studies. we also studied hepatoma, animals with liver cancer. It also has support to reduce the severity of the cancer in the liver. So you can generalize the phrase that tocotrienol is hepatotonic, a liver tonic. But well, of course, if you say it like thatm it’s too general and people don’t know what it’s for. So I have to tell people about the clinical studies. The best we have done so far is this huge group of people with fatty liver due to dietary mismanagement and that works on them.
Lindsey:
Was the dosage for those people 600 mg a day?
Barrie Tan, PhD:
Yeah, for the fatty liver 600 mg. For the type two diabetes anywhere from three to 400 mg in those studies. And for the prediabetic and people with dyslipidemia, it’s about 125 to 250 milligrams. So those are the range I know. We didn’t discuss this. We have about six or so clinical trials in Denmark, of people with cancer and the cancer we studied, two of them are specifically for women. Ovarian cancer, breast cancer, lung and colon cancer. And my colleague in Florida is studying pancreatic cancer. And in that case, we are studying stage four cancer. So as you know, stage four, there are no options available, it is the end stage. So we use the highest dose, which is 900 mg, people take 300 mg for breakfast, lunch and dinner. And in that series of trials, we have the ovarian cancer result back. The audience should remember, this is stage four cancer, which means that there are no more options available. So they were taking Avastin, which means that this is anti-angiogenic. It prevents the tumor from sucking food from the nearby artery. Angiogenesis is the growth of arteries, anti-angiogenesis is you cut the artery off, essentially, you starve the tumor to death. They take chemo for that. And in another group that does the same, they take chemo because it’s the standard of care, plus tocotrienols. That’s it, no other differences. Inoperable, not radiatable like that. And they have in the registry in Denmark already, after six months, then in the group that had Avastin, they are not around anymore. In the group that took the tocotrienols as well, 60% of them survived. In Denmark, this is a woman’s disease, so the nurses are predominantly women, and they really want the study to continue. The principal investigators said, “If we continue to study, what do we compare it with?” The group that they compared with were no longer there. Anyway, for good reason they persisted and they were able to, and I’m glad they did. They persisted the study for four times longer into 24 months, two years. And even after two years, 25% are living. So that’s a remarkable thing I consider.
We are still hopeful that the tocotrienol would work on cancer, but I don’t think I’ll have a prayer to ask the FDA for any claim. Maybe under the Compassionate Care Act of United States passed by Congress. When there are no options available, then the FDA may allow its usage. I don’t know if we have the wherewithal and financial muscle power at FDA, but we’re willing and have the will to complete the study. And then let people read the study. So hopefully, in another year or two, if you still remember me, you can call me, “Dr. Tan, have you completed the study, I’d like to find out more on that.” At the end of the day, I am as fascinated and as touched by this as an audience listening to this would be. I believe that it is this powerful because it is uniquely tocotrienols and it’s the most potent Vitamin E I have ever put my hands on.
In the end, and as I told you in the story earlier, I didn’t even go to South America to look for this. I was looking for something else. And I consider this spiritual to me. If you look at me, I’m Asian, I’m supposed to go to Asia and look for this thing. And then I cannot speak a word of Spanish. And then everything is an oddity, but then this meant to me when I get to this part of the Amazonia, other people could have discovered it, but they didn’t. They weren’t curious enough to look. I was curious enough to look. And I’m not supposed to be there. I’m supposed to be in all these other wonderful places in Asia. But that was not where I found it. I showed you the picture. I was in Peru. And I cannot speak – I’m sure you speak a lot more Spanish than I do. I do speak it, yes. That’s amazing.
Lindsey:
So you mentioned dyslipidemia, and I’m curious, do tocotrienols have any impact on Apolipoprotein A?
Barrie Tan, PhD:
We only did a study early on. It did drop the Lp(a) a little bit, but it’s not dramatic. On the whole cardiovascular emphasis, I should bear out so that you will know where it works better than others. It consistently dropped triglycerides. That’s a good thing. I’m going to give you a teaching moment here. Before people become diabetic when they’re prediabetic, their triglycerides are high, but the sugar is normal high, but still normal. The person who discovered metabolic syndrome, he call it syndrome X before, and that was a professor Gerald Reaven, you can Google, he gave talks. He is a retired Stanford endocrinologist and passed away now. I remember one time, I caught him when he finished his talk on the run to catch his flight. So he was a little bit irritated that I stopped him as he was walking out. I said, “Just tell me how to put my hand around this metabolic syndrome thing.” He said one sentence, and then he left like that. He said, “Dr. Tan, 10 hypertriglyceridemia always precedes hyperglycemia.” I never forgot it. So, in other words, before people have high sugar, they have high triglycerides. So therefore, if the triglycerides dropped, that’s a very good sign, and then the LDL drops. Most of the LDL that dropped are the dense LDL, not the buoyant LDL, but in LP(a), we didn’t study that in serious depth. We also studied oxidized LDL, because oxidized LDL is atherogenic. And then tocotrienols is a very powerful antioxidant. So not surprisingly, the LDL stays LDL and does not get oxidized. So we were thrilled to see that as well. So pretty much that is the group. Oh, the HDL did increase, not by a lot. It’s very difficult to increased HDL except when you exercise and the HDL increased typically about 5% better than the other direction. When people take a lot of carbohydrates, the HDL drops. And when you exercise the HDL increases, we noticed that tocotrienols, the HDL increases, not dramatic, by 5%, consistently, we see this.
Lindsey:
Okay, so I know that soluble vitamins do build up in the body. So I’m wondering if you can reach harmful or excessive levels of tocotrienols?
Barrie Tan, PhD:
To the best of our knowledge? No, because of the 15 to 20 clinical trials we study, the short one is about two to three months. And the long one is about a year, we didn’t see that. Like this fat delivery study, we asked the physician please to report any unbecoming side effects. They reported and they did not see any liver enzymes go up, no kidney function was compromised, nothing like that, that they saw. We didn’t see that at all. By the way, right now, the study in Texas is of men and women who are obese. So we were able to get an IRB, Institutional Review Board to approve. We found this in animals all the time. There when you take tocotrienol because they’re lipid soluble, they are deposited into fatty tissues like vitamin D or K. So we knew that in the animal. So this is a first study, where we have biopsies of the adipose tissue. And then so we will be able to measure how much storage of the tocotrienol is in the adipose tissue in this obesity study. So the obesity study will also be complete by the end of next year.
Lindsey:
Okay, and is it important to divide up the dosage that you take each day? Or can you take it all at once?
Barrie Tan, PhD:
It’s important if you can take tocotrienol up to about 300 milligram and after that, if you need to take more than that, you divide it, which is the classic example in the Kansas study. They take 900 mg at 300 mg soft gel for breakfast, lunch and dinner to get the 900 mg. And indeed, in the fatty liver study they take two 300 mg with lunch and dinner. And notice I always say with a meal, they’re lipid soluble so you shouldn’t take it with on an empty stomach like that. And then for studies that only require 100 to 200mg, they can take all of it at one time. Do not take more than 300 mg.
Lindsey:
Okay, so I use some of the typical functional medicine lab tests with my clients like the Genova NutrEval or the Metabolomix. And they only show tocopherol levels on those tests. So can you infer anything about tocotrienol status from tocopherol levels?
Barrie Tan, PhD:
No, you cannot. On tocopherols, they readily do that. And I know that had made the tocopherol story last as long as it did, because of the alpha tocopherol transport protein. Frequently when people take bloodwork because they’re looking for lipid profile for cholesterol in a fasting stage. And then it’s about 12 hours overnight fast. Then they look for vitamin E. If you asked for a blood work for vitamin E, besides alpha tocopheral like tocotrienol, in 12 hours, you’re not going to see any tocotrienol, even if they take it with the dinner about 10-12 hours last night before. On that one, it also has a story too. We did that 20 years ago and we found out that there were no tocotrienols in the fasting blood 12 hours after and, the research professor said, “See, the tocotrienol is not absorbed, it’s useless.” It nearly got thrown away, the baby with the bathwater. So then I said, “Wait a minute, you cannot say that, because the blood is only a snapshot on that day. Not that in the blood is no good based on a snapshot.”
So I have to go back to animal study. And in the animal study, this is it. In the cholesterol thing, because of the alpha tocopherol, let’s say if you think of it 2, 3, 4- 10 hours like that, the alpha tocopherol will go up like this. But with the tocotrienol let’s say this is five hours. It goes up for five hours, and then it quickly goes down six, eight hours. So if you have an overnight fast, it’s almost zero. First we showed this an animal and we showed this in humans. For me, it is as painful as it is heartwarming, we actually did the study just to show the pharmacokinetic at five hours, and then it dropped back like that. So why did it drop? It doesn’t have a transport protein, and when it dropped back, it was not picked up. It has already delivered to the organ. But the alpha tocopherols kept being in the blood. So therefore, as a clinician, if you say that it is in the blood, therefore it is absorbed, believe that but only to a certain extent.
Many things are not shown in the blood. It’s already been deposited into the organ, or if it’s deposited in the organ, it is not going to spool and continue to be in the blood. We found that we have consistently found that in all the different organs like I expressed in the liver, and when in animals, you can excise all the tissue, we see them all over in the brain, in the eye and in the other organs. Each person with 130 to 160 pound weight, has 38 trillion cells about 5000 times the population of the Earth. Each one of them is like a cell, say like a bean shape and has a cell wall. And most of the fat in the body is in the cell membrane. And the tocotrienol goes to the cell membrane and the fattier the organ is the more tocotrienol would be there. So you would expect that the tocotrienol would be found in your brain, in your liver, in your lung and in all fatty tissues, of course in your adipose tissue. Of course in people who said well, “How do you know that?” We know this because they work to kill the cancer in those tissues, but we cannot poke and get a biopsy because humans are not animals. In the fatty liver study, we were not allow to do biopsies. It’s a luxury we cannot have, however; if the person has cirrhosis, has liver cancer or Hep C, well that’s different, so they’ll do a biopsy.
The closest and the first ever we have this is with the obesity study. And for that we are only allowed to have biopsies of the adipose tissue where the love handle is. It is minimally invasive, but otherwise we are not allowed to do that. So therefore, in that case, it is legitimate to study it from the animal. We did have one study, it is a cadaver study and it was from that that we found out the liver thing. A lot of these are story findings. This professor at Ohio State got a US government grant to study tocotrienols in the brain. He was going to get a $5 million grant, but NIH told him, you have to show us before we give you the 5 million bucks to do your study that the tocotrienol is in all the different tissues and he said he was drawing a blank. How am I going to show him that the tocotrienol is in all the tissues? The reason NIH asked that was because they did not see it in the blood. That was the reason. so he had a problem. He didn’t know how to deliver to the government. And then the university was so creative. He said, “We have end stage liver failure patients and if they are on a liver transplant list and waiting, they may wait in vain and they may not get the transplant and then they die.” So if they give consent to take the tocotrienols and if and when they die, and they allowed their organs for human research, then you are good. So he did, he gave it to give it to the 20 or so patients, half of them passed away. That’s when he showed that the tocotrienols were found in the brain, in the eye, in the heart, in the lung, everywhere. So he’s got his money. A side note was half of the patients improved. Remember, he was doing this to show what he needed to get the grant for the brain study.
It was because of that that we decided to do a study on fatty liver. The study was, just show me that the tocotrienols go to different organs. He did! He got his money. But he published a study in the Journal of Nutrition, then he did, and we did. And so now, because he was asked by the US government to show that is found in different organs, now we’re able to find that, indeed, it even helped people with fatty liver. So sometime, findings are not a straight path. But it did lead to a good path. So that’s a blessing. So it did not come from me, Lindsey, so I cannot make the claim. I’m thankful that that professor did it. So we took the the cue from that and decided to engage in clinical studies.
Lindsey:
That’s awesome. So we’re kind of running out of time, but I want to get to GG or geranylgeraniol? So I know you’ve done research on that, and that it might have some relationship to gut health. So can you tell me about that?
Barrie Tan, PhD:
GG is an endogenous nutrient, which means your body makes it. I know that the body makes GG for at least three reasons, probably more. The body makes GG to make the first two easier. Behind me, that’s a molecule of GG here, and the other molecule is Coenzyme Q10. So GG is used in the human body for the synthesis of CoQ10. So everything you know about CoQ10, which I don’t have time to explain, you need GG, otherwise, you cannot make CoQ10 in the body. So second, GG is required in the body for making MK4. Everybody in our industry knows the gut fermentation makes MK7 so you can read everything about MK7, and other menaquinones using vitamin K. But I wanted to change the audience and your understanding. In the colon our body makes MK7 and other MKs. That is to make the good bugs go up and the bad bugs go down so that your gut is in a good place. But when people push the idea of making menaquinones remember, when menaquinone 7 is made in the gut, they are not absorbed. Absorption of nutrients is in the small intestine. So when you make it in the colon, it’s in the process of making poop. It’s excretory material through the rectum. So only water is absorbed back and forth like that. I’m saying that GG helps the good bugs to grow because they’re feeding material for the bugs to grow into. So they are growing more like a prebiotic.
By the way, another time, if you send me an email, we can send you the study: tocotrienols work in people with Crohn’s disease and inflammatory bowel syndrome. Maybe you should have me for another interview where I just talk about the colon. This one is more a general health. But for the GG PPs, the GG goes in the body and makes MK4. And the last part is, about 30 to 40% of our body weight is skeletal muscle. Skeletal muscle cannot be synthesized without GG. We need GG for making skeletal muscle. Not surprisingly, as we age we have sarcopenia and loss of muscle mass. And in the very specific instance, and I’m sure your audience will know this, many people take statin drugs to lower cholesterol. The same pathway to lower cholesterol, just right below it is GG. So therefore when you inhibit cholesterol, it’s obligatory, you will inhibit GG and the inhibition of GG is the reason why when people take statins they have low CoQ10. Now, did I connect the dots? Because you inhibit cholesterol synthesis, GG drops, and when GG drops, CoQ10 drops. So CoQ10 did not drop just because they took statins. CoQ10 drops when people take statins, it’s because there isn’t enough GG that statins inhibit and therefore CoQ10 drops. So in other words, if your patient takes statins, if you measure CoQ10 and the CoQ10 drops, it is very likely that the GG has dropped because GG is required for the synthesis of CoQ10.
And of course also MK4 and MK4’s story is very simple. It will affect the bone health process, the porosity, it would also litter the calcium in places you don’t want it to be like calcified arteries, kidney stones and gallstones. So that’s a very short story about the GG piece, it’s a very powerful biochemical. And I’m only talking about it today because humbly, on the same plant that I extract tocotrienols from, after I removed the tocotrienols and color, I still had some some chemical there. It looks yellowish like corn oil when extracted and studied it. And would you believe it? It is GG. So I’m blessed, you know? So this particular plant is an ancient plant in South America. It yielded the secret of tocotrienol, which I explained to you and now further yielded the GG, which the plant makes for making all kinds of things. For the human, it makes the three things I mentioned to you.
Lindsey:
Would GG then be something that’s helpful for people who have already calcified arteries?
Barrie Tan, PhD:
Yes, we are hoping to do a study now. Currently, our two studies we are doing: the main one we are doing is people who are on statins, who are under a cardiologist’s care and have myopathy. And if they take a GG, it it would mitigate the myopahty on those on statins. And so it’s a muscle type question at this point. And then we’re hoping to do some exercise sign on the muscle thing. And someday we also will get to the sarcopenia on the elderly population, we hope to get into those areas. And we hope also to study MK4; we believe the calcification is the MK4 piece. When the body does not have enough MK4, the calcium is not shuttled to the bone. You need MK4 for the shuttle to the bone and not leave it in the artery nor the gallbladder nor the kidney. So we are now working to see how we can conduct a study to do that. It is so exciting. I’m supposed to retire after the tocotrienols. And then I fumble on this GG. And GG is very exciting.
I know that the time is up, I want to tell you one thing. Please allow me, it will only take less than a minute. GG is found in the plant. It is the last common step that the plant and the animal share. The plant and animal are vastly different. They need green chlorophyll to photosynthesize. We need heme red to make oxygen, one needs carbon dioxide the other one needs oxygen. Like do you know that tonight when you go home and then you eat your food, your vegetables, you see green, you think GG. Without GG there’s no chlorophyll. And then when you see your color, your beta carotene, your lycopene, your astaxanthin, your lutein, everything, all this beautiful color, you have to think GG. Without GG, there will be no cartenoids. So now I feel very spiritual that I had this finding. GG is the last common step between these two. In the plant, it is essential. The plant cannot survive without GG. In the human, I just told you the three things that are essential. So I’m just thinking, wow, this GG is really cool. It is really an endogenous nutrient. And even if you take the statin thing away, when we grow old, why do we have low energy, and then we don’t make enough CoQ10. But nobody told me we don’t make enough CoQ10 because we don’t make enough GG SBH. Oh that’s an important thing. And we have a calcified artery because we don’t make enough GG and it’s unable to make MK4. And then don’t quickly jump onto MK7. They are several menaquinones, but the only menaquinone that is made in the human body is MK4 using GG, not the other menaquinones. The other menaquinones are made in the gut however, but they’re not absorbed.
Lindsey:
So would you be an advocate of the MK4 form of vitamin K, as opposed to the MK7?
Barrie Tan, PhD:
That is correct. I am a pro that; not for pushing any people to buy my GG. I’m saying that in true honesty. If our body makes MK4 to the exclusion of all the other MKs, don’t you think we should take notice? You can Google, do that. If not, you send me an email, I will send you all things. I hope the Japanese scientists and the scientists in the world who figured this out, I hope that they are nominated for the Nobel Prize. This is actually a classic vitamin thing. They deserve a Nobel Prize. I don’t deserve. I’m lucky that they told me this. And then I’m bearing these things out to people. If you Google menaquinone 4, it’s the only menaquinone made in 25 to 30 organs. You will never find an organ in the human body that makes MK7 or 9 or 11 or 13. Those menaquinones are made by the bacteria in the colon. Now in the colon however, you want them to be made, so the good bugs go up and the bad bugs are controled. That you want. So I don’t want to confuse that. That’s a good place, but when they make them, they’re not reabsorbed therere, only water is absorbed so that you either have diarrhea or constipation, you know, at that stage. But MK4 depends on vitamin K1 being absorbed and then the tail is cut off. The ring, which is on your dark green vegetables, go in and look for 25 to 30 organs, look for GG endogenous, stitch it on and when they do, that’s your MK4. I’m giving you it as simple as I possibly can. And then if you Google it, you’ll find a Japanese scientist studying this.
Lindsey:
Okay, well now I know I should be recommending the vitamin D/K MK4 supplements not the MK7.
Barrie Tan, PhD:
Yes. And then if you want to know of a company to do that, Designs for Health, they are a very good company. I think their product is called Tri-K. So they have three: vitamin D/GG, they have GG in it, and then vitamin MK4, I forgot. So if you just go to Designs for Health Tri-K.
Lindsey:
Yeah, I have a dispensary. I’ll put a link to it and people can go in there and I’ll put in my discount code (HDH15OFF) for the dispensary in the show notes.
Barrie Tan, PhD:
Wow, thank you Lindsey! Bless you and bless your all your listeners! Hopefully in another year from now when more of my clinical studies come out, you can have another interview of me particularly more specific on the colon health thing. And also on the other general overall health of the people. By then I will have more clinical trials completed.
Lindsey:
I’d love to. So briefly, can you just tell me about the supplements that you have that has the tocotrienols and the GG?
Barrie Tan, PhD:
Okay, you mean who sells them? Designs for Health as I mentioned, AC Grace, Allergy Research Group and then there are many people sell them on the internet. If you go to my website, American River Nutrition, and you say buying tocotrienols; usually people say you can buy from me. We don’t sell the finished product, so we’ll list all the companies that use ours. If you want to be sure that they come from us and not from other people, if it’s referring to GG, it’s called GG Gold, and if it’s annatto tocotrienols, it will be Delta Gold, because the main component is delta tocotrienol. We call it Delta Gold. We also make a product which is CoQ10 and GG. We call it DuoQuinol, it’s a play on the word. And then some companies out there sell it. So make sure that at the back of the bottle it will say DuoQuinol, GG Gold or Delta Gold, you will know it is from us. And we make this product in the United States of America, right here in Massachusetts.
Lindsey:
So the supplements sold through Designs for Health are sourced through your stuff.
Barrie Tan, PhD:
Yes, they are. They validated us to the nth degree and then we worked with them and we are pleased that they did a thorough job. They came, they looked, they did definitely, and then we’re also FDA approved, GRAS, kosher, halal and the whole works.
Lindsey:
Awesome. And then listeners can find you at BarrieTan.com?
Barrie Tan, PhD:
And if you want the book, BarrieTan.com/book, otherwise, if you lost that track, just simply type American River Nutrition, it will lead you there.
Lindsey:
And I’ll have these links in the show notes so they should be able to find them quite easily. Well, thank you so much. This was awesome. I love your stories and I’ll definitely have you back on and we’d love to hear more about Crohn’s and colitis and the outcomes of your studies.
Barrie Tan, PhD:
Thank you so much.
If you’re struggling with dysbiosis, diarrhea, constipation, leaky gut, candida, IBS, IBD, or other gut health or all over body problems, you’re welcome to set up a free, 30-minute breakthrough session with me (Lindsey). 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.
I got this recipe orally from Doña Carmen, my landlady when I lived in Costa Rica. Hence no specific amounts of things.
Ingredients for Broth onion red bell pepper garlic butter celery thyme oregano tomato sauce – roughly 4 oz. a bay leaf salt white wine 1 or 2 chicken breasts
Cut up a small quantity of the above ingredients and put in 3-4 cups of water and cook with chicken. Take out chicken when cooked, and then strain the broth, throwing out all the spices, etc. Shred chicken.
Ingredients 1 tbsp. olive or avocado oil 1 tsp. butter 2 cups chicken broth (above) 1 cup frozen peas 2 cups cooked rice (cooked hard, with little water) 1/2 red pepper, cut in strips and then thirds 1-2 tsp. achiote paste (annatto seed paste – find in Latin American food stores)
Heat oil and butter on medium. Add broth for 4 minutes. Turn to medium low then add achiote, mix, then rice, and mix. Add chicken and red pepper, cook until broth is absorbed, turning frequently so the bottom doesn’t burn. Add peas at the end and cook until warm, turning frequently.
Ingredients A big package of chicken-whichever kind you like (with bones) 3 cloves of garlic, crushed 1 tsp. salt 4 oz. tomato sauce 1/2 tsp. chili powder 1/2 tsp. achiote (annatto seed paste, find in Latin American food stores)
Skin the chicken. Put it in a pot with about a cup of water, the garlic, the salt, the achiote and the chili powder. Cook it on a low flame for an hour, or until chicken is done. Take out the chicken and then strain the juice in the pan (save it!) to remove the garlic. Throw out the garlic. Combine the juice from the pan with the tomato sauce and add the chicken to the sauce. Heat up the chicken and sauce for 5 minutes and serve over rice.
So why don’t you start by telling us about Novel Biome and the work you’re doing there with fecal microbiota transplants?
Shaina Cahill, PhD:
Yeah, so at Novel Biome, we focus on providing high quality, medically-supervised fecal microbiota transplantation (FMT). Our focus is specifically on children or adults with autism spectrum disorder though we do treat people outside of that. Adults that have other conditions that can be helped with FMT. We have four treatment locations in Hungary, Panama, Mexico and Australia. We’ve expanded these to try to reduce the stress and burden it is to try to access this level of treatment. We’ve been around since 2019, with a focus and being Novel Biome. And this came about – two studies were published in 2017, and 2019, by Dr. James Adams, his group out of Arizona State University.
Lindsey:
That we’ve had on the podcast twice.
Shaina Cahill, PhD:
Yeah. And so his work, I think, really stimulated more interest in the possibilities of FMT with autism. And so parents started to reach out about how FMT might be a good fit for their children. And that has just expanded from there. And we’ve focused in on on ASD, because we think that the research to date has been so valuable, but as well, children with autism spectrum disorder are three times more likely to have GI issues. These GI issues really impact quality of life and there seems to be some correlation between the severity of GI symptoms and the severity of ASD-related behaviors. And so there’s a good groundwork of research that’s been around for a long time tying gastrointestinal issues to children with autism. While this research on FMT is new, there’s been an understanding that there is a GI component for not all children with autism, but a good proportion of children with autism. So that’s what led us to do what we do.
Lindsey:
Yeah. And so, Dr. Klopp is from Canada originally?
