Today I’m going to be introducing you to a test that I use with a lot of my clients called the Organic Acids Test and explaining the markers on the test that can tell you about your gut health, excess oxalates and your mental health and give you some insight into how to interpret this test. And then in a future post, I’ll finish it off to discuss the other markers on the test that address your detoxification status, energy production and more.
So the Organic Acids Test is a test I use with most of my clients because in addition to giving insight into gut health issues and having the only reliable marker of invasive candidiasis, it also offers insight into bacterial overgrowths in the gut, other fungi, markers of mitochondrial health and energy production from all the macronutrients (carbs, fat and protein), detoxification markers, markers of excess oxalates, B vitamins, vitamin C and CoQ10 status and the state of your neurotransmitters (serotonin, dopamine, epinephrine or adrenaline, norepinephrine or noradrenaline and more). So it’s an amazing test to get a read on what’s going on in someone’s body and where problems could be arising. It’s also a urine test that can be done at home and can be ordered in most states without a doctor’s order, so that makes it easy and accessible. As far as I know, it is primarily offered by two labs – Great Plains and Genova. The Genova one is called the Organix with an x. But the markers on each are a little bit different. I generally prefer the Great Plains one because it includes oxalates, which aren’t on the Organix, and it has many more markers for fungi, including environmental molds.
So a little history on this test first as I understand it. One of my mentors on this test, Dr. Daniel Kalish, shares this history in most of his videos. He’s been working with Richard Lord, PhD for years to learn about this test and others and how to interpret them and to pass on Dr. Lord’s complex understanding of the body, and I’ve taken a course with videos and webinars from both of them on amino acids and B vitamins. But basically Richard Lord, in addition to developing the GI Effects test, was the first person to think of taking these organic acids tests normally given to infants to make sure they don’t die in the first few days or weeks of life due to certain genetic SNPs or single nucleotide polymorphisms, aka gene mutations, and apply them to adults. So while an infant with a homozygous form of a certain gene (meaning two copies of a mutation) might have extreme effects ranging from severe disabilities to death, adults who are heterozygous (meaning just one copy of a mutation) or only have one polymorphism impacting a given condition (as multiple genes can impact things), may have much more mild effects that only come to light when there are environmental factors at play like a poor diet, lifestyle or just the effects of aging. So the organic acids are metabolic byproducts in urine, meaning the end products of digestion by you or your microbes. And the markers point to the ways in which gut health or other root cause issues are causing dysfunction in the body and at the cellular level. I generally recommend this test to clients also struggling with complex issues like autoimmunity, fatigue, brain fog or mental health problems or who show symptoms of systemic candida infections like sugar cravings, a white coating on their tongue or recurrent yeast infections.
I’m going to be discussing markers on a sample Organic Acids Test, so you’ll want this open as you continue to read. So the first set of markers, 1-9 are yeast and fungal markers. The primary one to determine if someone has invasive candidiasis is number 7, Arabinose, which is the only fungal marker on the Organix. I will generally recommend taking action on that if someone is symptomatic and it’s above the yellow and orange bars, which represent one standard deviation around the mean, which is the black line in the middle. If someone isn’t symptomatic but has a number near the top of the range, like in this example, I will let it go. But if someone had bacterial dysbiosis/SIBO and had a high marker on Arabinose, like this, I would make sure I educated them on antimicrobial products that covered both bacteria and yeast, like most herbals do.
Another set of markers that are different from the candida markers are the furans – 2, 4 and 5. These three are markers of aspergillus, which is typically an environmental mold. When I see those elevated, I recommend mold testing in someone’s house. Number 6 can point to candida or aspergillus.
Then number 9, tricarballylic is associated in particular with a fumonisins, which are a toxin produced by the fungus F. verticillioides (vertasiliodees), which come from corn products contaminated with this omnipresent toxin. So generally when I see that elevated, I suggest people reduce corn-based products other than fresh corn. In this case, eating organic probably doesn’t matter, as it’s an equal opportunity toxin.
Then I’ll go briefly over the remaining markers. So number 1, citramalic, can point to elevated Saccharomyces species or Propionibacteria overgrowth. Although one of the most common probiotics and one I use a lot is called Saccharomyces Cervisiaie subspecies Boulardii (S boulardii for short), some people can have an immune reaction to this strain.
And then number 3, 3-Oxoglutaric, is also a marker of yeast overgrowth. That’s one I commonly see elevated. And 8, Carboxycitric is a general yeast/fungal marker.
Then the next section is the bacterial markers. So the first four (10-13) when elevated, point to bacterial overgrowths characteristic of SIBO or small intestine bacterial overgrowth. In combination with SIBO symptoms like bloating, constipation, diarrhea or soft stool, elevated markers here are a good indication of SIBO, since I generally don’t put much stock in breath testing. But of course when you see that, it’s best to get a stool test so you know if there are other things at play like parasites, or specific pathogenic bacteria like Enteroinvasive E Coli or H pylori, for example. Just treating with antimicrobials when you choose the wrong ones can leave someone with an overgrowth of something even more dangerous.
The other thing about these first four bacterial markers is that they are also metabolites of fruits and veggies and their polyphenols in the urine. So if they’re really low, that’s also not great, because it means that someone isn’t eating the proverbial rainbow as they should be. Polyphenols feed the good gut bacteria, so you want some moderate to higher level of them within normal. And then the last marker DHPPA is a marker of Lactobacilli, Bifidobacteria, and beneficial strains of E. coli, so elevations here are not generally concerning.
The final section on microbes is specific to species of Clostridia that can be pathogenic. Now there is a whole range of Clostridia, many of which are not just beneficial but essential to healthy gut function. So there’s the class of bacteria, Clostridia, which consists of many known butyrate-producers, including the genuses Eubacterium, Roseburia, Butyrivibrio, Coprococcus,Ruminococcus and Clostridium. So you see there’s the genus Clostridia or clostridium in the singular and the class clostridia. Butyrate producers like clostridia are essential to healthy barrier function in the colon, for keeping it anaerobic and feeding the colonocytes, or cells lining the colon. But there are pathogenic clostridia as well under the genus clostridium, like C. difficile, which is responsible for almost 500,000 cases of acute, chronic diarrhea and almost 30,000 deaths a year in the US.
Marker 17, 4-cresol is a marker specific to overgrowth of C. difficile (but also another clostridium called C. scatologenes). However, if you don’t have symptoms like diarrhea, your C. diff is likely still being kept in check by other bacteria, but it’s an important consideration in picking antimicrobials, because you don’t want to start killing off the other bacteria that are keeping it in check before reducing it. But when this marker is elevated, it impacts an enzyme called dopamine-beta-hydroxylase, or DBH in the brain, which converts dopamine to norepinephrine, which will show up later in the test as elevated homovanillic acid or HVA. High urine values of 4-cresol are associated with the most severe clinical symptoms in autism, multiple sclerosis, neurotoxicity, hallucinations, and other neurological and psychiatric disorders, but at lower levels can show up as symptoms of low norepinephrine, like anxiety, depression, ADHD, memory problems, headaches, sleeping problems, low blood pressure and low blood sugar.
Then marker 15, 4-hydroxyphenylacetic acid, can be a marker of various types of Clostridia overgrowth as in SIBO, but also a marker of any type of small bowel disease or possibly elevated because of celiac disease.
Then marker 16, HPHPA, is indicative of another group of clostridia overgrowing, which can cause a derangement in neurotransmitter balance, so I often see issues with neurotransmitters like dopamine and serotonin off when this marker is high. The same is true for 4-cresol as well.
Finally, marker 18, 3-indoleacetic Acid, is elevated when another group of clostridia is overgrown, and very high amounts of this metabolite, which is derived from tryptophan, can indicate that there is a depletion of tryptophan needed for other physiological functions. And tryptophan is the precursor to serotonin, our feel good hormone, which when too low leads to anxiety, depression and problems sleeping, because serotonin is the precursor to melatonin.
So you can see how the bacteria and yeast can start to impact your mental health, and this test really shows you the connection between them.
So the next page of the test shows the Krebs cycle or citric acid cycle, which is the cycle by which your body produces energy. So it’s showing you all the conversions between different organic acids that are on this test. When you have high levels of these organic acids, what you’re seeing are breaks in that cycle, and hence, in the production of energy.
Then below that is a model of the amino acids being turned into the catecholamine neurotransmitters, which are dopamine, epinephrine and norepinephrine – so you see how phenylalanine, an essential amino acid, meaning you have to get it from food, is converted to tyrosine, which converts to DOPA, then dopamine. That then converts to norepinephrine and epinephrine, and you see to the side of the arrow going to norepinephrine the enzyme that catalyzes the conversion, dopamine beta hydroxylase and the nutrients necessary for that conversion, copper and vitamin C. And then the metabolite of norepinephrine and epinephrine is vanillylmandelic acid, or VMA, and the metabolite of dopamine is Homovanillic acid, or HVA. We’ll look more closely at all this when we get to the neurotransmitter section.
So the next page, page 3, starts with the oxalates. And you can see on this example test that there are two oxalate markers that are officially high, and I just want to point out that once you see the orange/yellow bar reduced in size to the left like that and the scale ending, you know the levels are so high that they’re off the chart. Then you should look at the scale and the number you got on the test to get a sense of how high. Oxalic acid or oxalates are a naturally-occurring compound in plants, and they’re especially high in berries, nuts, legumes and dark green leafy vegetables like spinach. So when I see someone put down on their intake form that they eat a green smoothie each morning, I’m always thinking yikes, there could be an oxalate issue. Oxalates are also produced as waste by our bodies, as well as coming from our diet. If the oxalates bind to calcium in our digestive tract, it will be pooped out and won’t cause an issue. But often as people try to eat healthier, they often fill up on high oxalate foods and eliminate dairy, and then they start to get these issues like urinary tract infections or UTIs, because oxalates are little crystals that can make cuts in your urinary tract. They can also deposit crystals in your joints causing joint pain, be deposited in your bone and cause osteoporosis, be deposited in the kidney and form kidney stones, be deposited in the eyes and cause cuts and pain and in the muscles, blood vessels, brain and heart and cause problems in all those places. They can contribute to muscle pain in fibromyalgia, and oxalate deposits in the breast tissue have also been associated with breast cancer. Another source of high oxalates can be a bile acid deficiency. Bile is what helps break down fats, so when it’s deficient, the excessive undigested fatty acids in the diet will be poorly absorbed and they will bind to calcium, preventing it from binding to oxalate and eliminating it. High oxalates in the GI tract can also reduce absorption of calcium, magnesium, zinc and other essential minerals.
So oxalic, marker number 21, is the primary marker of excess oxalates in the diet, but can also be elevated due to dysbiosis from aspergillus, penicillium and possibly candida, or from high doses of vitamin C. However, my favorite oxalate expert, Susan Owens, believes that it’s the other way around: high oxalates can cause elevations in candida and bacteria. There can also be genetic causes of high oxalates. The other two markers, gycolic and glyceric, if low, rule out genetic causes for high oxalates. While oxalates are best known for causing kidney stones, I see lots of clients who have what I believe to be oxalate-related problems who have never had a kidney stone. Some of the most common manifestations I see in my practice are UTIs, joint pain and interstitial cystitis, or frequency or urgency with urination.
High glyceric acid, number 19, may be due to microbial sources such as yeast (aspergillus, penicillium, candida) or due to dietary sources containing glycerol/glycerine, or due to genetic factors.
High glycolic acid, number 20, can also be from overgrowths of fungi and yeast in the GI tract, including aspergillus, penicillium and candida, from dietary sources of glycerol or glycerine, and from a wide variety of bacteria. And glycolic acid can also come from fruits and veggies. According to Susan Owens, when glycolic is elevated, you should look for a B6 deficiency due to ongoing infections, like gut infections, because your body will create endogenous or internal oxalates if you have a lack of B6.
If you’re concerned about oxalates and how to lower them correctly (and mind you stopping all high oxalate foods suddenly is not the way unless you suddenly want have an oxalate dumping event where oxalate crystals start coming out of your body everywhere), you can check out Susan Owens’ web site lowoxalate.info. There’s also a Facebook group called Trying Low Oxalates.
For now I’m going to skip to the neurotransmitters and save the energy production markers for the next post. So skip to the bottom of page three and maker 33, HVA. This is your marker of dopamine. When this marker is very high, it means you’re going through some type of high emotional or internal stress and using lots of your neurotransmitters. When it’s below the mean, it indicates your dopamine production is low. This will happen with long-term antidepressant usage if it’s an SSRI or selective serotonin reuptake inhibitor, because serotonin and dopamine compete for resources in the body and SSRIs increase serotonin. It can also happen when you’re protein deficient, because you need phenylalanine, which converts to tyrosine, to make dopamine. So long-term vegan or vegetarian diets can lead to a dopamine deficiency. You can also have issues with missing co-factors like vitamin B6 that are necessary for dopamine production. Chronic stress can lead to this, but it can also be genetic. When dopamine is very low, you’ll see profound fatigue or physical exhaustion, difficulty concentrating, compulsive behaviors, loss of satisfaction, addictions, cravings, sensation-seeking behaviors including pain-inducing behaviors like cutting, or drugs, sex addictions, or food compulsions, like sugar cravings, because eating sugar temporarily causes a dopamine rush). Low dopamine has also been linked to Parkinson’s, restless leg syndrome and ADHD.
The next marker, VMA, is indicative of low levels of epinephrine and norepinephrine. Because they are converted from dopamine, there are similar root causes and symptoms of low levels, with the addition of a lack of Sam-e or S-adenosylmethionine, a well-known supplement used for depression, which is needed for the conversation of epinephrine and norepinephrine to VMA. Common genetic polymorphisms in the MAO and COMT genes can also cause a reduction in VMA. VMA values that are below the mean but which are much lower than HVA values are usually due to issues with an enzyme called dopamine beta hydroxylase or DBH due to the Clostridia metabolites HPHPA, 4-cresol, or 4-hydroxyphenylacetic acid, which we saw on the first section, or the mold metabolite fusaric acid (the one that comes from moldy corn). So again you see how the bacteria and fungi interact with the neurotransmitters and can cause mental health issues. There are also certain pharmaceutical drugs that can lead to low HVA values, as well as consuming aspartame, or deficiencies of the cofactors vitamin C and copper. If you have low VMA due to Clostridia metabolites or a genetic DBH deficiency, you should not take supplemental l-phenylalanine, l-tyrosine, or L-DOPA.
The next marker, 35, represents that ratio of the two above, so if it’s high, you can see there are conversion issues from dopamine to norepinephrine and epinephrine. Again, this points to a lack of cofactors like vitamin C or copper or the other causes I mentioned above.
The next marker, 36, DOPAC, is an intermediate in the metabolism of dopamine and when elevated, it can be from supplementing with l-phenylalanine, -l-tyrosine or L-DOPA, or because of factors that inhibit the DBH enzyme as I mentioned above. Because if you go back to the image on the bottom of page two, you’ll see that the DBH enzyme is helping convert dopamine to norepinephrine and epinephrine, and if it’s sluggish, then the dopamine will be shunted off to DOPAC, which converts to HVA. So that’s one way to see if DBH is likely an issue.
Then 37, the HVA/DOPAC ratio, will tell you if that final conversion is off, which can point to a lack of Sam-e, needed for the conversion, or a sluggish COMT enzyme, which catalyzes the conversion.
Then markers 38-40 are all about tryptophan metabolism. Tryptophan is an essential amino acid that is the precursor to serotonin. So when you see marker 38, 5-Hydroxyindoleacetic acid or 5-HIAA high, it means you’re using up a lot of serotonin, which can deplete tryptophan, which is needed for the formation of all proteins in the body except collagen, and can be caused by stress or SSRI usage. Levels below the mean may indicate low serotonin production related to long-term tyrosine usage or usage of ADHD medications, antidepressant usage, recreational drugs, a deficiency of tryptophan from a long-term vegan or vegetarian diet, poor absorption, and/or missing co-factors or an inherited deficiency. When you’re low on this marker, you’ll see anxiety, panic attacks, insomnia, chronic pain and digestive imbalances and constipation (because serotonin is involved in moving the intestines, assimilation and absorption, particle transport and fluid discharge in the GI tract). Also, serotonin is released as you eat and is nature’s natural appetite suppressant. So low levels will increase food cravings and lead to overeating and weight gain.
Then marker 39, quinolinic, points to faulty tryptophan metabolism, where tryptophan is being diverted into the kynuerate pathway because of stress or infections, and it eventually turn into quinolinic acid, which is neurotoxic. This will lead to decreased serotonin and its symptoms. The most common source of infections are viral, parasitic, fungal or bacterial infections in the gut or body in general, and the second most common sources of inflammation are chemicals and heavy metals impacting the liver as well as autoimmune disorders. There’s a diagram of this on the top of p. 7. High levels of quinolinic have been implicated in Alzheimer’s, autism, Huntington’s disease, stroke, dementia, depression and schizophrenia, and high levels are also highly correlated with the degree of arthritis impairment.
Marker 40, kynurenic, will be elevated if you’re inflamed, are defending against a pathogen or are deficient in B6 and the result will be a decrease in serotonin. Kynurenic is also produced in the liver, so if it’s low from the liver, that points to a B6 deficiency, but if it’s low because of the brain and stress, it points to neuroinflammation. If you see both kyurenic and quinolinic high, you know there’s inflammation impacting the brain. Then you need to find the source of the inflammation. However, if you see low B6 on marker 51 and high kyurenate but low quinolinate, it’s likely a low B6 problem, not neuroinflammation.
So I’m going to finish the remaining OAT markers in a future blog post, but that gives you a great insight into how the OAT can show you how bacterial and fungal infections in the gut or dietary issues, which can lead to mental health and physical health issues.
So if you’re dealing with either gut issues or mental health issues or chronic all over body problems, the good news is that this stuff is quite fixable. I work with clients using this test to reveal these issues and their root causes and educate you on how to fix them. If you want to talk to me about what you’ve been dealing with and see if I think I can help, you can set up a free, 30-minute breakthrough session with me. I’ll ask you about what you’ve been going through and I can let you know if I think I can help you. I’ll tell you about my 5-appointment gut or autoimmune healing program and you can decide it that seems like a good fit for you. 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.
Dr. Corey Deacon is the co-founder and Medical Director of Neurvana Health in Calgary, Alberta, Canada. He has a Masters in neuroscience, a Doctorate in Natural Medicine and is a Certified Functional Medicine Practitioner. He also holds board certifications in Neurofeedback, Holistic Health and Alternative Medicine. Dr. Deacon’s work with traumatic brain injuries led him to working with the gut.
Lindsey:
Let me start by just asking you what the connection is between traumatic head injuries or concussions and the gut?
Dr. Deacon:
Great question. There’s multiple connections between the brain and gut. There are very fast connections, which are essentially a physical connection between the brain and the gut in terms of nerve fibers. We have a nerve fiber that runs from the back of the neck, down the left side of the neck, underneath our diaphragm and down into our gut. And it innervates actually on a lot of our other organs, but specifically, we’re going to talk about the gut. It’s called the vagal nerve, or the vagus nerve. There’s two divisions of the vagus nerve: the dorsal and the ventral. It actually regulates gut motility. It regulates what is secreted in the gut in terms of enzymes, in terms of our bile acids, stomach acid or everything we need to break down things in the gut so that they can be absorbed. The vagus nerve also plays a role in regulating the immune system. This is a very fast connection, because it’s electrical. This vagus nerve runs in an electrical fashion.
Then, we have a slower connection, that is a neuropeptide connection and this is basically a fancy term for really small hormones that come from the brain and feed down to the gut. Actually two of these are my two favorite hormones in the entire body. One is called VIP; I call it very important peptide. It actually stands for vasoactive intestinal polypeptide. It actually seals the gut up. So we’ve all heard of this phenomenon called leaky gut or if you look at the research, it’s called gut permeability. It’s basically when the cells of the gut open themselves up and this is typically for the immune system to come in and deal with a problem within the gut. The gut is only one cell thick; it’s very easy for components to move from the gut into the bloodstream and into the immune system. This VIP is actually responsible for keeping those tight junctions sealed. Typically, what you’ll see and you’re seeing a lot of research published now on this phenomenon of leaky gut triggered by a brain injury. This happens because these peptide hormones get thrown off and so all of a sudden, you’re going to see the levels in blood of a VIP dropped very low and now the gut can’t seal up properly. This is a big problem.
The other hormone that’s really big, there’s a handful, but I’m going to just focus on these two. The other one is MSH. MSH stands for melanocyte stimulating hormone. It’s a hormone that gets released when we have sun exposure and UV exposure penetrates the arterioles in the skin. MSH is incredibly important for regulating the mucosal immune system. All the mucus layers in our body within our sinus cavity, our oral cavity, our entire gut tract, vaginal tract and urinary tracts are all coated by the mucosal immune system, typically it’s driven by an antibody called IgA or immunoglobulin A. This can be measured in saliva and in stool as Secretory IgA. This MSH, when it drops low from a head injury will now typically cause a low response of the secretory IgA. Now, we run the risk of overgrowing microbes that shouldn’t be there; dysbiotic microbes that we don’t want to be growing. Long story short, there are two connections between the brain and the gut. One is electrical and one is chemical. This is how head injuries can drive problems within the gut.