Shaina Cahill, PhD:
Yes.
Lindsey:
Where’s your clinic there?
Shaina Cahill, PhD:
We don’t treat in Canada. In Canada, we’re a biomanufacturing company for export and working with Health Canada. Health Canada doesn’t want FMT to be a treatment that’s accessible right now to Canadians, so when working with them, we don’t advertise. We don’t treat Canadians and our website is not even accessible in Canada. We primarily just work as a biomanufacturer and that’s in accordance and following all the rules with Health Canada. And they’ve evaluated and looked at everything and we’re working towards getting a drug establishment license, which then further solidifies our export processes as a drug as well.
Lindsey:
And then your clinic in Mexico – that’s in Tijuana, right?
Shaina Cahill, PhD:
No, it’s in Rosalia.
Lindsey:
Is it near California though?
Shaina Cahill, PhD:
Yeah, so it’s like driving distance from the US border, but that’s our closest, I guess, to the US site and that one’s been around for the longest. That was our first site and then we’ve kind of expanded from there working with clinics that have the capabilities and the understanding of FMT. We supply product and a protocol for them, and they provide the treatment there.
Lindsey:
And so why the focus on autism in particular? Does Dr. Klopp have any particular relationship with that or was it more just because of the patients asking about it?
Shaina Cahill, PhD:
It’s the relationship with the patients asking, as well as having a good groundwork for why FMT would work. The research today has been really good, and then that understanding of those GI symptoms, those are there. And so we know that there’s a good groundwork of support for why this would work.
Lindsey:
And what kind of GI issues do children with autism typically show?
Shaina Cahill, PhD:
Kind of runs the gamut. A lot of the major ones are a mixture of constipation and diarrhea, which oppose each other, but those tend to be the two. Bloating and abdominal pain seem to be the ones that we see the most in the literature. Those are the consistent ones that come up.
Lindsey:
And these aren’t just cases of SIBO that could be treated in a different way, or do you do deal with other potential treatments prior to going to FMT?
Shaina Cahill, PhD:
Yeah, so part of our protocol starts with a personalized pretreatment that’s done by a physician’s assistant. They go through basically what’s currently being treated, what tests have been done, what other tests should be done and what types of medication for before going into FTM. Sometimes we’ll find out that there are larger mold issues and things like this, and then we’ll hold off on FMT get all of those treatments done, so that the gut is ready to take on FMT. That’s a case by case and every case is different. So we make sure that we tackle any issues that could be solved before going into FMT.
Lindsey:
Okay, And so what percentage of your practice would you say is children with autism versus other issues?
Shaina Cahill, PhD:
That’s a good question. I would say probably 90% is autism and most of those are going to be children with autism, not to say that children with autism are only coming for autism. So we also see, some parents are really highlighting those gastrointestinal issues, or IBS or IBD, as well as, seeing that their child also has autism. It’s not always just that parents come in, they’re like, “We have an autistic child, we think an FMT will help.” It’s often that, well, we have these like gastrointestinal issues that are causing a lot of issues. We’d like to tackle that and if we see outcomes with autistic-related behaviors, that’s also great. What we try to instill is that the first outcome is always going to be GI, but we see these secondary outcomes with autistic-related behaviors. So it’s not that this is specifically a treatment for autism, it’s tackling one of the symptoms, which seems to be GI, which then leads to the secondary changes, which we don’t understand at this point. The research is not there to understand why these changes are happening, but it is showing that there’s a relationship between the two.
Lindsey:
Well, we can get more into the results in a minute, but first, I want to ask about your donors. So who are your donors?
Shaina Cahill, PhD:
So we have really stringent donor screening characteristics that we look for. There are published standards. There’s about nine of them that are out right now and what we do is we look at what those initial screenings are. And then we have our own subset that we also look at on top of that. We’re looking for all of our donors not having taken antibiotics in their whole life, having been vaginally born and breastfed. And we know these things are the pillars of creating a stable gut microbiome from the beginning. And then of course, we’re looking at their diets, as well as their exercise habits. We look at a wide variety of both in them and in their family history of any disorders that we think could be or might soon be understood to be tied to the gut microbiome, to try to reduce any transfer. So we screen our donors, and that leaves us with very few donors that we can even use and then outside of that their blood and stool is tested. That’s done regularly every three months to make sure that there’s nothing there. And so, like everywhere, we find donors that meet our requirements, and we use them as long as they’re willing to donate.
Lindsey:
Is there a an upper limit for age with your donors?
Shaina Cahill, PhD:
Right now, we don’t have any donors over the age of 30. I mean, right now, in the research, they’re saying there shouldn’t be huge shifts in the gut microbiome until somewhere in the 60s, 70s range, but most of the published cut offs are around 60. And we want to keep ours under that because we do know that there are changes and not just changes in the gut microbiome, but changes in how people live as they get older, which then impact that microbiome. So we’re trying to stay on the cusp of not having any of those issues. So right now, we don’t have anyone over the age of 30.
Lindsey:
Is that the exclusion age or is that just by chance?
Shaina Cahill, PhD:
By chance. Right now, our exclusion age – in our written documents, I think is 40. So that’s the same range, but we just want to ensure because we know that age impacts it. We’re still really understanding that and when that shift happens, There’s a whole bunch of issues in the aging gut microbiome research that I could go on for days about. So I think we’re just trying to stay on the cusp of what we know for sure, versus getting into ages where there might be impacts. With FMT, the more you can control what is going on with your donors, the better, because we want to ensure what we’re giving patients is consistent and safe. And so the more we can control what the donor is going to pass on, the better it is for the patients.
Lindsey:
And do you allow your patients to see the donor screening questionnaire that you use with their donors?
Shaina Cahill, PhD:
Yeah, so any patient or anybody that wants to kind of understand that, we can give that Anyone that goes through treatment can see the reports of the blood and stool screening and stuff like that from the donors. But that just we’d have to be somewhat mindful, because it’s their health records. So we can give a general understanding of what the donors have that they’ve passed all of these screenings, but we can’t give everybody “Here are these people, this is where they live, this is everything they do,” because we also do protect the donors themselves. So there is some information we can provide and there’s some information we just can’t provide, but we try to be as transparent as possible, where privacy allows us. Our donor screening and all that stuff is something that is readily available for anyone that asks. It’s not on our website, because it’s a very long –
Lindsey:
Could it be something that I could share with my audience? Would you be willing to –
Shaina Cahill, PhD:
Yeah, I can send the questionnaire to you. It’s a couple pages long, but yeah, that’s easy enough.
Lindsey:
I can post that in my show notes.
Shaina Cahill, PhD:
Yeah
Lindsey:
Cool. Can your patients see the pictures of the stool prior to processing?
Shaina Cahill, PhD:
I can’t guarantee you that anyone’s ever asked. We use the Bristol Stool Chart and there’s a cut off where if stool don’t fall in these two categories, we don’t use it.
Lindsey:
Three and four?
Shaina Cahill, PhD:
Yes, but outside of that, that’s all there is. I don’t know if we take pictures of it. We have a lab manager who does all of those things. But I highly doubt –
Lindsey:
But if someone asked they might be able to?
Shaina Cahill, PhD:
Yeah, I think if someone really needed to, but I think what it’s like is: this is the categories they fall into and, and anything that falls out of that is always documented. Of course, that donor is not used and then we categorize that donor until they’re back into that time period and figure out what could have happened, as well. So that we want to make sure we’re only using the best and so that’s not part of my job, but part of hers.
Lindsey:
Do patients get stool pretty much from one donor or is it mixed together with multiple donors?
Shaina Cahill, PhD:
We usually use at least two donors for patients. And we just want to make sure that the goal here is that like, it’s diversity, ensuring that you get everything you can by using two donors. We actually suggest people rotate back and forth between what donor they’re taking, so that we can get the best benefits. There’s some disagreement and some agreement about using multiple donors versus one. But most of what we’ve read in the literature seems to support the use is there’s a benefit to having multiple donors versus just a single donor. So we’re hedging our bets with that.
Lindsey:
And how do you process your stool for transplant?
Shaina Cahill, PhD:
That would be a good question for our lab manager. I’ve toured her lab, but I have not watched her process anything because she’s very picky about cleanliness and who’s around when she’s doing stuff, which I appreciate wholeheartedly, but that would be something that she would know more about than I do.
Lindsey:
Well, maybe you could ask her and I could just put a paragraph in the show notes afterwards about what the process is?
Shaina Cahill, PhD:
Yeah, we have standardized procedures, so I don’t think it’d be hard for her to pull, but that’s not something I know anything about that off the top of my head.
Lindsey:
And so what is your protocol for preparing the recipient for the transplant? Do they take antibiotics?
Shaina Cahill, PhD:
Yeah most of the time, everyone is going to take an antibiotic, but it’s individualized. So that’s part of our process. We work with parents and their children to see what is necessary for them to be prepared. I think we’re as a field starting to really understand the importance of pretreatment. There’s actually been some new studies that have come out and said, “In cases where antibiotics were done before FMT, there’s more success there.” So that is one of our standards, but it’s not consistent and not everybody takes antibiotics. That’s also dependent on the comfort levels and where we think some parents don’t feel comfortable, we use alternatives to antibiotics. It’s completely individualized for the person, so there’s no like, “Here are the three steps we use for everybody.” Because no person fits perfectly into a puzzle every time, we alter it depending on them.
Lindsey:
Okay, so if you didn’t use antibiotics, would you use herbal antimicrobials?
Shaina Cahill, PhD:
From my understanding that has been done. I mean, consistently, it is almost always antibiotics. For people who don’t feel comfortable, we use a natural alternative to an antibiotic.
Lindsey:
Is there a particular antibiotic that you prefer?
Shaina Cahill, PhD:
I think it’s normally vancomycin, but I can’t be 100% sure.
Lindsey:
That’s what I’ve heard from I think, Dr. Adams.
Shaina Cahill, PhD:
Yeah.
Lindsey:
Okay and how long is the course of treatment?
Shaina Cahill, PhD:
Our protocol, we do a two-day, high-dose, and that’s going to be at one of our treatment centers. The total protocol is 16 weeks of FMT treatment.
Lindsey:
Daily?
Shaina Cahill, PhD:
Yeah, daily for 16 weeks. We do that, because there seems to be a huge impact on the amount of time that treatment is done. Studies that have done four weeks, versus something like Dr. Adams’ study, which did eight, you see significant improvements. We’ve extended ours and we see more consistent outcomes and we think part of that is because of that kind of extended treatment period.
Lindsey:
And are these all being done by retention enema or are you doing capsules?
Shaina Cahill, PhD:
Yeah, so at our treatment centers, you can do either an enema or loading oral dose, and that depends on the child or the person getting treatment. Some children can’t take capsules, so they will take a retention enema. When they go home, for kids that can take capsules, they’ll continuously take the capsules. Anyone that can’t swallow the capsules, we have an oral powder, which can be mixed with water, juice or milk. They can take it that way versus having to take a capsule.
Lindsey:
Okay, so it’s highly purified the way that Dr. Adams’ stool is – to the point where it doesn’t resemble fecal matter anymore I assume.
Shaina Cahill, PhD:
Yeah, so it’s odorless, tasteless and colorless.
Lindsey:
Just the bacteria.
Shaina Cahill, PhD:
Yeah. And so that allows us to provide an at-home version of the treatment for kids that can’t take capsules. And that’s really common in smaller kids. That allows a comfort for that and it’s easy to mix it into something they would normally drink anyways.
Lindsey:
So it’s really just a fancy probiotic pulled from someone’s stool when push comes to shove.
Shaina Cahill, PhD:
It’s an engraftable, I guess. Because it’s a higher diversity, and you’re getting everything.
Lindsey:
Including the anaerobic strains. Does it have to be refrigerated?
Shaina Cahill, PhD:
For extended periods. So we suggest four degrees storage, because of what we’ve seen. So far, that’s been done, and we’re doing our own stability studies to get a better understanding, because there hasn’t been a ton done. But when it’s at four degrees, when it’s been partially freeze dried, we know that it’s good for up to about a year. So we suggest keeping it in the fridge and then keeping it at a consistent temperature because those temperature variations can cause some some issues as well. Yeah, and everything that’s in your gut microbiota aren’t bacteria. There’s a whole host of things, right. So you’re getting all of that and with a probiotic, it tends to be concentrated on a couple of strains. And we know that probiotics don’t engraft. So they’re good while you’re taking them, not good long term. There is a difference. I think because it’s purified and partially freeze dried, you’re looking at a more stable and something that can be used for a longer period of time. So there are differences. And as FMT is coming along, we’re seeing these improvements. Oral capsules weren’t a thing a couple of years ago. That’s really kind of changing what FMT looks like, and its accessibility. But as well now being able to partially or fully freeze dry it, now it’s becoming more shelf stable. The life, the longhood, the longness of it, how you can store it and how it’s able to be stored and then shipped and stored in someone’s house for longer periods of time makes it an easier product to have.
Lindsey:
So is that four degrees a typical – this is Celsius right?
Shaina Cahill, PhD:
Celsius, yes. Standard fridge temperature is the –
Lindsey:
Which is I think somewhere around like 40 degrees Fahrenheit or something like that.
Shaina Cahill, PhD:
Yeah.
Lindsey:
Okay, what gut health conditions, does the research say are most positively impacted by FMT?
Shaina Cahill, PhD:
It’s a wide variety. And we’re still learning. I think the biggest thing to say is, currently, it’s only approved for treating recurrent C Diff.
Lindsey:
In the US.
Shaina Cahill, PhD:
And the outcomes of that are magical. Because it’s been so safe and consistent, research is growing in other areas. Across the board, we need more randomized clinical trials. We need larger clinical trials and we need more patients to see consistency. I think that’s the first statement to make across the board. For Irritable Bowel Disease, there have been a number of positive studies. While the results aren’t what we’re seeing in C. diff, which is like 90%, it seems to be consistently around somewhere between 30% improvements.
Lindsey:
Irritable bowel syndrome, or inflammatory bowel disease?
Shaina Cahill, PhD:
Irritable bowel disease, and there’s no consistency. There’s been 10 studies done in Crohn’s and –
Lindsey::
We’re talking about Crohn’s and Colitis (or inflammatory bowel disease).
Shaina Cahill, PhD:
Yes. And so that’s around about 30%. But because diseases that fall under IBD are inflammatory in nature, and they’re cyclical, I think that’s what we’re seeing in the research. When people aren’t in an inflammatory state, their response is different than when they are. So that’s complicating the research a little bit. There are certain disorders where when you treat will also matter. There’s some really great, new clinical trials coming out for Parkinson’s disease – the stuff that’s been done to D has just been case studies and preclinical, which are promising and I think there’s four clinical trials coming that are currently ongoing for Parkinson’s disease. There’s a couple for MS, multiple sclerosis, Autism Spectrum Disorder, of course, we’re seeing clinical trials and growth and research there. There’s been some research looking at cancers. There are some steps specifically for cancer, but a lot of the research right now is looking at treating side effects of cancer treatments. The biggest beacon we’re seeing is people who are getting stem cell treatments or bone marrow treatments, because of what has to be done to prep the body to get those treatments, they’re actually finding using either FMT or autologous fecal microbiota transplantation, which is using someone’s own stool. They take the stool before they get any of the prep done for the stem cell treatment, and then do the FMT. They actually see that improves both uptake and any issues with graft versus host. But as well, it just makes the process more enjoyable or more easily reduces side effects. IBS is another one that they’re showing studies in, which seems to be a little bit more consistent than IBD, which I think is like 40 to 50% improvement. There’s not a ton of studies. And again, there’s more coming. The clinical trials are growing in this area. But those are kind of the main areas we’re seeing a lot of growth and research.
Lindsey:
Okay, cool. It was a good summary. And so I know that there was some controversy surrounding Dr. Klopp and his use of FMT, so can you can you explain a little bit about what’s going on with that?
Shaina Cahill, PhD:
Yeah, so we’re still in the midst of it. It’s been going on for too long. It started in 2020, where the main issues came out, and a lot of it was around manufacturing standards, the use of FMT in children with autism spectrum disorder, and advertising. So we’ve completely revamped how we advertise. And that’s something that we’re consistently changing as we enter new countries. We’re working with external help with that, because none of us are marketing people. We’ve been learning about that, as well as in Canada, worked with Health Canada, decided to not advertise. We don’t treat Canadians so that’s been part of the change, as well, for manufacturing standards. We’ve had Health Canada in. They’ve looked at our procedures, they’ve looked at our laboratory. For us, Health Canada’s the governing health body here, similar to the FDA in the States. We’ve been investigated and cleared of any deviations from acceptable procedures. We have a beautiful and wonderful lab. I am jealous of it. I worked for very long time in labs, and it is very, pretty clean and nice. I wish that’s where I worked previously.
I think that we’re working with governing health bodies, making sure we’re meeting all their requirements. And that’s all we can do. Unfortunately, none of those things have been picked up by the media, but everything else seems to continue to live there. We’ve reevaluated how much information we put out into the public. We didn’t put a lot out there, so we completely revamped our website. We’re more transparent about our donor screening and our screening that we do to blood and stool. We also have really put our time into providing education. What is FMT and why is it important? There’s not a lot out there and some of the research that is out there is really hard to digest. We’ve taken it upon ourselves to try to provide easily-accessible education so people can understand what FMT is, and what we know about it right now. How we’ve decided to tackle the negative attention we’ve gotten, is by evaluating what we were doing and why this could have happened. Our first thought was that while we’ve always been science driven, we weren’t being transparent enough about that. And then when it comes to manufacturing, we’re on the up and up. We’ve been evaluated by everyone that matters for that and that’s all we can do.
Lindsey:
And I know Dr. Klopp’s credentials were threatened. Has that been resolved?
Shaina Cahill, PhD:
We’re waiting for for the decision on that.
Lindsey:
He currently still has them.
Shaina Cahill, PhD:
Yeah, so he’s still a naturopathic doctor.
Lindsey:
Just wanted to make sure. Okay, so I know you were tracking your results internally. Are you tracking them with regard to the particular donors, or just in general?
Shaina Cahill, PhD:
Yes, right now we, internally, we collect a number of measures from our patients. So before, during, and after FMT, to monitor changes what we’re looking at across, we look at stool. We also look at GI symptoms, and then we look at a number of measures specifically associated associated with ASD. We also have a new observational study with Biohm that we’re looking at. The first thing is looking at the gut microbiome of children with autism to get a better understanding of what are the markers and what’s different about their gut microbiome? The second part is, we understand that there is an importance to donor and recipient matching. I think, as the field grows, we’re seeing that more and more so in this study, we’re measuring our donors as well as measuring our patients, but then measuring what the interactions and what the changes are based on how similar or different those gut microbiomes are, and what the outcomes look like. So we’re in the process of collecting data to understand the donor-recipient relationship, as part of our efforts to increase the research and data that exists.
Lindsey:
Have you had positive results or negative results of certain donors that have led you to no longer retain them?
Shaina Cahill, PhD:
No, we haven’t had any donors that we’ve not used. To become a donor is so stringent, I think standards based on what’s been published, about 50 to 80% of people don’t pass the initial screening. Our screenings are in even higher levels than that, because in a lot of cases, it’s like you haven’t had antibiotics in three to six months. We – just you’ve never had them. And we tend to go to the extremes for a lot of things to ensure that we’re not missing anything. So the number of donors you even get just past that initial screening s so few and then on top of that their blood and stool is screened and then regularly screened. The likelihood that a donor has something that’s specifically not good is very low. And then we retain our donors as long as possible, because they’re really hard to replace.
Lindsey:
Right? Are they coming in every day? Basically dropping off their samples? And these are all in Canada, right?
Shaina Cahill, PhD:
Yes. So you have to be close to our site. So we’re in Chilliwack, BC, so they would all be within easy driving distance.
Lindsey:
So let’s get to the kinds of success you’ve seen with FMT and ASD and other conditions.
Shaina Cahill, PhD:
Yeah, so I’ll focus just on ASD because that’s where we have the most. I don’t like to make conclusions about small things. But we do we know that the process is like, we know that when children take antibiotics, we do see changes in their behaviors and, when you start FMT, there’s always a period of time where you see changes like increases in hyperactivity, increases in some behaviors. We see that basically, once we think that the gut microbiome has started to kind of engraft and become part of the system, you start to see improvements. It varies, but most of our patients say between between the first and the third month, they start to see consistent improvements. in the first couple of weeks, it’s just the change. I think, a mixture of wiping out the first gut microbiome and engrafting the next one, you see a lot of changes. Before you see consistent improvements, we see those going into that one to three month mark. GI symptoms seem to be consistently improved and that’s supported in the research. The ASD-related improvements do vary, but a lot of them are the improvements in eye contact. Improvements in speech seem to be something we see consistently and then consistency is in behaviors. A reduction in stimming behavior and a reduction in aggressive behavior seem to be ones that we see more consistently, but we’re in the process of collecting more consistent data over longer periods of time, so that we can start. Our goal is to publish it so that it’s readily available for people to see, so that we have consistent data points that are done regularly and done by validated measures. We were only originally using one validated measure. We’re now using three and we’re also looking at quality of life changes, which is something we want to have a consistent measure on. These are all things that we’ve added in the last six months, so we’re still collecting data. Because our process takes so long, we have a 16-week treatment period. We’re just now starting to get people through their end of FMT and their follow-up. So we’re a little bit further away from having conclusive statements, but from what we’ve seen previously, and what’s been reported from parents, results are consistent. People do see changes and improvements in their quality of life, but we want to have objective measures across the board, because everybody’s perception of these things is different. We want to make sure that it’s validated.
Lindsey:
How long does that take? And are you also recommending diet changes or supplements? In addition?
Shaina Cahill, PhD:
Yeah, so we do consultations with our physician’s assistant at the beginning, in the middle of FMT and at the end of FMT. That’s used to monitor what changes are happening, answer any questions, but as well as put in place any supplements or anything that should be added to help stabilize that gut microbiome and feed it. We also work with parents by trying to provide them with information around what things in the diet are important, and to make sure that they understand how what you eat feeds that gut microbiome. And so you have to diversify the gut by diversifying the diet and ensure that you’re feeding every aspect of this new bacterial body that’s there. We try to provide them with information and we’re consistently researching what the most important things in the diet are for the gut microbiome. We always suggest you should eat 50 different foods every week. We try to help parents get to that point. Kids with ASD often have a lot of issues with certain specific foods. So what creative ways are there to increase what they’re eating and what foods to focus on first. So that’s all stuff that we provide, as the process goes along and try our best to answer their questions. It ranges from like, “Is this pack of lettuce better than this, because it has more things,” to, “What types of smoothies are better,” to ensure that they have the most support we can give them. It is a huge shift, but the more you can do that, the better that gut microbiome will be. That’s the goal – to make a stable, healthy gut microbiome once it’s been transferred.
Lindsey:
And what supplements do you typically recommend?
Shaina Cahill, PhD:
I cannot tell you off the top of my head, mostly because it’s individualized. I’ve said that before, but it really is like each person, depending on what they were taking before they started. Some people come to us with a very short list. Some people have a very long list of stuff that their children are already taking. And some of those are like, “We have to take some of these off.” Some of them that we add on for other people. So it really depends on each child and where their starting point is and where they end up as they go through the process.
Lindsey:
And is there any case study that you could highlight or any individual child that you could talk about, just to just to get a an idea of what’s going on?
Shaina Cahill, PhD:
We have done interviews and stuff with parents like what improvements they’ve seen, but it really is dependent on where the children started. We treat children that start as being categorized as mild, as well as being characterized as severe. Those journeys look completely different, because of what’s going to change and what the driving force was. A lot of parents consistently say that they’re able to go about each day easier. Some of the things we talk to parents about at the beginning of their journey, and the first things that start for them is being able to get their child to have their coat on and into the car has now been less of a battle. For some people that’s where it starts and it continues to go forward. Being able to have a conversation, for them to feel like their child understands them and to be able to integrate more easily. For a lot of parents too is that everyone can eat the same food at dinner. And so these are changes that happen throughout the process that make huge impacts for quality of life for both the child and the family. And those continue to go. So it’s not always specifically about different changes in their diet, or in specific ASD-related behaviors like stimming, or eye contact or aggression. It’s also about those changes all coming together to make life easier. And I think that’s what we hear parents talk about the most is just the changes in their day to day lifestyle, and how things have become easier. So I think outside of what you expect to see in changes in ASD-related behaviors and GI symptoms, it’s those changes in quality of life, as well, that a lot of parents talk about.