Lindsey:
Okay, so all this sunscreen… is that hurting our gut lining?
Dr. Deacon:
Sunscreen is hurting our gut lining. Not just because the chemicals that are found within the sunscreen, but even just on a level of light, because we’re not letting light penetrate our skin. UVA light is now found to activate insulin. Right? So what happens if our insulin is not activated? Well, now it can’t join into the receptor properly and we get blood sugar regulation issues. Now we create stress on the pancreas. Now we can’t break down things in the gut because our exocrine activity from the pancreas is low. So yeah, there’s a big connection. And you’re blocking ability to produce vitamin D, which regulates our mucosal immune system as well as this MSH. So yeah, typically what I tell people is: it’s not necessarily the UV light that’s bad. It’s how we approach the sun. We’re not out in the sun when it rises and getting this whole preparation process. We just jumped out there at 11 or 12, when the sun’s at the highest, and you’re going to get burned, right? You want to spend time in the sun around the times when the sun isn’t the highest. Now, typically, we don’t have that problem. I’m up in Canada right now. We do not have a sun exposure problem right now, in terms of sunburn. We need that proper sun exposure. It’s really interesting. You look at the use of sunscreen and when you actually dig into the literature, you’re not even seeing a reduction in skin cancer.
Lindsey:
Not of any type?
Dr. Deacon:
Of melanoma.
Lindsey:
I see my father. He’s got his arms are covered with scars from basal cell carcinomas being burnt off and I’m conscious of what’s going on in the alternative health world saying get your sun. At the same time, I’m thinking I’ve got his genes, and I’m going to end up with arms covered with skin cancers if I don’t watch it.
Dr. Deacon:
You have to be responsible with your exposure for sure. Yeah, for sure. So there is a guy who I love. A lot of his translational research, Dr. Jack Kruse, he’s a neurosurgeon. He talks a lot about this light exposure, and really the biophysics of how that works. I know that’s not really our topic for today but there’s a lot of a lot of complicated biophysics going on, where we do have to be aware and conscious of our light exposure. Yes, we need sun. We don’t want to burn so we want to do it responsibly. So yeah, in terms of the timing of the day that you’re spending in the sun is very important. If you’re prone to burning and you’re consistently burning, it’s a big problem,
Lindsey:
Okay so go out. Get a light tan, but don’t let yourself burn.
Dr. Deacon:
You got it because it’s also a big problem not getting in the sun and that’s actually a risk factor for melanoma. I know a guy, one of my patients, who ended up getting melanoma on his chest. Ever since he was a kid, he always wore a shirt in the sun because his mom was terrified that he would get cancer. He was always lathered in sunscreen and he always wore a shirt. His chest never saw the sun, yet he developed melanoma on his chest. So yeah, it’s important to be spending some time in that sunlight. If you look at the properties of MSH and what it does in the body, how it regulates cortisol, it regulates our sex hormones. It regulates our dopamine and our serotonin, our mucosal gut immune system. It’s really important and you start linng up and seeing, okay, this is why a lack of sun exposure can cause all the problems that it causes including cancer.
Lindsey:
Interesting. Okay, so back to the topic related to the brain and gut. So tell me about electrogastrograms or EGGs?
Dr. Deacon:
Yeah, so this is something that I’m incredibly excited about. Electrogastrogram is a way to actually look at the function, the electrical function of the gut. I’m certified in functional medicine. We’re very adept at looking at stool testing, breath testing, certain urine tests and saliva tests to look at the microbiome and look at the chemical/biochemical makeup, the microbial makeup of what’s going on in the gut. What we don’t look at is the electrical activity and the gut, the brain, and actually every cell in our body is electrochemical, which means without an electrical current or voltage, it doesn’t function. We got this chemical side kind of locked down. Then what we’re missing is this electrical side. I see the same thing with people dealing with brain issues and nobody’s looking at the electrical function of the brain. We’re getting MRIs, ETs, questionnaires and neurotransmitter testing, but I’m not seeing a big component of the electrical analysis. What the electrogastrogram is, it’s similar to an ECG or an EKG that you would get on your heart, where you’re looking at how your heart’s beating or how that electrical function is working. You’ll do this see the same thing with an EEG where you look at the electrical function of the brain. The EGG, or the electrogastrogram is electrical function in the gut. What you can do is put this electrical array overtop of your gut. You can run it through an app on your phone and you can collect the data over a 24 hour period of time: marking down when you eat, what you’re eating and when you have a bowel movement. From that we can actually look at: how is this you know, how is this gut functioning and how is it moving things through the gut. You’ll start seeing interesting things in people that have IBS, that have inflammatory bowel disease. They may have gastritis, GERD or reflux, they may have small intestinal bacterial overgrowth, chronic parasites or fungal problems. What you’ll notice is their EGG isn’t smooth, it’s not moving things in the proper rhythm. The proper motor rhythm is about .05 hertz. It’s a very slow frequency and it’s just slowly moving things through the gut. What you’ll find is a lot of people, it’s actually moving too slowly throughout the entire tract. We tend to call this dysmotility or slowed gut motility.
Lindsey:
Are we talking about the speed of the villi moving things through the gut?
Dr. Deacon:
You got it. It’s called the migratory motor complex. It’s the motor flexes essentially that are happening. It’s like the muscle flexing that happens through that gut tract to move things along the cilia, because of course, different parts of the intestine are made for different things, right? Whether it’s breaking things down, absorbing things, absorbing water; the large intestine’s main job is to absorb water and then of course, to make all sorts of our B vitamins and other things like that via the microbiome. When the movement gets disrupted, you get into trouble. You will sometimes see where there’s just little areas that are firing improperly. Sometimes you’ll even see them firing in the wrong direction. We all for the most part have heard of acid reflux, where we get heartburn, right? A lot of times this is acid coming back up the esophagus. This is actually able to happen all through the entire rest of the gut. It’s just very hard to tell that it’s happening because you don’t get this very obvious symptom of burning in the chest, in the throat. You’ll sometimes get this backwards movement and then you’re always prone to inflammation in that area because you get an overgrowth of dysbiotic organisms that drive inflammation and bacteria releasing lipopolysaccharides, aggravating that immune system and actually even affecting our detoxification.
Lindsey:
So with the EGG, can you then tell the difference between somebody who has low stomach acid versus high stomach acid because I know in the functional medicine world, everybody seems to have low stomach acid, but in reality I’m not sure that’s actually true.
Dr. Deacon:
Yeah, in terms of in terms of pH levels, you can’t get an idea of whether there’s a low or high pH, because that is really determined based on your chemical composition. Acid composition. For us, we typically do a stomach acid challenge. It’s not the best because the gold standard is not to just take HCl and see if you get heartburn, because there’s other factors involved if your mucosal immunity is low. You’re going to feel that that burning very easily and your acid may still be low. What I describe to people as it’s similar to pulling a hot pan out of the oven with really thick, nice oven mitts. You pull that pan out. You can hold it for minutes without even hardly feeling the heat. Now take that same pan and pull it out with rubber gloves. The pan isn’t any hotter, but it sure feels that way. What happens when our mucous layer breaks down in our gut is now we feel the acid. I know you’re very up to date on this research that a lot of people that have this heartburn problem, it actually isn’t even a high stomach acid problem. High stomach acid is very rare. It only happens usually with high gastrin levels, which is the hormone that tells acid to be released. It’s generally a low stomach acid problem allowing overgrowth of microbes.
Lindsey:
So if you actually have Barrett’s Esophagus, that would be indicative of the fact that you have high stomach acid, right?
Dr. Deacon:
Well, that’s indicative of a reflux problem, which is a phase reversal electrical problem up into the esophagus because the valve isn’t closing properly. There’s the esophageal sphincter isn’t closing up properly; it’s not getting the information to tell it to close. Which is a muscle, an EMG, an electrical function. Then on top of that you likely have low mucosal immunity as well. There’s a very high correlation between decreased mucous secretions and Barrett’s esophagus. Because the mucus is what protects us, right? It’s what protects us from that breakdown.
Lindsey:
How can we help that mucus?
Dr. Deacon:
There’s lots of different supplements that can be taken if appropriate. Colostrum, glutamine helps produce Secretory IgA, vitamin A… but typically when I’m seeing something like that, I’m looking at infections. I’m looking at SIBO, H. Pylori and then I’m looking at how are the brain and the gut are communicating on an electrical level because a lot of times you’re going to get this, what’s called a phase reversal, where all of a sudden things are traveling backwards and muscle sphincters aren’t as tight as they should be.
Lindsey:
Yeah. Well, let me back up just a second and ask you about the HCL challenge test because some people may not know what we’re talking about. I have done one, so I know but…
Dr. Deacon:
With betaine HCL, it’s a supplement that is essentially stomach acid. You take a capsule before each meal in a day, and if you don’t get any reactions, the next day, you take two before each meal and then three, four, etc. I tell people to go until they get a reaction or until they hit five capsules, which if you’re at 500 milligrams a capsule, you’re around 2500 milligrams. If you’re still not getting a reaction, it’s pretty obvious you have low stomach acid and you should keep it at dose until you start getting reaction in the form of an acid or burning sensation. What I’ll find, it may take less than the morning, more at lunch and more at dinner. Other people need to take more in the morning, less at lunch and more at dinner and it’s just going to fluctuate. Some people will find they need to take two in the morning, or three at lunch and two in the evening with dinner. That’s the stomach acid challenge. If you have to take more than one or two, you typically have low stomach acid and you’re going to want to be replacing that stomach acid when you eat. If you don’t, you’re not going to break down your proteins properly, which causes them to inflame your gut. You’re going to get malabsorption issues of your proteins and you run the risk of having microbe, bacterial, fungal overgrowth in the small intestine, which causes all sorts of problems. I just had a patient today who came in who had small intestinal bacterial overgrowth that was contributing to her migraines. And so when we just worked with that, getting her gut under control, her migraines went away. It can have a profound effect on the body.
Lindsey:
Okay, so you were talking about the EGG and how it could turn up, in the case of reflux, it would turn up something showing the electrical signal going the wrong direction.
Dr. Deacon:
You got it.
Lindsey:
So what can you do about that?
Dr. Deacon:
There’s a few things. You can actually do neuro and biofeedback techniques to train the nervous system to reorganize that signal. So neurofeedback, this is something that’s really interesting that I got involved with back in 2013. It’s a process of retraining the brain through operant conditioning, which is essentially audio and visual feedback. It allows us to look at functional disruptions in brainwave activity that can contribute to problems with anxiety, depression, epilepsy, sleep problems, pain, fibromyalgia, ADD and ADHD. It’s really come a long ways. It was actually developed in the 70s for epilepsy. What they were actually doing in the 70s was inducing epilepsy in cats. Then they were training this rhythm called the sensory motor rhythm, we call it the SMR rhythm, that is kind of in the central part of you. If you draw a line from your right ear over top of your head to your left ear, that’s your central somatic sensory motor cortex and that’s where this rhythm comes out of. It actually goes and talks down to the top of the brain stem and the cerebellum to elicit motor movements. This is also includes motor movements within the gut. They were actually training this rhythm and it was it was completely reversing epilepsy in cats. It was then taken and transferred into neurofeedback and now it’s blown up into this whole world of assessment and training. You can do the same thing with the gut; you can actually isolate the dysfunctional signal and train it to function better through operant conditioning. Then you can do SMR techniques at the brain if the brain is what’s affecting the gut. What’s really fascinating is when you combine an EEG with an EGG, so the electrical activity of the brain compared to the electrical activity of the gut, you can actually figure out which one is affecting the other. What you’ll sometimes see, and I think the best example is an eating disorder, is actually 70% of people with eating disorders, actually, that the electrical activity in the gut is affecting the brain. This is something that we have thought for years is a psychiatric condition. Now we’re starting to see it’s actually a functional digestive condition,
Lindsey:
Is it possible that it starts as a psychiatric condition, then changes are induced in the gut based on the behaviors like vomiting after eating and that sort of thing, that then cause the problem go in that direction?
Dr. Deacon:
Yes, 30% of the time but 70% of the time, what we’re seeing, because you can actually see what is having an effect on the other. With the brain and the gut, it’s kind of like a healthy marriage. It’s this give and take relationship that needs to happen. As soon as one starts taking control over the other, there’s a problem. You can actually see when the gut is taking control over the brain or when the brain is trying to take too much control over the gut. Actually in more instances than not, it’s the gut taking control of the brain and causing the brain to dysfunction to the point that then the behaviors of eating disorders continue.
You’ll see this with fungal overgrowth sometimes. I don’t know if you ever run into this problem. I do quite quite frequently, where somebody has a fungal overgrowth and they’re just craving sugar, like crazy. It’s the last thing that they should be eating but it’s making their brain feel good. It turns out that aldehyde molecules that come as fungal metabolites (after fungal fermentation happens, they release aldehydes) they make their way up to the brain and they stimulate dopamine release. These aldehydes actually make us feel good at the level of the brain, so it drives our behavior to eat more. This is an example of the fungal pathogens influencing our brain and behavior, to give them a more suitable environment to continue living.
It’s interesting because you’re going to see the same thing happen with gut motility problems because of the dysbiotic organisms that build up in these areas where the motor complex isn’t working properly. And so you will find in this in eating disorders as an example, that now all of a sudden, the brain has been influenced by the gut and the behavior continues. The reason why we actually came across this is we had a couple of people with eating disorders. Typically, we’ve always had good success with them. We had a handful of people we just couldn’t seem to get effect with. We’re looking at copper and zinc problems. We’re looking at the gut and the neurotransmitters. We’re working with neurofeedback and typically, there’s a lot of trauma and emotional regulation problems as well. We’re working with everything, doing all the right things and we weren’t getting anywhere. All of a sudden, we come across the research on EGG and we went, “Okay, you know, let’s take a look at this.” It turns out that the problems were being influenced and it’s actually the gut influencing the brain at too high of a degree. When we actually went and focused on biofeedback and retraining the gut rhythm, all of a sudden, then we started seeing the shift. It was quite fascinating. This was something that gastroenterologists back in the 80s were looking at using, but they couldn’t smooth the signal out; they couldn’t filter out the motor complex from the intestinal reflex through the abdominal muscles. We’re at the point now where we can actually filter it out with technology that we have now. We can filter out the abdominal muscles and see directly what’s coming in from the gut.
Lindsey:
When you’re talking about the biofeedback and retraining the gut and such, what does that actually look like? What is the process?
Dr. Deacon:
Yeah, so what you do is you hook up sensors onto the gut or under the brain, wherever you need to intervene. You will play either a game, a movie, music, or you might just have a little animation that plays when your gut or your brain is facilitating the rhythm that we want to see. One thing that happens with the gut and the brain is it’s always fluctuating. Okay, if our electrical activity wasn’t always fluctuating, we wouldn’t be living; we wouldn’t be able to function. There’s what’s called a normative database. We have these databases of people that don’t have any health issues or any major health issues. We can compare the assessments to these normative databases and then we can look at how far out of that normal range somebody might be. Then what we can do is we can train them back towards that range, so when they’re showing brainwaves that are going back into that normal range or gut rhythm waves, they’ll get feedback in the form of music, in the form of a video or game, that they’ll perform better when they’re playing a game. You can even do cool things like dim a screen when a child’s playing a video game, so you can make it really interesting.
But there’s these couple of regions in the brain called the superior and the inferior colliculi. We don’t call it superior because it’s better than the other, it’s just higher up in the brain. They respond to the audio and visual information. They will then send it to the limbic system, which sends it to the reward system in the frontal lobe or the punishment system in the right frontal lobe. It turns out that the limbic system, which is our system that brings in about a terabyte of information every second to try to make decisions about survival, it turns out that it likes stimulus. Who would have thunk, right? Tech companies have known this for years; our brain always wants more stimulus and this is an area called the amygdala that’s typically in charge of this. When we give the brain stimulus, it’s happy, whether it’s bad or good stimulus. We know this because we see bad news, bad media and these bad things that happen yet, we still want more of that, we want to have more of that feedback. When we remove the stimulus, the brain doesn’t like that. It actually figures out how it needs to adjust itself to get more feedback and it turns out that the only way we’re going to give it feedback is when it’s behaving itself better. When the brain and gut come more into sync and are on a more even relationship instead of one trying to control the other, this is something we call brain-computer interface. The brain learns how to drive the machine; it learns the algorithm and the code that you’re giving it. It learns what it needs to do to elicit that and because of neuroplasticity in our brain’s ability to change itself: what fires together wires together and what no longer fires together, no longer wires together. This is Hebb’s postulate; we actually can break down and extinguish old pathways that were creating the problem and build new healthy pathways that will facilitate health moving forward, facilitate that gut to actually move things through it properly.
Lindsey:
How long do you have to do that to retrain the brain and gut?
Dr. Deacon:
We tend to do about 45 minutes to an hour long sessions. Typically, we’re going to do it two or three times a week. We run people generally through a minimum of 16 to 24 retraining sessions. In most cases that are of mild to moderate severity, that is quite sufficient. The way that we describe it’s like you’re working out and you’re working to lose weight. You’re training your body. You’re training muscle memory. It takes time; it takes repetition. We get that foundation and then typically, people will maybe do one every session every week or two to four weeks. Can continue that just as a maintenance type program; we do have a lot of wear and tear on our brains through mental emotional stress, through physical stress, when we do have a lot of wear and tear on our on our gut as well in terms of environmental toxicants, in terms of dietary contaminants, biotics, medications, etc. We do typically put people through maintenance sessions as well. We’re hoping in the next year to two years for us to actually have an at-home system developed for the gut, particularly. The gut is a lot simpler. I mean, it is complex, but in terms of its motor rhythms, it is a simpler animal. We hope to have something like that to be able to bring it to an app and the cell phone. And people can do this type of training at home. There are actually options for neurofeedback at home training right now. If it is a brain driven issue, people can get units that they can actually do at home as well. We know that health is a long-term maintenance policy. That’s sometimes what’s required.
Lindsey:
When might people develop these kinds of problems in their gut with the going the wrong direction or wrong speed?
Dr. Deacon:
What we’ve seen is emotional and physical trauma. Emotional trauma triggers long-term issues with something called the dorsal-vagal nerve division. We have two divisions of this vagus nerve: one is the ventral and one is the dorsal. It means that the dorsal is higher up and the ventral is lower down on the brainstem. When we’re in a joyful, exciting, motivated type of a rhythm, we’re happy; we’re content; we’re relaxed; we’re in a rest and digest state, which is also called the parasympathetic state, also known as the ventral-vagal state. When we get chronic stress of any sort, this could be an emotional trigger or it could be a physical trauma that happens, we can actually head up into the dorsal vagal state, which is actually through the fight or flight state into this other division, which I call freeze or appease. It’s the fainter, the play dead response. Essentially, when that happens, motility virtually shuts down in the gut, but it doesn’t shut down everywhere. The gut will pull resources to where the most important areas are at that time and the other areas will go sluggish. If you’ve had a head injury or anything else that can cause a vagal nerve encephalopathy (encephalopathy is just a fancy term for nerve dysfunction or brain dysfunction) but when there is a nerve encephalopathy or neuropathy, it doesn’t function properly. Toxins are notorious for causing this, like a mycotoxin or mold toxin problem. Stealth chronic infections will cause this as well, so you’ll see it with Lyme and coinfections. I particularly see it a lot with a Bartonella infection in the gut. What happens is all of a sudden, the gut doesn’t have the energy that it used to. The energy resources are being directed elsewhere. It only has so much; it’s kind of like it’s living off of scraps. The energy is directed to parts of the gut that are needed. Typically higher up in the gut, lower down in the gut for bowel function you’ll get a lot of areas where all of a sudden, they’re not firing at all or they’re wanting to fire backwards, because it’s actually easier for the gut to move things backwards or stay still did from an energy perspective. One of the things that I’ve found with phase reversal, which is a fancy term for when things are traveling the wrong direction in the gut, back up the gut instead of down, is head injury. There’s so many different manifestations of the dysfunction that will happen to that vagus nerve. We don’t know exactly where it’s going to happen, but we can see where it has. If it tends to move around, you know that there’s typically a toxicity or an emotional trauma. If it tends to stay in the same place and the problem’s always in the same area in the gut, typically I’m looking at the physical injury phenomena.
Lindsey:
These ares where it is is something you would know from the EGG, right?
Dr. Deacon:
You got it; you got it.
Lindsey:
You couldn’t just feel like, “Oh, I always have a problem here in my gut”?
Dr. Deacon:
You can, but we like to measure it so that we can actually have something objective to go off. Then we can see if we’re actually improving. There’s a point you start working with people and you might not see improvement in four weeks; subjectively where symptoms are getting better, but you might be able to see that you’re at least on the right path. Sometimes it does take a little bit of time and so we always want to know: are we on the right path, are we actually getting changes or are we just stuck because if we’re stuck, we need to look under another rock. Yeah, it’s something you could tell. Like I remember when I dealt with all my head injuries, it was always lower gut right in the middle of my abdomen. You could tell that it was lower small intestine, I had a fairly good idea. But what I didn’t have a good idea of was, is it just not moving, is it just inflamed, is it phase reversing and so there’s different approaches depending on what is actually triggering those problems.
Lindsey:
If somebody came to you with IBS and no history of head trauma, what would you start with in terms of testing? Would you start with the EGG or would you start with a stool test or something else?
Dr. Deacon:
We always start with an EEG, and if it is a gut complaint, an EGG. I want to see what the electrical function’s doing because the chemical problems that go on have an effect on the electrical system and we can predict that. I can actually start figuring out if it is just something that is gut centered or whether it is a peptide problem. I never take people’s head injury reports as gospel because so many people forget that they’ve had head injuries. You would be blown away by how many times I do that in my intake: have you ever had an injury, and I’ll usually ask about four or five different questions: ever had a whiplash injury, ever had a car accident, etc. No. Then I asked, when you’re little, did you ever hit your head? It’s like, oh, yeah, I fell off my swing set when I was little and I landed on the top of my head. Does that count as a head injury? Yeah, it does count as a head injury.
Lindsey:
I don’t think anybody’s not had a head injury by falling down and hitting your head while you’re little.
Dr. Deacon:
That’s right. Little things like that they can add up and they don’t always trigger issues right away. Personally for me, I played football and hockey and I had never formally been diagnosed with a concussion. I think this is important for listeners to know is you don’t have to have a diagnosed concussion to have a problem with brain injury. So especially if you’ve had multiple hits to the head. It actually only takes about a 10th the amount of energy or force to injure the neck as it does to get a concussion. If you have enough injury, enough force to injure the neck, you have enough for us to actually mess your peptide hormones up and your vagus nerve. I actually just had somebody come in for an initial, right before I started talking to you, and she’d had a car accident, diagnosed with a whiplash injury. They were very careful to tell her that she’d never had a concussion. It was not a head injury; it was only a neck injury. She’d kind of gotten away completely from even thinking that this could be a head injury problem. Migraines triggered a month after and gut problems triggered six months after and nobody was connecting them for her. So as soon as we did our assessment, I looked at everything. I mean, right away, you can tell that neck injury triggered a vagal nerve dysfunction and you could see from the EEG and the EEG exactly what was happening. She’d never made the connection because she was told, well, I didn’t have a concussion. You don’t actually need a concussion to trigger these problems. Subconcussive blows, which is a fancy term for a blow to the head that didn’t actually cause concussion symptoms, that is actually enough for us to cause the problem.
Lindsey:
Well, now that you’re talking about this, I’m thinking my son had a concussion about a year ago and he has periodically had headaches that I think of as migraines because he’ll say they’re really pounding hard and I don’t actually know if they’re fitting the definition of migraine but here in the US, in Arizona, should I should I him in for an EKG… what’s the one for your head?
Dr. Deacon:
Yeah a quantitative EEG. That’s what you want to look up. If you go to bcia.org, you will be able to find practitioners in your area that are board certified in neurofeedback. They may even be diplomats of quantitative EEG. You want to go into there and then look at the clinics, look at their websites, give them a call and make sure that they’re doing a quantitative EEG. That will compare his brainwaves to other boys his age and you’ll be able to start seeing if there are communication problems. We use software called neuro navigator that actually can see cerebellum. The cerebellum is an area that sits kind of right behind the occipital lobe just above the neck, really important for balance and coordination. If there’s an asymmetry in the cerebellum, it is almost 100% the chance that this is brain being affected by a head injury. These things don’t always reverse on their own. Even though we might get better functionally and symptomatically, the brain doesn’t really have an idea of what its baseline is. It’s a machine that reads what’s happening in the environment and then creates perceptions and reactions. It doesn’t always know like, hey, I’m not functioning like I used to be. I should function this way, not the way I am. It doesn’t have that feedback. All it does is it gets shocked, it gets hit in the head, you get shearing of white matter and communication problems and it just keeps continuing, adapting that way because it has no information to tell it that is not how it should be functioning. This is where neurofeedback is incredible, because we actually have the ability, it’s like putting a mirror in front of our brain and going here, this is what you look like. It’s like to say to people, it’s kind of like trying to shave without a mirror or try to put your makeup on without a mirror. You can do it, it just might not look pretty at the end of the day. Whereas when you can use neurofeedback, your brain gets that exact feedback. It’s like looking in a mirror and it goes, oh, okay, I’ve got to adjust myself this way, and you can actually get to get that those pathways to reorganize themselves. Then there’s usually less of a need for medications as well, if anybody’s on medications, which is very cool.
Lindsey:
Okay, so back to the gut. If you go through the neurofeedback process, you fix the migrating motor complex and everything’s running smoothly, will that take care of SIBO or Candida overgrowth and things by itself or will you still need to use medications to get rid of those?
Dr. Deacon:
Yeah, great question. Some people yes; that is enough for them to get it under control. Other people depending on how well it’s laid itself down, if you’re speaking particularly about SIBO, it may still require treatment. The nice thing is it won’t recur; the chances that it will recur and come back are very low because you’ve actually dealt with the reason why it was able to grow in the first place. Now, there’s still stomach acid and that sort of thing. That’s the other cool thing is you’ll see people with low stomach acid, all of a sudden, their gastrin is working properly, which is a peptide hormone, known to be affected by head injury tends to drop low. The gastrin regulates; so now your stomach acid, your natural production actually starts working better.
Lindsey:
Do you use the IBS smart test at all that can tell you about the antibodies to vinculin and anti CDTB antibodies that cause problems to the migrating motor complex?
Dr. Deacon:
I’ve seen the test itself and I’ve seen some of the research. I haven’t actually started utilizing it yet but I am meaning to. I just like to really dig deep into things and know as much as I can before I start integrating them. I’ve seen it. I think it’s great.
Lindsey:
Yeah, I’m just wondering if you have that autoimmune post food poisoning problem in your intestines, whether you could still use the neurofeedback to repair the damage.
Dr. Deacon:
Yes, and so this is interesting. It depends. What I see is what I call illness trauma. When people all of a sudden lose their health, it’s traumatizing. If that trauma lays itself down and the switch gets stuck on in the brain, the limbic system, it will actually cause the immune system to fall out of balance. The immune system, I like to say, is like a three-legged stool. If one of the legs gets too short or too long, all of a sudden the stool is off balance, and if it gets way too long, or way too short, the stool falls over. This is what happens with autoimmune reactions is you get one or two divisions of the immune system cranking themselves up and another division going too low. I investigate what might be throwing that out, because oftentimes a head injury or food poisoning is the trigger but there’s something else within the terrain of the body that’s allowing that reaction to continue. You’ll see the same thing in PANS and PANDAS, which is a pediatric autoimmune reaction, that’s a neuropsychiatric syndrome from strep infections. That’s the same thing. It’s like the strep infection was the trigger, but there’s a milieu or the underlying terrain within the body, something else is going on that it’s keeping that immune system out of whack. One of those things that will do that is trauma. If the trauma response or the trauma switch is stuck on in the body, that immune system will stay completely out of whack. I’ve seen some interesting cases of this. I haven’t run the smart test for IBS yet to see if this is happening, but I have seen cases of Hashimoto’s, which is the autoimmune thyroid, where when we address the emotional component of their illness (they worked with a psychologist doing some trauma-centered therapies), their autoimmune reaction went away. They’re very interesting but if you look at the effect of the limbic system on the innate immune system, it makes sense. When it’s active, it upregulates all these inflammatory cytokines: interleukin 1 and 10, tumor necrosis factor alpha, your TGF beta, C3A’s, C4A’s and now you can get all sorts of activation of microbes. Your immune system, if it’s not balanced, you’re going to be in trouble.
Lindsey:
It’s all so complex. I’m sure that people listening are thinking, wow, now there’s 1000 different ways I thought I needed to approach this problem. And here’s one more. For people who are interested in maybe getting an EGG for themselves, you’re in Calgary, do they need to come see you?
Dr. Deacon:
No, people do not need to come see us necessarily; a lot can be done through a distance now. We do see people from all over North America; some people opt to come up here, just to do the initial assessment and initial testing. We can ship things to people, test kits, EGG machines, etc. We can also coordinate with people who may be able to run and collect an EEG near them. So like you said, you’re in Arizona, you know, we’re happy to help facilitate with clinics down there: get the raw data from the EEG, or if somebody is doing EGG; there’s very few people doing it; we can get the raw data and we can help people work out different protocols and things that can be done. We do offer, if anybody’s interested, a 30-minute complimentary phone consult with a health care advisor in our clinic. They can actually just book a 30-minute comp. call and we can talk about what they’re dealing with and maybe help them figure out what a good direction is for them; maybe decide are they the right fit for us and if you are, then yeah, we can talk about how we can work at a distance or, or like I say, some people are just wanting to come to get the initial assessment and go from there. Retraining, though obviously, it would have to happen up there over an extended period of time. It would be pretty tough to do if you lived far away. Yeah, so again we’re trying to coordinate with clinics that are near them.
Lindsey:
Yeah, who else does this in the US? Do you know? The EGGs?
Dr. Deacon:
Neuro and biofeedback is pretty much everywhere. There’s 1,000s of practitioners within that realm. If you go to www.bcia.org, you can see where all the practitioners are. Some people are doing biofeedback, neurofeedback, and different types and there’s a lot of different software and that sort of thing. We can help find someone that might be appropriate for them. The other thing that people will do too is come down maybe for a week, come up to see us for a week. We just do an intensive program at that point and then they might do that a couple times a year. That is an option as well.
Lindsey:
But the EGG, are there other people in the US who are doing those?
Dr. Deacon:
The only place that I actually know of and this could be obviously there’s others, but the only people I know of is at the University of California, San Diego. The guy actually to get in touch with there is Dr. Todd Coleman. They’re the ones who’ve rejuvenated the research on all of this and are developing some amazing things. But I would just run a run a search electrogastogram or EGG in your area. It’s not really heavily marketed and advertised. So it might be something you can find and then we can always take a look at the raw data as well.
Lindsey:
Is this prohibitively expensive test or what’s the cost on that?
Dr. Deacon:
It’s not at all actually. We include it in our initial assessment. I mean, it probably has a base cost of around $50 to $100. It’s really not overly expensive. We weighted it around the $100 Canadian mark, including time spent going through the data.
Lindsey:
Yeah, so if somebody wants to order it from you, it costs how much.
Dr. Deacon:
I would essentially price it at $100 Canadian.
Lindsey:
Okay, well, yeah. Not bad at all. Okay, so I think this is a lot of information for people to absorb in one podcast. We should wrap it up, anything else that you wanted to mention that we didn’t talk about?
Dr. Deacon:
Lots of things, but not on this topic. I always I always find it fascinating just how interconnected everything is. We started talking about the gut and all of a sudden, you can’t only talk about the gut anymore, because there’s influences from all angles.
Lindsey:
This is interesting, because you’re the first guest who’s talked much about the brain with regard to the gut. This was good new material for our listeners.
Dr. Deacon:
Great. Yeah, I would just add, if you’ve had injuries in the past, whether or not your symptoms were triggered immediately after, maybe it took years before they triggered; it’s definitely something to keep in mind. It could be affecting the problems within the gut.
Lindsey:
Okay, great. Well, thank you so much for this information and I hope maybe to have you back on some time to dig in deeper.
Dr. Deacon:
That would be great. Thanks so much for having me. I had a great time.
If you’re struggling with from IBS, SIBO or other gut health issues, 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 gut health coaching 5-appointment program 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.
Einar Jordan has Associates degrees in chemistry and microbiology, a Bachelor of Science and a Master’s in Project Management. He is a quality and process engineer currently working as a Project Manager in Research & Development in the biotech industry. He has worked for over 25 years with Tissue, Medical Devices, Pharmaceutical, and Biologic companies in different capacities. He has done repeated fecal transplants on himself using his son’s stool to address various conditions including interstitial cystitis and chronic bladder pain, fibromyalgia, IBS, histamine intolerance, chronic tendonitis, joint pain and hair loss.
Lindsey:
So as I understand it, before resorting to a fecal transplant or FMT, you had already done a lot of things to address your health issues. Can you just give me a brief synopsis of when your health went downhill, why and what you did to address it up to the point of doing FMTs with your son’s stool?
Einar:
Okay, my health probably started going down around age 10, but it was not really noticeable until about 2006, when it really hit me like a ton of bricks. I developed interstitial cystitis of the bladder; they still call it today prostatitis, but it does not seem to have a significant link to the prostate. Eventually, with time, I started developing IBS, fibromyalgia, etc. So every couple of years, I was developing something new. The tendonitis was so probably before even the IC of the bladder, and my eyesight started deteriorating. I needed to have new glasses every year or two years; then my blood pressure started skyrocketing; triglycerides; I was prediabetic. I lost all my hair. The list… it’s hard to even remember the list of things that I was developing. I did not think I was going to live this long.
Lindsey:
TMJ, I think was another one on there.
Einar:
Yes, TMJ was probably one of the last ones. I thought I had an ear infection. So to treat this condition, I had to take Clonazepam for five years, which is an awful medication. I mean, it saved my life for that period of time. It allowed me to sleep. Eventually, your mental health starts to deteriorate and I had chronic anxiety and depression as a consequence. I had it before, but it got much worse, around four or five years.
Lindsey:
A lot of people may not know all these abbreviations or even what these conditions are about, but just briefly, interstitial cystitis is like urgency and just sort of a constant feeling almost like having a bladder infection, except that you don’t.
Einar:
Yes, you have to go to the bathroom about 50 to 60 times a day, so every 15 minutes or so. You feel like your bladder is full of blades and battery acid. You lose your ability to sleep, you start losing your mind very slowly; it is a horrible condition. I have a PhD in pain.
Lindsey:
Okay, and then TMJ stands for… what is it? Ten…
Einar:
Temporomandibular joint (corrected). I think it is sort of an arthritis condition of the jaw, where you feel like you have an ear infection at the same time as very bad discomfort in the jaw. Every time, you try to chew things, your jaw really starts getting inflamed. This kind of arthritis of the jaw.
Lindsey:
Okay and fibromyalgia. Talk a little bit about what the symptoms of that are like.
Einar:
Fibromyalgia, they sometimes call it separately, so brain fog, but it is pretty much a part of the same thing. You feel like you’re burning and you lose your capacity to process thoughts. You think very, very slowly. You’re exhausted all the time. You have very, very little energy. I never had chemotherapy, but that exhaustion that you get from chemotherapy and that weakness, it is something sort of like that to give you an image.
Lindsey:
Okay, and so when you say burning, you’re talking that your skin feels like it’s burning.
Einar:
Yeah, your skin and your muscle. For me it was the upper shoulders and arms. Anytime I lifted a 10 pound weight, I’d be exhausted for days, I’m burning.
Einar:
Okay, so go on with your story about what you did about all that.
Einar:
So when I try, because I come from a scientific background, I’m able to read a lot of research articles. I started doing experiments on myself based on whatever came out. If there was some medication that came out, I would immediately try to convince my doctor and I’d show him the research or how this is helping, but everything at least on me, was not helpful whatsoever. I even did some things for me because I had a pneumothorax, which means that my left lung collapsed at a very early age so it had to be stapled shut. I tried hyperbaric chamber therapy and that made you feel a little better for a little while, but it was short lived.
Eventually, some people figured out that dairy was the biggest cause of fibromyalgia. And it seems to be dairy. A big issue for at least most people that I think the theory is that lactose buildup puts pressure on the vagus nerve, so I cut out lactose. I started feeling better. My doctor kept on telling me to eat less meat and less fat and that just got me even worse, so I did the opposite. I actually ran into Michaela Peterson’s and Jordan Peterson’s story of how they healed themselves from multiple diseases with a carnivore diet. I did a keto diet; that was very helpful, then a carnivore diet was even better, but still I was unable to process foods because most of these conditions are very high histamine intolerance. My theory is that the histamine intolerance is due to the fact that the food is not being processed through your body, so it’s rotting. If you tried to eat more food, the higher the histamine, so I run into an IBS study, because the IBS was now driving me crazy, that they were successful for six months to two years doing an FMT and I decided to give it a shot.
I couldn’t figure out where I was to find the healthy donor. Then it dawned on me that, you know, I subconsciously was raising my children to have a better than average immune system or a microbiome. By feeding them very low carb diets, making sure they’re breastfed much longer. There were also vaginal births. There are all these conditions, all these things that improve the person’s microbiome, and keeping them away from antibiotics. I decided to test my son and it was very, very stressful. I tried to tell everybody that even if I am used to doing experiments, I normally, even if I do them on myself, I normally never experienced this level of anxiety. Within two hours of conducting the FMT and I used capsules for the fecal transplant; I use enteric capsules. I have people call me and this is not a simple thing for a lot of people; they get desperate and they make a lot of mistakes; it’s an incredible number of mistakes they’ll make. Within two hours, the constant bladder pain just stopped. The IBS kind of progressed later on. It got better about a day or two later because when I did the FMT, I had a little diarrhea and I started testing on day one on two different things. Alcohol was something I could not touch; very few types of alcohol; very little amounts. I tested red wines, stout beers, pistachios, dark chocolate, coffee, within moderation; I have very small amounts, which I could not tolerate before in any way or form. And I was able to tolerate them as soon as I did the FMT. So I did the FMT 10 days in a row. Each day, I consumed via capsules, a solution of 50 grams of fecal matter, which I separate from the solids.
Lindsey:
Okay, and that was how many capsules?
Einar:
The average I’ll say is about 100 capsules a day; 0.8 milliliters per capsule, that you feel very bloated.
Lindsey:
Did you do those all at once, or like throughout the day?
Einar:
The protocol I recommend and I want to specify that I’m not a doctor, not a nutritionist. To make sure that the capsules release in the intestine, I fast for 16 hours, because food can interfere with the process, it could delay it. They could accidentally release in the small intestine or in the stomach, and they can make you sick. I accidentally made this mistake three months later; I had a full stomach, I was like well, let me take a couple of capsules, and I gave myself SIBO, which you do not want to give yourself SIBO. It is a horrible condition. I was able to reverse it. It took me about a week to reverse it. I want to emphasize this, it is complicated. It’s not that simple. For every day and I took a break of one day or two days within this 10 day period. It was a 12 day period. Again, my son produces fecal matter usually every day but not every day. So there were two days he didn’t produce, so I didn’t do this.
Lindsey:
How throughout the day, you’ve said 100 capsules, are you taking these all at once? Are you taking these like in three batches or how did you do it?
Einar:
No, I sit in my bed, well back then it was my bathroom. I have a very large bathroom. I fill each capsule and I consume each capsule immediately. I consume it within less than an hour. I processed and consumed within less than an hour. I think two hours is still okay, but you want to take the microbiome as fresh as possible, if you have the ability to do so.
Lindsey:
Yeah, but most people don’t have a donor who’s right there in their house ready to give each day. You’re not freeze drying or anything, you’re taking a solution and presumably have some sort sterile way of getting the solution into the capsules without spilling…
Einar:
Yes. Well, the challenge that the biotech industry has with this procedure is that we are used to being in a sterile environment. And this is the dirtiest thing you can possibly imagine within the biotech industry. It’s poop. There are 500 bacteria species and 90% of our DNA is basically bacteria species. This could explain probably why we have more DNA from the mother than the father, because we inherit all of these species when we’re born. One of my many crazy theories. I fill each capsule because the enzymes of the FMT will start dissolving the capsules from the inside. At the same time, the acid in your stomach, could probably put some pressure on the capsules. Then, once he hits the colon, then it releases. And if you’re healthy and if you can process food fast or normal, fresh capsules are not a problem. If you have a slow digestion, I normally tell, when people call me and ask me for my advice, I say, “Well, I would personally do an enema if I’m constipated”, but if I am digesting very fast, I do capsules and I would fast 16 hours before, and not eat anything for two and a half hours. Part of the biotech industry testing for any product is we take whatever you consume, it’s called the acid simulation or the stomach simulation test. You take a strong acid, I’ve got a swimming pool, so I got the acids from a swimming pool and I put the capsules in it. The capsules will last in a stomach acid for a long period of time but that does not simulate the pressure your stomach will put on or your colon areas that are going to put on the enzymes that are there. That’s why when I do it fresh, I do it within very quickly for any type of capsule. And the frozen they normally have to use a double capsule to prevent them from falling apart. If you actually put it in, you will see within two or three minutes, the capsule, once you put the fecal matter in the capsule, the capsule starts dissolving from the inside, they start getting soft. So I just fill them, take it and when people call me and ask me for details I say, “You don’t sit and do 10, you do one. If you’re really sterile, you do two or three, and if you can swallow three at the same time, sure. If you can’t, do one at a time.”
Lindsey:
Okay, but do you have some sort of a capsule filling system to make sure there’s no fecal matter on the outside of the capsules is what I was getting at?