Lindsey:
And so if somebody is coming to you for something else, like IBD, or IBS, is it a much shorter protocol?
Shaina Cahill, PhD:
From what I understand it’s average is between two to three or two to four months, depending on the person, what their journey looks like and where they’re starting. Our process starts always with a call and you talk to someone on our team, and we get a better understanding of why you think FMT would be a good fit, what your current situation looks like, and that starts the process of, “Is this a good fit for you or not?” And then you meet with a physician’s assistant to talk about what issues you’re having, what kind of reports you have, from your doctors to see where are we right now and where do we want to be? That determines the length of treatment, and how we approach your pre-treatment and your post-treatment as well.
Lindsey:
And roughly how much does this cost for ASD or for shorter conditions.
Shaina Cahill, PhD:
So for our ASD protocol, which includes meeting with a physician’s assistant, meeting with a behavioral or clinician who does assessments, we use the CARS assessment, as well as the treatment, and treatment at our sites is $14,300 USD. And then that’s kind of our standard. If you’re coming to us with something else that would be dependent on the length of treatment, and if it would all be at home or if you would be coming to one of the sites as well.
Lindsey:
So it is possible to just do it at home?
Shaina Cahill, PhD:
Depending on who you’re referred by. We have patients that come to us for C diff and so their gastroenterologist or their doctor will send us a request form and then we can send out just an at-home treatment for them to do.
Lindsey:
Can you send out at-home treatments for people in the US?
Shaina Cahill, PhD:
Yeah, so for C Diff, we have done that.
Lindsey:
But not for IBS or IBD?
Shaina Cahill, PhD:
That would be something that you would talk to the team about, because it would depend. For some people, having those loading doses will be a requirement. It would depend on where they are and what works and if at home is the best thing then we work with them and their doctors to ensure that we can get it to them at home.
Lindsey:
But they have to come in via one of your clinics in those various countries.
Shaina Cahill, PhD:
Or they can have their doctor submit a request form for treatment and we can send it directly to them. There’s some flexibility but it would have to come as a request from a physician. That’s the way that we can do it.
Lindsey:
Okay. Because I know that obviously, in the US right now, it’s only FDA approved for recurrent C Diff. I’m curious how that works. Just because if a physician requests it, does it somehow get around that rule?
Shaina Cahill, PhD:
I don’t know. So all of our stuff has been done for C. Diff. I think for all of our secondary patients, it would depend on on their case, and that stuff I don’t know about, because I don’t work directly with patients. I have a PhD, not an MD, so they keep me away from all of the people. But we know we do have cases where, we work with them to try to make sure that the process is something that can be handled, but I’m not sure how it works. And it may be country specific, because for each country, the rules for FMT are different. And we treat globally. So that’s why we always say, talk to the team, they will figure out where you are, and what the rules are, and then how to kind of approach that.
Lindsey:
Like you might be able to refer them to a doctor in their area?
Shaina Cahill, PhD:
Yeah. And if they’re in a different country where FMT is regulated differently than it is in the US, then the procedure would be different, because it always depends on what the health authority there’s requesting and what the procedures are. So, we treat in the US, but we don’t treat all in Canada, but we have patients in Europe and South America, everywhere. So it’s dependent on where they’re located. I think the procedure depends, and that’s why I always say, the best thing to do is book a call and talk with us. And we can work through all of that, because there is a lot of legality and rules around where you’re located and how treatment can be done. So it’s hard to make a singular statement, I guess. Yeah.
Lindsey:
Is there anything else you would like to share before we finish up?
Shaina Cahill, PhD:
I think that if you have questions about FMT, or if you think FMT might be a good fit for you, book a call and ask questions, and see where it is, because it is something that’s growing, and we’re understanding more and more about it. But I think for every person, it’s going to be different. And our goal is to ensure that you’re informed, and that you have an understanding of what the possibilities are. I think that’s always the best is to just do your own research. Look at our website, we have a YouTube channel where we make educational videos. You want to get a better understanding of what FMT actually is, or what the gut microbiome is, but then book a call and talk with someone on our team to get an understanding if it is a good fit for you.
Lindsey:
Is there a cost for that initial call?
Shaina Cahill, PhD:
There’s no cost and you’re not tied into anything. We’re just as likely to say it’s not a good fit for you, because we want to make sure that anyone that’s coming to treatment with us is getting treatment that we think will work or will be a good fit. It may be that maybe it’s not a good fit for you now, or maybe we don’t think that it will be be helpful for the symptoms that you have, just as much as we want to answer your questions for you to be informed about making that decision. So we have that as an open ended so you can you don’t feel locked in, you don’t feel tied up with anything and then you can get an understanding of how it fits for you.
Lindsey:
Okay, awesome. Well, thank you so much for sharing about all this. I’m sure that there’s a lot of people who are curious about it and considering it.
If you’re struggling with dysbiosis, diarrhea, constipation, leaky gut, candida, IBS, IBD, or other gut health or all over body problems, you’re welcome to set up a free, 30-minute breakthrough session with me (Lindsey:). 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.
So I know from the intro that you have a child with ADHD. So can I ask you about your personal story and what led you to the holistic approach to ADHD?
Dana Kay
Yeah, definitely. And I think, like most sort of alternative health practitioners, there’s always that story behind their motivation. And there’s no different for myself, believe it or not, I was actually an accountant in a previous life I plan to continue in that field. If the concerns over my son’s health hadn’t grown, I always dreamt of being a businesswoman in an office and my dream came true. But then my son’s health started to deteriorate. And by the age of two, he’d have these meltdowns just like any other terrible to child but then they sort of didn’t go away, and they seem to get worse and worse, and you just would be at the playground, and you’d have so much energy compared to any other child. And I kind of sort of felt like I was on this emotional roller coaster. I’d be dealing with so much energy, and then we’d have this massive meltdown. And then for an hour, he’d be okay. And then we’d have this massive meltdown again, and it just, it wasn’t really what I imagined parenting to be like. And so I’d I’d asked friends, I talked to teachers in the preschool, and everyone’s like, “Oh, don’t worry, he’s just a boy, he’ll grow out of it.” And so I just kept going along with that. And things started to get worse at age three, age four, and sort of by the time of mid fours, late fours.
That’s when sort of the teachers or the preschool started to notice a bit of a difference. And we went to the pediatrician who referred us to a neuro developmental psychiatrist, and he was diagnosed with ADHD. And we were immediately handed prescription medication. And honestly, between you and me, I was relieved with the diagnosis similar to myself. I’m not a bad mom, this is not my parenting and this is not my fault. There’s actually something that is contributing to what’s going on in our family. And I was excited to fill the prescription medication, bounced into the drugstore, bounce back out, gave it to him. And that was the thinking to myself that that was finally the thing that was going to help us get help for our family. At first things were okay until they weren’t. And we started having these side effects and went back to the doctor and they increased the dose. Then they prescribed another medication to counteract the side effects of the first so he was losing weight, not able to sleep and didn’t want to eat. And then he’d have these mammoth mammoth meltdowns that were worse than before, in the afternoon when he was like coming off that medication. And so it was like, Yeah, okay, he was able to sit still at preschool. But when he got home, it was actually ended up worse than what it was before. And so this sort of continued until my son who was now five was on three very strong medications. And the doctor suggested a fourth medication to counteract the anxiety that had now come up from it. And that’s when I sort of said, doesn’t seem right. And I just couldn’t do it anymore. And this is where sort of my career path completely changed. And back to school, I did my holistic health degree, multiple specific certifications in this particular area. I really learned that medicine wasn’t the only way. I began to learn that ADHD symptoms can be reduced naturally and I learned how food can affect so many aspects of our lives as you have too, Lindsey, and in your story and what you share. Look, today, my son is in middle school. He’s a teenager. He’s thriving. He hasn’t been on meds for years and he’s a straight A student. But right now he does have a B, which is very upset about which but for me, I don’t care. Like the most important thing for me is he’s happy, my family’s happy and we now have that peace and that calm and that balance in our house that I knew that we could get to. Once I learned this, and once I saw the changes that all of this had, on my own family, I really couldn’t keep this information to myself. I didn’t want anyone else to have to go through the struggles and the challenges that I went through. I’ve been lucky enough to have helped over 1000 other families get to the same place as me but just so much quicker, and without as much stress.
Lindsey Parsons
That’s wonderful. Yeah, So tell me about how diet impacts ADHD and kids.
Dana Kay
Yeah, so look, I like to think of diet as the foundation. When children are diagnosed with ADHD, the first course of action that most doctors suggest is medication and many of them don’t mention that altering the diet can significantly reduce ADHD symptoms. This is very much exactly what happened with my son and I started to learn about the effects of gut health – that’s why I love being on this podcast – gut health on ADHD symptoms and how when we heal the gut, ADHD symptoms are reduced or removed completely. That’s why I like not only… I’ll go into the details of why diet does help, but I think that it’s so important that food should be first. Food should come first. I’m not against medication, but it shouldn’t be the first cause of action, not when food can sometimes be even more effective with absolutely no side effects. So if children continue to eat these processed inflammatory foods, like gluten like dairy, and soy which I’ll go into why, those ADHD symptoms are not going to go away, because the foods they are eating are exacerbating the symptoms. So when we take these foods out, they’re so highly inflammatory. And I like to sort of think of it like a bucket, and everyone’s born with this metaphorical bucket. Our goal in life is to keep the load on that bucket low. Some of our kids might have bought been born with stuff in the bucket already.
My son was born given antibiotics straight away, was in the NICU, was on a CPAP machine, wasn’t breastfed there was a lot going on. And so his bucket already had stuff in it. Now, the goal in life is to keep that bucket low. And some of us are really good at emptying that bucket outside of our body because our detoxification pathways are optimized, whereas, others may have some genetic issues, gene mutations in certain areas and they cannot empty that bucket effectively, which happened to my son. And so what happens is, we put this load on the bucket inflammation, and inflammation can come from food, it can come from toxins, it can come from environmental toxins, it can come from medication – which came from my son, and this will load and load will rise up until it gets the bucket gets so full. And if you can’t effectively empty it out or tip over into our body, and our body will be riddled with inflammation. And that’s when symptoms come out. For kids, they might be born with that bucket that has stuff in it already and then they start eating these foods. Now when you’ve got a high bucket, and you start eating other highly inflammatory foods, that load is going to get up very, very quickly. So I get a lot of questions. “Well, why does say gluten, dairy and soy affect one kid but doesn’t affect the other kid, even if they’re in the same family, and I bring it back to that bucket?” Well, that kid’s bucket might be full already and that kid’s detoxification pathways may not be optimized. That’s sort of the way that I look at it. Now, gluten, dairy and soy are the top three inflammatory foods that I think of, and they’re the top three culprits that are driving inflammation in our body and, and these highly inflammatory substances can lead to an immune response. And they lead to increased intestinal permeability or leaky gut. I’m sure your listeners probably know a little bit about leaky gut, am I right?
Lindsey Parsons
Of course.
Dana Kay
Yes, so they can lead to leaky gut and kids with ADHD are more likely to also have compromised immune systems. So the effects of these substances tend to have a whole greater effect on the body. Now in terms of why do they cause leaky gut, I won’t go into detail about all of them. But I think gluten is probably the number one food that I recommend that all children with ADHD cut out of their diets. Pretty much everyone should not be eating gluten, in my opinion, but we’re talking about kids with ADHD here. Now, gluten is so inflammatory, that even if someone doesn’t have an allergy, it does cause leaky gut. It’s harmful for everyone and that’s because it triggers intestinal permeability in everyone. That refers to sort of the breakdown of the intestinal walls. Now when functioning properly – I don’t know if you want me to go into detail on this if your listeners already know this – but intestinal permeability is the breakdown in the intestinal walls and it allows that water and nutrients to pass through but blocking other things from entering the bloodstream. When there’s that breakdown, it can lead to leaky gut, which basically means the tight junctions in the gut, that are supposed to control what passes through the lining of the intestines. They’re not doing their job very effectively. So they’re allowing toxins and other harmful substances to get through into the bloodstream. When toxic substances get into the bloodstream, the body fights them off and tries to get rid of them, so when something enters the bloodstream that’s not meant to be there, it triggers that inflammatory response as the body seeks to rectify it. Gluten leads to increased intestinal permeability, which leads to leaky gut, which leads to inflammation, which leads to a load on that bucket. And when that bucket is high, it it leads to the symptoms like stomach aches, constipation, brain fog (which is like inattention), hyperactivity, reflux, anger issues, nose or wheezing. I could go on and on, but a lot of those symptoms correlate with ADHD. By cutting out gluten, parents of children with ADHD are removing one food that significantly contributes to inflammation in their body and the load on that bucket. In my experience, if we remove that, along with those other highly inflammatory foods like dairy and soy, and feed the body with the right things, then ADHD symptoms diminished significantly, and sometimes disappear completely, because they allow the gut to repair. Does that explain it okay?
Lindsey Parsons
that’s awesome. Yeah, absolutely. So I, as a parent felt at one point that my son was likely gluten intolerant when he was in his middle school years, and I tried to get him to go gluten free. And I only got him to agree to about a two week trial of this. So that was it. I mean, it was just a losing battle, because even if he was, say, restricting it, the best I could get him to agree to was say, you still eat it once a week. And I’m thinking, well, that’s kind of meaningless in the end. So I’m curious whether you had better success. And obviously, your child was younger at the point at which you started doing this. But how in the world do you get these other families to do it?
Dana Kay
Yeah, look, it is a lot. And that’s why I’ve sort of designed my program, the way that that I have. My son was a lot younger – the younger, the better – because they grow up with it and that’s what they know. With the older kids, it’s a lot harder, and you do need to get a little bit more buy in. But the way that you do it with the older kid is really getting them to understand the feelings in their body and how that affects their body and if they are having that gluten intolerance, and they’re experiencing symptoms, when they stop the gluten, they can actually feel the changes in their body. That’s where you jump on it to try and get that buy in. And so when they do eat something, they would experience the symptoms coming back. I can tell you that I’ve seen it time and time again and so it is really important that you’re constantly having those conversations with the older kids. There are so many challenges that can come up with it. What I tell with families is that it’s not an overnight change. I tried to change everything on day one, I literally took out gluten, dairy, soy, artificial flavors, artificial colors, salty food and sensitivities that were in his food sensitivity panel on day one. Let’s just say I had multiple panic attacks on the floor of my bedroom. That is not what I teach in my program. I always tell families that Rome wasn’t built in a day, transforming their family’s diet won’t be completed in a day either and so it’s okay to take it slowly. When you’ve got an older child, that’s important, because you need to take them along in the journey with you. If you just throw it on them, they’re going to rebound. So it’s okay to take one step at a time. And if that pace that’s doable for you and your life is one change a week or one change every two weeks, then that is okay. Families really need to give themselves permission to take things slow, because it’s not a diet. It’s not a phase. It really is a permanent lifestyle change, but when it becomes part of your lifestyle, it’s second nature. You don’t even think about it anymore. So very much, I think that having support when doing it with a family is key to this. Trying to do it alone is so hard. Take my word for that one. I did it by myself and it was so extremely hard. And so we my program, we’re literally there every single day with families holding their hand step by step, telling them exactly laying out that blueprint for them on what they need to do next. So they don’t need to think about it. When that challenge does come up, which it will, we can help them overcome it because that is our powerhouse. That is what we know best. Having helped over 1000 families, we know what works, we know what doesn’t work. And we know if there is a challenge most likely we’ve dealt with it before.
Lindsey Parsons
Yeah, so obviously it helps if you have buy in from both parents. I’m curious whether your husband bought into the entire idea of changing the diet because my husband wasn’t bought in at all. Yeah
Dana Kay
I love this question. No, he wasn’t bought in – probably still not 100% body and either, but you know this wow, this is that’s just the way it is. We’ve seen so many changes but he’s a man of science, as most men are, and also stubborn and I love him. He’s upstairs and I always throw him under the bus. The positives outweigh the negatives. I’ve run into many non believers in my time and I will tell you like it was the science that first made me rethink the direction we were traveling with my son. And same for him. And the fact that we obviously had significant side effects from the medication. But there are so many studies out there to support this. And I think that, really, when you’re trying to convince the unconvinced, you’ve got to hit them with science. I’ve got so many studies out there that just really, really drive at home, that diet is so important. Look, it’s not just about diet. I don’t just teach diet, but it’s diet. It’s detox. It’s lifestyle. It’s reducing toxins. It’s all of that. But I mean, I could list off studies and studies. I don’t know if you want me to but I could I could list off some studies and I think that you hit the unconvinced with the studies. And sometimes mums just need to take it into their own hands. And honestly, that’s what I did at first. I said, Look, this is what I’m doing. Too bad. Come on the journey, or you don’t. I just went forward and did it Aand they they start to come on board when they actually see the changes – and the changes are amazing. And mean the first change that you see with reducing that inflammation in the body, is a reduction in tantrums, a reduction in meltdowns, a reduction in anger, the severity, the length of time, the frequency all reduced. For my son, it was literally within two to three weeks of changing the diet. And honestly, the emotional dysregulation is the hardest thing for a family to deal with, because it’s so loud.
Lindsey Parsons
Absolutely,
Dana Kay
It puts a family on hold basically. It’s that roller coaster of emotion. So it’s actually really nice to see that that’s one of the first changes that happen.
Lindsey Parsons
Absolutely. So, obviously, taking out the bad stuff is necessary, but what about what kids with ADHD did eat more of?
Dana Kay
Yeah, look, it’s really like the same thing for anyone else. It’s really about not what just to take out. It’s also what to put back in the diet because I always say to people, “Gluten and dairy free is not necessarily healthy.” If you’re gonna replace packaged goods with packaged goods, you’re not gonna get to where you go and sometimes gluten free can actually be worse than the non gluten free. As far as what to weight, my best tip is to focus on whole nutritious, fresh fruits and veggies, grass fed animal proteins, such as meat, poultry, seafood, eggs and also plenty of healthy fats like avocado, coconut and olive oil – really avoiding those refined oils. You also want to be drinking plenty of spring water. I mean, the numbers of families that come to me whose kids, the only thing they drink is juice, soda and milk, they you take the juice away, you take the milk away and the soda away and there are different kid and you don’t even need to make the dietary changes, but you do for their health. By drinking plenty of spring water to avoid harmful chemicals that are in some waters, but also, obviously water helps detox the body and remove the toxins that are already there. I find that all of these foods really provide us with the nutrients we needs so we can function at our best along with our kids. When buying ingredients, my rule of thumb is (ingredients in terms of like a package food), “If there isn’t something that you can’t pronounce, put it back,.” If you don’t know what it is your body is not going to know what it is. Try to stick with an ingredient list that’s less than five or six on there. The more ingredients, the more worry that there’s going to be those other things in there as well.
Lindsey Parsons
Right. So you mentioned detoxification a couple times. I’m curious, are you testing kids in your practice? With with what kinds of tests might you use to check the detoxification? Yeah,
Dana Kay
Look, I think functional lab testing definitely plays a role. I would like to say that about 50% of the families I work with, we just do sort of the diet lifestyle, like detoxification, and reducing toxic exposure and they get to where they need to go without doing lab testing, which is amazing. What that tells me is probably 50% of the kids that are diagnosed with ADHD are not in fact, having ADHD. It’s probably a byproduct of what’s going on in their body. You apply that to the 6 million children in the US today that have been diagnosed with ADHD. That’s probably 3 million children that have been wrongly diagnosed, but the other 50%. Yes, it helps dramatically, but there’s something deeper going on in their body that we need to check out. And we use functional lab testing to identify those HIDDEN stressors. There are four basic tests that I suggest to families. There are many more and I have access to many more but I find these four a really great starting point. Now, the first test is a stool test. It gives us a really clear picture of the state of the gut and things like parasites.
Lindsey Parsons
Which one do you use?
Dana Kay
I currently use biomeFX from microbiome labs, I have used a number of different ones over the time, but I do actually like to look at the most real up to date technology. PCR testing is one that is getting out of date now and so this is using a DNA sample of each of the bacteria or the parasites so it’s much more accurate in that way. So we’re looking for what’s going on in the gut. We’re also looking for inflammation and leaky gut and digestive enzymes – things like that. The next one we use is a food sensitivity test and not just a standard one that you can buy online. They’re not all created equal. I use a lab called vibrant wellness, and we do their food Zoomers. And so I’ve had people that have got an IgG food sensitivity test from online, and just say for example, eggs come up negative – because what that is doing is just testing the food at the top protein level. But with the food Zoomers, what they actually do is they check the food down to the peptide level of the protein. So for example, egg has something like 18 different peptides in it. So what the Zoomer is doing, is actually checking all of those 18. So I’ve had times where it’s come up negative on a food sensitivity paddle, but we do an egg Zuma this so highly reactive at the peptide level, just not at the top protein level. And so a lot of the time we won’t be successful if we didn’t remove egg. Now, food sensitivities, are not true allergies, but they do cause inflammation in the body that would a load on that bulkhead. So you can actually heal from the sensitivities. Once you heal the gut, you can start to add them back in.
Lindsey Parsons
Do you make sure they’re off of the gluten dairy and soy before you run the food Zoomer just so that the level of leaky gut is essentially reduced prior to checking for other sensitivities?
Dana Kay
No, I don’t and that’s because we’re doing it sort of side by side. Obviously families just start with our phase one. If they start with our phase one, then gluten, dairy and soy will be removed for six months. If they go to phase two, which is testing, then they will do it that way. Some families – when we talk about their health history, they’ve got very traumatic health history, and we know that we just need to get to it. Now I will tell you, I have had families that have come to me three years of being gluten, dairy and soy. And we do a wheat Zoomer on them. And they are so reactant to gluten, it’s not funny. They’ve been eating gluten and are probably not aware of it.
Lindsey Parsons
I’m just curious though, whether they’re coming up with pretty much every food that the the child is eating on the food Zoomer, such that, they’re left with nothing to eat.
Dana Kay
Yeah, look, a lot of the some of the time they do. But what we’re there because we’re there every single day holding their hand, we’ve got five weekly group coaching calls, there are so many foods out there that they can eat. We’re really guiding them through that process and if we just get so many, we prioritize – we just take the biggest hitters, and we leave the rest. We use a rotation diet on the rest. And so really, with a kid, we sort of feel where they are. We feel where the family is, we don’t want to overwhelm the family too much. Some come back with only like five sensitivities, others coming back, like my son, had 40. I actually did every single one, obviously, that’s the best, but at the same time, we need to make sure they’re getting the nutrients and everything to grow. So it is about “Let’s work out what’s best for this child based on the knowledge that we have.” So the third test that we do is an organic acid test, which I love.
Lindsey Parsons
Great Plains?
Dana Kay
Yeah, I loves Great Plains, but at the same time, it’s really keeping an eye on the different technologies that are out there, which one is the most up to date and which one is going to give us that best result at that time. I’m always open to making sure that I am currently using the best. Now, I love Great Plains. This organic acid test really gives us an overview of the whole body and how its functioning the need for specific nutrients, such as B vitamins, which are super important for our compromised kids – further diet modifications, so things like oxalates and salicylates, which again can be an issue for our kids. At the same time, there are many practitioners out there that will say, “Go on a low oxalate diet. Go on a low salicylate diet,” but I focus on is, why they are high. When you’ve got high oxalate, it’s usually because of mold or candida that is producing those elevated levels of oxalates. So some fruit for kids, a lot of the time in the first round, I don’t tell them to go on a low oxalate diet, because when we fix the gut, it actually comes back down into normal ranges. It’s also looking for detoxification and that’s where by looking at that, and seeing that they detoxifying properly. It’s looking at neurotransmitters, so your serotonin and your dopamine, yeast, mold, clostridia, C diff, mitochondrial function – lots of markers, there’s over 70. That’s why I love that one so much.
Lindsey Parsons
Yeah, I love that test too.
Dana Kay
And then the final test, which not many people know about, because it’s really specific to mood and behavior, and it’s called a cryptopyrol test. Pyrols are a normal chemical byproduct in the body. They attach to vitamin B six and zinc and draw these elements out of the body when they’re excreted through the urine. So, if a kid has elevated urine cryptopyrol levels, it can result in a dramatic deficiency of zinc and B six, and those are two critical nutrients needed for mental health. But pyroluria, which is what they call it is frequently identified in behavior disorders, ADHD, depression, aggression, violent behavior, and the symptoms are like, one for one with ADHD symptoms, or tolerance to physical emotional stress, or anger control, mood swings, poor short term memory, sensitivity to light/sound and tactile sensitivities. Another one is poor dream recall, or inability to tan. You don’t have to have all of them. You could have one or two. You could have all of the symptoms or you can have half of the symptoms. That really doesn’t matter, but I see that in probably about 50 to 60% of the kids that I test. And really, it’s about bringing in some key nutrients. The pyrols is part genetics, part oxidative stress, so a breakdown in the cells. And when there’s high inflammation, that’s when you get oxidative stress. So we reduce that oxidative stress, we reduce that inflammation. But some kids actually need a lifelong management of the Zinc and B six if there is a strong genetic component to it.
Lindsey Parsons
Yeah, so I’m curious how high do you typically have to supplement thing can be six, if they have pyroluria
Dana Kay
It’s based on weight. We do a metabolic weight factor and look at the weight of the child. We also bring in some key antioxidants to reduce that oxidative stress. So like vitamin C, vitamin E, selenium, I’ve actually created my own payroll supplement, because when you add in sync B six in two different forms, C, E, selenium, I actually added magnesium to it as well. You’re cutting down on sick five different supplements, and I bought it all into one, and then I adjust the dosages based on weight.
Lindsey Parsons
Oh, okay. So like, once they hit adulthood, how many pills a day? Is it of your supplement? I’m curious.
Dana Kay
With 100 pounds, like I only sort of go up to 100 pounds in mind. So with that, it’s probably five in the morning, five at night.
Lindsey Parsons
Okay, so that’s it another small number. With magnesium in there. I knew it had to be high, because that alone takes a lot of space. Exactly.
Dana Kay
Exactly. Yeah. But with kids, it’s only like it’s either two in the morning to a night or three in the morning, three at night based on that weight.
Lindsey Parsons
Of the chewable?
Dana Kay
No, we’ve got we’ve got a powder and we also have captures up into juice, or else. Yep.
Lindsey Parsons
Got it. So did I say I would love to have some of those studies just to link in the show notes?
Dana Kay
Okay, sure. I can definitely dothat for you.
Lindsey Parsons
Yeah. So obviously, since this is a show about gut health, I want to be sure we talk about the gut brain connections. So how does this apply in the ADHD world and we talked a little bit about the leaky gut. I also know that a good portion of kids with autism tend to have gut issues. Is this true for ADHD as well? Do you see a lot of gut infections?
Dana Kay
Definitely, definitely do. And as I said, like, we change the diet. For some kids, we open up detoxification pathways, and we reduce that inflammation and their gut starts to heal on its own. And so I think that the reason why the gut is so important to this, I just want to bring it back to a couple of statistics. We know that all of these disorders and illnesses are on the rise. Everyone’s like, “Well, why is there this epidemic?” It’s actually estimated that 54% of American children have been diagnosed with a chronic illness in 2018. That figure was only 15% A couple of years ago, and I look at that increase and I’m like, “Oh my gosh, this is just awful.” One in two have anxiety, asthma, diabetes, epilepsy, cystic fibrosis, learning disabilities. One in five have allergies. One in six out developmental delays, and one in I think it’s 42 now, have autism. The reason in my opinion, the rise is happening happening so rapidly is it all begins in the gut. And that’s because 80% of the body’s entire immune system is within the gut walls, along with billions of nerve cells and extensive amount of gut bacteria. So all of our children’s health is quite literally connected to everything that occurs in the gut. And obviously, all of ours as well. It’s not just our children. The amount of families that I’ve spoken to, we always ask them, “Have you been on antibiotics when you were younger,” and a huge percentage have. I actually wish I’d kept a tally, which I haven’t. But as you probably know, and as the listeners probably know, most antibiotics work by killing bacteria or preventing it from growing. But unfortunately, most antibiotics can’t distinguish between good and bad bacteria. That means that they wreak havoc on the gut’s, healthy bacteria. And actually, many people suffer lasting changes to their gut flora as a result of taking antibiotics. So a huge percentage of these kids have been taking multiple rounds of antibiotics. That in turn is compromising the gut and when the caught the gut is compromised, because 80% of the body’s entire immune system is in there, it’s not a huge surprise to see that these disorders and illnesses on the rise. Now, to tied gut health to brain health and ADHD – that’s really the gut brain connection and that means that our brains are deeply connected to our guts. If our guts aren’t functioning well, our brains won’t be able to function well either. Now, the main area involved in gut function is the frontal lobe and that’s the area of the brain that talks to the gut via two way chemical messengers and nerve branches. The frontal lobe is involved in things like attention, focus, executive function, planning, organizing and problem solving, which are often issues that kids with ADHD struggle with. Because the frontal lobe is in the brain, many people are under the impression it’s the brain that needs care, when in reality, it’s actually also the gut that’s causing the problem. I think the biggest thing for me, and this is why we see such a dramatic change with kids when we just change the diet, 95% of the body’s serotonin and 50% of the body’s dopamine is produced in the gut. These neurotransmitters or hormones are the ones that help us manage emotions. They balance mood. They help our cognitive function and emotional dysregulation is a common symptom of ADHD. But many parents don’t realize that this emotional dysregulation actually starts in the gut where the serotonin and the dopamine are made. So the problem is not the emotions themselves, but the fact that the correct amount of these vital neurotransmitters are not being made in the first place. So by working to improve gut health, many parents of children with ADHD find that the emotional disregulation problem solved themselves. The frontal lobe starts to get optimize. A lot of those symptoms can be helped with with healing that gut.
Lindsey Parsons
Awesome. So beyond the food question, are there supplements that are evidence based for supporting kids with ADHD or adults for that matter?
Dana Kay
Definitely. I do like to preface this to say that one thing to keep in mind with supplementation is that everybody is a bio individual meaning that every child is unique. So what works really well for one child, might show little effect for another. But that being said, there are a number that like there are there are four supplements that I love for ADHD in particular – the most studied – and one is a good quality fish oil that has Omega three and Omega six fatty acids. It’s really important to get them in the right balance. It’s really important to get a quality one and not a gummy that has sugar on it. There are a lot of studies out there that support the Omega three and Omega six fatty acids can support things like memory, hyperactivity, clear thinking, behavioral disorders and organization skills in children. The next thing is a good quality probiotic. There’s a lot of research we know that that taking a probiotic that contains either certain types of gut bacteria or spore forming probiotics can really help with boosting that gut brain connection helps supporting detoxification, it helps with anxiety and mood and also support the body against the damaging mental and physical effects of stress. Probiotics are not created equal, so really ensuring that you have a good quality probiotic is is important.
Lindsey Parsons
So what are the ones that you like?
Dana Kay
I like megaspore biotic*, which is a small forming probiotic. I’m not sure if you’ve discussed this on the podcast before. The reason why I like it so much is it’s kind of like springtime, where you want to make sure your grass starts growing and you put down seeds. So you’re reseeding the grass so it can grow, and the plants can grow and they can prosper. And so this is kind of like what that probiotic does it. It seeds, the the gut and lets the good bacteria grow in what that needs for that person, whereas, a lot of the strain based ones don’t survive digestion. So they go in, they go into your stomach and they go out, and you’ve just got a lot of expensive poop. That’s why I do prefer the spore forming ones. I’m actually in the process of creating my own custom blend that has those spore forming probiotics. It will also have saffron which is supported in helping brain health as well. And it’s also going to have a couple of other strains of probiotics that help with calmness and mood as well. So I’m in the process of doing that right now.
The next one that I love is magnesium and magnesium is great for everyone. There are so many studies out there. Magnesium is needed for over 300 biochemical processes in the body. There are many different types, but parents find that it makes a surprising difference in their kids anxiety or depression, aids in sleep and also helps hyperactivity. Research suggests that children with ADHD and anxiety often have low magnesium levels, so using supplements can have a calming effect on behavior, insomnia, agitation, muscle cramps and things like that. It can help so many different things. There’s two forms that I like. One is glycinate, which helps with that calming. The other one is the three and eight, which crosses the blood brain barrier, which helps with the brain. So that helps with ADHD, for sure. The final one, which everyone should be taking, is vitamin D. find that it works wonders are with children with ADHD and anxiety, especially when taken with omega three fatty acids. We all know that the best way to get vitamin D is to get outside, But when you live in Seattle like I do, there’s not a lot of sunshine, except for maybe five weeks of the year. My kids and I are on a vitamin D and K to supplement like most of the year except for maybe four or five weeks of the year. It’s definitely beneficial for most people.
Lindsey Parsons
Yeah, of course. So, are there other common underlying stressors that you see in kids with ADHD – beyond the diet question?
Dana Kay
Yeah, look, there, there are a number of things that exacerbate ADHD and we really are focusing on reducing that inflammation, those four base tests will give us a high level view. Other things that can contribute to it are things like nutritional deficiencies, and making sure that they’ve got the right balances of those nutrients. Other things like minerals and heavy metals is a big one as well. We find copper overload quite consistently in kids with ADHD, if you actually Google, copper overload and ADHD, there’s actually there’s a lot of information out there about that. The problem with it, though, is we need to be very careful of copper dumping. You’ve just got to really do it slowly, especially with with kids. Food intolerances – that’s obviously another one. Heavy metals, environmental toxins, dysfunctions in body systems and even cultural or lifestyle factors can contribute to it. Hormone imbalance, inflammation, leaky gut, pharmaceutical medications create underlying issues as well, because they can contribute to the toxic load on that bucket. There are a number of common underlying stresses that can contribute to symptoms and really, the way that I look at this journey is we are trying to reduce inflammation as much as possible to allow healing to occur. And we do that in multiple ways. We do that with diet. We do that with detox. We do that with food, which I’ve just discussed, lifestyle changes, reducing toxin exposure, reducing heavy metal exposure, reducing the infections in the gut and optimizing the gut brain connection.
Lindsey Parsons
Awesome. So tell me about your new book and where listeners can find it.
Dana Kay
Yeah, it was a labor of love. It is called thriving with ADHD, which is a guide to naturally reducing ADHD symptoms in your child. Years ago, when I was going through with this with my son, I wanted a book, a program a call or whatever, on ADHD that would clearly spell out exactly what I needed to do to support him with ADHD naturally, but I couldn’t ever find it. I was constantly googling for something, anything that might actually help us get some relief from my son’s challenging behaviors. And when I was looking for that book years ago, I just struck out over and over again and there was just nothing out there. There was a novelist named Toni Morrison and he once said that if you find a book you really want to read, but it hasn’t been written yet, then you must write it. And that’s what I did. And I still can’t hardly believe it actually. It’s an international bestseller in multiple categories, including children’s health, which just blew me away and it’s my life’s work. It’s the guide I needed when I started this journey with my son, but couldn’t find. It’s different from other books out there, because I’m not only a practitioner, but I’m also a mom who gets it 1,000%.I just, I just want families out there honestly, at the end of the day, yes, I’ve got a business. Yes, I do this for a living. But my goal will my passion to get this word out there to found there are so many families out there struggling. They do not need to struggle, and I’m not going to be able to work with everyone. Hopefully, this book makes it more accessible to other people out there. One day my dream and my vision is for the doctor, instead of handing a prescription medication when the child’s first diagnosis, they have this book. They say, “Go and implement all of this and if you still got issues, come back to me and we’ll talk about something different.”
Lindsey Parsons
It’s a great dream, but I’m not picturing it
Dana Kay
I know, it is a great dream, but I’ll do whatever I can to just get this message out there to as many people as possible, because parents do not need to suffer. Listeners can find more about my book at ADHDthrive institute.com/book. It’s available on Amazon.
Lindsey Parsons
Yeah. Okay. And where can they find your program? Same place?
Okay, great. Well, I will include all those links in the show notes, and any parting thoughts for everyone?
Dana Kay
All I want to say is that we’ve probably got some parents listening who are like, “Oh, my gosh, that sounds amazing, but it sounds so overwhelming.” I’m just going to take them back to the fact that Rome wasn’t built in a day. You do not need to make all of these changes on day one. Get support when you need it. I’m very much how about I’m not an expert in everything. I will pay for experts time and advice in the area that I need specifically when it comes to my business or even my even in my personal life. All I wanted back in the day was a program like mine, and it wasn’t out there. It is possible to reduce ADHD symptoms naturally. If you’re on this vicious cycle of trial and error of medication or trial and error of anything, and you just can’t get off that roller coaster, then there are things that can help. Don’t lose hope. I’ve seen it with over 1000 families. I’ve seen it with my own family. There are solutions out there that can help.
Lindsey Parsons
Wonderful. Yeah, that is that is my theory for everything. I might be exaggerating, but you could certainly make a good dent into almost any kind of chronic health problem through functional holistic medicine. So diet changes and such. Okay, well thank you so much for sharing all this information with us and it was great talking to you.
Dana Kay
Thanks, Lindsay. It’s been fun
If you’re struggling with dysbiosis, diarrhea, constipation, leaky gut, candida, IBS, IBD, or other gut health or all over body problems, you’re welcome to set up a free, 30-minute breakthrough session with me (Lindsey). 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.
I wanted to start by just summarizing what we went over in the last podcast. People should definitely go back and listen to it, but nevertheless, here’s a brief synopsis. Correct me if I have anything wrong on this, but basically, you as a neurologist were seeing patients who had problems with sleep, and you determined that it might be a deficiency of vitamin D. You started supplementing people with vitamin D and got them to that optimal range of 60 to 80, at which point their sleep seemed to improve and everything seemed to be going well. Some amount of time later, people started developing other symptoms like burning in their hands and feet, the sleep started going bad again, or they had arthritic like pain. Based on a book that you had read about B5 or pantothenic acid, you determined that must be a deficiency.
You figured out that there was a synergistic relationship between vitamin D as a growth factor and the B vitamins, because the bacteria are taking in the vitamin D and they’re producing the B vitamins. They then exchange the B vitamins amongst themselves between the different phyla of bacteria that are the primary residents of our guts. You then start trying to put people on just a B complex, a B100 complex*. And you saw people’s symptoms go away (with all the ones that had come back), and even saw some patients who had IBS symptoms clear up as their phyla became more balanced. You also saw that for some people, the B100 Complex (where it was 100 milligrams of most of the B vitamins) was too much. You dropped to B50* for some people, but would just keep them on the B complex for a limited period of time, (around three months), unless problems started developing again. Does that sound about right?
Stasha Gominak, MD:
It is and can I go from there?
Lindsey:
Please.
Stasha Gominak, MD:
None of these things individually make any sense. Keep in mind, I’m operating in the same belief system, as most people. We aren’t doing well because we eat wrong, we live in a toxic environment, we have IBS or food sensitivities because we have the wrong microbiome. I’m operating in that same belief system. After I start to give vitamin D, their sleep gets better. I presume that vitamin D is a growth factor to the bacteria. We had no proof of that at the time. The reason why I presume that is because IBS showed up at the same time as D-related diseases of multiple kinds, including sleep disorders in the early 80s. My thought was, “D goes low, the bacteria need D. And oh I’m going to be a hero because I’m going to give back this D and everybody’s going to lose their IBS, as well as lose their sleep disorder.” That’s not what happened.
At the end of two years, there were three things that didn’t get better with D that I thought should. One, my patients did not lose weight. They were exercising, they were energetic, they were feeling better, because they were sleeping better, but they didn’t lose weight. It turns out that’s linked directly to what’s living in your belly. The second thing was their IBS didn’t go away. So even though I thought it would go away, it didn’t go away. The thing was, golly, it wore off. The third thing that happened was this effect of improved sleep wore off at two years. So many people were complaining, “My sleep is bad, and my D is 65. I’m doing exactly what you told me, but my sleep is terrible and my joints are hurting me.” I’m about to see the rheumatologist and, personally, I’m doing exactly the same thing as my patients. I had this really weird buttock pain where I couldn’t sit down at the end of the day. It didn’t have anything to do with injury. In the build-up to this, I built in my mind this idea that sleep is about becoming perfectly paralyzed for this part.
So we’ve talked about sleep apnea, and that we can get too paralyzed here, but if you’re not paralyzed enough, your legs may still be moving. I wondered whether or not the leg movements that we see on sleep studies contribute to poor healing in certain joints. I was assuming that maybe my hamstrings are activated while I’m asleep. I’m in a fetal position and I’m holding on my butt bones. I’m making this up because I don’t really know why. So I have this urgency of thinking I’m doing something to my patients with this D that has other repercussions that I don’t understand. That makes me really uncomfortable. In two years I’m giving D, I’m left with this suspicion that something else has gone deficient, or there’s some long effect of D. It doesn’t make any sense to me that D should be causing this in two years. It’s at that point that a patient brings me a book about a B vitamin deficiency and it was well timed because I’d had two gals who had burning in their hands and feet. And the only thing they had was a headache. They didn’t have diabetes. They were already on B12. My experience in neuropathy as my specialty told me that this has a B vitamin ring to it. I read this book about pantothenic acid, and research publications from the 50s. They block pantothenic acid, a vitamin that nobody’s talking about and they caused burning in the hands and feet within two weeks. There was a scientific basis. I’m thinking, “Okay, I don’t have a good explanation for why this would happen. Why don’t I just give them this pantothenic acid.” I went to the store and I bought 400 milligrams. But at the same time, I remember them saying in medical school, “If you give one B, you should give all of them.” I have no understanding of why.
I’m completely a novice, I am not an expert like you are Lindsey. I go and I grab this B100 stuff*, because I can at least guarantee that each person I give the recommendation to will be taking the same thing. B complex is very confusing. It can have 3Bs, 2Bs or 1Bs. You never know what’s in there. I wanted to be sure I was recommending the same thing and B100 is a non-proprietary mix of 100 milligrams of each. It’s a large dose of eight B vitamins. That piece is really important. I take it myself and I give other people 400 milligrams of pantothenic acid and B100. That means I’m taking a total of 500 milligrams of pantothenic acid. It did not interrupt my sleep, but my restless legs went berserk. Immediately, I think, “Oh, it’s taken me four days to realize this. This is probably too big a dose.” Just like that vitamin D stuff, you can’t believe what’s in the literature. I stopped the 400 milligrams of pantothenic acid and I just took the B100. Everything went away. My butt pain went away in a day, which was very bizarre. I know nothing about vitamins, but I know that they’re not supposed to help your pain and make your sleep good, especially overnight. Now all my patients are coming back and they consistently answer in the negative, which is, “This 400 milligrams of pantothenic acid nearly killed me.” “I got very anxious or revved up,” or “I couldn’t settle down.” They’re using the same phrasing. I stopped it after two days because I couldn’t sleep. This is like the ADD medicines. This is a vitamin that goes right up into the brain and makes you agitated. Some people say, “I stopped the 400 milligrams, and I just took this B100.”
The surprising part of this was that there was a vitamin that was actually running our ability to pay attention, our ability to sleep and our feeling of anxiety and agitation. That vitamin given in certain doses would actually cause those symptoms. It was not obvious to me what was actually happening, but it turns out the final answer is that vitamin D makes the final enzyme choline acetyltransferase, which makes acetylcholine. Coenzyme A and choline are used by that enzyme. The actual formation of acetylcholine is dependent on both D and B5. Choline is usually not deficient in most people. Making acetylcholine is how we stay focused. Not surprisingly, the epidemic of ADHD started to be reported in the 1980s. Your ability to focus using the frontal lobe is directly related to how much acetylcholine you have in the frontal lobe. When it goes up too high, you can actually become anxious from it, so anxiety is a direct measure of how much acetylcholine you have. We use acetylcholine to run the parasympathetic side of the autonomic nervous system which allows us to rest and digest. This means that side is all about GI tract motility, and is about calmness during the day and sleeping at night.
It turns out that you can become B5 deficient by losing your microbiome because the actual truth is that there is no B5 in any of the foods we eat. It does not come from the food. Its only source is the bacteria in our gut. If that means if you happen to be D low or deficient, and you don’t have the right gut bacteria, you can actually lose one of the most important parts of your body – an organ that runs many of the neurotransmitters that allow us to sleep. The bringing back of the microbiome was really by accident. I gave the D that the microbiome wanted, but the correct four pieces of the microbiome weren’t still down there. They were missing the B vitamins that they needed from their buddies. When I happened to give them B100, as I was thinking about what I was doing, I thought, “If I’m right that these B’s are really coming from the bacteria themselves, I just saw what it was like to have too much pantothenic acid.” If we take this too long and the bugs grow back, pretty soon, you’re going to have two sources. You’re going to have the pill you’re taking, and your normal microbiome. Your sleep is going to fall apart and your pain is going to come back.
It turns out, if you take the B50 plus D, for three months, your bacteria come back, and you stop the pantothenic acid. It did not interrupt my sleep, but my restless legs went berserk. Immediately, I think, “Oh, it’s taken me four days to realize this. This is probably too big a dose.” Just like that vitamin D stuff, you can’t believe what’s in the literature. I stopped the 400 milligrams of Panasonic acid and I just took the B 100. Everything went away. My blood pain went away in a day, which was very bizarre. I know nothing about vitamins, but I know that they’re not supposed to help your pain and make your sleep good, especially overnight. Now all my patients are coming back and they consistently answer in the negative, which is, “This 400 milligrams of pantothenic acid nearly killed me.” “I got very anxious or revved up,” or “I couldn’t settle down.” They’re using the same phrasing. I stopped it after two days because I couldn’t sleep. This is like the ADD medicines. This is a vitamin that goes right up into the brain and makes you agitated. Some people say, “I stopped the 400 milligrams, and I just took this B100.”
The surprising part of this was that there was a vitamin that was actually running our ability to pay attention, our ability to sleep and our feeling of anxiety and agitation. That vitamin given in certain doses would actually cause those symptoms. It was not obvious to me what was actually happening, but it turns out the final answer is that vitamin D makes the final enzyme choline acetyltransferase, which makes acetylcholine. Coenzyme A and choline are used by that enzyme. The actual formation of acetylcholine is dependent on both D and B5. Choline is usually not deficient in most people. Making acetylcholine is how we stay focused. Not surprisingly, the epidemic of ADHD started to be reported in the 1980s. Your ability to focus using the frontal lobe is directly related to how much acetylcholine you have in the frontal lobe. When it goes up too high, you can actually become anxious from it, so anxiety is a direct measure of how much acetylcholine you have. We use acetylcholine to run the parasympathetic side of the autonomic nervous system which allows us to rest and digest. This means that side is all about GI tract motility, and is about calmness during the day and sleeping at night.
It turns out that you can become B5 deficient by losing your microbiome because the actual truth is that there is no B5 in any of the foods we eat. It does not come from the food. Its only source is the bacteria in our gut. If that means if you happen to be D low or deficient, and you don’t have the right gut bacteria, you can actually lose one of the most important parts of your body – an organ that runs many of the neurotransmitters that allow us to sleep. The bringing back of the microbiome was really by accident. I gave the D that the microbiome wanted, but the correct four pieces of the microbiome, weren’t still down there. They were missing the B vitamins that they needed from their buddies. When I happened to give them B 100, as I was thinking about what I was doing, I thought, “If I’m right that these B’s are really coming from the bacteria themselves, I just saw what it was like to have too much pantothenic acid.” If we take this too long and the bugs grow back, pretty soon, you’re going to have two sources. You’re going to have the pill you’re taking, and your normal microbiome. Your sleep is going to fall apart and your pain is going to come back. It turns out, if you take the B50* plus D, for three months, your bacteria come back, and then you stop the B50.
Lindsey:
That’s amazing that you discovered all that, and were able to help people recover their sleep and the bacteria.
Stasha Gominak, MD:
It’s pretty freaky. I have to say, I still think it’s pretty amazing.
Lindsey:
I did have one client who told me that when he first started B complex, he felt very agitated. Is it the B5 in there that could have been causing that?
Stasha Gominak, MD:
Yes, and it’s not just B5. B12, B5 and several of the Bs are working together. They never work alone. That original comment that “if you give one B you should give all of them” is usually, not always the right recommendation. Because the nervous system really uses all of the Bs to make the neurotransmitters. What we feel and what we experience is about dopamine, serotonin, norepinephrine, epinephrine, acetylcholine. The paths to make those are all linked to the B vitamins. I have patients who get agitated with B12 as well, so they’re linked in some way that isn’t completely clear to me.
Lindsey:
Do you use Organic Acids Testing at all, in your practice?