Einar:
Oh, yes. I use a syringe with the blunt needle to make sure that all the drops go in. Sometimes I use a pipetter. After 25 years working on many, I have the dexterity of a god. I was born in a veterinarian’s house because as a child, I was mouth pipetting from age 5. I’m actually very good at dispensing things. Again, the normal person might not have- it sounds like I’m exaggerating. No, it is actually hard to dispense and pipette. People have to go through extensive training to do this for years.
Lindsey:
Let me stop you for a second; you said you went on the carnivore diet. What changes did you see from that versus the ones you saw after doing the FMT?
Einar:
They were very similar. They were a little slower. For the carnivore diet, it took close to a week to start feeling the pain stop in the bladder. The fibromyalgia also went away, the IBS did not.
Lindsey:
Was your IBS like a IBS-D or an IBS-C?
Einar:
IBS-D. I mean it started with a C probably earlier on but usually in most people it’s then progressing to a D, but it is possible that mine might have not been as much IBS because a high fat diet makes you very regular. Some people take nine months to a year and a half for the stool to solidify. I did it for six months and then I added some carbs on and off, but in most conditions, tendonitis improved significantly, my hair started growing and my eyesight started getting better. I don’t remember when my graduation was, but it improved by 50% so where I needed to see you before with glasses, I don’t need them now for long distance. I only need them for reading. I’m still shocked, and they are sort of things that I didn’t list that were unexpected. Some people ask me, “oh, well, maybe what it was, it was in your head. It was a placebo effect. I’m like, “I used to bite my nails since age 10. I was constantly biting my nails. I won’t bite them anymore.” When I came off Clonazepam. I had a hat fetish. I could not leave my house or be anywhere without a hat, including inside my house. I have a 30-hat collection right now. All of a sudden, within two hours, it took me a week to realize that, hey, I’ve been a week without wearing a hat. It was a very odd thing. So I have some theories about the nail biting, it’s that your body is so starving so much for this bacteria that it is looking for any dirt under your nails to pick it up in your stomach.
Lindsey:
Interesting. Okay, and then some other things that you had put on the list for me, high cholesterol and triglycerides.
Einar:
Oh, that disappeared with a carnivore diet. I was shocked.
Lindsey:
HBP, high blood pressure, was it?
Einar:
Well, sorry, my blood pressure did not change a lot. I’m not sure if it’s because I was not eating enough salt and I was having the occasional drink. About a few months ago, I did quit cold turkey, alcohol, or at least like cut down to a significant level. This is the problem with FMT. Everybody wants to go party the moment it works and live again. You feel you want to be normal; we all want to be. I went to the doctor and my blood pressure was 190/50 about a few years ago. I went to the doctor about a month ago, and it was low: 120/70. I think it was, which I was like, I haven’t had that blood pressure since I was in my late teens.
Lindsey:
Oh, so you were saying it was 190 before?
Einar:
Yeah, well, 150 or 190.
Lindsey:
Okay, because I thought you said 90, which I had blood pressures taken like that that were 90/50 and the people were a little bit nervous. They’re like, is it usually that low?
Einar:
I work with a lot of pathologies, that I’m not a pathologist or a doctor. I do remember that there is a significant difference between women and men on blood pressure and it may be also diet related. I’m not sure.
Lindsey:
Yeah, no, I’ve had doctors tell me eat more salt.
Einar:
Yeah, you know. We’ve been told that salt was horrible for us and I nearly cut off all salt and my blood pressure did not drop. I’m eating fistfuls of salt. And my blood pressure is beautiful.
Lindsey:
Yeah, I tend to think of high blood pressure along with the entire spectrum of metabolic syndrome, prediabetes and I think high cholesterol goes along with that. So your prediabetes, that also resolved under the carnivore diet?
Einar:
Yes, yes. It improved significantly; it went away. I don’t get those blah after you have a meal. I can run all day. Let me go back a second, I did a whole video on the night after. I was feeling a bit of anxiety and I thought it was a lot of anxiety what I was feeling when I did the FMT, but because I had that surgery on my lung, I can tell changes in my breathing pattern better than most people. So I felt my lungs started stretching. I had free breathing abnormally compared to how I was breathing normal, not abnormal, but I always been breathing abnormal, so I couldn’t tell the difference. What I realized is that, children breathe through the diaphragm, so all of a sudden, I’m using my full lung capacity, I’m standing straight, like I always had like a hump, and scoliosis. All of a sudden, I’m standing super straight. Same thing happened with a carnivore diet, you start standing a lot more straight than before, your muscle mass and tone improves significantly. I’m breathing and I’m only needing to sleep 4 hours. I’m all wired, like a two year old running around the house with so much energy. I wrote like a 30,000 page book in a week. I have come down since, but those 10 days of FMT were just…
Lindsey:
It was like Superman.
Einar:
Yeah, and with the carnivore diet, your sleep pattern gets reduced because you get better quality of sleep. You don’t need to sleep 12; I used to sleep 12 hours today and I was exhausted. Now, four-six hours I can. I’m trying not to run a marathon because I’m done with that, but…
Lindsey:
Feeling so good, okay, and so just to differentiate between the carnivore diet. It sounds like you did the carnivore diet and most of your things cleared up, but then you started eating some more carbs and then maybe some of those things were sort of coming back? What was coming back or what was still an issue at the time you did FMT?
Einar:
One of the problems with a carnivore diet for me is that I didn’t have the right bacteria to process some types of meat. So I couldn’t do dry meat, aged meat and a lot of different meats that are higher in histamine. I had to basically eat raw beef almost. I seared it 30 seconds per side. That was it. It’s not the worst life but it’s not the greatest either. When I did the FMT, it allowed me to process all these other meats I couldn’t eat before and occasionally cheat and have a normal life. I can go out and I can have sushi, and I don’t have to just eat the sashimi. I can add some rice to it. I don’t have to pay for it heavily. I’m trying not to do that every day because my research indicates that human beings are not supposed to eat as much carbs as we’re eating now. That’s seems to be the root cause of all these illnesses, or at least what then starts the illnesses progressing. That and antibiotics seem to be the issue. The carnivore diet was very interesting in that it helped me improve, but the quality of life was not the greatest when you can’t do a social life. Eventually you get bored and blah of eating fat and lard. It’s just… you need at least a day off once in a while.
Lindsey:
That sounds pretty miserable. How did you assess your son’s fitness as a donor for FMT?
Einar:
Well, I developed a very long questionnaire and probably won’t bore you with every detail, because I don’t have it open and it’s hard to remember every single step of it. I developed this for a couple of tissue banks in my career, where you have to assess a donor. It’s not just blood work, that does not tell you what the microbiome is like. The microbiome is associated with pretty much everything. If you’re losing hair or your hair is thinning, that’s a microbiome issue. If you don’t have good muscle tone, microbiome isssue. Your eyesight; your skin. I looked at my son and the first thing is okay, how was he born: vaginal birth. Ding ding, that’s a good one. Breastfed through it was one year and eight months. I exposed him to dirt and that’s a huge thing for children right now. They’re trucking, I can’t remember what European country, is trucking dirt to kindergarten so kids can play with dirt. So I had run in a previous study from Mongolia, where they find out that Mongolian people consume more dairy than anybody per capita, I think, and they don’t have a genetic abnormality to process that much dairy. And the reason is, because they don’t sterilize their dairy products. They’re still heavily contaminated with the organisms that live in the natural environment, so I let my son play with a dog. I didn’t sterilize the house, I just clean very, very normal. We go out into dirt like with cow manure and throw it everywhere in the garden. He plays; he gets dirty; he finds the dog’s . . . sticks his hand in it. Sometimes I cringe when I say, he sticks the dog bone in his mouth. I let him do his normal things that I guess Paleolithic men were doing. That’s where they were healthy and strong. I was born in a third world country; the healthiest people are the countryside people that work directly with the farm and the animals. I did that because children are the harder target to get. You also examined the mother, because their microbiome comes from the mother. The mother doesn’t have any health issues that at least I’m aware of and you also want to see the demeanor of the person that you’re transplanting from, that the demeanor is also a big indicator if a person has depression, anxiety, sad in thought, erratic behaviors and so on.
Lindsey:
In terms of pathogens, you did a GI Map on your son, right?
Einar:
Eventually I did. At first, I didn’t do it because I didn’t suspect him to have any pathogens. Most pathogens show in different patterns. At the time, I had nothing to lose.
Lindsey:
It does sound like it. I saw the GI Map from your son and I noticed that he does have H pylori in his gut. I’m just curious about your thoughts on taking in stool that has H pylori.
Einar:
Yes, H pylori is natural. There is H pylori and then there is H Pylori and then there is an amount of H Pylori. If you read, there is a target and then there is a number. The number is below the target. So, I think the target is 103 or 104, and then the amount he has is about one log below that. That is normal and then I think below you have all the pathogenic type of H pylori, because you can consume, for example, raw food that has E coli and nothing happens because it has not switched or you could drink dairy that has Candida. You’re not going to get sick from Candidiasis.
Lindsey:
It doesn’t have the virulence factors. I do see a lot of clients who have H pylori with no virulence factors, but they are very symptomatic. And even clients whose H pylori shows up on the GI Map below the reference range, but still again are symptomatic and very much improved after it’s gone. I’d be hesitant to be honest. I would be hesitant to take on H pylori, but as you said, you didn’t have much to lose.
Einar:
Yeah, but you’re not going to find or is very rare to impossible to find a person without any amount of H pylori. That’s why you do the examination. Okay, you have H Pylori. Is it making you sick? No. So then you have normal, healthy amount of H pylori, right?
Lindsey:
There’s enough of other good bacteria to keep it in check.
Einar:
Yes and for example, my ex-wife and one of my cousins, they develop the bad type of H pylori, but they are symptomatic. If you’re asymptomatic, is very likely that H pylori is not really pathogenic.
Lindsey:
Okay, and so, you did over 10 days, you were taking a bunch of capsules a day, did you do any kind of ongoing FMT protocol then after that?
Einar:
No, I chose the fasting before and after 16 hours. I tried to eat a low carb diet, except for the foods I was introducing on my experiment. My reasoning is that every person has yeasts, aerobes and anaerobes. You want to say they have… let’s call it an army, let’s call it the 300. You can have about five to 25 pounds of poop in your gut. What you’re introducing is let’s just say, most companies sell about 10 grams per dose. It is a very, very small amount. The 300 is fighting the Persian army of a million. To give it a fighting chance, you have to cut down on the bad bacteria you have in your gut. So you give them a fighting chance. A lot of people just go crazy eating carbs and this is why it doesn’t work long term or if it doesn’t work at all, for most people, especially unless you get the dose that I introduced myself. I also put my son under the same diet. I increased the chances of his microbiome to be strong. My son has always been on a paleo diet with dairy and high fat. I myself am on a high fat diet and that probably helps with that.
Lindsey:
Okay, and so just to go back to interstitial cystitis. After the fecal transplant, did that completely resolve or is there still some trace of that?
Einar:
No, there is some trace. The frequency improved significantly around day 10 of the experiment, but eventually the frequency when I started introducing more carbs started getting worse. Right now I’m going back to eating a more carnivore diet again.
Lindsey:
When you say carbs, are you talking about vegetables or we talking about rice? What do you…or bread?
Einar:
Any type of carbs. Yeah. So I spoke with a Candida expert and she explained to me that the reason why her and a lot of other scientists suspect that a lot of these conditions are caused by candidiasis. The reason you can’t really eliminate it entirely is because it fits through the bloodstream directly, not through the stomach only, even if you cut off all carbohydrates and sugar, you just basically put them dormant or slow them down, but they’re still going to be there.
Lindsey:
Your body converts protein to glucose.
Einar:
Yeah, currently, yeah. Glucose. Sorry. Yeah. So I guess until we figure something out, I’m stuck with it.
Lindsey:
Yeah. Have you tried reducing oxalates? Well, I guess if you’re eating meats, you’re not having any oxalates but any kind of…
Einar:
Oxalates, I forgot the names of them. I have reduced all of that and it makes a difference on other things, but on IC the bladder, not as much. I’m going guess it’s just glucose; the issue with that.
Lindsey:
Yeah. I see a lot of people who have urgency and maybe not an official IC diagnosis, but then when they go on calcium citrate to help absorb oxalate crystals and then also reduce their oxalates in their diet, that improves a lot.
Einar:
I mean, you also going to get some oxalates from animals that consume these vegetables and then you’re processing because they are not already eating the natural diet that they’re supposed to be eating. We’re feeding them a high corn diet, but I can’t afford to go. I mean, a carnivore diet is already expensive enough, to do an all grass fed diet.
Lindsey:
Yeah, I can imagine. I know you have posted several videos to YouTube. Can you tell me about what those videos are about and I’ll link to those in the show notes.
Einar:
Well, I wanted to teach people how to do the process as asceptic as possible, because I’ve seen a lot of videos but they don’t explain a lot of things about the process in the FMT. I did an entire video on how to assess a donor based on the characteristics of the donor. I did another one explaining high histamine… so a lot of people we see or call me- SIBO is a tough one to help people with – but I did a video explaining why the histamine reaction happens because of the slowing down on the body of the food processing, that it starts rotting. You don’t have the right bacteria to clear that out of the way. It just sits there, rots and creates all these histamines and you start getting worse. I got requested to do it also in Spanish. I’m multilingual. I did a video called tricks and tips on how to process FMT because of the gagging reflex. We have been programmed to think of poop as a bad thing and then all of a sudden, you’re trying to no matter how you encapsulate it, you have to sit there, process it and smell it. It smells awful. I have worked with cadaver tissue. I have worked with a lot of things that were disgusting, but this one was the worst. I explain how to put Vicks under your nose to help you a little, it’s not a perfect thing. How to maybe run an extractor. If you’re in a bathroom or near a bathroom, how to stay away from water sources, because there can be contaminants, although poop is already heavily contaminated, but keeping pets away so the dog hair can’t just get in it or cat hair. On how to clean the area, what materials and equipment to use, what’s the right type of capsules, and the type of syringe is probably going to be more beneficial because a lot of people want to use a pipette, sounds cool, but it’s not, it gets plugged very easily. A 10 cc syringe is probably the best with a blunt tip, even if you cannot get the blunt tip, the 10 cc syringe will be good enough. I originally bought a 60 cc syringe, which was very big and bulky to maneuver, but I settled after all the equipment that I bought, on a 10 cc syringe.
Lindsey:
Just to make sure people don’t go off and just grab their kid’s stool and start doing FMTs, I do want to say it is a good idea to test for all types of pathogens. I can link to a list of all of the different things one should be testing for. I think it’s the European consensus or something on stool testing for FMT.
Einar:
Yes, there is the European consensus. The FDA has some guidance. I mean, the GI Map is a good test to conduct and you have to go through a doctor. You can call him and ask him or talk to a microbiologist or somebody. I have read on reviews a lot of and I’m not, I don’t work as a microbiologist, but I work with a lot of laboratories that were under my supervision that I have I understood enough and I have to release tissue products as part of quality engineering. I can read them well enough, but I wouldn’t call me to release for other people. Better an expert.
Lindsey:
Okay. Are there any supplements that you took in addition to doing FMT that were useful for your situation?
Einar:
When I did it, I didn’t, because in itself, the FMT is going to be much better than any anything you can take. Later on, I discovered there are some supplements and other bacteria you can take that can help different conditions. I ran into a study that used L-glutamine to rebuild the gut, because most of our conditions seem to be linked to leaky gut or they’re causing the gut to leak for some reason. The L-glutamine, I think, study suggests that 15 to 20 grams a day and it helped about 70 something percent of people with IBS. Then I ran into a few other studies, one used S boulardii.
Lindsey:
Saccharomyces boulardii. It’s a yeast.
Einar:
Saccharomyces boulardii. I used that yeast. They use S boulardii to treat SIBO. So if you cannot get your hands on FMT, I would try that and then Lactobacillus casei. It’s been a couple of years since I’ve dealt with microbiology. So my apologies, Lactobacillus casei seems to help people with prostatitis or chronic bladder pain, IC of the bladder, sometimes it’s called BPS, which means bladder pain. BPS, PBS; it has many different acronyms and names. The consensus is still out there. I personally think that all of them are the same condition. This is my theory. Your microbiome is about 70% of your immune system and then your genetics are the other issue that you have. Your microbiome can protect your genetic deficiencies, if they’re still not being stressed out enough, so it protects. Once the microbiome starts dying, then all your genetic conditions start causing problems. My theory seems to make sense it’s, for example, people with schizophrenia, when you do an x-ray of their brain, you can tell that the person has schizophrenia, but not everybody that has that brain condition is schizophrenic. My theory is that it’s the microbiome that basically protects that person. There are people with a genetic trait of celiac; you don’t see them with celiac disease. It is complicated and I think that using these other ways can probably improve your odds if you’re doing. I didn’t know then what I know now. Right now, I’m taking boulardii, casei, and I’m doing the L-glutamine.
Lindsey:
Yeah, that’s a pretty common supplement for leaky gut sealing up or concurrent with the gut healing protocols.
Einar:
I’ve got to tell you, it’s very hard to think straight when you have all these conditions on top of you. You’re coming out of Clonazepam. So the things that are clear and simple and make sense now . . . I don’t even know how I held a job for the last 15 years. I’m still wondering about that.
Lindsey:
You read all the studies and did all that stuff. So it great that you’ve been able to…
Einar:
I rebuilt houses with fibromyalgia. I was passing out every now and then. Raised children… I don’t know how I did it.
Lindsey:
Sheer will power, I think. Having a positive attitude has a lot to do with it. Because even if you’re feeling miserable, if you have a good attitude, you’re still hopeful and you just keep pushing through, then somehow . . . versus hopelessness. I can see people who are truly hopeless and it’s a heck of a lot harder to push through.
Einar:
I want to do a video on this, but I don’t really know how to do it. I don’t really like videos that much but I get people calling me on they’re like: “I’ve been suffering for a couple of years.” And I’m like: “try 40.”
Lindsey:
Just to back up, what do you think destroyed your microbiome? Did you take a lot of antibiotics or…
Einar:
Yes, when I was around 10, I was very thin and the doctor thought that there was a bacteria in my gut that he needed to kill. I was given an abnormal overdose of tetracycline. I do remember that. I developed a lot of skin cancer since. It was like every year. That also seems to have stabilized.
Lindsey:
Skin cancers?
Einar:
Oh, god, yes.
Lindsey:
As a child?
Einar:
From age 12. Yeah.
Lindsey:
Basal cell carcinoma, not like melanomas?
Einar:
All of them.
Lindsey:
Really, even melanomas?
Einar:
Yeah. I had several melanomas, one of them in late stages. It almost entered my bloodstream. It was about an inch, inch and a half in diameter. I am a human wreck. I’ve got more stitches than a baseball.
Lindsey:
I’m glad that one didn’t go metastatic! . . . Well, thank you so much for sharing about your experience with us. It’s very interesting.
Einar:
It’s been an absolute pleasure. Anytime you need to reach out and talk to me about anything. I’ll do my very best. I’m not an expert on all of this because it’s not my full time job, but I do what I can to help people because I know what you suffer, what I’ve gone through. This is not good.
Lindsey:
Well, I appreciate you coming on!
If you’re struggling with from Interstitial Cystitis, IBS, Fibromyalgia or other gut health disease, 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 gut health coaching 5-appointment program 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’m going to start with some basics about autoimmune disease and then get into how it relates to gut health, because the two are all tied up together.
For those who don’t know, autoimmune disease is where your immune system attacks your own body’s cells, tissues and organs. I personally have two autoimmune diseases, which you may have heard me talk about on other podcasts: Hashimoto’s thyroiditis and post-infectious IBS. The latter is when a protein called vinculin that’s involved with the migrating motor complex, attacks my small intestine, which creates stagnation in the small intestine and bacterial overgrowths. I did receive a third autoimmune diagnosis in 2013 of ITP or idiopathic thrombocytopenia, which is an autoimmune disease impacting your platelets. However, the doctor has subsequently told me he didn’t think I ever had it, as the diagnosis criteria have changed. And I was also diagnosed at one point with pernicious anemia, which is an autoimmune attack on the parietal cells lining the stomach, which leads to malabsorption of vitamin B12, but have since had negative antibodies there, so I don’t consider that a current diagnosis.
If you think of individual autoimmune diseases like Hashimoto’s thyroiditis, lupus or rheumatoid arthritis, you may not think it’s all that common, but when you add up all the different autoimmune diseases, it comes to more than 50 million Americans impacted, which is a threefold increase in autoimmunity over the last 50 years. Interestingly 78% of those impacted by autoimmunity are women.
Other than the ones I just mentioned, some of the other most common autoimmune diseases are Celiac disease, Grave’s disease, Type 1 Diabetes, vitiligo, scleroderma, psoriasis, inflammatory bowel disease, Addison’s disease and Sjögren’s. There are more than 100 autoimmune diseases that are either systemic or attack individual organs.