Stasha Gominak, MD:
I know what organic acids testing is, because I’m a neurologist. We did that in early childhood development diseases, but I do not use any of those tests. I use a very simple set of tests. I’m interested in the B12 and the D level and that’s it. I’m mostly focused not on what is your unique genetic problem, which is still important. I believe that people like you, Lindsey, that are expert in other areas, will get more success or greater range of success by putting back the normal microbiome and getting the D. All the stuff that you guys know about zinc, or copper, and all the specialized things that are only partially known, I’m not even sure anybody knows that yet. I’m hoping that this natural part, when we put it back, will then lead to being able to build on it have better success in the interventions that you’ve discovered.
Lindsey:
I only asked because on the Great Plains Lab Organic Acids Test, there’s a marker for B6, but I’ve literally only had one client ever who’s had a normal level of B6 on that test. I’ve heard other people talking about this as well, so I’m just curious whether B6 deficiency is a super common thing, but you don’t test B6, in any case.
Stasha Gominak, MD:
I don’t, but it’s interesting to note that B5 and B6 were studied together back when they were actually studying vitamins. Back in the 50s, 60s and 70s, they used both of those. B6 is really important because it’s necessary to make dopamine and that means it is absolutely a player in making the neurotransmitters that make us sleep. It appears to me that B5 acts like there’s no controller on the enzymatic formation of acetylcholine. To me, it’s completely sloppy and dangerous that something I should take as a supplement would mean I can either sleep or not sleep. That just freaks me out. There should be a modifier. If my bugs happen to make enough B5, or they don’t, there should be somebody up at the brain level saying, “We can still make an even amount of these neurochemicals. I think that’s the case for most neurotransmitters; that you don’t see someone make too much dopamine when you give them B6. There aren’t clinical symptoms that go along with that. To me, this is still an unexplained error. It does suggest that our gut bacteria is pivotal to making us be calm and sleep. That’s really important. It’s certainly something we’ve observed. People have gotten higher incidences of depression, anxiety and suicide over the last 40 years. At the same time, we’ve made up separate explanations for that. It would then suggest, maybe we should explore this possibility to maybe this abnormal gut biome is actually making us have these emotional states that we don’t want.
Lindsey:
Yeah, it’s kind of tough nowadays to pull apart what’s happening nutritionally, the sun exposure, the social media and the devices. There are a lot of confounding factors. In your experience, was the onset of IBS symptoms after giving vitamin D or did they already have IBS, and then when you give them the B vitamins that help cleared it up?
Stasha Gominak, MD:
I never induced IBS with vitamin D. In my experience, what I saw was probably a quarter of my patients who remember, are seeing a neurologist, so they’re not coming in with IBS as a complaint. I personally became very sensitive to onions, garlic and things like that in my 30s. We were actually trading recipes for probiotics at the time. I’m taking something and they’re saying, “No, my GI doctor has something better.” That was really the only answer to IBS at the time, but it hadn’t worked, or they wouldn’t be trading recipes with me. I thought this deal was going to fix that, but it didn’t. Not everybody has complaints, but the people who had IBS still had IBS. I thought that was a good idea, but it didn’t work. This idea came to me. They’re making the B’s. Why would we have things called B’s? Maybe that’s what they’re lacking. I stumbled into this completely by accident, but it works beautifully in the people with IBS. By the end of the three months, we learned to stop the B’s and their IBS was gone.
Lindsey:
How many people are we talking about?
Stasha Gominak, MD:
1500 at the time.
Lindsey:
1500 with IBS?
Stasha Gominak, MD:
No, 1500 people total that I’m doing this with in my process; so maybe a quarter of that many. It’s been very successful since then. Here’s the problem. As soon as you get those bugs back, you have to pay attention to the fact that once you’ve gotten back the bugs, they are not the only reason why your belly may be out. If the nervous system of the belly starts to complain, that’s the same nervous system that does rest and digest. Your belly system is directly related to how your sleep is. It usually turns out if you don’t have the B’s or if you’re taking them when you don’t need them, if you’re giving your nervous system an extra one that doesn’t want them, you can see agitation, anxiety, sleep problems and a belly that feels just like IBS.
Lindsey:
That’s interesting. I have a client who stopped sleeping. Now I want to go back and make sure what’s going on with the with B vitamins. I suggest B vitamins for a lot of people.
Stasha Gominak, MD:
They are important and they work. It’s a different framework to think about them as their job to bring the bugs back. Once the bugs come back, we have to sit for a while with the B’s off board and say, “What does my body and my nervous system say about the production that my bugs are giving me now?
Lindsey:
It seems like we’re having an epidemic of sleep apnea and I know some of it is connected to obesity, but obviously some of it isn’t. What do you think is at the root of that?
Stasha Gominak, MD:
One of the things that happened to me when I went into these B vitamins was my husband handed me this article that was out of the economist journal, which was peculiar because it’s a journal about making money. This article is still, in my view, a very brilliant article about all the things that the GI doctors had learned about poop bacteria. It’s not my specialty. You can access it on my site or you can just go to the economist journal and ask for Me, Myself and Us. It’s a three page article. One of the important things they have in there is this: you take a mouse, and you do a gastric bypass on it or you’ve got to do a gastric sleeve. You take the poop bacteria from that mouse, and you transplant it into another mouse, the second mouse loses weight. It’s really not the sleeve. It’s that the bacteria that live inside us actually govern our appetite. They make small chain fatty acids that go up into these little receptors in your nose, and make high fat, high calorie foods smell better to you. They have actually been running our appetite. They also run what we do with the calories we eat. There’s a huge argument on these health and wellness internet sites about what it is that makes me fat. Some of the controls are really not in the hands of the endocrine system of the person who is obese – it is really their microbiome that is saying, “We’re in winter. Winter means I take the calories you eat, and I put it into fat.”
When you look back, I happened to go to my 50th high school reunion. There are very few people who are obese in my entire school in 1972. This epidemic is not just about what was available. Because pizza, hamburgers and cheeses were available, then, part of it is that you have the wrong microbiome. That turns out to be playing a huge role in your endocrine system. It is a part that generally all the MD’s have missed. They’re starting to pay attention to the fact that when we do fecal transplants, you better ask who your donator is, because if they’re skinny, you can get skinny. If they’re obese, you’ll get obese. There was a connection between the D that we make on our skin, which runs whether or not we’re in a winter microbiome, or a summer microbiome, there was a change. Bugs would train our body to conserve and make fat. We, oddly enough, follow bears around and collect their poop during the year. We showed that their microbiome changes throughout the year and that the bear gets into a, I’m going to put on fat mode in the fall to allow the bear to make it through the winter. And we don’t we don’t shame fat bears. We just think that it’s helping them survive. Medicine hasn’t seen it through this lens. It’s not about eating very much. Those people who are still hungry after they’ve eaten two full meals are being run chemically to still be hungry.
Lindsey:
That explains some of the some of the obesity connection to the microbiome, but what about the sleep apnea?
Stasha Gominak, MD:
Oddly enough, the acetylcholine that we talked about is a chemical that allows us to get perfectly paralyzed. It’s not the only chemical. There are multiple neurotransmitters that are actively involved in not only allowing us to switch in and out of sleep. You have to fall asleep. That’s a complex process, and it’s run by chemicals. When you go from light sleep to deep sleep, you become paralyzed and there are specific chemicals that are running that process. Acetylcholine turns out to be one of those that you can come become deficient in by having a low D and losing your microbiome. That means you can actually get too paralyzed when you’re supposed to be in this space where you are perfectly paralyzed. We first found that disease in men who were post op from a cardiac surgery in the post op population. That means we found it at its most severe.
Those people that had sleep apnea for 20 years, got cardiac disease because their microbiome was screwed up, they had low D, and their sleep was bad. Sleep apnea is one of the worst manifestations, but it’s really on a continuum and it includes not being able to sleep. Insomnia is greatly overlooked. You spend all this time talking about sleep apnea and blaming the oral pharynx. There is an anatomical part to getting incorrectly paralyzed so that when you’re sleeping and deeply asleep, you’re supposed to be able to keep the airway tube open. If it doesn’t work, then you stop being able to keep the airway tube open. Part of that is anatomy, but part of it is the central controller that makes us paralyzed in certain phases, and that links back to acetylcholine, D, and the B’s that we make in our belly. Normal animals do not get sleep apnea. Those normal animals that live outside and have a normal microbiome don’t get sleep apnea.
Lindsey:
They don’t get a lot of the stuff we get.
Stasha Gominak, MD:
It is interesting, because they are exposed to the same toxins are. One of the things that struck me was if we look at this as humans just being one of millions of animals on this planet. Why is it that only the humans globally have developed sleep apnea? By the way, we’re not really the only animal. Our dogs and cats, (dogs especially) already have these legends of running while they’re asleep. They are actually acting out their dreams just like we do, because they are not paralyzed because their D is wrong, and their microbiome has changed. It’s not that the toxin stuff is not correct. It’s important for us to pursue that. In terms of what I can do personally, for myself, going outside, more getting the microbiome to the right are things that can still help.
Lindsey:
So sleep apnea sufferers: get more sun, get your D corrected, possibly go on a B complex as well.
Stasha Gominak, MD:
And go to my site and learn about how you’d want to use those two together.
Lindsey:
What relationship do you believe sleep has had to the rise in mental health issues and children?
Stasha Gominak, MD:
I think that in the background, when we don’t acknowledge that most kids who have emotional disorders during the day also have a sleep disorder. The hard part is realizing that we only see what’s normal sleep. We see what other parents say to us like, “My kid gets up twice during the night.” I’m talking to my colleagues that are 30 years old at the same time, and their kids get up the same way. My mother says, “You guys didn’t get up in the middle of the night.” We don’t pay attention to what mom says. We say, “Everybody I know has kids who get up in the middle of the night.” You really have to go back to the 1960s and ask what the sleep studies were showing then and is there something that could be affecting every pregnant mom (i.e., they’re doing what their doctor tells them), which is to put on sunscreen and not go out in the sun. They’re also not exposing their newborn to the sun. Are there things that could be going on in these last two generations that are relatively new? Emotional problems are related to how well we make our neurotransmitters, and the neurotransmitters are made while we’re sleeping. They’re made in certain deep sleep episodes. We also make growth hormones. We make all of the hormones that are important to our behavior and our well being, so the hormonal systems as well as the neurotransmitter systems are tightly linked to whether or not we sleep normally. All of us know that we feel better, we’re more patient and we just feel better about ourselves when we sleep better.
So basically, get your kid out in the sun and go to my website to learn about D, because you’re going to have a very difficult time talking to your physicians about putting your kid in the sun. You have to learn more about it. There’s a huge controversy right now about taking D as a supplement versus going out in the sun. If your child has an autoimmune disease, has food sensitivities, is very anxious and has lots of things that we’re talking about in adults, those things are linked to the microbiome. You’re going to want to do the D plus this B complex for a while. It’s a little bit bigger. If you just have a kid and he wakes up once a night to ask for a glass of water, and everything else is fine, then I would just put that kid outside more. If it’s much more complex than that, then there’s a bit of depth that you have to understand. I actually have a set of videos that help with pregnancy, fertility and first year of life because you’re giving breast milk to that baby. You have to know about the B’s and the D through breast milk. There’s another set of videos about how to do this in a child, what age groups and what is really normal sleep for toddlers or teenagers.
Lindsey:
You mentioned as you were talking about children that D is something the mother is giving to the child. Is the child not getting sufficient D from the mother?
Stasha Gominak, MD:
Yes, the child is not getting sufficient D from the mother. Most women now are trying to get pregnant when their Ds are quite low and D by itself is a major player in infertility. That’s in the OBGYN literature on fertility and early premature delivery. The D covers the placenta. You are really carrying another being inside you. You do not want your immune system to recognize that other being as not belonging there and D is heavily involved in what the immune system sees, doesn’t see and tolerates. Low D leads to increased delivery at prematurity. Low D is also now in the literature about pre-eclampsia and, unfortunately, things that have to do with physical malformations of the baby. Mostly, it’s about being able to carry your baby to term that is in the OBGYN literature, yet, the fertility experts are not using it. All you really have to do is get your D above 40 and you will get pregnant (for a great majority of women). It also probably affects fertility in males, but predominantly in females. When the D is low, it suppresses the ability of the ovary to ovulate. It doesn’t make the woman able to have babies. Once the woman gets pregnant, the only D that baby will get is coming from the mom through the blood into the fetus.
The second piece is that the only B source is not the prenatal vitamin. There are some B’s in there and the prenatal vitamin is a disaster, but the gut bacteria of the mom are the primary supply for the Bs for the baby. That means in early development, the first 12 weeks where all the basic functional development of the arms, legs, heart, etc. takes place. That means we already have a whole body of literature that talks about cleft lip, cleft palate being related to B vitamin deficiencies. The neural tube defects are related to B vitamin deficiencies. That means all you have to do is get the moms D above 40, get her on a B50 and get her microbiome back – her risk of early natal development issues in the baby goes way down. Once you know that, you can actually listen to things people tell you about their experience in the delivery of their first, second and third kid having these additional problems. The birth order also plays a role – by the time mom is having her third child, if she hasn’t been going out in the sun, her D is even lower than it was before. Her Bs are now depleted and that child is more likely to grow up starting with problems with waking up frequently and having microbiome problems. A lot of the interesting stuff the other practitioners who are working with me say, “This kid isn’t sleeping. You give them iron, and they start sleeping.” That’s because the microbiome is naturally set up to help you absorb the small charge ions. The mom is iron deficient because she’s been walking around since the second kid with a microbiome that doesn’t allow her to absorb iron. It’s much more complex than just the B’s and the D – there’s a bunch of other things that the microbiome is doing. When you don’t have the normal microbiome, you’re at risk for all sorts of things.
Lindsey:
Interesting. It’s also is interesting, because I think about how I went through infertility for many years, and I’m sure that nobody tested my D or looked at that. At some point I got into eating organic foods and I’m not sure if, I don’t recall taking many supplements, but I eventually got pregnant. So something went right.
Stasha Gominak, MD:
Sometimes you can trace back to going on vacation and a sun-filled environment. I have one friend who had five miscarriages and then went to the Bahamas. Oh, got pregnant. It’s really straight D related.
Lindsey:
You were saying above 40 and I’ll tell you this. I have clients get their D tested if they were not supplementing with D and without fail, it’s somewhere between 20 something and early 30 something. I don’t think I’ve ever seen a level in the 40s from somebody who’s not supplementing.
Stasha Gominak, MD:
That’s correct. You can occasionally see it in somebody who’s 17 who just was at the tanning booth for the last three weeks because she’s just about to get married, but that’s really the only occasion where I’ve where I’ve seen that happen.
Lindsey:
Right? I just think unless or maybe somebody perhaps who works outdoors and has decided not to wear sunscreen, but that’s pretty unusual.
Stasha Gominak, MD:
Very unusual.
Lindsey:
Tell me a little bit more about acetylcholine. I’m interested in this because I’m not very familiar with the topic. You touched on it, but I need to hear it again – about its role and origin in the body and what disorders are associated with the lack of it.
Stasha Gominak, MD:
First off, acetylcholine is something that no layperson should be familiar with. Nobody talks about it. I’m a neurologist, I should know. When we’re taught early pharmacology, we are taught about the parasympathetic nervous system, lay people know about the sympathetic nervous system, because we talk about it. The autonomic nervous system is two halves, one of which calms you down and runs the GI tract. The other one is the sympathetic. The parasympathetic is basically run by this chemical called acetylcholine. I saw all these things I just described to you in my patients, and I’m a neurologist, but I don’t really understand why they’re getting agitated and anxious. I just really don’t have a chemical basis for that, but when I’m starting to give lectures about it, I think I really have to come up with a better answer than, “It acts like caffeine.” I just typed into Google “coenzyme A and the brain.” What was in the book I told you about was: coenzyme A, (B5 becomes coenzyme A) is pivotal in making cortisol. So that was the underlying reason why they were giving B5 to people with rheumatoid arthritis. We knew that they had a problem. We gave them prednisone and they got better – so maybe there’s a cortisol link.
I really didn’t understand why giving B5 caused people to be agitated, anxious, etc. I found, “Coenzyme A is pivotal to make acetylcholine,” and I think, “I’m a neurologist. Acetylcholine, what does it do in the brain? I don’t even know.” I mean, I know it’s related it to Alzheimer’s disease. I know it’s at the neuromuscular junction, because we have myasthenia gravis, and people get weak, but what does it do? I started to look around and it turns out these sleep diagrams that show us how we get paralyzed, have acetylcholine as a player there. The next thing I realize is, why don’t I know what acetylcholine does in the brain? I know what serotonin does. I know what norepinephrine goes. It turns out we learn as neurologists what neurotransmitters do by giving them drugs. I have dopamine, I give it to Parkinson’s disease patients. I have a serotonin reuptake inhibitor. That means it prolongs the action of serotonin and I give it somebody who’s sad.
There are no drugs for acetylcholine. There’s nothing except nicotine. Nicotine turns out to be one of the oldest drugs we have available, and early on in the early 1910-1920s we were studying the nervous system. We started to realize that there are nicotinic receptors for acetylcholine, and muscarinic receptors. That means we’ve actually written our textbooks with nicotine as part of it and it turns out that acetylcholine acts like nicotine. In some receptors, it acts like this other drug, and I’m looking at this going, “This is weird. Does that mean that the people who smoke a cigarette and feel better could have an acetylcholine deficiency state in their brain? Does that explain why I smoked a cigarette and immediately felt agitated and threw up? Could it mean that the people who get addicted to this chemical are actually feeding their brain with a chemical they’re deficient in – much like I’m taking a serotonin reuptake inhibitor, they’re smoking something. If you’ve been around smokers, if they’re really addicted, they get up in the middle of night, they smoke a cigarette and go back to bed. For those of us who don’t smoke, it’s bizarre. It means that they are actually treating themselves with a chemical that we have vilified, but we should really start thinking of it in a different way.
Now, the next thing that leads to is, I’m reading these articles about the frontal lobe and the ability to concentrate. Some of these articles are said to be by clients and they say, “Hey, have you looked at this? This is about acetylcholine.” It turns out that the basic scientists have been studying acetylcholine and its actions in the frontal lobes. They say acetylcholine is what allows us to get distracted and come right back again. When you get to the conclusion of the article, they say, “This really means we really shouldn’t be giving ADD kids things like methamphetamine”, which is what we’re giving them. The amphetamines up the norepinephrine. They say, “We should really be giving them nicotine.” There’s no way I’m going to convince a 32-year old mom with two kids to give their kid a cigarette at recess, but it means that we’ve missed an opportunity, because there are no drugs. There are now studies using nicotine patches in kids with ADHD and in autistic kids. Acetylcholine is actually a neurotransmitter that you can develop a deficiency state of, looking like a normal human, but really not being, because you don’t have the poop bacteria that you need. It turns out there are multiple different acetylcholine deficiency states, Parkinson’s is one of them.
Alzheimer’s disease is another one. There are other ones that grow out of that, having to do with tremor and gait disorders that are important to neurologists – that have been documented that pathology and by various studies using MRI and other imaging studies that show the acetylcholine tone, or how much of that chemical you have, is actually deficient. Oddly enough, in the last three years, there have been a couple of articles out of a specific lab that’s actually studying B5 deficiency states at autopsy in both Huntington’s disease and Alzheimer’s disease. I thought I wouldn’t be alive when they finally got around to that, but they kind of stumbled into it by accident. So there are many acetylcholine deficiency diseases. It turns out that anxiety is one of those and it may turn out that in autism, some of the features of autism are related to that. Absolutely. ADHD is basically a description of this person not having the right chemistry minute to minute. A lot of my clients now will be able to say, “When I get my B5 dose to this, I’m just calm and organized. I reorganized my entire basement and I’m not yelling at my kids.” It’s just weird and it really is something that lasts for eight hours before it goes away. Some of my clients have to add an additional tiny dose towards the afternoon.
Lindsey:
Of B5? It’s what’s bringing up the acetylcholine in the context of a B complex.
Stasha Gominak, MD:
Usually I use it in the B complex. There are certain people who wind up in huge doses of B5. Here is the part I left out for you. On that original group of people, there’s 40 people I see in a week. I recommend 400 milligrams of panothenic acid and B100. There were a couple of outliers who didn’t come back and say, “Were you trying to kill me?” The two gals with a burning in their hands and feet were much better in two days. There were two or three people who had a little bit of a tremor and a little bit of signs that looked kind of Parkinsonian. They came back six months later, still on 400 milligrams of pantothenic acid, suggesting that there are some circumstances in which 400 milligrams of pantothenic acid is exactly what their nervous system needs. That’s really a big topic and there are all sorts of genetically related things. There’s a whole bit about choline, iron, and a few other things that are necessary to make acetylcholine. Iron is actually a regulatory cofactor also, and I’m just starting into that path.
Lindsey:
What’s the relationship chemically between choline and acetylcholine?
Stasha Gominak, MD:
I can show you the equation if you’d like, but there’s choline, then Acetyl Co A. Those two have an enzyme that’s called choline acetyl transferase. That enzyme is made by D. When D hits two receptors in the brainstem sleep receptors, choline acetyl transferase is made. It’s the final enzyme. So you need the two basic pieces, the enzyme and you get acetylcholine.
Lindsey:
Okay, so not the exact same things. They’re not just like the active form, but actually chemically different.
Stasha Gominak, MD:
There’s another piece to this: within the last 15 years, there’s another process called the acetylcholine anti-inflammatory pathway. That is related to vagus nerve stimulation, which is the big wire that makes the parasympathetic. Vagus Nerve Stimulation was being used to control epilepsy. When they stimulated it electrically, they saw that the spleen responded to that stimulus by secreting T cells out into the body. Those white blood cells (a specific type) secrete choline acetyl transferase. They secrete the enzyme that makes acetylcholine. That means there are pathways that adjust our inflammation minute to minute in our body. I saw a bunch of things with people that I didn’t understand. We get to D and B5 to a certain place and now they have eczema and a rash. Now they have weird skin stuff that I can’t even understand. What about all those people with that joint pain? What was that about? It turns out the inflammatory system is also in controlled minute to minute by acetylcholine as well, but it’s a completely different pathway that doesn’t even involve D.
Lindsey:
Can you supplement directly with acetylcholine? I feel like I’ve seen supplements.
Stasha Gominak, MD:
The problem is that it will be broken down as soon as you take it. It needs B5 to become coenzyme A, and it needs enough choline, which is deficient in some people, that it needs this enzyme.
Lindsey:
A lot of choline in egg yolks.
Stasha Gominak, MD:
Egg yolks. It’s famous for that.
Lindsey:
I know we’ve run out of time and again, I’ve really enjoyed getting into the geeky level science stuff on this and perhaps we’ll have to have you back to get into the whole endocannabinoid stuff.
Stasha Gominak, MD:
Yes, I would love to do that because that plus the B vitamins, childhood development and autism are really important.
If you’re struggling with dysbiosis, diarrhea, constipation, leaky gut, candida, IBS, IBD, or other gut health or all over body problems, you’re welcome to set up a free, 30-minute breakthrough session with me (Lindsey). We’ll talk about what you’ve been going through and I’ll tell you about my 3- and 5- appointment health coaching programs in which I recommend lab tests, educate you on what the results mean and the protocols used by doctors to fix the problems revealed. Or if you’re ready to jump in right away or can just afford one appointment at a time, you can set up an 1-hour consultation with me.
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Adapted from episode 85 of The Perfect Stool podcast and edited for readability with Danielle Daem, Certified Holistic Nutrition Coach & Sugar Addiction Expert.
Lindsey Parsons:
Can you tell me a little bit more about your own journey with sugar addiction?
Danielle Daem:
I’ll try to keep it short. Obviously my journey stems back as for most of us to childhood. From the minute I was born, obviously things are impacting my gut and my dietary preferences. I grew up in a traditional household as many of us did. Sugar was just a really big part of our every day. I was a really picky eater growing up as well. I often joke that I only ate things that were white – white bread, bagels, white pasta and just white sugar. Those simple, processed carbs were my go to. My poor mom – she did get some vegetables in me at some point. Now obviously the start of this huge desire to have sugar as a big part of my life more than just the physical pieces. Looking back, sugar was such a part of how we celebrated. If I got a good grade or scored a goal at my soccer game, “Oh, let’s go and get some ice cream.” There was always that sugar being a huge part of how we celebrated, how we showed love and just all the pieces that we know now go into just our relationship with sugar.
About six years ago, I had my “sugar wake up call.” My husband and I quit our jobs in the finance industry and went traveling to South America for a year. That was really obviously a soul-searching journey. We did a lot of work on ourselves and really just rediscovered what mattered to us and what we wanted out of life. On that journey, I got to witness how people of such a different culture in South America live compared to here where I live in Canada. In a lot of these countries that we visited, people related to their food a lot differently. They went to the market and they actually cooked all their meals. It was very rare that people would go and eat out. Obviously, it’s becoming more and more prevalent with the fast food chains like McDonald’s and Burger King just getting into all these countries; however, it really showed me a lot of where I was getting sucked into this fast, convenient food sort of lifestyle that so many of us live in, and how that wasn’t going to serve me in the long run. I started really reflecting on my health and the way I was not actually nourishing myself. We didn’t eat well on that year-long trip – eating things that could survive on a 30-hour bus ride was pretty much just bread, cookies, cakes and things in packages. At the very end of our trip, we ended up actually living off the land in the middle of the Colombian jungle for a yoga retreat for two weeks. It was there that I say I went we went through our accidental sugar detox because I wasn’t really aware of what was going on. We were still having a little sugar because we were actually eating mangoes from the trees and we were eating off the land, but I went through my withdrawal symptoms there. I didn’t know it at the time. I thought I was sick. I also happened to get a parasite at the same time, which was absolutely horrible. Don’t drink the juice if it’s made with water from the land. I should have known that. It got me and it was horrible. That combination obviously made for a very interesting stay. It really was the catalyst for me to start reflecting on the changes that were happening in my tastebuds. As I was in that accidental detox, getting off of the processed food that I’ve been living on my whole life, I really started noticing my taste buds change. I noticed my cravings change and I noticed that I’m not really needing a cookie today like I used to. That really just started percolating those thoughts for me. “Oh, I think that there’s some sort of control that sugar has over me.”
Coming home from that trip, (about two weeks after that), we actually came to Canada and I started really diving into learning more about health and nutrition and just how to nourish my body in a better way. I started learning and studying at the same time as starting to get into my own spiritual and meditation practices. That’s when I really started discovering my passion for nutrition and for actually making these shifts. I started having some big light bulb moments – looking at my genetic lineage and the state of health of my mom’s side of the family and my dad’s side of the family riddled with every single chronic disease that you can think of. I started really understanding the role of what I put in my body and the stress in my life. That’s been a big, big inward journey as well, for me, and really realizing that if it wasn’t stress that was going to kill me, it was going to be sugar and these hugely toxic foods in my life. I just started noticing those patterns and really making that connection for myself that I didn’t want to live a life like my mom does. Her and my dad’s entire families are just being riddled with issues that have prevented them from fully living life. I’m someone who wants to just fully live like I want to be traveling and hiking and exploring when I’m 90. These light bulb moments really helped me understand that the way that I treat myself (and especially the food that I put in my body), my mindset and calming my nervous system, and all these important things have a direct link on turning those genes on and off. I do have a big say in what my future looks like when it comes to my body and its ability to actually do things like travel when I’m 90.
I feel very lucky and unique in my journey that nothing bad happened for me to shake me up. Obviously watching my grandparents pass away from various diseases; I never met my grandpa on my dad’s side because he died of a heart attack when he was 50. Nothing dramatic happened to me. I know a lot of people wait for something horrible to happen, especially when it comes to gut health. People wait until they get diagnosed with Crohn’s disease, SIBO or something really bad happens before they they start to make a change. For me, it was just a series of really deep understandings and connections with what I wanted out of life and the role that I had played in that. That was kind of the start of it. It was about six years ago that I really went into nutrition. I started my business in helping women build a healthy relationship with food and themselves and it’s morphing every year. It’s an ongoing process, as I’m sure you know.
Lindsey Parsons:
Yeah, thanks for that background. When I gave up sugar, that impacted my weight. It mostly just ended that battle with a baby belly that I kept thinking I’d get rid of somewhere in between my first and second child – I adopted my second child so then I had no more excuses. I had to do something. I’m curious, did it impact your weight when you gave up sugar?
Danielle Daem:
Yes, it did. I’m also someone that’s never been overweight. I’m grateful for that. I’ve been able to outrun and exercise it, especially in the first 30 years of my life. As things change, obviously, we go through different changes of life, it becomes more prevalent, but yes, I definitely remember like the inflammation of my body going down – feeling more energized and my tastebuds coming back online. I definitely did notice a little bit of weight balancing. My body was getting back into balance when I started eating real, whole foods. Who would have thought?
Lindsey Parsons:
Who would have thunk it? So let’s talk a little bit about how sugar impacts the gut.
Danielle Daem:
Yes, let’s do it. I’m sure that you’ve touched on this lots in many of your episodes as well, because sugar is one of the biggest culprits when it comes to what we’re actually putting in our body and how it affects our gut. A couple of things are going on here. We can dive a little bit deeper into some of these. Caveat here, I’m not a scientist and you definitely are more in this area of all the specifics around gut health for sure. When I’m talking about sugar, I’m mostly talking about really simple carbohydrates like white bread, white pasta, sugars, honey, maple syrup or agave. I’m not necessarily talking here about complex carbohydrates, although some things like yams and beets that are higher in sugar can be really sensitive for some people.
What most people are struggling with are highly processed foods, all of the added sugars, all of the juice and all of the things that really sneak in to give us that crazy blood sugar spike. One of the things that’s really going on here, and we can talk a bit more about this is, is understanding that sugar and processed foods feed the bad bacteria in our gut. We’re getting a huge surge of all of this yummy food for all of the “bad guys.” right? These nasty pathogens, or yeasts and bacteria that live in our gut that normally lie dormant. Sugar is the preferred source of fuel for these bad bacteria. They can really start to take over and obviously that leads to all sorts of issues. Our over consumption of sugar increases the acidic environment in our gut (and our whole body). Our gut is becoming more and more acidic, because sugar is extremely acidic. This leads to inflammation and can lead to degenerating the intestinal lining, which we know is not a good thing. So many diseases ultimately stem from inflammation, from gut damage, which is why I love what you’re doing so much, Lindsey, focusing on the gut, as it is really the hub and the number one area to look at and focus on when we’re looking at total body health.
As I just mentioned, this bad bacterial overgrowth can really take hold and can produce this dysbiosis. Balance between the good bacteria and bad bacteria in the gut is thrown off. These harmful bacteria that love sugar that in a perfect gut, live dormant, and live peacefully being managed by the good guys. Any of the bacteria that can be considered pathogenic, or yeast-like will be fed by sugar. Some of the specific bacteria, Staphylococcus aureus is definitely one that that gets fed in a big way by sugar, and obviously produces a variety of toxins that can really lead to disease and damage.
Lindsey Parsons:
That’s, by the way, if you’ve heard of MRSA, it’s Methicillin-resistant Staphylococcus aureus, which is that skin infection that doesn’t go away unless you get antibiotics, but you catch it in the hospital.
Danielle Daem:
Another one that can obviously be loving this increase in sugar is Clostridium perfringens. This is something that you get from contaminated food and it can live dormant and the amount of sugar that we’re feeding it just just allows it to grow and take hold. Obviously, there’s E coli as well. That’s a big one that gets fed by sugar. Like I said, the list is long so if you know a lot of the fancy technical names for these strains of bacteria, just know that they’re really being fed by sugar. I was doing some some extra research actually before this interview Lindsey, because I wanted to really have some more facts to share with all of you. I found this one study published in the PNAS journals that was actually showing the link between fructose and glucose, which are the simplest sugar molecules. This study showed that it decreases the abundance of a protein in our gut that actually regulates gut colonization. It’s possible that this increase in consumption of sugar is actually preventing our gut from being able to colonize with the healthy bacteria. We know now that over the years with how we’re eating and how we’re living, the amount and the variations of our amazing microbiomes and the beautiful bacteria that we want in there, the thousands of strains that we actually want existing in our gut is becoming less and less. Just like we look at the world, and we see cultures and languages being lost as we sort of come together in this one world energy. This is happening in our gut too and that’s a big problem, because we need the variety. We need these these ancient strains to provide this total body health.
Lindsey Parsons:
Because I think you’ve also seen too how all the studies show that the more diverse your gut microbiome is, the better your health outcomes.
Danielle Daem:
Yeah, totally. This is where the studies are proving that children who are born vaginally versus C section get more of that initial gut bacteria on birth and that actually gives them stronger immune systems and just in total. It’s kind of serious. We need to be paying attention to what’s going on at a bigger level, not just even personally, right. That’s why I know you’re doing such amazing work here with the podcast, because this is of huge importance. We’re losing diversity in all areas on the planet. When we lose that in our gut, we essentially are just continually weakening ourselves and leaving ourselves susceptible to disease, viruses, diabetes, cancer and mental illness. All of these things are stemming from that imbalance. I found another study that I just wanted to mention actually out of Oxford, that was really interesting. It was called “The Adaptation of Gut Microbiota to Modern Dietary Sugars and Sweeteners.” It’s essentially hypothesizing that the gut bacteria living in there, even the ancient strains, are actually shifting and genetically modifying based off of the types of sugars that we’re eating. The type of diet that we’re eating is now impacting our internal environment in a big way. It’s actually changing the cellular structure of our gut microbiome, of our gut and of all the cells in our body to adapt and to live and to thrive off of these, whether it’s artificial sweeteners or regular sugar as well. Our human body is trying to adapt to all this processed nonsense that shouldn’t be in it in the first place, and unfortunately, we’re getting caught up in this wave of inflammation, cravings, addictive behaviors, let alone all the things that are happening in the brain when we’re eating sugar as well. I found that to be a great reminder for all of us. This is having a long term impact not only on our gut microbiome, but also on our children. If we’re wanting to procreate, we’re passing that on.
Lindsey Parsons:
Absolutely. You mentioned artificial sweeteners and I thought that’s an interesting topic. I was going to talk a little bit more about better sugar alternatives, but I just want to for just one second, talk about things like acesulfame potassium, NutraSweet, aspartame and those types of artificial sweeteners? Can you talk a minute about that?
Danielle Daem:
I don’t know all of the science and studies specifically on them. There’s a couple of things actually to really know and to consider when it comes to what I just called alternative sweeteners. There’s so many sweeteners out there now being produced, obviously, in laboratories. This is the first red flag for me. This is not something that came of the earth, so why is it in my body? This is just something really important to consider when we’re putting any foreign substance into our body. Our body is going to be a little bit confused about what’s going on and it’s not going to have necessarily the pathways to metabolize it, to flush it out or just recognize it and let alone use it for any use in the body. When it comes to a lot of these sweeteners, and obviously a lot of them are slightly different. Artificial sweeteners and alternative sweeteners are really designed to be way sweeter than even normal table sugar. A lot of them are designed (especially aspartame and sucralose) to be like more than 100 times sweeter than sugar. We’re still giving our tastebuds a crazy hit of sweet and that’s still sending signals to to our dopamine centers saying, “Sugar is coming!” It still releases the insulin into our blood, because our whole body thinks sugar is coming. It alerts the whole digestive system that sugar is coming even though sugar doesn’t end up coming. A lot of these these sweeteners don’t have glucose or fructose in them so that they’re being touted as being safe for diabetics and those sorts of things, when in fact, there’s still a response in the body taking place that’s really abnormal and actually leading to inflammation around our insulin receptors. It’s really important to understand how the food industry actually does a lot of trickery. The billion dollar food industry knows that we’re on to them about sugar. They know that the masses are understanding processed foods, seed oils and sugar is bad for them. They are one step ahead of us trying to find ways to sell us on their food products, so they can label things as sugar free. All of these nutritional labels are a red flag in my opinion. We need to really be careful in making sure that we’re staying with whole real foods as much as we can. These sweeteners are processed and made in a lab. I would put them in the pharmaceutical category. These are things that are foreign to our body. We’re still discovering and research is still being done. We’re never really going to know the overall effects, but there’s a lot of information coming out there now. It’s very easy to find and do your own research on a lot of these sweeteners. I have a lot of clients who would have things like Erythritol or sucralose and they would get extreme diarrhea or bloating. That’s obviously a telltale. Your body is telling you to stop that because it’s not working. There’s there’s definitely a lot of things to consider there, especially around the actual addictive tendencies that we all have. We’re not actually solving a sugar addiction problem, or a sugar eating problem, when we’re just swapping out natural sugar for unnatural sugar that’s 100 times sweeter. We’re still using it in the same way. We’re still using it to treat ourselves or to emotionally eat and avoid stress at the end of the day. We’re still doing that when we switch over to these “healthier sugars.”
Lindsey Parsons:
Thanks for that elaboration. I asked the question, because I had a nonprofit advocating for healthier food in the Montgomery County Public Schools in Maryland and the studies show because of course they were saying, “Okay, we’ll take the sugary sodas out of schools, but we’re going to leave the diet sodas because those are good for kids.” Studies came out showing that there was a higher correlation between diet soda and type two diabetes than there was with sugary sodas and the action mechanism hadn’t been elucidated, at least at that time. Some of the suspicions were that (and there were studies showing) people ate more when they were drinking diet soda. It wasn’t like you could just replace the sugar craving with diet soda. That sugar craving kept them eating, which was fed by the diet sodas.
Danielle Daem:
That is really fascinating. I’ve heard of that as well in different studies and also just in my own experience seeing my clients the last six years. When we eat these alternative and artificial sweeteners, a lot of them are actually like exactly that. The mechanism in the body actually drives more cravings. Our body thinks we’re about to eat something with nutrients in it and it doesn’t get nutrients. Things like fructose are now being shown to actually turn off our hormone that makes us feel satiated. That ability for your brain to know you’ve had enough. Fructose is something that we can just eat constantly – hence high fructose corn syrup being used in every processed food. The food industry knows that it’ll just keep us coming back for more, keep us craving and disconnect us from our body’s natural ability to know when we’re satiated. There are very intricate things happening in the body that are keeping us going. I love that example in the in the school systems, I’ve heard of other examples like that as well – where it’s just leaving more and more cravings, more sugar intake and not solving any problems.
Lindsey Parsons:
I’m curious whether you recommend a cold turkey approach to cutting out sugar or gradually decreasing your consumption? What works better for people?
Danielle Daem:
I love this question because my answer is, “It depends.” There’s no right answer to this. I would really encourage anyone here to really just tune into yourself. It’s kind of a 50/50 split. Some of my clients love going cold turkey. Funny enough, actually, the day we’re recording this interview, my current group program just started sugar free today – their 4 week detox. They’re going cold turkey today, but we’ve actually spent the last four weeks in that program getting them ready mentally and physically to take that leap and go off sugar. It’s going to be really dependent on your personality, your lifestyle and how much prep you’ve done in advance. If you want to go cold turkey, it’s really important that you prepare yourself in advance. There’s a lot of prep that needs to go into that to make you successful to stick with it. Meal planning, keeping your freezer stocked with emergency foods, keeping healthy snacks, and really thinking through how you’re going to handle challenges that come up – birthday parties, holidays, vacations and all of those pieces that can really us throw us off course. If that terrifies the living c-r-a-p out of you, then maybe a gradual approach is more manageable for you. For a lot of women especially, there’s this huge fear of losing our best friend when we begin getting rid of processed food. I know this fear is very real. There’s this belief that we’re not going to have anything fun in our life, we’re not going to have any joy and my best friend is going to be gone. In that case, it is really helpful in my opinion is to gradually ease into it. I find that people who do gradually ease into it with the proper plan and support tend to be way more successful because they’re ready for the challenges that come or ready for the hiccups, the withdrawal symptoms or the things that might show up in their body once they’ve slowly built in some whole, real foods. It’ll also be a lot easier on the body if we spend four weeks gradually minimizing our sugar intake before taking it all out. It’ll be a lot easier on your body than a sudden cold turkey.
Lindsey Parsons:
What kind of withdrawal symptoms do people experience?
Danielle Daem:
Another great question. When we think of withdrawals, that can be headaches, there’s often digestive upset in the beginnin,g especially someone who’s going cold turkey and switching from processed food to real food. Your bowels and your gut are going to be very confused for a while, so there’s going to be digestive issues. Pain can really come out as the toxins are being pulled out of your joints and muscles. You might notice some extra pain, headaches and exhaustion, especially for the first couple of weeks.
Lindsey Parsons:
I’m sure there’s got to be a die-off reaction because the pathogenic bacteria aren’t being fed and they’ve got that lipopolysaccharide, which is an endotoxin.
Danielle Daem:
Exactly. We’re realizing a lot that some people also have cold and flu like symptoms. They feel really tired and sick. Just knowing that all of that is normal is really, really helpful. There’s quite the process. It’s almost like it has to get worse before it gets better kind of feeling. You have to push over the hump. And it usually only lasts one to two weeks, maybe three. Everybody’s very different, obviously. I know for some some of my clients, it lasted three days, and then they start feeling great again. It depends, but it’s important to stay on course and pay attention.
Lindsey Parsons:
It’s going to be exactly like a Herxheimer reaction. When you start taking antimicrobials, the first two or three days could be really bad for some people who have a really severe overgrowth. So you mentioned seed oils. Let’s talk for a minute about why seed oils are bad and what they are.
Danielle Daem:
Seed oils are heavily processed fats that have been designed by the food industry because they’re very shelf stable and you can put them in a lot of processed foods to add some flavor. This is one of their sneaky ways of trying to add flavor and fat, especially if they’re not going to be using sugar in a product. These are pretty much any of the oils that you see in the grocery store shelf in a clear plastic bottle. Things like canola oil (rapeseed oil), sunflower, oil, vegetable, peanut, soybean, corn or margarine – any of these oils that are from plants. These oils are essentially just toxins to the body. They oxidize like nobody’s business, and can create a lot of free radicals in the body and start augmenting and causing damage to our cellular structure. What they also do is inflame our cells They also inflame our insulin receptors, which can support and lead to more insulin resistance.
Lindsey Parsons:
That’s a relatively unknown piece of it. I think I listened to an hour and a half podcast on the very sciency details of exactly how you need Omega six oils to have type two diabetes. This is a little, well known trick. I think if you told someone, “The only thing you need to pull out of your diet is is seed oils.” Everything else would come with it because there’s no processed food that does not have seed oil. You could just tell them the only thing you’re not allowed to eat is that.
Danielle Daem:
I’ll have to try that. That’s a neat trick. Another thing that they do is get into our fat cells and damage our body’s ability to actually burn fat for fuel. This just really damages our metabolism and the processes that are able to, in an ideal world, be metabolically flexible and burn glucose or fat for fuel. I mentioned earlier already about the oxidation and they’re just extremely inflammatory. Just think of seed oils as cancer-creating inflammatory substances that should not be used. I don’t know, Lindsey, if you or any of anyone listening has ever seen the YouTube video of how they make canola oil. You can find it on YouTube. It’s a very old video with horrible filming footage, but watch that and never again will you ever want to eat a seed oil in your life. It’s really eye opening what they actually do to produce it, making the sludge and what they mix it with. It’s pretty shocking too. I encourage anybody to just do a YouTube search for how Canola is made and it will come up. It’s a really powerful visual.
Lindsey Parsons:
I’ll try and find it and link to it in the show notes.
Danielle Daem:
I know a lot of experts in the nutrition space. We have debates of like, “What’s worse sugar or seed oils?” It’s kind of a 50/50 debate. They’re on par and there’s a lot of people out there touting that seed oils are even worse for you than the sugar that we’re ingesting. Either way, they’re both equally as toxic and produce a lot of cellular damage, free radicals and toxins in our body. We’re dealing with a toxic load just living in the world that we live in and we don’t need to be putting these added toxins into our body if we if we don’t have to.
Lindsey Parsons:
Briefly, what oils do you recommend people use?
Danielle Daem:
Things like butter, ghee, avocado oil and olive oil are good for no heat. You don’t want to heat those oils. We can get into flax oil and walnut oil. Those need to be kept in the fridge. We want oils that are really delicate. These are these are going to be the ones that are more packed with omega threes and the saturated fats that we do need. Coconut oil is another good one. Any animal fat is recommended. I actually have lard in my fridge, who would have thought that we would actually be promoting lard again? I remember the whole “don’t eat fat” craze back in the day. We need to get over that because we do need fat in our body. Tallow is another one – any of those fats that can be rendered from animals. When it comes to high heat cooking, you should do your best to use fats that are solid at room temperature. Those are the ones at least that I use in my home and that I definitely recommend. Pay attention to that heat amount, because fats can become very unstable very quickly. Things like beautiful olive oil is absolutely an incredible addition to your diet. You don’t want to heat it or agitate the cellular structure of the oils, because if you do, we’re ending up in the processed seed oil category again.
Lindsey Parsons:
You certainly don’t want it to burn. Like if you see your oil smoking, pour it out, in the garbage, not down the sink, and start over.
Danielle Daem:
I’ve done that. I’ve been heating coconut oil on the stove and I forget about it and I’m like “Oh no, it’s burnt!” In my line of work, the emotional connection that we have to food is one of the biggest root causes around sugar addiction, beyond the physical addiction that’s actually going on. For most of us, this is actually the stronger addiction. It’s the emotional piece. There’s so much that I could talk about with emotional eating and this emotional connection, but when it comes to our gut, these heavy emotions or the difficult emotions that we might be dealing with on a day to day basis are driving us to actually want to eat the processed food. We’re going for comfort. We’re going for the junk. When we’re eating the junk, it’s doing all these things that we just talked about. We need to start looking at our triggers and our patterns around this. When it comes more specifically to eating time, and our digestion, we are often not in a relaxed state. Most of us are not when we eat. I look around to see that we’re eating in our car, we’re eating quickly at our desk, we’re eating in front of the TV, not even paying attention to what we’re eating. We’re eating maybe while we’re arguing with our husband. All of this puts our body you know, essentially in a stress state and in a state where we’re not relaxed. We’re not aware that we’re about to digest food. This obviously can do a lot of things to our body. The biggest thing it that really does is shutting down our digestive system, especially if we’re not mindful eating. Our digestion starts with our eyes or our nose. A lot of my clients don’t even look at their food or don’t even know that they’re eating. They’re watching TV, and scrolling on Instagram at the same time while they’re shoving things in their mouth.
Lindsey Parsons:
Let’s talk a little bit about the emotions around eating and how that impacts gut digestion. And the chips are just going into the mouth, right?
Danielle Daem:
They’re just appearing in the mouth as if from nowhere; it’s magic. When we do that, our body and the rest of our digestive system doesn’t get the signal that there’s food coming in. We need to release the enzymes. We need to release all the protein. We need to release the bile and all of the things that we need to actually break down these foods to properly be digested into our bloodstream. This is the argument for mindful eating and learning to get back to actually prioritizing, sitting down, going slow and being present with our food – even if it’s for 10 minutes. Even if it’s just for that quick bit of time to really do our best to minimize distractions. When we do that, we also support our body in calming the nervous system. We need to be in the rest and digest state. Because when we’re not, if we’re in a stress state or we’re ruminating over an argument that we had with a friend yesterday or we’re just feeling heavy and nervous or we’re worried about work and we’re just in a tailspin of nervousness and stress, what that tells our body is that we’re in danger. When we’re in danger, all of our energy and our internal resources are being sent to our brain and our limbs. The digestive system is the last place that gets energy if we’re in a stress state, whether it’s mental or physical stress. Our body has that reaction, even if it’s not actually in our reality. When we relax, our body can actually send the appropriate energy and resources to the digestive system so it can function properly. This is a great example and maybe experiment for anybody. If you’re eating when you’re stressed and you feel like you’ve got stomach cramps, gas and other digestive symptoms, it is probably because you weren’t focused on your food. You weren’t relaxed in that state actually allowing your digestive system to do the magic that it does. Those are a couple of the ways our emotional state really plays a big role in keeping our digestive system calm and working optimally. It’s more than just meditate and relax every day. There’s a big practice here that I’m not perfect at.
Lindsey Parsons:
Nor am I.
Danielle Daem:
I’m going to be the first to admit that this is still something I work on.This is harder said than done, but it’s important.
Lindsey Parsons:
It’s something I teach some of my clients, especially the people who come to me for weight loss. If you sit down to the table, really feel your stomach tense, you just stop and do a couple minutes of 5-5-7 breaths – five in, hold for five and out for seven – in two minutes, you can just completely change into that parasympathetic, rest and digest state and have such a better chance at assimilating your nutrients.
Danielle Daem:
People often complain about eating healthy being expensive, but how much money are we wasting by not digesting the food that we’re actually paying for? It’s a very interesting kind of argument, maybe for another day. And I don’t have the answer for that, but how much are we actually wasting financially and energetically when we’re not paying attention and we’re just shoving food in all day long and really not being present with that process?