Based on twin studies, about 25% of autoimmune disease can be attributed to genetic causes versus 75% environmental causes. In reality, it’s always a combination of genetic and environmental factors that lead to the manifestation of an autoimmune disease. Thanks to the work of Dr. Alessio Fassano, a world-renowned gastroenterologist and gluten intolerance expert who is chief of Pediatric Gastroenterology and Nutrition at MassGeneral Hospital for Children and Director of the Center for Celiac Research and Treatment, we know that there are three necessary precursors to autoimmunity: a genetic predisposition, an exposure to a trigger such as trauma, stress, toxins, the use of certain medications or exposure to an antigen, and intestinal permeability or leaky gut.
Now before I delve deep into gut related infections and triggers, let me just mention the other autoimmune triggers. So in terms of antigens, which are toxins or other foreign substances that induce an immune response in the body, there are viruses like Epstein-Barr Virus, aka mononucleosis, including a reactivation of a prior infection, cytomegalovirus, mumps, rubella, Herpes simplex virus and Hepatitis C. Then toxins can come from your diet and the environment, including chemicals and heavy metals, which can provoke intestinal permeability and other gut health problems, which we discussed in my last podcast.
In terms of medication-induced autoimmunity, one of the most common is drug-induced lupus, in which more than 90 medications from more than 10 drug classes have been implicated. Don’t think this is just rare, unusual drugs. There are case reports of drug-induced lupus from drugs as common as statins, antibiotics, PPIs and NSAIDs. And there are even reports of drugs used for other autoimmune diseases, called TNF blockers, that have induced lupus syndrome.
Other autoimmune diseases for which drugs have been implicated include RA, polymyositis, dermatomyositis, myasthenia gravis, pemphigus, pemphigoid, membranous glomerulonephritis, autoimmune hepatitis, autoimmune thyroiditis (Hashimoto’s), autoimmune haemolytic anemia, Sjögren’s syndrome and scleroderma.
Now let’s zero in on the relationship between autoimmunity and gut health, starting with the role of leaky gut or intestinal hyper-permeability. I did a whole episode just on leaky gut on March 17, 2020, so you can check that out if you want to go super deep on this topic. There are several ways in which the gut can become permeable. First, you can have openings between the cells lining the intestines or the enterocytes, whose tight junctions hold them together, but also allow for them to open up and let nutrients and water through. When there’s dysfunction, they open too wide and for too long. This has been observed in celiac disease and gluten sensitivity in particular, but can also happen with other food sensitivities. The most common culprits are other grains that may be gluten free, in particular corn; pseudograins, including quinoa, amaranth, buckwheat and chia; diary; eggs; nuts; seeds; legumes (in particularly soy and peanuts) and nightshades (which are tomatoes, eggplants, potatoes and peppers).
I believe that most of the more obscure food sensitivities are secondary to a gut infection, dysbiosis, stress, a poor or very repetitive diet or some other cause, although I have found that gluten, dairy and nightshades tend to be common primary causes.
You can also have a permeable gut because a substance or infection causes direct damage to the enterocytes, or cells lining the intestines, which actually creates a hole in the lining of the intestines. This can come from certain foods containing lectins. There are two potentially harmful subclasses of lectins, called prolamins (found in grains, legumes and pseudo-grains, including quinoa, rice, peanuts and soy) and agglutinins (found in grains, pseudograins and nightshades). Legumes also contain saponins, another substance that can harm enterocytes. Keep in mind that even though there may be negatives associated with legumes (meaning beans, peas and lentils, but not including green beans, snow peas or sugar snap peas), overall they are super healthy foods with high fiber and the lectins and agglutinins found in them can be reduced by soaking, sprouting and fermenting. They’re also deactivated by the heat during prolonged cooking, so if you do need to go off these foods for a time while healing your gut, you should eventually try to reintroduce them, if you’re cooking them properly. Some beans are worse than others, such as soy, peanuts and kidney beans, and the agglutinins found in them are more resistant to deactivation than others, so if you do have an autoimmune disease, you may want to steer clear of those ones forever, and the others until you are feeling better, and then slowly reintroduce a variety of legumes rather than focusing on one or two.
Two other potential disruptors to proper digestion and mineral absorption that can cause a leaky gut are digestive enzyme inhibitors and phytic acid or phytates, which are both found in raw nuts and seeds, which is why when you have too many nuts you get that full, bloated sensation. If kept in low quantities, it’s fine. But if you really want to clean up your nuts, you can soak them in salty water then dehydrate them.
Finally, the more obvious and common culprits of damage to enterocytes in a standard Western diet are alcohol and synthetic food additives.
An autoimmune paleo diet systematically eliminates these potentially problematic foods and then reintroduces them slowly so you can test your body’s reaction. While some people may need to eliminate these foods long-term, especially if they experience autoimmune symptoms when they’re reintroduced, many can be reintroduced in reasonable quantities in the context of a varied, healthy, whole-foods diet.
Another potential cause of leaky gut is a gut infection causing damage to your intestinal lining. This includes parasites like Blastocystis hominis and giardia, as well as bacteria such as Yersinia enterocolitica, Helicobacter pylori, Klebsiella, Campylobacter, E. coli, an overgrowth of proteobacteria and Borrelia (the bacteria that causes Lyme disease). Gut tests like the GI Map, which I have many of my clients order, reveal most of these types of hidden infections and dysbiosis.
Let me just mention that while many healthy people have Blastocystis hominis in their guts, there are two different types – the amoeboid form and the protozoa form. While the former is associated with chronic hives and adheres to the gut cells more, the latter is not, which may be one way to distinguish a Blastocystis hominis infection that should be treated versus one that can be left alone.
Then SIBO or small intestine bacterial overgrowth, can be another cause of leaky gut. This can happen for a whole slew of reasons related to either low stomach acid or slow motility in your small intestine. However, a prior episode of food poisoning is one culprit that can lead to post-infectious IBS like I have, where you have elevated vinculin antibodies, which are tested using the ibssmart test. When you have that, you’ll likely have a lifelong struggle with SIBO, but it is manageable.
And of course, invasive candidiasis can lead to intestinal permeability when the candida turn into their hyphal form and send tentacles out through the gut epithelium or lining. Note that we all have candida in our gut, but it can grow out of control due to a poor diet, stress and certain medications, including antibiotics.
Speaking of stress, 80% of patients reported serious emotional stress before the onset of their autoimmune disease. Why would this be? Chronic stress leads to elevated cortisol levels. This leads to decreased digestive function, lower secretory IgA, which is your gut immune defense cells and elevated blood sugar. This opens you up to first gut infections, when your gut immunity is decreased, as well as poorly digested food, which has proteins that can trigger autoimmunity when they escape out of a leaky gut from a gut infection.
Which gets us to the mechanism for autoimmunity. So when you have a hyper-permeable gut lining, and especially if you aren’t digesting your food well, which can be from a lack of digestive enzymes or hydrochloric acid from a variety of causes, undigested proteins will escape out into your system and trigger your immune system. When your immune system is triggered against certain proteins, it can also end up attacking similar proteins in your body. This is especially the case with gluten and Hashimoto’s thyroiditis, which I have, because the gliadin protein in gluten resembles the cells in your thyroid gland. However, studies have shown gluten to be an issue in many autoimmune diseases, and in creating intestinal permeability, so if you have any autoimmune disease, gluten is the first thing to eliminate for the long-term.
Another contributing factor in Hashimoto’s and leaky gut can be a depletion of two key nutrients for gut health: l-glutamine, which is an amino acid, and zinc. Both are necessary for rebuilding the gut lining. They can often become depleted because of high stress, because they are also used in producing adrenal hormones. You’ll find zinc carnosine, the form especially good for the gut lining, as well as l-glutamine in leaky gut sealing powders like GI Benefits, which you can find in my Fullscript Dispensary. Before you go out and buy that, if you think you have a leaky gut, note that I generally don’t recommend using something like that until you’ve healed or while you’re healing SIBO, SIFO (aka small intestine fungal overgrowth) or other gut infections.
Given it’s one of the most common autoimmune diseases and one I’m very familiar with, and because it has a special relationship with SIBO, I’ll just go a little deeper on Hashimoto’s, which is the cause of about 80% of the cases of hypothyroidism. First, it was found in one study that more than 50% of people with hypothyroidism had SIBO as well, because the slowing of your metabolism from being hypothyroid causes a slowing and stagnation in your intestines leading to bacterial overgrowths. This is often the case with constipation-related SIBO. But of course it can occur the other way around – where SIBO causes a leaky gut that leads to Hashimoto’s and hypothyroidism, as I already mentioned. Symptoms of hypothyroidism include constipation, pale dry skin, hair loss, muscle aches, weakness and tenderness, a goiter, a puffy face, brittle nails, excessive or prolonged menstrual bleeding, enlargement of the tongue, memory lapses, depression and joint pain and stiffness. If you have a TSH or thyroid stimulating hormone test and your level is above 2.0 (which is still within the standard reference range but not the optimal one) and you have any of those symptoms or symptoms of SIBO, I’d recommend asking for further testing including thyroglobulin antibodies and thyroid peroxidase antibodies to rule out Hashimoto’s. If you have SIBO, I’d recommend asking for your TSH to be checked because if your hypothyroid is caused by Hashimoto’s, then you can address it naturally, starting with gut healing and removing gluten and dairy from your diet, as well as testing and replenishing key nutrients. Left unchecked or just medicated with standard thyroid medications, which are important and necessary if you’re hypothyroid, Hashimoto’s will gradually destroy the thyroid gland, enlarging it and inflaming it. That was what my doctor told me would eventually happen to me in 2013 when I was first diagnosed. Happily, 9 years later, because I’ve done all the natural things I could to reverse the process of autoimmunity, my TSH levels remain normal and my antibodies have been normal for about 2 years now.
Reversing Autoimmunity
Ok, now on to what to do if you have an autoimmune disease and want to try to put into remission and reverse as much as you can of the damage to your body. This is a brief summary, but I work with people to help them do this, so please reach out if you need some help.
First, work to identify any food sensitivities using at minimum an elimination diet for 4 weeks of dairy, gluten, added sugar, artificial sweeteners (but stevia and monk fruit extract are ok), alcohol, processed foods, processed seed oils, soy and corn. If you have a very debilitating autoimmune disease, then I’d go full on a full autoimmune paleo diet (AIP) and also eliminate other grains, pseudograins, caffeine, nightshades, legumes, eggs, nuts and seeds, including spices derived from nightshades and seeds. There’s a specific way to eliminate and reintroduce foods on the AIP diet. Also, for some people, another helpful adjunct in decreasing immune activation and food sensitivities is proteolytic enzymes. One particular brand, Wobenzyme, has been studied and found to be particularly helpful in decreasing Hashimoto’s antibodies when taken in large doses on an empty stomach.
Second, do stool testing or Organic Acids testing to determine whether you have any gut infections. Even if you’re not symptomatic, sometimes a combo of different gut pathogens combine to mean you have neither diarrhea nor constipation but you may still have an issue that’s causing inflammation and a leaky gut. Of course, if you have any gut symptoms, then that’s definitely a likely factor. Usually herbal antimicrobials, probiotics, prebiotics and polyphenols, through diet or supplements and digestive supports like Betaine HCl to replace low stomach acid, pancreatic enzymes or bile support may be needed, depending on what is found on your tests.
If nothing comes up in your gut testing, you may need to be tested for other viruses like Epstein-Barre to see if there’s been a reactivation there, so you may need some antiviral support.
Third, after gut infections are dealt with, a gut sealing and healing supplement is helpful in sealing up a leaky gut and rebuilding the gut lining.
Fourth, you may need to test for and address nutrient deficiencies of key nutrients like vitamin D, omega 3 fatty acids, B vitamins, selenium, zinc and magnesium, which can also be a factor in autoimmunity, or at minimum take a multivitamin, fish oil and any other nutrients that show up as deficient on an Organic Acids Test. Testing for nutrient deficiencies and supplementing where necessary gives your body the tools it needs to modulate your immune response, fight bacteria and viruses and support an appropriate inflammatory response.
Fifth, another factor that can often impede healing is a congested liver that is overloaded dealing with toxins, which can be identified on an Organic Acids Test. If you find this, there are certain supplements that are recommended to support your liver in detoxifying your body. In initial interviews, I also ask people about signs of potential heavy metal toxicity and mold exposure. But other basics like making sure your water is pure and you’ve eliminated toxins in your personal care products, cookware and food is important in decreasing the burden on your liver.
Sixth, since stress is so intertwined with autoimmunity, finding and addressing causes of stress, and managing unchangeable causes is an important step. This may involve starting therapy, ending toxic relationships, leaving a stressful job, or a program of meditation, mindfulness, prayer, yoga or breathwork.
Finally, and probably the most important step, is persistence. Reversing autoimmune disease doesn’t happen overnight. It takes long-term persistence and commitment to yourself and caring for your health. I was diagnosed with Hashimoto’s in 2013 but didn’t see my antibodies normalize completely until a couple of years ago, so it took patience to eliminate foods and change my diet, clean out my liver, stabilize my nutrients, work on my gut health issues until they were truly under control and then stick with all those positive changes over time. Of course, the rewards are great if you can persist.
If you’re struggling with from an autoimmune disease, 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 gut health coaching 5-appointment program 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.
Wendie Trubow, M.D., MBA is a functional medicine gynecologist with a thriving practice at Five Journeys, and is passionate about helping women optimize their health and lives. Through her struggles with mold and metal toxicity, Celiac disease, and other health issues, Dr. Trubow has developed a deep sense of compassion and expertise for what her patients are facing. She is the co-author of Dirty Girl: Ditch the Toxins, Look Great, and Feel Freaking Amazing!
Lindsey:
So I understand that you started your career focusing on gut health. So I’m wondering what got you into gut health, and then what moved you towards a focus on toxins?
Dr. Wendie Trubow:
I think at the end of this conversation, you’re going to think that I’m completely self-focused. But as a celiac who was undiagnosed for many years, my gut was a hot mess and so I really naturally gravitated toward that, because I wanted to fix my own struggles. Then I saw the impact of how much of a difference it made for my patients and then simultaneously, I fell into the toxins hole because I was full of them and had a sort of second health crisis in my late 40s. So that really then served as the jumping board, springboard, for developing all my toxins expertise, because, again, I was struggling really badly and had to learn about it so I can fix myself, so I can take care of people.
Lindsey:
Interesting. Now, when you say your gut was a hot mess from celiac, so that other people who might have celiac could potentially hear their symptoms called out and go, “Oh, maybe that’s what I’m going through.” What might that look like?
Dr. Wendie Trubow:
Sure. And I think I would broaden it to not just celiac because you can have gut dysfunction, and not have the autoimmune component of it. If you think about it, a gluten allergy doesn’t just develop overnight for most people; it’s slow and steady and goes from no reaction to a little reaction, which could be some gas or bloating after eating. Then you maybe get constipated or maybe you have some diarrhea, or maybe then you get an irritable bowel. So it’s this whole progression of symptoms. I kind of had all of the above: I had stinky gas, bloating, constipation some days, and then some days, same day constipation and diarrhea, or maybe back and forth between them in any given day. Then the celiac part, the part where I had the autoimmune issue, was where it started to impact outside of my gut. So because of the celiac, it causes this degradation of the lining of the gut, you don’t absorb your minerals and nutrients properly. So I had mineral, nutrient deficiencies and that was ranging from iron to magnesium to B12 and folate; often celiacs have osteoporosis because they don’t absorb the calcium and the vitamin D. So I kind of had all of the above without the osteoporosis; and then head to toe issues so brain fog. I’m not an anxious person, but I had anxiety and difficulty synthesizing information: so executive function was impaired, I had thyroid disorder, I had heart palpitations, asthma, all the gut stuff, fertility challenges, bad periods, heavy periods, the wasting… I was wasting, like I was about 10 pounds lighter than I am now.
Lindsey:
So a lack of nutrients will kind of destroy your body all over?
Dr. Wendie Trubow:
Yes, yes. Head to toe. It was a mess.
Lindsey:
Okay. And I imagine with all that, lack of B-12 and iron, you must have had some fatigue?
Dr. Wendie Trubow:
Oh, yeah, I didn’t mention that.
Lindsey:
I didn’t hear that one.
Dr. Wendie Trubow:
Sorry, I got out of bed because I was the primary breadwinner and otherwise I would have been quite happy to stay all day in my bed curled up.
Lindsey:
Yeah. Well, I have to say I had one client who came just for one appointment. And he had not been diagnosed with celiac until he was in his 60s. So you can imagine the fatigue that builds up over that many years of poor absorption of your nutrients?
Dr. Wendie Trubow:
Yeah, yeah.
Lindsey:
Okay, so tell me what the connection is between toxins and gut health?
Dr. Wendie Trubow:
Sure. It’s so great. It’s creepy, but it’s awesome. So there’s a million levels at which this occurs. So toxins themselves irritate the gut: just flat out irritate the gut. If you do quote unquote everything right and you just can’t get a handle on your gut, it’s often because there’s this underlying thing called a toxin, which I’m referring to heavy metals, mycotoxins, which are the mold that when mold gets in you, it puts out these toxins called mycotoxins, or others like gasoline fumes, nail polish, phthalates, BPA, all that stuff that in the other category, so that flat out irritates the gut, A. B, if you’re somebody who has toxins, it’s creating this enormous pull on the body to detox and in order to detox you need to have your adrenals, your liver and your gut in good shape because your liver is responsible for in some way converting the toxins into a water soluble form that you most often poop out. But if you have dysfunctional poop, so say you’re constipated, and the poop is just sitting there and your gut not moving properly. You have you have these enzymes called beta glucuronidase and their job is throughout the body, but in the gut, what they’re doing is taking the toxins that your body has already packaged up nicely with a binder and they’re separating it from the binder. Now remember, I told you it’s water soluble to go be pooped out; the minute you separate it from that binder, it becomes fat soluble; it can’t stay in the gut; it gets recycled into your body; it’s super toxic. Your body freaks when it sees it; you put it in your fat. So if you have any dysfunctional processes in the gut, and by the way, any gut dysbiosis can have inappropriate secretion for beta glucuronidation for some of these nasty bacteria, so it’s like circling the drain, right? You know, you have this toxin that irritates the gut, the gut gets thrown off and then it doesn’t properly function and then you can’t get rid of your toxins. You just keep going around in circles.
Lindsey:
So the beta glucuronidase when elevated is an indication of some improper processes and the toxins are becoming recirculated?
Dr. Wendie Trubow:
Yep and by the way, Lindsey, it’s not just toxins that you think of like bleach; its toxins like hormones, which can be toxic.
Lindsey:
Right, of course, and a potential cause of breast cancer is elevated.
Dr. Wendie Trubow:
Yep.
Lindsey:
Recycling of estrogen.
Dr. Wendie Trubow:
Yeah, yes.
Lindsey:
I know, I have a client in this very situation.
Lindsey:
Oh, no. No, I’m sorry to hear that.
Lindsey:
Post breast cancer situation: elevated beta glucuronidase, but we’re bringing it down.
Dr. Wendie Trubow:
We’re going to fix that, right?
Lindsey:
Yeah. Okay, so are there specific conditions that have their root in toxins? Like, does it tend to to be more one condition than another or could it be any of the IBDs, IBSs etc.?
Dr. Wendie Trubow:
Yeah, can really be any of them because it’s just how your body is responding to that particular stressor. You know, I get this question a lot. Why? Why is this my symptom and not that, or why am I having any symptoms? And I’m like, well, that’s just how your body’s processing it. So you really can run the gamut from just bloating, just gassiness. You could have poor digestion of stools or IBD, IBS, etc. I mean, it runs the gamut; you can develop anything from exposure to toxins.
Lindsey:
Oh, speaking of which, I’m wondering, do regular doctors test beta glucuronidase? Or is this only within functional medicine?
Dr. Wendie Trubow:
No, ma’am. That is a functional medicine test.
Lindsey:
Okay. And I was just curious if it was the kind of thing that you could get an easy follow-up at the doctors, but obviously not.
Dr. Wendie Trubow:
Nope, nope.
Lindsey:
And so do toxins have an impact on your hormones?
Dr. Wendie Trubow:
Yeah. So again, it’s like circling the drain. So some of these xenoestrogens that we get from plastics, they mimic the estrogen in your body and they look kind of like estrogen enough that your body goes down the let’s process you like estrogen pathway. And so it all ties together. So if you have these toxins, they look like your estrogens, then you’re not processing your estrogens properly. You can also go down the harmful processing of estrogens pathway with these xenoestrogens, when they wind up in your gut and they confuse the body. So that’s one part to it. But then, if your hormones are not properly processing, that can make it more difficult to deal with your toxins. And because a lot of it winds up in the gut, it throws the gut off. It really is this big circle of dysfunction.
Lindsey:
So when you have the xenoestrogens in your diet, does that then increase your estrogen? Decrease your estrogen? How does that work?