Lindsey Parsons:
I do still a little bit coach people on weight loss, but a lot more at the beginning of my career, and breaking the sugar habit. Of course, some of my clients came to me with eating disorders, not necessarily bulimia, but certainly binging cycles, followed by punishing cycles and starving themselves. I’m curious how you work with people who do have an eating disorder. I found that to be one of the most challenging things for me personally.
Danielle Daem:
This is such a good question, Lindsey. This actually came up on one of my group calls in my current group a couple of weeks ago, because there is this easy trap to fall into when we talk about giving up sugar. “Are we not just on another diet? Are we not just limiting, controlling and starving ourselves of something over here?” I’m actually of the belief that we do need to really be careful with what we tell our brain we can’t ever have again. This goes especially for food. This can be really a slippery slope, because as soon as we are told we can’t have something, we want it more. We feel like we don’t have the freedom to make our own choices. A lot of my work is really about tuning back into our true selves, and rebuilding a deeper relationship with ourselves, and thus a relationship with food. When we feel fully empowered, and we fully know and love and respect our body, it becomes a choice to avoid certain foods. I’m making a loving choice to not eat processed seed oils and sugar. It’s not that I can’t have it. It’s that I’m choosing not to because I know what it does to my body. And I love myself too much to do that. This is really like just scratching the surface on a lot of the deeper work that we need to do if we want to actually make a healthy relationship with healthy food in a lasting way. There’s no quick fix here. We need to really go inward and take a hard look at why we’re eating sugar in the first place, what the relationship with food is, our beliefs about food, our beliefs about ourselves. I often say that our relationship with sugar is just a byproduct of our relationship with ourselves. We have to start repairing that relationship with ourselves. You need to really be paying attention to what’s coming up for you. If you notice that restricting sugar in your diet is triggering that old pattern of bingeing and purging, that’s really important information for you to then lay off. Maybe you need more guidelines. Maybe you need less hard rules. Maybe there’s some more work to be done there. I really believe that all of our patterns stem from a deeper level. There’s an old neural pathway and your ego is using that pattern to get something or to accomplish something from a survival mechanism standpoint. We need to look at that stuff and actually do some deep healing. Does that answer your question?
Lindsey Parsons:
Yeah. Obviously, it’s a complex problem to solve. It’s not an overnight problem. Sometimes I think about working with clients who start out with a self-professed eating disorder. Don’t anticipate in 12 weeks that you’re going to lose weight, if that’s your goal. Anticipate that you might maintain, which probably is a step forward. Maybe another 12 weeks, you might actually get to the point of losing. It’s not an easy proposition undoing a lifetime of an eating disorder.
Danielle Daem:
Yeah, for sure. There’s a lot of baby steps and obviously, unfortunately, there are of a lot of detoxes and things out there that might not work for you if these are your old patterns. It’s definitely a tricky rope to walk. It’s very person specific. It’s very individual. It’s hard to give any specific advice here, of course, but just be gentle with yourself. Understand that this is a process and a journey. The more that you connect to your true self, go inward and repair that relationship with yourself, making better choices becomes a lot easier. The mindset work is really about not guilting or shaming or making up stories about yourself, right? We need to find a way to understand that we’re human and understand that most of us have spent decades to get to where we are, especially when it comes to our addictive patterns. This isn’t going to change in 12 weeks. This isn’t going to change overnight. I’m still learning, growing and finding weak spots that I’m working on. This is six years into my sort of self discovery and healing journey and it’s going to continue onward, because I’m human.That’s okay. I’m always learning and growing and being challenged.
Lindsey Parsons:
That’s one of the first things that I tell people after the first meeting is, I want you to go and watch without judgment, just with curiosity, what you’re doing around food. When you eat sugar, what is going on in you? Just to try and not be judgmental of ourselves for the first time, perhaps, in your life. Because there’s so many people out there who are just beating themselves up every time they eat sugar or every time they overeat. The first piece is to pull out the judgment and just understand.
Danielle Daem:
Yeah, yes! That’s definitely where I start as well. I’m glad you mentioned the word curiousity. That’s a huge focus when I work with my clients too. Curiousity and awareness number one. And also number two, I have to remind everyone about this, our addictive patterns and our unhealthy habits with food are not our fault. It is sick, when you actually do the research and you learn, this world that has been created around us by the food industry, and the pharmaceutical industry and the government, and just all of the way that we have been taught to use food for emotional reasons to you know it’s everywhere, it’s in the media, it’s in false news and studies that have been paid by politicians. There’s a lot of documentaries out there now that are really great, really pointing to some of the injustices that have happened. That’s important for any of you listening who are putting this on you, that there’s something wrong with you. “Why can’t I give up sugar, why can’t I eat healthy, what is wrong with me?” I think we all massively need to take that pressure and blame off of our shoulders because we’ve been raised in a world to use food for every possible emotional reason, to treat ourselves, to show love, we’ve been constantly bombarded with the message “feel bad, eat sugar”. It’s everywhere and it’s been hidden in our food. And there’s so many things that have been out of our control. I often say this: “It’s not your fault, but it is your responsibility if you want to turn the corner and live a long, healthy life.” There’s nothing wrong with us. Ugh! We need to throw that out. It makes me so sad that every woman I meet is going around with this belief that there’s something wrong with me because I can’t get off sugar.
Lindsey Parsons:
Meanwhile every single store you go to, it’s in the checkout aisle at the hardware store.
Danielle Daem:
Right? Why is there a huge candy section here? I want nails and screws! Every restaurant adds it to sauces. It’s just, we’ve become addicted for many reasons and most of them are not our fault, nor were they our choice. This is not a you problem, everybody listening. This is a massive societal problem, which you can do a lot about. You can absolutely take your power back. You can absolutely do this deep healing work that we started talking about. Arm yourself with this beautiful knowledge from this podcast and actually make changes. There’s so much that you can do. Please know that you’re not powerless, but it is important to take that blame off because that blame is just going to crush you and keep you in the shame cycle. You’re going to stay in the guilt cycle and you’re never going to come out of those patterns if you stay there. There needs to be some self compassion and curiosity is a great place to start.
Lindsey Parsons:
Tell me where people can find you and the break free from sugar program that you host.
Danielle Daem:
My website’s a great place. It’s DanielleDaem.com. You can come and find me on my podcast as well. Lindsey, you’re going to come and be a guest on the “Beyond Sugar Freedom Podcast.” That’s probably the best space to connect with me. I’m on Facebook and Instagram as well @DanielleDaem. I put my podcast up on YouTube too. I’m in many areas, but I’d say my website and podcasts are probably the best places to start if you want to start diving deeper into your relationship with food, your relationship with sugar and dive into some of those inner pieces that we touched on today.
It’s a 10 week program. I’m just in the middle of a run now. I only host it a couple times a year. Actually I haven’t hosted in a year. This is the first time in a year I’ve hosted it, but I have a couple other programs as well that I host. I am going to be hosting it again in 2023 so you can get on the waitlist on my website and definitely check out some of the other resources there.
Lindsey Parsons:
Okay, great. Do you coach individually as well?
Danielle Daem:
I don’t anymore actually. There’s group and then I have a VIP option with my group programs as well for people who want one-on-one sessions in the container group.
Lindsey Parsons:
Thank you so much for sharing your knowledge about sugar and how to get off of it. And I hope some people can check you out and who need help in that area.
Danielle Daem:
Thank you so much for having me on Lindsey. This was such a great, great conversation. I really enjoyed it and thanks, everyone for listening. I would love to hear from you. Please feel free to reach out and looking forward to having you on my podcast, Lindsey.
If you’re struggling with dysbiosis, diarrhea, constipation, leaky gut, candida, IBS, IBD, or other gut health or all over body problems, you’re welcome to set up a free, 30-minute breakthrough session with me (Lindsey). 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, test and dispensary links are affiliate links for which I’ll receive a commission. Thanks for your support of the podcast and blog by using these links.
Adapted from episode 84 of The Perfect Stool podcast hosted by Lindsey Parsons, EdD with Erin Dunny, aregistered dietitian specializing in Integrative Gastroenterology in her online private practice, Blunt Nutrition.
Lindsey:
So why don’t we start by talking about your gut health issues? I know that your history includes methane SIBO or SIBO-C or what’s now called IMO. And perhaps you can explain those terms and then tell us about your own story.
Erin Dunny, RD:
Absolutely, I never started out being a beacon of health. Nutrition wasn’t really on the top of my mind. I actually started out in communications and public relations. I was very overweight. As a child, I grew up basically eating pop tarts on the way to school. In college, it kind of caught up with me and I started having a lot of abdominal symptoms. I couldn’t eat anything without feeling nauseous, I probably lost about 75 pounds in a month. At that time, I went to multiple doctors, and they found out it was actually a gallbladder issue. It wasn’t functioning well. They ended up taking the gallbladder out, which if I would have known what I know now, I probably wouldn’t have gone that route, but it is what it is. Not having a gallbladder created further digestive issues. Personally, I had a really hard time with protein, so I went vegan for about seven years. I couldn’t digest anything else and it’s what I could tolerate at the time. After about seven years, I started getting really bad constipation and abdominal cramps. Anything I ate made me feel incredibly bloated, so I got the whole rundown, EGDs.
Lindsey:
What’s an EGD?
Erin Dunny, RD:
I had an endoscope (the tube that goes down to look at the stomach). I got colonoscopies. In a roundabout way I was diagnosed with irritable bowel syndrome, which basically is a diagnosis of symptoms. It’s not an actual diagnosis. It’s sort of a, “We don’t know you have these symptoms. So we’re going to label you with this, right?” So I decided that I just couldn’t take it anymore. I wanted to figure it out. I went actually back to school and that’s when I got my degree in dietetics. Next, I started working for a gym that introduced me to more of the functional medicine. The more I looked into it, I discovered small intestinal bacterial overgrowth. I got tested and I actually had hydrogen sulfide of small intestinal overgrowth. So I treated myself for that, and was able to become fully recovered, which is how I became passionate about just helping women in general managing IBS, which about 84% of the time, SIBO is a major contributor.
Lindsey:
It’s interesting that you had hydrogen sulfide SIBO, because I associate that normally with a high meat-fat diet. Although, I guess if you did not have a gallbladder, you probably weren’t digesting fats terribly well.
Erin Dunny, RD:
I was not. It’s always kind of an anomaly, but likely without a gallbladder, like you said, you can’t do fat.
Lindsey:
Right. And you were eating dairy?
Erin Dunny, RD:
Yes.
Lindsey:
Okay, that makes sense, then. So because you’ve had your gallbladder out, I’m curious how you support your digestion now, and your protein digestion, and how you would support a client’s digestion of fats without a gallbladder?
Erin Dunny, RD:
Yeah, so the one of the recommendations out there is ox bile. That one is very, very popular and works well for people. Personally, I couldn’t really tolerate ox bile. It would cause really bad diarrhea. I use digestive bitters. I do a couple of drops before every meal. That’s where I support, from a digestive standpoint, from the fat standpoint, but as far as the proteins, I don’t need that much support anymore. Once I worked on the gut and got everything healed up, those enzymes came back. Originally, I did have to start with a broad spectrum digestive enzyme. I also had to do a hydrochloric acid/pepsin combination in order to get my stomach acid backup as well. I remained on that treatment for a little while until I could get everything healed up and ready to go. I was able to move off of it, so now I only have to support with the bitters.
Lindsey:
Were you seeing a functional medicine person then when you got diagnosed with hydrogen sulfide SIBO.
Erin Dunny, RD:
I actually, believe it or not, wasn’t, but my doctor, (my PCP at the time) was more in the functional medicine space, so she worked with a naturopath. They were actually doing the testing in office and she consulted with the naturopath at the time. So in a roundabout way, technically I was.
Lindsey:
And how many years ago was that?
Erin Dunny, RD:
Oh man, I think probably 10 or 15 years ago now. It was a little while ago.
Lindsey:
So I’m thinking maybe you had hydrogen SIBO, not hydrogen sulfide, because hydrogen sulfide testing has only been around for like, three years. Yeah. I mean, honestly, it was at the time where they just started introducing it. It wasn’t yet super reliable over whatever they were doing anyways, so I think they were just guessing, and it ended up working. Obviously, we know a lot more about it now, but back at the time, when I was being treated, there wasn’t a lot out there. So they were kind of like, “Here, try this.” Oh, okay. Well, I did want to focus on SIBO-C, or constipation SIBO or IMO (intestinal methanogen overgrowth) today. I wondered if you could tell me first of all, do you see a lot of patients with that?
Erin Dunny, RD:
Yeah, absolutely. A lot of times, constipation is more of a different kind of beast in and of itself, even to the extent where they’re thinking about renaming it. When we’re looking at methanogen dominant SIBO, the species or the organism is actually an archaea. It’s not even a bacteria, so I feel like the name is kind of misleading (which is why they’re looking at renaming it). So because we’re looking at a different type of species, if you will, we’re looking at a different treatment method. This is what happens: we have archaea in the body. It’s not anything foreign. Our small intestine is very sterile. There’s not supposed to be a lot of stuff in there. These little guys can get an overgrowth either in the large intestine, or the small intestine, and it starts creating issues.
Lindsey:
Right. Yeah, I guess that’s another reason to call it IMO, rather than SIBO-C is because it’s not just SIBO (small intestine bacterial overgrowth). It could be a large intestine methanogen issue.
Erin Dunny, RD:
When you’re looking at a methanogen dominant [SIBO], there’s a couple of things to consider. One, you want to potentially test for other things. You might not only have that methanogen. You might have a yeast, you might have a fungus or you might have a parasite. Double check and make sure that that’s not the only thing contributing to the symptoms. From there, where you start with as far as treatment, you need kind of a broad spectrum of herbals. You want to rotate them a little bit just to prevent any sort of resistance. With methane dominant, specifically, some of the herbals that work really while are going to be your oregano oil, which is very popular to use for that. Allicin, which is coming from garlic, has been known to really help absorb that methane, and pairing with maybe a neem oil or berberine. Your primaries are going to be your oregano oil and your Allicin. You can then add a supportive, but I mean, really, everybody responds to herbals differently. Another thing that you can potentially use is Atrantil*. It has a peppermint oil, so it can help with some of the abdominal symptoms. Other things that have been shown to work really well for methane specifically, monolaurin can help. There’s also probiotics, which is very controversial as far as a treatment method. However, Lactobacillus plantarum* has been shown to work really well for methane or like a spore based, so as long as you don’t have an overgrowth in the large intestine, it kind of bypasses that. Those are just some of the options that you’re looking at as far as treatment and like I said, everybody is going to respond differently. You don’t use all of these. It’s just you have different things to manipulate based on how somebody responds. As far as length of treatment, it’s going to be different for everybody as well. Usually anywhere from two to three months is possible – just for the killing off phase, if you will. Exactly.
Lindsey:
What do you do for patients with this? With hydrogen SIBO. I see clients respond pretty quickly once you start to give them the antimicrobials Do you see the same thing with methane SIBO or does it seem to take a lot longer to begin to notice an effect?
Erin Dunny, RD:
It seems to take a little bit longer in my experience, and I don’t know if that’s the same for you as well. They’re just pesky little guys and it’s also possible because archaea feed off of hydrogen. It’s possible that you could have some bacterial overgrowth that are producing the hydrogen and it’s feeding the methane. You have to potentially kill both, which is also going to take a little bit longer as well.
Lindsey:
Right. It’s sort of a vicious cycle, right? You’ve got to kill the food source as well as the archaea. Do you have a product that you like?
Erin Dunny, RD:
Yeah, I really like Allimax* (find in my Fullscript dispensary) I use that primarily. It’s a good product, and I really haven’t had a lot of issues with it.
Lindsey:
Okay. Do you find though, that the methane SIBO is more intractable than other types of SIBO, just harder to eliminate?
Erin Dunny, RD:
SIBO, in general has a very, very high reoccurrence rate. It’s essentially like a giant puzzle, because there’s a lot of different factors that can trigger the progression of it. Not only do you have to kill it off, but you also have to figure out that root cause on how it got there in the first place. A lot of times, we’re looking at motility issues as well. We’re looking at low stomach acid; we’re looking at low pancreatic enzymes. If you have a history of abdominal surgery, that can cause issues, medication use. So depending on what that root cause is, how long you’ve had it and how severe the motility issues are, it definitely can make things harder as well.
Lindsey:
Do you use breath testing? Or do you do stool testing? Or both?
Erin Dunny, RD:
I primarily do stool testing. But I also go through Vibrant Labs. I actually do the testing for cytolethal distending toxin B. So what is that, basically? A lot of times when people get SIBO, it can be from food poisoning. When you get food poisoning, which is very, very common, (it could be you don’t even know you have it), the bacteria is going to produce this toxin. We’ll just call it CdtB. That toxin is going to start attacking a part of your digestion called vinculin. Vinculin basically regulates your migrating motor complex. I’m using a lot of big words. What does that mean? Basically, that migrating motor complex, you can consider it the Roomba of your digestive track. Every 90 to 120 minutes, as long as you’re not eating, this migrating motor complex is going to create a wave; it’s going to take all of that debris sitting in your stomach and wipe it out. It’s kind of like that Roomba going through and cleaning any debris that’s on your floor. So what happens is, if you get damage to the vinculin, then that’s going to make it to where your body is not scrubbing out that debris, so it’s just sitting there and it’s creating this breeding ground for bacteria, archaea, all of that to feed off. I tend to test that as opposed to doing the breath testing just because it’s another measurable way to detect whether or not SIBO is present. You can use that with the stool tests to figure out whether we’re dealing with some SIBO.
Lindsey:
Does Vibrant Labs have that marker then?
Erin Dunny, RD:
Yes.
Lindsey:
Okay, because I’ve used the IBSsmart that has the anti-vinculin antibodies and the anti-CdtB antibodies, which incidentally, I have elevated. I have post infectious IBS, essentially. I didn’t realize that Vibrant Labs was but I can’t access their tests because they don’t let health coaches order them [Note – I can now through my new Rupa Health account]. So you mentioned rotating, tell me about how you rotate.
Erin Dunny, RD:
Gotcha. Yeah. As far as the supplements?
Lindsey:
Herbals, yes.
Erin Dunny, RD:
So I typically will start somebody out with a Candibactin AR and BR* (find in my Wellevate Dispensary), just because I like that it’s a broad spectrum. Plus, I find that your oregano oils, it’s just very potent. Typically, I don’t necessarily like to use that right away because also that die off reaction can be very intense for people. Sometimes people tolerate the Candibactin AR and BR* just fine. We might just do a little bit longer with that. If that’s not working, that’s where I then will do the heavy hitters like the oregano oil. The other thing to consider with oregano oil is just double checking and making sure that people are getting the enteric coated; because, if it’s not enteric coated, it’s just going to go in your stomach. That’s not going to help anything either. That’s typically how I would do it and I would just keep people potentially on the oregano, potentially throwing in that neem or the monolaurin. Keep them on a little bit longer. The other thing I didn’t mention is berberine. Berberine is also another one, although that specifically responds a little bit better to diarrhea and the berberine is nice because it does have a little bit of a biofilm disrupter. If you need something to kill that protective shield that some of the bacteria can have, or archaea can have, that’s nice, but it’s also if you have a fungal overgrowth or some sort of yeast, the berberine is going to help with that as well.
Lindsey:
Right, right. So when you say rotating, I was thinking you meant short term rotations. I’ve heard of practitioners using four day rotations, but you’re talking more like six week rotations?
Erin Dunny, RD:
Exactly, I don’t rotate that much. If somebody’s not responding, that’s where I’ll add some of these other things. So, you’re not necessarily changing too much. You’re kind of using the same thing. You’re just playing around with the dosages and also adding some of these other supplements to see if they might respond better to that.
Lindsey:
Yeah. And have you found that some people need to stay on something long term? That it comes back so quickly, you just have to keep them on it.
Erin Dunny, RD:
Yeah. So typically, with the right dosages, I like to have people test every three months and I think that’s another thing that I see. At the end of the day, I know it’s a hard investment for people to make, so they don’t necessarily want to retest. I know a lot of practitioners out there are saying, “Okay, well your symptoms are at 90%. We don’t have to retest.” That’s why I like testing the endotoxin that we talked about in the vinculin because it’s a way to see if we are making progress. I think that because most of the protocols are only around six weeks. Herbal people are feeling better and they go off of it. They get the reoccurrence because they didn’t retest to ensure that it was completely gone. So the question is, “Is there a high reoccurrence rate because it’s really hard to kill? Or is there a high recurrence rate because people aren’t retesting?” Ideally want to test at three months and at six months, and make sure that it’s 100% gone. And then getting into more of the supportive measures where we talked about including some herbals, to support that migrating motor complex to make sure that you’re getting that motility and getting things pushed out. To support that migrating motor complex, you’re going to be on six months to a year. That’s a little bit longer term than the initial kill off, if you will.
Lindsey:
And are you keeping people on antimicrobials up through the testing then?
Erin Dunny, RD:
Ideally, yes, because I don’t want to stop treatment until I know it’s gone.
Lindsey:
Interesting. Are you retesting with the full stool test or full vibrant labs with the antibodies? What are you retesting, just the antibodies?
Erin Dunny, RD:
Just the antibodies because it’s a lot cheaper to do that. it’s nice, because you can just pick that one and just retest that.
Lindsey:
And you see those numbers come down on the antibodies after treatment?
Erin Dunny, RD:
Absolutely.
Lindsey:
Okay. I never I never actually thought to retest the antibodies. That’s an interesting technique. Do you find that people with IMO or SIBO-C have worse bloating? Are they in more pain? They seem to be just more uncomfortable than people with hydrogen SIBO?
Erin Dunny, RD:
Yeah, absolutely. If you think about it, bacteria kind of sit and feed off of the stool, right. If it’s just sitting there and not going anywhere, basically, it’s full on feeding ground, where when they are eating the food that’s essentially just sitting there for them. They produce so much gas, and methane gas is so uncomfortable.
Lindsey:
I’m curious because obviously, if you’re looking at an elevated CdtB antibody, you could be dealing with any type of SIBO, so are you basically judging on the this is a constipated person versus this is a person with diarrhea at that point to decide? Often I’ve discovered that when I look at stool tests for methane, I see the presence of the archaea, but I don’t necessarily see that it’s elevated. It doesn’t show as elevated.
Erin Dunny, RD:
Vibrant Labs’ stool panel is very, very comprehensive. They have the archaea, they have. They have the Methanobrevibacter smithii. Yeah, it might not necessarily be high, but you can tell based off of the symptoms as well where they’re at. I would say, just in my clinical practice between those two, I’ve had really good results to where I haven’t really had to do the breath test. The breath tests, you can argue back and forth, are not always going to be accurate either. In my experience, just using those two markers has been enough to say, “Okay, this is what you have.”
Lindsey:
I do find though that when you get somebody with H. pylori sometimes you get this overlap with H. Pylori and the methane SIBO and they both cause constipation. Now you’re not quite sure which one you’re dealing with and you deal with the H. Pylori, I feel like sometimes that might cause the methane to overgrow, because you’re killing off bacteria that respond to the mastic gum, perhaps, but those aren’t the archaea.
Erin Dunny, RD:
Exactly, and like you said, H. pylori itself can produce methane as well. If you have both, you’re getting just doubled up on the methane and yeah, that’s real uncomfortable.
Lindsey:
Okay, I didn’t realize that H. pylori was a methane producer. So I understand that your history also includes a severe case of COVID with complications. So can you tell me more about that story?