Dr. Wendie Trubow:
Yeah, so if you imagine that there’s 100 people in a room and the door is a foot and a half wide. So basically, one person can go through that door at any one time. Say now there’s a fire in the room and everyone’s trying to get out of that door but still that door is only a foot and a half wide. You have essentially people building up in the room trying to get out; that’s like your hormones. So your body can deal only with what it can deal with. But when you start to pile on, there’s xenoestrogens in the room, there’s estrogen in the room, there’s testosterone, there’s progesterone; they’re all piling on. Essentially you’ve flooded your body’s ability to take care of it so one can increase the other and vice versa. So they’re tied in together.
Lindsey:
Okay. And then what are your sources of xenoestrogens typically? I mean, you mentioned the plastics, but how far do you have to go in trying to eliminate that? What’s a reasonable way to work on that particular problem?
Dr. Wendie Trubow:
Yeah, I mean this is not just limited to xenoestrogens. I think the question is, how can we systematically decrease our exposure to things that really increase the risk of making us quite sick, right?
Lindsey:
That’s right.
Dr. Wendie Trubow:
So when you take it from this big picture, look, you go, “Okay.” Really easy, low hanging fruit for a lot of people is how do you level up on your food: start with food, it’s foundational. You do it every day, multiple times a day. So aim for food that’s minimally processed, organic, if possible, local, and in season. That’s sort of the basis and then with that goes your drinks. So don’t drink anything from a plastic bottle because that’s a source of the xenoestrogens. Don’t drink alcohol because alcohol is straight up a toxin. And so that makes it harder for your liver to deal with the other stuff it’s being presented with because it’s busy dealing with a more important toxin, essentially. Alcohol will directly kill you if you don’t deal with it so your body knows we have to deal with this and get rid of it. So that’s the easiest way. And then all of us through our lives have exposure to hundreds of chemicals throughout the day. So what I say to people is, pick the thing you’re running out of, I don’t care what that is, whatever you’re running out of: be that house cleaner, weed killer, makeup, deodorant, hair products; it doesn’t matter. That’s an ideal moment to go to either Think Dirty, or EWG.org and look to see, what’s a better option here? What’s something where I can get three steps better, or 10 steps better? Depending on how bad it is, right? Maybe it’s really bad and you want to go a lot or maybe it’s not so bad. And you go, you know what, this isn’t a priority right now. But to systematically do that throughout your life as you start to run out of things.
Lindsey:
Okay and so we’ll get back to the toxins and getting rid of them in a minute, but I wanted to ask first, what is the best and most economical way to test for the various toxins?
Dr. Wendie Trubow:
Sure. So I’m not clear that I can say it’s necessarily economical straight up. The testing is a little bit pricey so, we use urine testing. You can test in the blood, but for metals, that’s only indicating if you had an acute exposure. You know, like the kids in Flint, Michigan, they have acute exposure; their lead levels are elevated, but for the rest of us, we’re not getting acute exposures, so blood’s not that accurate for that reason. We use urine, and the metals testing is not that expensive to test for. The system we use, it’s $69 for the test; you do two of them, because you always do a baseline and then you do a provoked test, and the provoking agents cost like, I don’t know, 35 bucks, so it’s not that expensive.
Lindsey:
And what do you provoke with?
Dr. Wendie Trubow:
We provoke with DMSA. And that’s pretty cheap to test because there’s so many prongs to treating metals, the treatments more expensive, but the testing is cheap. And then we usually do a urine test also, for the mycotoxins, the other environmental toxins and the pesticides and glyphosate. You can break those up or you can do them all together. So if you do them all together, it’s 500, just under six, $560, basically, which is not cheap. You can break them up, so it’s like 300, 201 and 100; you can do them piece meal, but you are going to need to see a functional medicine provider because your conventional doctor doesn’t have these tools in the office. It’s like going to the mechanic and asking for a haircut. Right? It’s just the wrong access.
Lindsey:
So the $69 test is that urine for metals.
Dr. Wendie Trubow:
Yeah, that’s urine for metals. It’s a cheap test.
Lindsey:
Okay, what about hair testing?
Dr. Wendie Trubow:
I’m not a huge fan of hair testing, personally, because hair testing is showing what your body’s basically voluntarily getting rid of, and this is for metals not for mycotoxins; you’re not going to see it there. For metals, it’s really only looking at water you’re kind of voluntarily excreting; it’s not looking at what’s stored, because 95% of your lead in particular is stored in your bones. You’re not going to see that in your hair. You know, it’s like a fraction of what’s really present.
Lindsey:
But it would be in the urine.
Dr. Wendie Trubow:
Yes. Well, when you provoke it.
Lindsey:
Right. Okay, so you take the DMSA that prompts your body to start releasing toxins and then you see.
Dr. Wendie Trubow:
Yep.
Lindsey:
Okay, got it. How far apart? Or how long will you treat with DMSA before you do a provoked test?
Dr. Wendie Trubow:
It’s the same day: what we do is we say to people, we need a baseline, “Get up and pee”. That’s the test. That’s the first $69 test. And then as soon as you’ve emptied your bladder, you’re starting with a clean slate. So take your DMSA and we collect for six hours; for six hours, collect that information and then at the end of six hours, empty your bladder so you complete the test at six hours. And that’s what we’re comparing against. We treat people if they have high levels; we treat over eight, which is just the reference range for that lab. Say someone comes in and for example, they have no hair anywhere on their body. I’m sure we’re going to see high levels, but say we didn’t; say their detox is so shut down, you don’t see it. We’re going to treat them anyway and keep monitoring them.
Lindsey:
Okay, so no hair would be a sign of toxins.
Dr. Wendie Trubow:
Yes.
Lindsey:
Okay. And so how much DMSA will you give them then?
Dr. Wendie Trubow:
It depends on how big you are and how old you are. So I don’t treat kids so I won’t speak to the dosing for that; for our adults as long as they’re a normal weight, we’re going to give them 1500 milligrams, and then we have that compounded by a pharmacy.
Lindsey:
Okay, so you mentioned there’s the metals, then the mycotoxins, and then there’s also the all the pesticides right?
Okay. And then other… is that a whole separate one?
Dr. Wendie Trubow:
Well, it’s on the same Great Plains test, but that’s all the stuff that we’re exposed to throughout our life. So the MTBE which is the gasoline fumes, the styrene plastics, asparagine, the burnt foods, tobacco, smoke; all of the chemicals in all of these things: makeup, nail polish, hair products; all of these things are captured in this test. And so it’s looking at all of them and really, I typically look for a level of 75 percentile or above, at around the 75th percentile and like, “Hey, we got to treat this.”
Lindsey:
Got it. Okay, and what kind of gut conditions might prompt you to think that there could be a toxin issue?
Dr. Wendie Trubow:
So we do a ton of toxins work in our practice, because we get a lot of people who say, “Okay, I eat right, I’ve done a stool test, I fixed my dysbiosis; I fixed my SIBO; I don’t eat gluten, do everything right. And I’m still not right. You know, I have this irritable bowel or bloating, gas, diarrhea, any of the above, right?” So if you do everything, right, and you’re still having symptoms, that deserves a toxins look, because what else is it; unless you’re so super stressed that your body can’t process? It’s a toxins issue.
Lindsey:
And so talking about getting down to the level of specific toxins, what are the most common sources say of lead?
Dr. Wendie Trubow:
This is great. So for lead, the most common sources are lead pipes, living in a house built before 1978, because almost all of them had lead in the paint. And everyone says to me, “Dr. T., I’m not licking the walls.” I’m like, dude, I know. I know, you’re not licking the walls. However, as that house settles down, you’re getting exposed to all of the lead dust and you absorb it in your skin; you breathe it and you touch it; you eat it, so you’re absorbing it in various ways. The most likely causes are living in homes built before 1978 or lead pipes. However, there’s lots more causes and one of the other really subtle ones is being born to someone who had lead in their system who also nursed you, because it will cross the placenta and it does come out in breast milk. My poor kids, right? I’ve got four kids; I nursed them all and I was like, “Nursing is a detox event for the mother.” And tox up event for the kids.
Lindsey:
Perfect example of this: I have a friend who got really sick at a workplace she was at. I’m not sure what ultimately contributed to it, but during her pregnancy, she felt healthy. And then her son ended up with all these food sensitivities and allergies. And then as soon as he was out, you know, then she was really sick again. She was just transferring all those toxins to the baby the whole time.
Dr. Wendie Trubow:
We’re so generous to our children, right?
Lindsey:
Exactly. Okay, how about aluminum? What are sources of aluminum?
Dr. Wendie Trubow:
Aluminum is usually just aluminum foil and that’s actually one I look at less. I usually focus on lead, mercury, cadmium, thallium and arsenic. The big five. Mercury… it’s so funny, Lindsey. So Mercury is fish and fillings. The fillings are the mercury amalgam silver fillings and even having one in you is enough to create problems for some people, and then the heavy mercury fish. So what’s horrifying is that as wildfires occur, say in California, they release all of the stored mercury in the forests. That mercury gets into the water system, which gets converted to methyl mercury, which the fish eat, it hangs out in their bodies. They can’t excrete it any better than we can. Then we eat the fish. So one serving of a heavy metal fish such as Mahi Mahi, tuna, swordfish, tilefish, Chilean sea bass; one serving, theoretically, it has enough for like a month’s supply of mercury. But if you’re someone like me, who’s not the best detoxer, I say to my patients, you should not be eating that period. It’s not like, “Oh, once a week.” It’s like no; we’re not going to eat that. It will make you sick.
Lindsey:
I think I literally had just Chilean sea bass last night. I never thought of that.
Dr. Wendie Trubow:
I know, right? All the super yummy fish are high in mercury.
Lindsey:
I think that is what I had last night.
Dr. Wendie Trubow:
Oh, can I tell you a story? So we have a patient in our practice who had no hair when she came to our practice. And she was just told by… of course people see 20 doctors. If you have no hair, you keep going to doctors. So she came to us and she had seen 10 doctors. All of them had said to her, “Oh, you just have autoimmune alopecia. Nothing to do. Sorry.” So she came to us and she saw my husband first. I stole her from him. She saw my husband and he looked at her. He said, “You have heavy metals.” She had really high levels of lead. So this was about just under two years ago, just as the pandemic was starting she came in to us. She has been successively working on her hair and last year her hair started to grow back. I saw her two weeks ago in my practice; and she said to me, “I feel like I’ve plateaued.” Now by the way, what I will say is she has about two inches of hair growth all over her hair and she now has to go back to waxing and shaving and plucking because she’s grown hair in all the places women tried to get rid of it. But I was like, you know it’s a mixed bag, buddy. No hair on your head, but you didn’t have to wax, but now it’s the reverse. So she’s growing hair on her head but she said, “I feel like I plateaued.” And I said, “So what’s going on? Let’s drill into it.” Well, she was down at a remote job. And as a treat, one to two times a week, she was eating sushi. And I said, “Okay, well, what kind of sushi? Are you eating? You know, what are you having? Are you having salmon? What are you having?” She said, “I’m having tuna.” I was like, “Oh, no. We just got all this metal out of you. You can’t do that. You don’t have good detox.” So I said to her, “That’s it. Like, I hope you enjoyed your last meal. Because no more of that. It’s too much.”
Lindsey:
Yeah and so do you think you can get away with the safe canned tuna though?
Dr. Wendie Trubow:
Yeah. As long as they’re testing for mercury, there’s a number of brands that will test for mercury and canned tuna. So yeah, that’s reasonable.
Lindsey:
It’s Vital Choice* and Safe Catch* that I know… Okay, so yeah, I had my last mercury fillings removed. And I was glad I went to the dentist I went to, although it cost me a pretty penny, I had it replaced with gold. I’ve got two gold fillings and I feel like I’ve got my bling in the mouth.
Dr. Wendie Trubow:
The price of gold; you’re kind of like a kidnapping risk.
Lindsey:
I know, seriously, they’re each like $1,000. But I mean, given the number of years I have left to live and you know, the composites are not supposed to last that long. So I had to make my choice. If somebody is getting their mercury fillings removed, I know you should go see the biological dentists and all that. But say you can’t afford that; you can’t do that. What could you ask your regular dentist to do to just keep you safer or what can you do yourself?
Dr. Wendie Trubow:
Let’s look at things you can do yourself, because I can’t really speak for whether your dentist is going to say yes or no, but I can make some recommendations. So things you can do yourself: one, don’t eat any high mercury fish period. Okay. Particularly as you’re approaching this. Two, on the days preceding the mercury, I would take activated charcoal; especially the day of, take a couple of tabs of activated charcoal in the morning. Then when you get home, take a couple of tabs of activated charcoal and ideally fast so that you’re not bothering your body. It has to digest foods; you’re just focusing on binding the metals because a charcoal will bind to your food too. So don’t take it with your food. So take the charcoal, eat lightly, increase glutathione for a couple of days before and at least a couple of weeks afterwards.
Lindsey:
By taking glutathione?
Dr. Wendie Trubow:
Correct, Yeah.
Lindsey:
Like liposomal?
Dr. Wendie Trubow:
Yeah, the best one is by Quicksilver, which is a liposomal form. We have another one, it’s called SafeCell glutathione (find both in my Fullscript Dispensary*). It’s a liposomal in a gel, which is easier for people who don’t want to refrigerate it or can’t remember to take it.
Lindsey:
It’s a Tesseract product, isn’t it?
Dr. Wendie Trubow:
Yep, yep. So that’s a great product and then you can also do simple things like cilantro, parsley and chlorella help. All these things are super helpful, so I would say load up on those for the days preceding, the days after and the day of so that you give your body every opportunity to bind those metals. By the way, don’t drink any alcohol because your liver can’t deal with metals and alcohol. Yeah, too much. Do all those things. Then if you can find a functional medicine doctor who will give you metal binding IVs. A couple of weeks afterwards, you can get some IVs to bind up those metals so that you’re not just letting them float around and go back into your bones and your fat. So that’s for you to do and manage your stress because if you’re stressed, you’re not going to detox anyway. A lot of layers, right?
That’s just for you; then what you say to your doctor is, “Hey, can you give me oxygen while you’re doing this? Because oxygen can help…” I’m not sure of the mechanism. It either binds to the metals or it prevents you from absorbing metals. But oxygen helps, A. B, Can you put a dam on the tooth you’re working on so that nothing falls down my throat. You know how they work in those little chips and you swallow them? You want them to not fall down your throat so could you put a dam on the tooth that you’re working on? Most dentists if they’re not comfortable with this are going to be like, “No thank you. And by the way, you can find another dentist.”
Lindsey:
Yeah, my dentist was not like trained as a biological dentist, but it’s a very simple piece of plastic that you just surround the tooth with. It covers the rest of the mouth and he put that on. He had like a vacuum cleaner under my mouth. Yes. Yeah. I mean, very low tech, but like it did the job.
Dr. Wendie Trubow:
Yeah, low tech and make sure they irrigate a lot, give you oxygen and keep it from swallowing it. So it’s not rocket science, right? I just can’t vouch for whether they’re going to say yes to doing that. Then the other part to that is, if you have a mouthful of fillings, do not get them all done in a week, period. You’re going to be really sick.
Lindsey:
Yeah, yeah. So how many at once reasonably?
Dr. Wendie Trubow:
Not more than two. Unless they’re tiny, you could do three but I was really reluctant to get my mercury fillings out because I said to my biologic dentist, “They’d been here for over 40 years. What difference are they making really?” She said to me a lot. It’s 50% mercury weight, A. It never stops off gassing, B. C, just so you know when we take that out of you, we can’t throw it in the trash. It’s considered toxic hazard. We have to put it in special trash. It’s so toxic. She said, “So that’s in you.” And I was like, “Oh, okay. Persuaded. Let’s get it out.” I got them taken out; but I was pretty resistant. You don’t want to do more than two and you want to give yourself two weeks between every two, at least so that if you have a reaction, don’t go back to get more done if you’re still reacting, right? Don’t pile it on.
Lindsey:
Keep taking the activated charcoal or…
Dr. Wendie Trubow:
Yes, and glutathione, it’s really weird: Metals deplete your glutathione and you need glutathione to get rid of your metal. So another case in which you’re circling the drain, if you have metals constantly depleting your glutathione. Okay and now that I see that, I just realized I didn’t take it this morning before I left the house. How aggravating.
Lindsey:
And in this case, would NAC also do the job as a replacement for the glutathione?
Dr. Wendie Trubow:
Yeah, so NAC and Alpha Lipoic Acid are precursors for glutathione. They help your body make the glutathione so you can give your body these things and they can help get you where you need to be for the substances your body needs to get rid of the metals.
Lindsey:
Okay, so we talked about mercury, how about arsenic?
Dr. Wendie Trubow:
Yeah, rice. No good deed goes unpunished. So… you eat brown rice, because you’re like, “Oh, I’ve got to get the fiber.” Except the whole seems to have more arsenic in it, so white rice, organic Jasmine, white rice has less. It’s unfortunate but you have to pick your battles. If you’re someone who’s really dealing with blood sugar issues and cardiovascular things and when you eat rice, you’re going to want to do the brown rice but be aware that you want to monitor your arsenic. Then otherwise, I would go for white rice and go for a smaller portion so that you don’t have a spike in your blood sugar, but then you don’t get the arsenic.
Lindsey:
My parents, I had them both do an ION profile and both of them came up with high levels of arsenic. They barely ever eat rice.
Dr. Wendie Trubow:
I’ll have to look up other sources. It’s not the only source but rice is like far and away the biggest source.
Lindsey:
I mean, it can come from other grains I think too.
Dr. Wendie Trubow:
You know, I don’t know the answer to that. I always think about glyphosate from other grains. So I’ll have to look at that. I’m not sure.
Lindsey:
Okay, fair enough. How about cadmium?
Dr. Wendie Trubow:
Cadmium is west coast oysters, tobacco and I think there’s a couple more that I’m totally blanking on, but really the big ones are West Coast oysters and tobacco smoke.
Lindsey:
Okay, so don’t get your oysters from the West Coast.
Dr. Wendie Trubow:
No, ma’am.
Lindsey:
Get them from somewhere else or avoid them altogether?
Dr. Wendie Trubow:
Correct, Yeah.
Lindsey:
Get them from somewhere else. Okay. And how about chromium?
Dr. Wendie Trubow:
Thallium was the next one I focus on and this is back to the no good deed goes unpunished. So you’re doing a good job, you’re eating organic. A lot of it comes from California. You’re happy because it’s in the United States, you’re buying you’re buying American. However, California soil is contaminated with thallium. The organic vegetables happen to be particularly high so if you’re someone who eats a lot of green leafy vegetables from California, you’re at risk for getting high levels of thallium. Thallium can cause hair loss in high doses and maybe even constant doses. I always say to people, let’s work on improving your detox because I would vote that it’s better for you to eat organic, we’ll deal with thallium rather than eat non organic and then we have all these pesticides, which have even other consequences. It’s pick your poison here, right?
Lindsey:
Well, if you get your vegetables locally and you don’t live in California, then you’re good, right? So I guess that’s the eat local part.
Dr. Wendie Trubow:
Yes. Yeah.
Lindsey:
Or grow them yourself.
Dr. Wendie Trubow:
We should talk about mycotoxins too.
Lindsey:
Let’s talk about mycotoxins.
Dr. Wendie Trubow:
There’s a lot of layers to this. Water damaged buildings are probably the biggest source for people of mycotoxin exposure. Then food is another source; the foods that are the biggest ones – and by the way, I had a patient whose car was moldy kind of randomly. When I diagnosed her, she said, “My car’s moldy.” I was like, “Really?” She goes,”Yeah.” She had her car tested when she had her house tested and yeah, it was moldy. So she sold it. So anyway, foods that can increase your mycotoxin burden: coffee is a big culprit and grains are a culprit because, you know, they sit in these big sills and silos and they’re wet. One way that they dry them out is with glyphosate. Glyphosate was originally developed as an antibiotic and then was converted into agricultural use. In 2014, I don’t have stats beyond 2014; couldn’t find them. But in 2014, there were over 250 million pounds used in the United States, which is just ridiculous.
Lindsey:
It’s banned in Europe, isn’t it?
Dr. Wendie Trubow:
I don’t know the answer to that actually.
Lindsey:
I’m going to Google that while we are talking.
Dr. Wendie Trubow:
So it’s a probable carcinogen according to the World Health Organization. It wouldn’t surprise me if it was banned in the EU because they actually do a lot better job at preventing harmful things. So only about 500 different items have been specifically tested for whether they’re toxic. And then there’s another 150,000 things that haven’t been tested, specifically. So now we rely on just studies. So it’s pretty horrifying because they don’t have to prove that it’s not harmful, they have to prove that it’s not directly harmful in large doses. It’s a little bit of a nuance but the combined cumulative effect of lots of toxins in small amounts can be just as bad as one major exposure. So back to the mycotoxins, a lot of them are ochratoxins, which comes from grains that are wet.
Lindsey:
Okay.
Dr. Wendie Trubow:
Did you find it?
Lindsey:
I did actually find the answer. Yeah, so it’s currently approved for use in the European Union until December 15, 2022. But Austria already banned it in July 2019. And Germany is going to start phasing it out by 2023. That’s what I got in my quick search.
Dr. Wendie Trubow:
I mean, it’s pretty nasty. Back to gut health, it disrupts the microbiome because it was developed as an antibiotic. The World Health Organization has classified it as a probable carcinogen, because there are a number of cancers that are associated with it; most of which are lymphocytic, like non-Hodgkin’s lymphoma, things like that. It’s again just sort of horrifying. So I want the listeners to think, “Okay, I have control over this, right?” Because you can take control of the narrative and sometimes you have to get that horrified in order to make a change. When you’re eating the grains, even organic grains are sometimes contaminated with glyphosate because of the drift that occurs. It’s sprayed on these massive farms. And then the wind carries it to adjacent farms, which happen to be organic. There you go, your organic grains are now contaminated, as are like all of the garbanzo beans in the United States are contaminated with glyphosate.
Lindsey:
Even the organic ones?
Dr. Wendie Trubow
Yep but eat the hummus. Eat the hummus; it’s better than not eating it, right. It’s good for you. It’s just when you balance it.
Lindsey:
Okay, so I know there are people out there who are just like, “Well, I don’t eat organic, and I’m okay.” Correct this line of thinking.
Dr. Wendie Trubow:
Yeah, I think you have to look at that moment in time. So a lot of disease is from the cumulative effect of abuse. Meaning over the course of years, you get exposed to different things. I didn’t have celiac when I was 15 but I had certainly gluten sensitivity. I just didn’t know it. 20 years later, I had celiac. So it’s really about at what point do you want to intervene in the disease process. So there are certainly people I call them strong like bull; nothing impacts them, right? They can take a beating and nothing fazes them, they can eat anything, stay up all night, drink all night and the next day, they’re chipper. I’m not like them. There are some people like that cool. If you’re a bull, cool. It’s going to take a lot to bring you to your knees. The rest of us are generally not strong like bull, we’re more like a mouse. We can be brought to our knees a little bit faster than the like bulls and basically, everyone’s eventually going to break down with things.
When you look into your optimal health, you can start to see the dysfunction at a cellular level before you see it at an organ level. When I was 15, I had iron deficiency and B-12 deficiency that didn’t respond to supplementation. By the time I was 35, I had wasting, right? So it was a 20 year process. I’m sure I had celiac earlier than 35. I just wasn’t tested. Nobody knew. So when you talk to these people who say I have nothing wrong, well I’m not so sure about that. Maybe you just don’t know about what you have wrong. Have you tested and the other part of it is: humans are very quick to explain things away, right? So when I hit the skids with all my toxins, exposure stuff, I was like, “Well, 48, perimenopause is terrible. Hate it. This is the worst, right?” Except it wasn’t perimenopause. It was a toxins exposure. But in the absence of knowledge, you might assume or chalk it up to something else. Oh, that’s how my family is; everyone in my family has insulin resistance or diabetes or everyone in my family can’t lose that 10 pounds or everyone in my family goes bald, whatever that is, right? We’re very quick to say that’s just how my genes are, as opposed to something’s turning on those genes.
Lindsey:
So you’ve piqued my curiosity by mentioning perimenopause. Tell me what symptoms you think were associated with toxins that went away after you detoxed.
Dr. Wendie Trubow:
I was losing hair at a very rapid clip and you can lose your hair in perimenopause. I gained almost 10 pounds and you can have weight shifts in perimenopause. I got a rash which wasn’t really perimenopause, but I was like, I don’t know what else it is so… right. I’m having a terrible perimenopause. So yeah, it was the weight and the hair loss.
Lindsey:
And what toxins were you particularly high in? And where were they coming from in your life?
Dr. Wendie Trubow:
Yeah, well sit down, okay, because it’s a long list. So I had lead. I was born in 1970 so I grew up in homes that were built with lead paint. We did construction on homes that have lead paint. We had lead pipes when I was a child, so those exposures. I had mercury from both fish and fillings. I had four strains of mycotoxins. I had seven or eight different environmental things such as nail polish, toxins, gasoline, fumes and plastics, styrenes. I had a whole bunch of those in me. That was really the impetus for writing the book because I got all this tests. I mean, Lindsey, for the last 16 years, I’ve eaten gluten free. I don’t eat gluten substitutes. So I’m eating like no processed food, no sugar; I don’t drink alcohol. I’m really boring on paper. I don’t do anything fun. I exercise to get enough sleep.
Lindsey:
I am sure you do something fun.
Dr. Wendie Trubow:
But like, I’m not fun. People aren’t like, “Oh, let’s go to her house and have like an ice cream sundae.” No. I’m not that person. So there’s nothing fun in my diet, basically. And yet, I had all these toxins. That was the impetus for the book. When I got all this data, I said to my husband, “I am such a dirty girl.” And then he went, “Oh, that’s the book we need to write because don’t do what I did.” Right? Let’s provide a roadmap so you can avert getting to where I got to where I could not lose weight, hair was falling out, brain fog, fatigue, rash on my face, like all these problems. It’s preventable.
Lindsey:
Yeah, yeah.
Dr. Wendie Trubow:
And something else. I forgot to tell you because this is about poop, right? I used to be the canary in the coal mine for gluten. So if we went out to eat, and it had any trace of gluten, I was sick. The worst exposure I got, I was sick for three months and it was awful with brain fog, emotional problems, anxiety and really being sensitive. You look at me funny, I start crying and then got stuff like super sensitive diarrhea all the time, no matter what. It was awful. What was really amazing was when I started to treat the mycotoxins in particular, I only noticed this in retrospect, because you only notice when you don’t have a problem when you have a problem, I guess. So I used to have 6 to 12 weeks of problems with a gluten exposure. Then I noticed, it was like 4 weeks and then I noticed it was 10 days. Then I noticed it was 24 hours and then I noticed it was just overnight. Being someone who couldn’t eat at a restaurant at all, converting that to someone who can now, I’m not indiscriminate, but going to restaurants that are careful. I can eat out. That has transformed my life because my gut is no longer this raging torrent of reaction. It’s a lot quieter. Just an unexpected benefit, but that goes back to that these are all very irritating to the gut and when you start to pull them off, the gut can relax.
Lindsey:
Your detox systems can handle the gluten because it’s not all preoccupied with everything else.
Dr. Wendie Trubow:
Exactly.
Lindsey:
Yeah. Mycotoxins. If somebody, they have no obvious exposure to them in their life. So they’ve never lived in a moldy house that they know of. They’re not having extreme reactions. They’re not losing hair. They’re not, you know, that kind of stuff. Is it worth still worth testing?
Dr. Wendie Trubow:
Yes and no. So this depends on what your philosophy is. So if your philosophy is, I feel fine; I’m going to wait for a problem to develop and then I’ll deal with it, then no, you should not test. Right? Because there’s no problem that you’re treating. If you take a step back and you’re someone who says I really want to have optimal health. I understand that these mycotoxins are associated with degenerative diseases such as, as Alzheimer’s, dementia, Parkinson’s, cancers. I understand that these are a risk factor and I want to pull off any risk factors that I have, or I’m having symptoms, then yes, I would test. But it depends on your philosophy. It’s very upsetting for people when their philosophy is: I’m going to wait till it gets worse and you try to make them change. They’re not ready because there’s not a problem that they can react to.
Lindsey:
Okay. So in terms of treating each of these and detoxing, is it specific for each toxin how you detox or is it more general?
Dr. Wendie Trubow:
It’s both. So there’s basically three buckets. The metals fall into one treatment category and that includes improving the liver’s ability to remove the toxins, binding to them specifically and then replacing the minerals and nutrients that you pull out when you bind the toxins. So that’s the metals. The mycotoxins are specific binders based on what strain you have. So that’s really targeted therapy. You have to test because actually. There is a fiber, propolmannan fiber will bind to all the mycotoxins. But basically, you do want to know what you’re treating to know when you’re done even. Then the environmental toxins and pesticides almost universally trickle down into responding to a smaller group of things that include glutathione, NAC, sauna, B-12, niacin and things to improve phase two. So it’s a lot smaller but again, you want to know like what are you treating? But it would never harm you if you took glutathione, NAC, B-12, cilantro, parsley and did a sauna every day. That would not harm you.
Lindsey:
Right and can you just explain phase two detoxification a little bit?
Dr. Wendie Trubow:
Yes, it’s horrifying. I remember when I learned it in the context of hormones. Your liver’s responsible for doing the majority of work to get rid of anything that your body doesn’t need or is harming it. So that largely falls into toxins and hormones. Although alcohol too or medications; I guess I could keep going on. So your liver is responsible for doing lots of work. In phase one, you take this substance and you convert it into what’s called a toxic intermediary. It’s a middle ground substance that’s even more toxic than what it started out as. Don’t ask me why; it doesn’t make any sense to me but that’s what your body does. Then in phase two, there are six different detox pathways you can go down: you can bind it to a methyl group, you can put it on a glucuronic group, you can put it on a sulfur group, there’s lots of things you do to it, but you basically bind it, make it water soluble and poop or pee it out. Phase one is generally pretty fast, especially for women. Phase two is generally slower. So your body, it’s really good at making these toxic intermediates and then it’s like, “Oh, crap. Wait, now what do I do with it?” So it puts it in your storage units, which are your bones and your fat. It hangs out of there, out there until phase two is ready to actually pull it out and deal with it and excrete it. This is why when your gut has overactive beta glucuronidase and you’re recycling these toxic hormones it’s so harmful because not only do you now need to deal with what you’re already dealing with, but now you’ve just piled on more and your body can’t deal with the volume.
Lindsey:
Is it better then to support phase two detoxification before doing anything with phase one?
Dr. Wendie Trubow:
You want to do them together and there’s a lot of overlap actually.
Lindsey:
And phase one supports are things like…
Dr. Wendie Trubow:
Minerals, nutrients, curcumin, ginger… that’s funny. I’m less versed in phase one, because I’m like, everyone’s fine with phase one, right?
Lindsey:
Generally, people have that under wraps. It’s the phase two they need help with.
Dr. Wendie Trubow:
Yeah, they’re generally better. If they need help, I’m like, go to my nutritionist. She’ll take care of you. But then phase two, it’s actually very hard for vegans to do effective phase two, because a lot of support for phase two comes from flesh: meat, chicken, other poultry, fish, eggs, and dairy. So it’s harder for vegans. It’s not impossible, but it’s harder.
Lindsey:
So they might be more inclined to have a buildup of toxins.
Dr. Wendie Trubow:
Yeah, counter intuitively, because they eat much healthier.
Lindsey:
Great. Well, so tell me about your book.
Dr. Wendie Trubow:
It’s a fun read. Reading our book is like talking to me. So it’s pretty much like a conversation, well conversational. It’s all about: how are the ways that we’re getting exposed to various toxins and what are the things that we can do to control the narrative before you ever get to a functional medicine provider. There’s so many things that you can do to take control of your health: how you eat, how you live, how you drink, how you stress, how you exercise, the supplements you’re taking, all of these play a role and you really can alter it. There are a lot of things people can do on their own until we go through that in the book. We talk about what would make you even think that maybe you have toxins? Because some people don’t even have the awareness that it’s a toxins issue.
Lindsey:
Yeah, so the things that should make them suspicious of toxins we’ve talked about, like hair falling out, weight gain… any other sort of big red flags?
Dr. Wendie Trubow:
Unremitting fatigue. Really pronounced issues with any hormone stuff, you know, really bad periods, fertility challenges. Any type of cardiovascular disease or metabolic disease, so high blood pressure, heart disease, diabetes, and pre-diabetes; all those indicate toxins, bad cholesterol profile. Those indicate toxins.
Lindsey:
Even if you have a genetic predisposition to have high cholesterol?
Dr. Wendie Trubow:
Yep because your genetics are only one facet of the conversation. Your genetics aren’t your determinant for life, they just make you more likely, but when you pile on the toxins, it makes it 10 times harder to deal with.
Lindsey:
So tell me, I understand you have a free gift for my listeners.
Dr. Wendie Trubow:
I do. I mean, after listening to this podcast, you may be saying to yourself, “Okay, I really need to clean up all the products around me, at least so I can stop being exposed.” Because this was my passion play and I had all these problems, we spent hours looking for products. Then we were like we’ll put it together in a guide, so that people don’t have to do as many hours of research as we did, because we did like… I don’t even know, I stopped counting, actually. So it’s the “Nontoxic Guide to Healthy Living.” It’s meant to really go with the book, but you can also use it alone. And that’s on our website.
Lindsey:
Okay, great. I will link to that in the show notes and all the other places and your different social media.
Dr. Wendie Trubow:
Yep. We also have a podcast. It’s the Five Journeys Podcast. So people can also find us there.
Lindsey:
Ok, great, wonderful.
Dr. Wendie Trubow:
Because there’s probably a lot of overlap between us and people who like you, probably like me and lots of other people. So we do that, too. It’s somewhat fledgling, but yeah. Instagram, Facebook, X, LinkedIn is all Wendie Trubow MD.
Lindsey:
Great. Well, this was really informative and interesting, and I think will be useful to a lot of people who have kind of gotten to the stuck place after trying to fix the gut stuff and are not getting anywhere.
Dr. Wendie Trubow:
Right. Yeah, definitely. It’s definitely helpful for people.
Lindsey:
Awesome. Thank you so much for sharing your knowledge with us.
Dr. Wendie Trubow:
My pleasure, Lindsey. Thanks for having me here.
If you’re struggling with your gut health, 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 gut health coaching 5-appointment program 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.
Sabine Hazan, MD is Founder & CEO of the Malibu Specialty Center and Ventura Clinical Trials, where she conducts and oversees clinical trials for cutting-edge research on various medical issues. She’s board certified in Gastroenterology, Hepatology and Internal Medicine and is a top clinical investigator for multiple pharmaceutical companies. She also acts as the series editor of Practical Gastroenterology on the microbiome, a peer-reviewed journal that reaches 18,000 gastroenterologists, and is the lead author of the 2020 book “Let’s Talk Shit: Disease Digestion and Fecal Transplants”.
Yeah. Yeah. Master and pioneer of fecal transplants.
Lindsey:
Yeah. Well, so funny story about him: I’ve been obsessed with fecal transplants and this whole field for years, well before I was working in it. My previous career was in international education. And I was actually working at Georgetown University, in the Center for Australian, New Zealand and Pacific Studies, and we used to bring in visiting scholars and people to do talks and such so I realized there might be a connection there since he was from Australia, in which I could somehow reach out.
Dr. Sabine Hazan:
Oh, that’s funny.
Lindsey:
So I dug through old papers; I found his email and I wrote him and invited him to come and give a talk at Georgetown and he agreed to it in theory, but then I left that job, and I’m not sure, I don’t think that ever came to be.
Dr. Sabine Hazan:
Yeah, he’s a great guy. He’s definitely responsive to anybody calling him over the years; I cannot tell you how many gastroenterologist have said to me, “Oh, my God, Dr. Brody held my hand on my first fecal transplant; I was so scared; patient had C. diff and the colon looked awful and I was so scared to just put poop in there, and he just held in their hands.” And that’s what he does. He’s been a mentor to so many of us; he’s so open with his ideas and his innovations. And probably too much because people take advantage of him and use his ideas to make a business out of it. And I started collaborating with him and I said to him, we need to educate the people on what’s coming and we need to educate them on the microbiome. And it happened during the period of COVID in January 2020, where I thought the end of the world was coming is when I finished our book with Shelley Ellsworth, who basically helped us. And when we finished the book, I said, I’m not going to call it “Let’s talk microbiome”, I’m going to just call it what it is. So people are aware, because this is an emergency. And also in the book, there is a chapter that gives you an idea of how to survive COVID. And we actually mentioned in there, the microbe that we believe could be protective against COVID. And in fact, there’s a publication coming from my lab with those microbes, lost microbes of COVID-19, and that microbe is in there so…
Lindsey:
Then what is it?
Dr. Sabine Hazan:
So I forgot, which chapter it is, but at some point, the first third part of the book, I talk about the importance of bifidobacteria, and how people that have obesity tend to have low bifidobacteria. And if you think about it, that’s the same population that’s been hit with COVID, right? And so the first bacteria that popped up as being lost in patients with severe COVID was actually bifidobacteria.
Lindsey:
And that’s also something that decreases with age, right?
Dr. Sabine Hazan:
Yeah. And also something that decreases with age, is decreased in autoimmune processes. You know, it’s a very important microbe that is in our gut. In fact, it’s the microbe that sustains the whole billion dollar industry of probiotics, right? If you look at the back of all these probiotics, it says bifidobacteria. If you look at kefir, it says, “bifidobacteria”. How many products on the market say they have bifidobacteria bacteria? Right?
Lindsey:
Right, right.
Dr. Sabine Hazan:
And so that was the beginning. So to me, it was so important for people to read the book, because I said to myself, this is going to give them an idea about gut health and how to survive COVID. And at a time where we didn’t even have vaccinations or any treatment. And so that’s why I wanted it to be a catchy name. And also, I figured, I’m embarking in a world where I’m challenging the narrative a little bit. Dr. Borody and I, we’re scientists. So we are the rebels that are going to look the other way when everybody’s looking to the right, we will look to the left for the solution, right? Because if everybody looks to the right, then you never find anything, right? So imagine like you’re looking for gold and everybody’s looking in the same spot, well you’re never going to find anything.
Lindsey:
Yeah. So how did you get involved with FMT?
Dr. Sabine Hazan:
Oh, it was interesting. So my friend Neil Stallman, who was my mentor, and a couple of years older than me, and when I was in residency, he was in fellowship. He was in fellowship of GI at University of Miami and in Jacksonville, at Jackson Memorial Hospital and I looked up to him as a GI doctor, and I wanted to be like him when I grow up kind of thing. So I went into GI because I was always impressed by his way of being a physician. And his vision that nobody’s really right about anything, that we need to be looking constantly for solutions. And no science, no research is wrong. Everybody has an opinion. And so when I was a fellow at University of Florida, he took me around the posters. I was presenting my own poster; it was visceral hyperalgesia at the time, and he took me away from my poster and he said, “Look, look at this data, the future is in the microbiome”, but he didn’t say it like that. He said, “The future is in shit”. And I said, “Neil, if you bring me down that path, I’m going to hate you.” And basically, what happened is he went down that path, right, he started speaking, he would always invite me to all these meetings, ACG [American College of Gastroenterology] and he was always the main speaker. And I remember and I would do the clinical trial side that was cleaner, with pharmaceutical companies. I would basically do the new antibiotic for C. diff and the new pill, and when the pill wasn’t working, or the clinical trial wasn’t working, I would go to fecal transplant, and back then it was a lot.
I remember calling him for my first case that I was doing. And anyway because I didn’t call, I didn’t know Dr. Borody at the time, and I wasn’t going to call Australia. So I would call Neil and I would say, “Neil, how do I do this?” “Go figure it out.” I read all the literature, and then I figured it out. And I figured out my own little protocol, per se. And my first case was a physician. And I was shocked. And you know when you see a colon that’s a disaster inside with all sores and bleeding and mucus. And you go, “Oh, my God, I’m just going to put stools in there, and then it’s going to improve it?” And then sure enough, a week later, a month later, the patient is better, they stopped having diarrhea and something happened, right. And that was the first case for me. But I still didn’t like doing it because I had to put Noxema in my mask. Nobody likes to play with stools. So I was still the clinical trial girl. And if the client – and I would tell my patients, look, I’m going to put you in a clinical trial for C. diff . and if the trial doesn’t work, then I’m going to do fecal transplant on you. And I would use the funds from pharma to basically pay for the analysis of the stool donor and everything. In other words, they would pay me to conduct the trial. And I would use that money to look for perfect donors for these patients and their families, or using the spouse and making sure that that the spouse had clean stools, right.
And that’s how, when clinical trials became fecal material and the capsule, one could say, me and Neil joined forces because clinical trials became fecal transplant in a way. And so I joined the shit business, and then I said, well if we’re going into the pharma world, I better start looking at these microbes carefully, because what’s the complication of fecal material in the future and what are we doing long term to the patient’s short term, long term? Certainly I saw cases of personality changes with fecal transplant, BMI changing post fecal transplant, inflammatory changes post fecal transplant and then you start reading from other physicians, Colleen Kelly, Sahil Khanna and Paul Feuerstadtand you start reading all these other improvement or side effects, right? So you start educating yourself, and you have all these questions that are not answered. And when those questions were not answered, for me, I started wanting to understand the microbiome in a more personal way, because in my family, I had family members that I wanted to understand what was going on in their microbiome. And when I sent those tools to different labs, I wasn’t getting the same validated results. And not only that, but even in the bioinformatics pipelines, the bioinformatics pipelines were different. And so I asked the questions, well, how do we know what’s working and how do we know what we’re doing if the pipelines are not even validated, and the stool labs are not even validated? And so I set myself on a mission to understand the microbiome especially after I had a case of Alzheimer’s where the patient remembered his daughter’s date of birth after fecal transplant. And I did it for C. diff. I published that paper; it actually took probably about five years to get approved then published because they didn’t believe that the patient remembered his daughter’s date of birth. I actually had to send him the mini mental status of the patient with the square the triangles that are drawn perfectly fine. He went from a Mini Mental Status of 20-21 to 26, and then to 29, after six months. So to me, that was like one of those n of one that you go, wait, something’s happening in the microbiome with Alzheimer’s, we’ve got to pay attention.