Erin Dunny, RD:
Yeah, my digestive health has been real fun. There was a series of events leading up to it. To kind of backtrack a little bit: I had knee surgery in November. I was out for a little bit with that. In December, my husband brought home what felt like the world’s worst stomach bug in the world. I don’t even know where this thing came from, but he’s a grown man literally, keeled over on the floor with such bad body aches he couldn’t even move. So he recovered from that in about 24 hours, but my son who was three at the time – what can happen after a stomach infection, which we learned, the lymph nodes in your stomach can swell. He ended up being sick for a month. He threw up between 2 and 3 a.m., every single night for a month with severe body aches. Needless to say, I was under a very large amount of stress for a good three months at that time. I say that because it’s important leading up to the COVID situation and why I got it so bad. It took about a month for my son to get better and when I say he threw up every night for a month, he threw up every night for a month; it was insane. Two days later, I was going to go back to work, but we got COVID. My husband got it from work and didn’t know. They were fine. During the actual COVID, I was fine. I just had a little bit of body aches, but a couple of weeks later, I would start waking up in the middle of the night. My heart rate then would be 150 beats per minute, which if you ever wake up in the middle of the night with your heart rate that high, I will tell you, it’s terrifying. You’re from a dead sleep, you don’t even know what’s going on. So that would actually happen a few times. I would just be sitting on the couch and my heart rate would just jump up or my right left arm was starting to get numb. Sometimes starting from my chest, it felt like lava started to flow through my body. Needless to say, that shouldn’t happen to an individual. I contacted my primary care physician. Because I had COVID, they wouldn’t see me in office, even though I was two weeks out, I wasn’t contagious anymore. They wouldn’t see me. I would go to urgent care and they couldn’t really help me. They found me a new PCP. That PCP was like, “Well, have you’ve had a lot of stress lately and so it’s silent anxiety.” He just wanted to give me Lexapro and sent me on my merry way. It kept getting worse and worse. I went back. I went to the ER, because all my heart blood markers were fine, they’re said, “We can’t do anything for you.” They just labeled me long haul or COVID and sent me home. I went back to my PCP and he changed his story to, “Well, you’re a COVID long hauler,” and just gave me a steroid injection. In a two-week time span went to the ER four times, as it was getting worse and worse. They kept sending me home, like to a point that a nurse came in saying, “I don’t know why you’re here, we’re not going to do anything for you.” For a time, I was literally begging and pleading for my life and saying, “Something is wrong, do not send me home.” Luckily they admitted me. So I ended up in the hospital for about three days, I ended up with myocarditis, which is an inflammation of your heart, I had a small scar on my heart, as well. So that’s where the irregular heartbeats were coming from. I developed a massive stomach ulcer that actually was about to puncture if they hadn’t seen it. First moral of the story: you know, something’s wrong, advocate for yourself. Don’t just say, “I’m just gonna go home and live with it.” Second moral of the story: So I started diving into the literature and come to find out COVID can actually cause a lot of stomach issues. Part of that is because COVID impacts ACE-2 receptors and that’s how it gets into the body. Basically, you have ACE-2 receptors in the lungs, which is causing all the lung issues in the heart, your heart is lined with those. However, your intestinal tract has a bunch of them. You have them in your stomach, you have them in your small intestine, you have them in your large intestine. What we’re starting to see is that one can cause ulcers. A combination between high-stress medications, because I mean, at the end of the day, when your heart is going nuts, I’m going to do whatever they want me to do, because it’s incredibly scary. You’re getting residual impacts, because of that, the steroid use and things like that. So one, COVID is causing ulcers due to the medications and treatments. The other thing that it’s causing is intestinal permeability, because it’s breaking down that lining of the stomach that’s supposed to be blocking out things. You can look at your intestinal tract like a cheesecloth, it’s supposed to keep out the the bad things and only let certain amount of things in. Basically, COVID can cause these little holes or bigger holes in the cheesecloth. What’s happening is you’re getting these proteins and other things into the body that are not supposed to be there. It’s causing this incredibly large inflammatory response and that can create digestive issues like bloating, constipation. You can get postinfectious – they’re looking at postinfectious COVID now – triggering IBS. Lastly, it can create dysbiosis as well. So you’re getting some bacterial imbalances in there as well. I did run the Zoomer on myself and actually confirmed all of these things. I had leaky gut, I had my secretory IgA, which if it’s low, your immune system is going to be crap, that was low. I did all the research and ran the panel, and my results lined up perfectly for that. Yeah, it was really cool/not cool for me, but it was cool that it basically confirmed I had intestinal permeability which lined up perfectly with the research.
Lindsey:
So what did you do for yourself?
Erin Dunny, RD:
Yeah, great question. So in my particular case, I had to bite the bullet and I did have to take a PPI for a couple of months. I did a couple different things. I did the mastic gum, I did a GI microbial. I did licorice root. I did Aloe – literally none of that worked.
Lindsey:
Did you have H. Pylori too?
Erin Dunny, RD:
No.
Lindsey:
Okay, yeah.
Erin Dunny, RD:
When I was in the hospital because they did check that, they biopsied it. I didn’t have H. Pylori or anything like that, and I had no other risk factors. I was a little frustrated because none of these things worked. So really, the PPI was the only thing. I did the standard leaky gut profile. I did a combination of EPA DHA. For my anti-inflammatory, curcumin, I did as an anti-inflammatory. Berberine actually can really help support the mucosal tissue and start regenerating that. L glutamine – I did that, vitamin C and zinc. I also did a little bit of magnesium, because I think because with COVID, your adrenals are impacted with that. If your adrenals are taxed out, which given the series, I was very stressed out obviously. So I needed to do some sort of support there as well, because if your adrenals are taxed out, your immune system is low, and it’s going to be harder to manage the gut. The gut isn’t going to heal as fast because you just don’t have the capacity. So I did add some of that in as well.
Lindsey:
How long did it take you to recover from all that?
Erin Dunny, RD:
I would say I’m at 90% right now. So about seven months, a long time.
Lindsey:
And did you have fatigue?
Erin Dunny, RD:
For probably about six weeks, I could only handle walking to the end of my driveway and back.
Lindsey:
Wow. Did you did you use any L-arginine?
Erin Dunny, RD:
I did not.
Lindsey:
Oh, yeah. That’s what I’ve heard for the blood vessel impacts that happen. What did they do for your heart, though?
Erin Dunny, RD:
For the heart stuff, I just was put on Metaprolol. I am on that basically until we are confirming that the inflammation is gone. After that, I’ll wean off of it, but it’s just one of those things where I think sometimes it’s hard in functional medicine. You really don’t want to take medications and you almost go too far the other way, where sometimes you need to do a combination of the two, but it can’t be all or nothing. I think is hard is that sometimes it’s either doing all herbals or you’re doing medication, and then there’s this argument between, but really I found some good results doing a combination of both.
Lindsey:
I wouldn’t goof around with like a heart problem. It’s one thing to take herbals for your diarrhea or constipation; it’s a whole nother thing when your heart is at risk. I’ll take what the doctor said.
Erin Dunny, RD:
Exactly. There are some things that you need to concede on. That’s definitely one of them. No, I mean, I am just so honored to have the opportunity to come on. And I think I really enjoyed having the opportunity even to talk about the COVID stuff, because I feel like it’s really not talked about a lot. And the more I see people and the more I work with them, I’m finding that it’s really becoming a huge issue having so many digestive issues post COVID. So I think the biggest takeaway I want to let people know even from my experience, and through all of this is that it’s never in your head. You’re not making stuff up. You know your body best. If you’re not finding results from one person, keep finding and I think that there’s something to be said about using functional medicine along with conventional medicine. The two can definitely work together. It doesn’t have to be this either or situation. I think just looking at your care team and making sure that you have some good people behind you to help figure this out. You don’t have to do it alone and these conditions are very complicated. There are a lot of layers to it and I think it helps working with practitioners, both in the functional medicine and conventional space to help you kind of deep dive into what’s going on specific for you and figure out the best plan of attack based on what’s going on.
Lindsey:
Well, all that is very interesting and I appreciate hearing about your story. Anything else you want to share before we get off? Yeah, yeah. No I do and have heard and do know from my own experience, that if you have existing gut issues, that COVID is likely to give you gastrointestinal symptoms. You definitely want to get your gut in order, because COVID is still circulating and, you’re much better off if you have healthy gut – that and good vitamin D levels
Erin Dunny, RD:
Absolutely and get off those PPIs if you can. Like I said, if you need it you need it; one study I even looked at COVID becomes inactivated with a stomach pH of less than two. So you really do need that stomach acid as another layer of defense to basically increase your chances of not having a severe outcome. Think about how many people are on PPIs right now. COVID isn’t going away. It’s going to be living with us. Not to sound like doomsday, but we’re going to have other viruses that are coming out. If you look at history, we have one coming out every two to three years. So we just need to make sure that we are supporting the gut because that’s a huge part of our immune system. That’s 70 to 80%. We just need to make sure that that’s intact, so when the next thing comes, we’re strong, and we’re going to be able to fight that off as well. Tell me where people can find you. You can find me in all the places for the most part – Facebook and Instagram. I also encourage you to go to my website, Bluntnutrition.com. I have a blog on there, so if you want to learn more about topics surrounding IBS, right now, I’m writing a series specifically about COVID and its impact the gut. If you’re interested, hop on over. Join my email list. I have a nice little freebie on there – a roadmap to becoming symptom for IBS. That will get you on my email list, so you get some exclusive content every month as well. Just other nutrition tidbits and other little goodies with that.
If you’re struggling with IMO, constipation or other gut health or all over body problems, you’re welcome to set up a free, 30-minute breakthrough session with me (Lindsey). We’ll talk about what you’ve been going through and I’ll tell you about my 3- and 5- appointment health coaching programs in which I recommend lab tests, educate you on what the results mean and the protocols used by doctors to fix the problems revealed. Or if you’re ready to jump in right away or can just afford one appointment at a time, you can set up an 1-hour consultation with me.
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What is SIBO (Small Intestine Bacterial Overgrowth) and how does it relate to IBS?
There are 1-10 trillion bacteria in our intestinal tract and most of them can be found in the colon or large intestine. These bacteria take care of the final breakdown of food into a form where it can be absorbed into the body for nutrients or discarded as waste. These bacteria play a critical role in maintaining health throughout the body.
The small intestine normally contains far less bacteria compared to the large intestine. SIBO (small intestine bacterial overgrowth) occurs when the bacteria in your small intestine become unbalanced and overgrow. SIBO can damage the intestinal lining, leading to leaky gut, which can cause further health complications. For example, an imbalance in bacteria could lead to nutrient malabsorption, which causes you to get sick from a lack of vital nutrients, or histamine reactions, which surface as food sensitivities. If untreated, SIBO has the potential to snowball into even worse health conditions.
Typical SIBO symptoms include bloating, gas, diarrhea, soft stool, constipation or a mix of diarrhea and constipation, burping, abdominal pain or cramps, food intolerances, B12 and iron deficiencies, fat malabsorption, and if left untreated long enough, autoimmune diseases, skin disorders or systemic diseases like fibromyalgia or chronic fatigue syndrome. SIBO is broken into three types – SIBO-D or diarrhea, which is not exclusively diarrhea, it can just be soft, messy stool, which may or may not be very frequent. This is caused by either excess hydrogen or hydrogen sulfide producing bacteria. Then SIBO-C for constipation, also known now as IMO or intestinal methanogen overgrowth, which is not necessarily in the small intestine but can be throughout and may be more a question of dysbiosis, or an imbalance of bacteria and methanogens, which are archaea, a different kingdom of microorganisms, rather than an overgrowth, per se. Methanobrevibacter smithii is the primary and most well-known methanogen, meaning methane producer. And then SIBO-M or mixed, which may have some constipation and diarrhea, sometimes because you have breakthrough diarrhea when constipated, or because as your diet, eating habits or underlying root causes change, things shift back and forth in your intestines. About 70-80% of what’s called Irritable Bowel Syndrome, basically a diagnosis of exclusion, is caused by SIBO, so I think of them almost synonymously.
What causes SIBO or IBS?
There are a range of possible root causes of SIBO/IBS, some of which can lead to recurrent SIBO if not addressed. Some relate to impaired digestion – such as low stomach acid or hypochlorhydria, which is important for breaking proteins into amino acids, or a lack of pancreatic or brush border enzymes (which can come from celiac disease). Enzymes help digest all types of foods so undigested food can serve as fuel for bacterial overgrowth. Other potential causes are low secretory IgA, your gut immune defense system (which can follow from chronic stress) or poor bile flow, which is essential for digesting fats. Of course if you’ve had your gallbladder taken out, which stores the bile produced by your liver, then you can assume you have insufficient bile. Medications such as opiates, narcotics, antidepressants, proton pump inhibitors, cholestyramine, antibiotics and antispasmodics can also cause SIBO or IBS-like symptoms. Then there are physical issues like Ehlers-Danlos Syndrome, adhesions from abdominal surgery, endometriosis, and ileocecal value dysfunction that can cause SIBO. Then there are environmental causes like mold toxicity and other health conditions like diabetes, pre-diabetes, hypothyroidism and traumatic brain injuries that can be at the root of SIBO symptoms. Then what I suspect is the most common cause – an autoimmune dysfunction caused by an episode of food poisoning that impacts the migrating motor complex is the final cause, and this one will definitely cause recurrent SIBO. This is what’s called post-infectious IBS and is the reason I personally have recurrent SIBO.
Testing for SIBO
You can get tested for SIBO either using a breath test, there are a number of hydrogen or methane breath tests out there for SIBO, or test for all three possible gases, including hydrogen sulfide, with the triosmart test, the only one that includes hydrogen sulfide currently. Or stool tests like the GI Map or GI Effects can also point to the presence of SIBO in conjunction with symptoms, when you see many elevated opportunistic bacterial markers or even elevated commensal or good bacteria markers. And you can also see whether certain bacteria associated with different types of SIBO are present or elevated, such as Desulfibrio piger, Bilophila wadsworthia or Fusobacteria for Hydrogen sulfide SIBO or Methanobrevibacter smithii for IMO.
Treating SIBO
So the first round treatments for SIBO are either herbal antimicrobials or rifaximin (the generic name of Xifaxan®), a very expensive antibiotic that only impacts the gastrointestinal tract. And for people with methane-dominant SIBO, the antibiotic neomycin is often prescribed as well. I ended up taking a round of rifiximin, which was 2 weeks long at 3 pills a day after I didn’t feel that herbal antimicrobials had done the trick for me (this was years ago and I have since taken different herbal antimicrobials that have worked better for me). The main drawback to rifaximin is that it will only kill bacteria. And many people I see have an overgrowth of candida (a yeast that’s a normal part of our digestive system) as well from a history of antibiotic use, or from the same root causes that caused SIBO. And while the herbals kill both yeast and bacteria, rifaximin only kills bacteria, which then offers yeast an opportunity to overgrow or overgrow even further.
I should also mention elemental and semi-elemental diets. When all else fails, this is another route for dealing with SIBO that has shown good success. These are liquid diets of predigested nutrients, which seem to work equally well, with the semi-elemental being a bit more palatable than the elemental diet. One study in 2004 of a prescription elemental diet on 93 patients showed a SIBO lactulose breath test normalizing after 2 weeks for 80% of subjects, and 85% by three weeks, with a 65% improvement of IBS symptoms at 2 weeks. But since this requires you eating no real food for 2-3 weeks, I don’t think of it as a first line option, as that doesn’t sound like much fun to most people.
There is also good evidence supporting the use of probiotics in SIBO, but since this is controversial and debated, I’m not going to go too far into the topic right now.
Lifestyle Factors in Preventing SIBO Recurrence
If you’re going the route of antimicrobials, in conjunction with taking them, there are other things you can do to ensure success and prevent recurrence. First, making sure that you’re observing good meal hygiene: trying to eat in a relaxed parasympathetic, or rest and digest state, not while stressed out, working, at the computer, on the run, etc. This will help your body produce the stomach acid and enzymes it needs to digest properly. A minute of 5-5-7 breaths (5 in, hold for 5, 7 out) can help bring you into this state prior to eating if you sense you’re in a stressed state. And then maintaining this parasympathetic state while digesting, which can range from 30 minutes to 4 hours, depending on the size or your meal. Then chewing each bite very well, like 25 times well. And they say not drinking too much liquid with meals, but this is something I struggle with, but you can experiment with that and see if it’s helpful.
Second, not snacking between meals, and spacing your meals out to every 4 to 6 hours. The migrating motor complex stimulates peristalsis, which is how your body moves food and bacteria through your digestive system. When you’re in a fasted state, specifically, when there is no more food in the duodenum, or the first section of the small intestine, it secretes motilin, which starts off the peristaltic wave, emptying out your intestines. This helps clean out bacteria and move them towards the large intestine. This happens generally around 90 minutes after eating but up to 2-3 hours after eating, and lasts around 2 hours. If you’ve heard your stomach gurgling when hungry, what you’re hearing is the migrating motor complex, which is a good thing. If you never hear stomach gurgles, it’s either because you’re eating too frequently, or you have had some disruption to your migrating motor complex.
And then third, trying to have a solid overnight fast of 12, even better 13 hours. Or even longer if you’re trying to lose weight (in 14-16 hour range). This will give your body a good chance to clean out the intestines.
How does my diet impact my SIBO?
And I should mention that with particular types of SIBO, a diet change may be in order. So methane dominant SIBO, or SIBO-C or IMO, tends to occur more in vegetarians and vegans, as the archaea that are dominant in this condition, like Methanobrevibacter smithii, feed on carboyhydrates. And protein sources in vegetarians and vegans, like tofu, beans, lentils, etc. are pretty much all high in carbohydrates. Moving more towards an animal-based diet with higher fats and low in fermentable carbohydrates, like a low fermentation diet or low FODMAP diet is in order. It is possible to do a vegetarian low FODMAP diet, but in my experience, its people on vegan diets who have the most stubborn cases of IMO.
SIBO-D, which is characterized by an excess of hydrogen-producing bacteria, typically responds well to a low FODMAP diet or if you want to get really fancy, a biphasic diet.
And then Hydrogen Sulfide SIBO, which is characterized by an overgrowth of hydrogen sulfide producing bacteria, also presents as diarrhea but with the added benefit of it smelling like sulfur, and often accompanied by visceral sensitivity, which is a lower threshold for pain in your internal organs and excessive flatulence. This is more likely to occur in someone who is on a ketogenic or primarily animal-based diet. So moving more towards a plant-based, low-fat, Mediterranean diet with no dairy but avoiding sulfur-containing vegetables like garlic, leeks, onions, scallions, and shallots and cruciferous vegetables, if they bother you, is recommended in this case.
And sometimes of course there is overlap, because methanogens eat hydrogen, and hydrogen sulfide producers eat hydrogen, so killing off all types of bacteria and/or archaea and their food source (the hydrogen producing bacteria) at once may be necessary to quell the overgrowth.
But note that diet alone will not likely get rid of your SIBO, and all of these diets will result in nutritional deficiencies if followed in the long-term, so doing some other primary treatment while using diet as an adjunct or for symptom relief is generally how I view SIBO diets.
Is my SIBO/IBS autoimmune?
So if you have a history of food poisoning, meaning you’ve ever had unexplained diarrhea, the stomach flu, Montezuma’s revenge or the like, and you’re dealing with ongoing bloating and or diarrhea, you may want to check if your SIBO is autoimmune. And mind you, if you have persistent diarrhea or soft, messy stool, this is also abnormal, it doesn’t have to be full on diarrhea. Autoimmune SIBO almost always tends towards the diarrhea type, rather than the constipation type. It starts because your body starts attacking its own protein, vinculin, that helps with the migrating motor complex, because it ressembles the toxin produced by the offending bacteria – CdtB – Cytolethal Distending Toxin B. So if you’ve succeeded in fixing your problem at least once using antimicrobials, prescription or herbal, and it’s come back, it’s time to determine whether your underlying cause may be autoimmune.
If you are constipated, you should also double check that your constipation is not from H pylori, a bacteria that can cause ulcers and stomach cancer, if you have the virulence factors, because it can also cause bloating and constipation. I like the H Pylori profile from Diagnostic Solutions as a simple H pylori test, although the full GI Map is a more thorough test that includes the H pylori profile and the virulence factors. And don’t assume you don’t have H pylori because your doctor tested you on an endoscopy. They miss it all the time.
So to check for autoimmune SIBO/IBS, there is a test called the ibssmart test that will tell you. It’s $199 and you can order it yourself online from the US. They even show some international distribution of it now as well on their web site but that may require a doctor’s prescription. It will show if your antibodies to vinculin and cdtB are elevated. If vinculin is elevated, you’ll probably have a lifetime battle with SIBO. Then the steps above I mentioned regarding meal hygiene and timing are especially important for you. In addition, you will likely want to start trying prokinetic, or small intestine motility agents, to help your migrating motor complex do its job. I’ll go into those more in a moment.
If your ibssmart test is negative, but are seeing SIBO recur, you may have some other underlying condition that’s at the root of it your symptoms. Some obvious ones are your prescription medications – check their list of side effects and wean off them as directed by your doctor to see if that will impact you. Another is hypothyroidism that isn’t properly addressed with thyroid medications and/or autoimmune reversal protocols for Hashimoto’s thyroiditis. Another common one, blood sugar dysregulation can cause IBS symptoms. If you know that you’re prediabetic or diabetic and do not have your blood sugar under control, then getting completely off sugar and simple carbs, reducing carb intake to 100 grams/day, including protein and healthy fats at every meal and if you’re having any snacks, and including some intermittent fasting in your days or weeks are first steps to reversing that and getting things under control. And of course seeing your doctor and getting prescription medications as necessary. Or a traumatic brain injury or a mental health trauma that’s causing vagus nerve dysfunction could be at the root. If you have a traumatic brain injury or history of concussion, check out my episode 73 with Dr. Corey Deacon, Head Injuries, IBS, SIBO and the Gut-Brain Connection. If you have a serious history of trauma and also experience depression, I’d check out the book Accessing the Healing Power of the Vagus Nerve by Stanley Rosenberg. And if you have endometriosis, or adhesions from abdominal surgery, visceral massage, hormone based treatment, or surgery may be necessary to address it.
Prokinetics for Recurrent SIBO
If you determine that your SIBO is or will be recurrent, one of the best things you can do is take a prokinetic before bed or possible between meals as well. There are some prescription ones, which would require a very SIBO-informed gastroenterologist to prescribe. These include Prucalipride which is the generic name of Motegrity at ½ mg/day, which you get by cutting a pill in half, low dose erythromycin, which is 50 mg, or low dose Naltrexone, which is also often used for autoimmune conditions in doses ranging from 2.5 mg to 5 mg, usually more for constipation. There are actually services online for prescribing low dose Naltrexone where you can talk to a doctor virtually and then get a prescription.
Then in terms of over the counter prokinetics, there’s Iberogast*, which is used before bed, 30-60 drops. It’s a combo herbal product. And then there’s GI Motility Complex (find in my Fullscript Dispensary*), which contains a formulation called ProDigest, which is a combo of ginger that’s formulated to not produce that ginger burn effect but helps with small intestinal motility and artichoke extract, which helps with stomach emptying) and apple cider vinegar powder. Then there are a few more formulations like Motility Activator, MotilPro, Prokine, SIBO MCC (find all in my Fullscript Dispensary*) and Bio.Revive Kinetic. Some of these have 5-HTP which is not just good for your intestinal motility, because it’s a precursor to serotonin, most of which is made in your gut and helps move the intestines, but also good for your mental health, because serotonin is your feel good neurotransmitter which helps for anxiety and depression. These may be more helpful for people with IMO or SIBO-C. And the last one I mentioned, Bio.Revive Kinetic is sold in the UK, not sure about the U.S. has some of the ingredients of the ayurvedic preparation triphala, which is known to be good for constipation in particular.
What to do when my SIBO comes back?
So say you’ve gotten rid of your SIBO and you’re taking your prokinetic but then you notice the telltale bloating, soft stool, diarrhea, or constipation coming back. What to do?
Well you might start by increasing the dose or frequency of your prokinetic. I take mine before bed, but you could also take it between meals. Or you could try a different prokinetic. But if things get back to where they were, then you will probably want to take another course of antimicrobials. I have also seen clients who just give themselves ongoing small doses of antimicrobials on a daily or every 2-3 day basis. For this I’ve heard of them using products like oregano oil or Biocidin drops (find in my Fullscript Dispensary*). Of course the danger with any single agent like oregano oil, is that the bacteria could become resistant to it, as I know that this can happen when treating yeast with oregano oil.
But recurrent SIBO has been my story for years now since I am positive for the antibody to vinculin, which is a protein essential to the functioning of the migrating motor complex, which is what the ibssmart test tests for, so I pretty much have gone the route of just taking another course of antimicrobials whenever things get bad again. But before I do that, I try to curtail snacking, eat a clean diet, stop eating dessert before bed (yeah, I know you probably think because I’m a gut health coach I’d follow my own advice but we’re human right, and I get lazy and self-indulgent like everyone else). But if that doesn’t work, then I know it’s just time to kill off more bacteria.
So if you’re struggling with ongoing bloating, constipation, diarrhea, soft stool, etc. 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 if you think you might like to sign up for a 3 or 5-session package. Or I offer individual consultations as well.
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