Lindsey:
And he had C. diff . That was why he was…
Dr. Sabine Hazan:
He had C. diff. That’s how we were able to do it.
Lindsey:
Right.
Dr. Sabine Hazan:
And so I presented that case to all my colleagues, and they’re like, “Wow, that’s an amazing case. But that’s an n of one. We’ve not seen that.” And of course, you know, you saw the case of Colleen Kelly with alopecia areata and two patients. And then next thing, you know, the patients grew hair. And you have to ask yourself, well, what grows hair in the microbiome space? Right? Because Dr. Borody, he tried to do that on another patient and it didn’t work. So which makes you wonder, well, maybe donor matters. Maybe the microbes matter that we’re implanting. And so that was the importance for me to create Progenabiome with the interest and I realized, I was shaking the beehive a little bit, because every time you start something that’s new, and it’s a physician on the frontline of clinical research doing it, it is shaking the beehive of what’s already there, right? Because if you find answers, there’s a whole industry that’s going to be gone. Right?
Lindsey:
Right, right.
Dr. Sabine Hazan:
Especially if let’s say we find answers for Crohn’s disease in the microbiome space, well, will the biologics disappear from these pharmaceutical companies? But I always believe, and that’s always the fear. And that’s why there’s always powers that try to destroy the innovations, right. But I’m a big believer that the same way that the post office works and email works, we didn’t decrease the work of the post office by bringing on emails; we just expedited the mail transfer back and forth between people in writing, right?
Lindsey:
Then started mailing everything packages and ordering everything.
Dr. Sabine Hazan:
Yeah, but the mailmen are still busy. And you know, I always joke, I say, we used to think like, well, we create internet, it’s going to remove the need for the post office. And it’s going to remove the need for books and library and papers, right? But the reality is, you’re busy in the real world, and you’re busy in the virtual world. You know, my desk is full of papers and my email has over 2900 emails that I need to deal with. So I’ve got this stack of papers on my desk that I need to deal with, and I’ve got these stack of emails I need to deal with. So I think in general, we’ve complicated our lives as human beings, period.
Lindsey:
Yeah, the pharmaceutical companies will find something else to work on if they don’t do the biologics.
Dr. Sabine Hazan:
I think we’re here to help pharmaceutical companies, right? Yeah, we’re here to help them improve their outcomes. You know, in medicine, it’s never a one pill solution. It’s never a one treatment solution. You know, you have patients that respond to Remicade, for example, but then they need nutritional supplements, they need a psychologist to deal with the trauma that started off the stress level that created potentially the dysbiosis in the gut, right? So it’s never a one pill solution. It’s never a one treatment. That’s why a lot of these patients, they need their psychologist, they need the nutritionist, they need their acupuncturist; they need all the ancillary support to help them function because it is a complex disease for a lot of people.
Lindsey:
Yeah. So let me stop you for a second and just ask, how successful is FMT as opposed to antibiotics for C Diff?
Dr. Sabine Hazan:
Very successful. So antibiotics . . . so what we’ve come to discover at Progenabiome is that if you look at the genetic sequencing of the microbes of an individual, you will notice that a majority have non-pathogenic C. diff in their gut as their fingerprint, right? So if C. diff is in – in fact, it’s in my gut, it’s in all the GI doctors that have analyzed their stools. So one wonders, when did we get colonized with C. diff? We’re exposed to patients. Did I get C. diff somehow in the GI lab touching the handle, touching the door knobs, etc.? Is it part of our signature microbiome? If it’s been part of our signature, and I really believe that it’s been part of our signature for 1,000s of years, I think we all have C. diff in our gut as a baseline microbiome because if you look at C. diff, it’s 10 million years old at least right? They found it in one of the studies I remember seeing.
So if you’ve got C. diff in your gut, and you’re taking an antibiotic, what are you doing with antibiotics? You’re basically depleting the other microbes, right? So you’re allowing, in a way, C. diff to become pathogenic, to secrete its toxin, right? So because if you look at the microbiome of patients with toxigenic C. diff, you will notice that they have a lower diversity than everybody else, right? How did that diversity get killed? Well, it got killed with the antibiotics we gave them. So what am I doing when I give vancomycin? Well, I’m killing the diversity of the microbiome. So if you look at patients with vancomycin, their diversity is much less than a healthy individual and even lesser than a patient will C. diff because you just gave them the antibiotic. So what are you doing when you do fecal transplant, you’re not killing the diversity. You’re replenishing the diversity. So the message here, why is fecal transplant helpful with C. diff is because we’re replenishing the diversity of the human being; we are giving the human being a new garden in their guts; we are removing the weeds, which was the toxigenic C. diff that was taking over the gut because we killed everything around it. Imagine it’s like, basically, you’ve got this group of microbes and you just killed off all its families. Well, what is it going to do? It’s going to try to kill the host now right? You just killed off all its families. So now, what do you do when you’re replenishing? You’re replenishing new families. You’re calming that little microbe in a simplistic way, right? You’re appeasing the balance of the microbiome system and therefore the individual is healthy again.
Lindsey:
And do you use antibiotics prior to doing the fecal transplants?
Dr. Sabine Hazan:
Yes. So you always want to kill off as much as everything because you’re going to give a new microbiome.
Lindsey:
And how long do you use and which one?
Dr. Sabine Hazan:
So I use I usually do either vancomycin or fidaxomicin. Depending on coverage of the patient. Sometimes I’ll do flagyl; it’s not really great, mostly because most patients can’t tolerate it. But usually vancomycin or fidaxomicin.
Lindsey:
For how long?
Dr. Sabine Hazan:
For 10 days; 10 to 14 days. And then basically I do fecal transplant.
Lindsey:
And are you finding it hard to find donors who are qualified? Like will you take a donor that has C. diff?
Dr. Sabine Hazan:
No. No. Wait, wait. You mean non pathogenic C.diff?
Lindsey:
Yeah.
Dr. Sabine Hazan:
Oh, I’m going to find… yes, all donors have non pathogenic C. diff in their gut.
Lindsey:
Okay.
Dr. Sabine Hazan:
In the genetic sequencing. And this is a very, very important thing to mention. Toxigenic C. diff is the C. diff that secretes the toxin and therefore causes diarrhea. Non toxigenic C. diff is just a fingerprint of the microbe that’s really doing nothing in your gut. So even if you find it in the gut, it doesn’t mean that it’s doing anything,
Lindsey:
Is it a different strain, then what’s the name of the strain?
Dr. Sabine Hazan:
No, it’s still the same bacteria, but it’s not but it’s not potent, right?
Lindsey:
And how can you discern that in a…
Dr. Sabine Hazan:
Well, in a genetic sequencing world, you have to do a messenger RNA pipeline, to basically see if it’s reproducing. In a research world, in a clinical world, you have to do a PCR to see if you have toxigenic C. diff.
Lindsey:
Okay, so who does that test?
Dr. Sabine Hazan:
Oh, anybody does that test, all the GI doctors do that test. So if you have diarrhea, and you’re basically, you know, you’re going to go to your doctor and your doctor is going to do a C. diff by PCR to look for toxigenic C. diff.
Lindsey:
Okay. Got it.
Dr. Sabine Hazan:
And they’re looking at that point for a specific strain that stimulates… that, basically, they… if you’ve got the diarrhea symptoms, and you’ve got the C. diff positive by PCR, then by all that’s C. diff in the patient. What we look at is the genetic imprint of C. Diff; that doesn’t mean that that C. diff is doing anything. It’s most likely doing nothing, especially if the patient is asymptomatic. When you look at a patient and a donor, you have to do a whole bunch of a workup, right? So the first thing is obviously you do a GI panel. You know, you want to make sure you don’t have C. diff and that donor toxigenic, toxin A and B so your test for C. diff toxin A,B, you’re going to look for Adenovirus, Campylobacter, E coli, Entamoeba histolytica, Salmonella, Shigella, Vibrio cholerae, Yersinia… you know there’s a lot of bugs that live in the gut. You want to make sure they’re not active in your donor because if you give those stools to a donor and there’s a lot more microbes, obviously, especially now with COVID, you have to make sure the donor doesn’t have COVID, right, in the stools, because if you’re giving it to an immunosuppressed patient who has C. diff to begin with, because he’s immunosuppressed, you could kill him. And that’s why we’ve seen the four cases post fecal transplant that died.
Lindsey:
Four? I didn’t realize there were four. From that same single donor?
Dr. Sabine Hazan:
No, no, no, no, there were two other cases that were brought up in probably in the last two years, I think. There’s been four cases altogether.
Lindsey:
And were they from… I think the originals were from E. coli. Right?
Dr. Sabine Hazan:
Yes.
Lindsey:
And what were the others?
Dr. Sabine Hazan:
Yeah, I can’t remember what the other two were but I remember, it was like four cases.
Lindsey:
Okay.
Dr. Sabine Hazan:
I don’t think the other two they even knew what it was that we’re concerned about. You know, the patients were extremely immunosuppressed to begin with. So you don’t… in those patients, you have to try no matter what the risk, to look at the risk benefit ratio. But definitely, you know, that brought up the idea of looking for vancomycin-resistant E. coli. And I looked up, and then that’s basically why we are doing all these tests. And now with COVID. Look, we were looking for a donor recently in one of my patients that had C. diff, and I used her daughter as a donor. And low and behold, I found COVID in her stools, you know, so I can’t donate it to her elderly mother with COVID in the stools. So you know, so it is becoming challenging to find good donors. It is also becoming challenging, because with COVID, the microbiome changed with potentially vaccination, maybe the microbiome is changing; with the stress that people underwent, the post-traumatic stress from COVID and the quarantine and the wearing masks, the microbiome changes. Certainly wearing these masks all day long, full of infections, you know, is not really helping your microbiome because it’s… they’re infected and you’re just breathing in all these germs that are in the mask. So all that affects your microbiome, in my opinion, and so it is difficult to find good donors right now.
Lindsey:
Yeah. I know I’ve had a few people who’ve come to me wanting to use a relative for fecal transplants just doing it on their own. And, you know, I told them what tests to run and invariably, they show up with H. Pylori and with C. diff , and with all these other things, and I’m like, I can’t recommend that you use that person.
Dr. Sabine Hazan:
Well, that’s it. That’s the problem, right? I mean, it’s like that daughter that was healthy to begin with. But then I found COVID in her stools, right. So I’m not going to be giving a stool donor with 4000 copies of COVID, that I found in the stools to a little elderly woman, God knows that would shut down fecal transplants really fast. So we have to be careful. And it’s funny, because even the procedure, you know, we joke in the GI lab, because sometimes we’re sterile, we’re very clean, in the way we process putting the stools into the colon, right? And things happen and you’re like, “I can’t believe I’m that sterile, because I’m dealing with poop to begin with.” But we have to be sterile because unfortunately, the microbiome is fragile, it’s not meant to be put back right? Fecal material is meant to be out; that’s why God created us to have colons that evacuated our secretions, right, the bad stuff from our bodies get out. So that’s the whole process of putting it back into the earth, right? And then the earth processes and all these microbes, right? It was never meant to be put back.The fact that we’re finding some improvement with C. diff. To me, I think that C. diff was really the can that got opened to look at the microbiome and to look at the destruction that we’re doing, to say, “Hey, guys, you’re killing the microbiome.” And C. diff is popping up in these people and all these bugs, by the way that are super resistant, these virulent bugs. Bugs don’t just become Super Bugs, unless we do something to them to make them Super Bugs. And I think that’s the most important thing to reflect on, right? Especially with COVID. COVID just didn’t happen, right? The human microbiome has got to be pretty messed up for COVID to penetrate and create disease to begin with, or create people to die. So when you look at the people that are affected, the autoimmune people, the people with cancer, the people that are elderly, the people that are overweight, there is a picture there that tells you dysbiosis of the microbiome, penetration of COVID, penetration of COVID wouldn’t happen if that dysbiosis didn’t happen. I really believe that if you have a strong microbiome, and those are the people that are fascinating to me to study, and you’ve probably seen me on X, saying, if you’ve not been vaccinated and you’ve now gotten COVID, please call me. I think these are the people that are super fascinating to study. Because in my opinion, they hold the mystery to why they survived COVID.
Lindsey:
Well, that would be my sister.
Dr. Sabine Hazan:
Yeah, so I’d love to test her stools, because, okay, those are the people that are… Yeah, no, I mean it’s fascinating, because I’ve been the guinea pig on this pandemic. And, you know, I test my stools on a regular basis, because I own the genetic lab. And I have to tell you, it’s fascinating to see my microbiome progress over time, during the pandemic. I mean, it’s been fascinating to watch so because I test if I take a medication, or if I get a vaccine, or if I get anything. I look at my microbiome. What is my microbiome doing while I took something?
Lindsey:
And yeah, what kind of differences do you just see over time?
Dr. Sabine Hazan:
Well, that’s going to be published, so I can’t really talk about it, but you are going to see it, because like I said, I am doing my timeline and I’ve been following myself and what I’ve done and what it’s done to my gut. But I think also, we’ve been following the guts of a lot of people and we’ve also looked at before the pandemic. We have probably over 1,000 stool samples. And we’re going to be looking at after the pandemic to kind of say, “Okay, well, what is different, right?” Because I think that’s fascinating data as well. And also correlating with those patients: whether they got vaccinated, whether they got treatment, some people are taking hydroxy, some people are taking ivermectin, some people are getting boosted and vaccinated. So it’s important to look at it to see what is all that doing to the microbiome, and then get a better idea of what the future is going to be and how to survive the next bugs.
Because you can imagine if you’ve gotten COVID, there’s obviously a dysbiosis in your gut that predisposed you to having COVID. So now the next virus that comes around has a potential of becoming super virulent in that person, so that’s why when you follow people who have gotten COVID the first time, then they get COVID the second time. If we don’t address the microbiome dysbiosis, it’s a domino effect constant until, you know, you wake up one morning with an autoimmune process or something. And you go, well, what happened? Well, the domino started way back when you had COVID. The first time that was your first sign, right? It’s like C. diff patients; you hear the story of a patient that gets C. diff and then down the road, they’re given antibiotics and then down the road they get an autoimmune process going on. You have to wonder that C. diff … was that the beginning? Was that the sign that said, “You know what, see, this was my first sign of dysbiosis. I should have paid attention.”
Lindsey:
But I mean, 80% of Americans at this point have had COVID. So I mean, how can you say that that’s all dysbiosis generated?
Dr. Sabine Hazan:
Well, is America a dysbiosis… dysbiotic country?
Lindsey:
Sure.
Dr. Sabine Hazan:
Is it
Lindsey:
What percentage of people in other countries? I don’t know those numbers? Are they getting a much lower infection rate?
Dr. Sabine Hazan:
I mean that’s it. Those are the things to look at; I mean, certainly America is high in processed food; they certainly take on a lot of microbes. They’re eating tomatoes in December; you look at Europe: they don’t mix microbes so much. You look at the American way of life: high, stressful, high go go go. Not as much as, if I look at the Spanish population, and again, Spain is becoming more America today. But if you look at the olden ways, where people used to sleep from two o’clock to three o’clock and rest, and it was like work, family and pleasure. Now we’ve become a society that’s just go go go; we’re on our cell phones constantly. We’re not doing any yoga, meditation, breathing; we’re not outdoors in nature; we’re not gardening. Certainly when you look at kids with ear infections, and you see kids in the classroom have more diseases and more infections than kids that play in the gardens. I mean, we’ve certainly seen those studies, where exposure to microbes from the earth definitely protects these kids, right? Is the American population, big on going outdoors, hiking, playing with the earth, gardening? Not really. So 80% of the population. If you look at the statistics of the American public, probably the 80% that got COVID is because they were not doing all these things. I can tell you that just with the people that I’ve treated, because I’m correlating that the people that do amazingly well are my farmers and my gardeners, you know. I have like husband and wife where the wife is gardening constantly, got COVID, mild symptoms and then the husband’s a physician and he’s high stress, he barely made it. So I think severity of symptoms also probably correlates to lifestyle and stress factors. Definitely, you know, in the stress from the news and listening to the television, and, you know, the drama, the conflicts and all that, what is all that doing to your microbiome, right?
Dr. Sabine Hazan:
Okay, well, let me stop you. Let’s dig into some other gut issues stuff. So with the testing you’ve done, have you noticed that there is a pattern of bacterial dysbiosis for certain diseases?
Dr. Sabine Hazan:
Yes. But nothing I can really discuss because it’s all preliminary data. So with me, you always hear that because remember, all data needs to be validated, verified and reproducible. There’s definitely a lot of interest. I wouldn’t be continuing this if I didn’t see something. But we are looking aggressively at diseases like Parkinson’s, Alzheimer’s, autism, ALS… That’s all interesting to me.
Lindsey:
Yeah. Okay. Now, on the Progenabiome website, I see blurb that says, “Want to learn more about gut refloralization, contact us below and we’ll follow up with you.” So I’m wondering, do you have options for FMT for people who don’t have C. diff?
Dr. Sabine Hazan:
We do not. We work with the agencies; we work with the FDA; we submit what’s called an IND [Investigational New Drug] to the FDA for emergency cases. So for example, I had a case of metastatic mesothelioma. So I submitted that case to the FDA to allow me to do fecal transplant; they approved it and we did it. So that was one case. We got allowed to do autism in one child; we are trying to get approved to do 30 kids. We’ve been working on it, mind you, for the last two and a half years. So it’s time consuming. It’s extremely expensive to put these protocols in to the FDA. We’re lucky because I’m a Research Center. And so therefore, I have a portal with the FDA that I use to submit all those INDs. However, it is expensive; it’s a lot of back and forth with paperwork. I think if you look at Alex Caruso, and there’s a lot of videos on the Malibu Microbiome Meeting. There’s a lot of videos because I do a lot of lectures with doctors that are doing fecal transplants. There’s going to be lectures from Dr. Sahil Khanna, Dr. Borody. It’s going to be on that website. So I encourage everybody to go to the Malibu Microbiome Meeting.
Lindsey:
I’ll link to that in the show notes.
Dr. Sabine Hazan:
Yeah, and this way, they can see the videos. Neil Stallman does a great lecture on Microbiome 101 for anybody that doesn’t know. Refloralization, I put it in there because it’s a vision of what I believe the future to be. I didn’t like the term fecal transplant. I know it’s been we retermed, Alex is calling it, Dr. Cruz is calling it microbiome transplant, which is a more appropriate term for it. I like refloralization because I believe we come from flora and we go back to flora. You know, the process of dying is our microbes in our gut get stronger and then they decompose our bodies back to the earth. So to me we go back to the earth; those microbes go back to the earth; the foods we eat come from the earth. So essentially, we’re feeding ourselves constantly with microbes from the earth, so from the earth to the earth. So I believe that in the future, it’s probably going to be more of a refloralization procedure, in the sense that finding what’s out of balance and replenishing it by what to create the balance. I think that’s the pharmacy of the future. That’s my vision. So that’s why I put the term refloralization; we are seeing certain microbes are improved with certain nutrients and certain vitamins and certain products. So that all plays a role in the refloralization process, in my opinion.
Lindsey:
So assuming most of the people who are listening to this podcast, they don’t have super healthy microbiomes. But assuming they can get back to a state of a healthy gut microbiome, what would you recommend for people staying that way?
Dr. Sabine Hazan:
Well, I think if you’re healthy, then keep doing what you’re doing, right? If you’re healthy, don’t do anything because whatever you’re doing, you’re doing great, especially if you have longevity in your family. Don’t mess that up, right. If you’re unhealthy and you have a family history of heart disease, etc. Well, that’s time to take charge of your health, right? And that means starting to educate yourself: seeking nutritionists, seeking naturopaths, seeking functional medicine doctors, seeking someone that will guide you in in a good way to proper nutrition and also help you with, I like to call it the fermentation of your gut right, so gut health really is what it’s all about. And gut health is not necessarily the same for every culture, right? Because you could see a Japanese person is eating Mexican food, you probably won’t tolerate it. And a Mexican person eating Mexican food will not tolerate Japanese food. You know, certainly I’ve been a gastroenterologist long enough to know that there’s certain foods that people don’t tolerate. You know, I think probably we’re born with a certain predisposition to eat foods from our culture and our races. And I think that’s your comfort food, you should stick to the comfort food. I think anytime people try to change what’s working is when they get themselves into problems.
Lindsey:
Okay, so I’ve had this theory for a while that issues with vaccinations are often related to antibiotic use and a dysbiotic microbiome. Do you have any insight into that?
Dr. Sabine Hazan:
No, I stay away from vaccines or discussing vaccination because I want to stay alive. Not that anything would happen but to me, but you know, vaccination is a complex product. It’s a complex issue. I don’t think anybody’s really looking at it. I think it needs to be looked at. I think anytime, look what we learned from antibiotics. Twenty-five years ago, antibiotics were given for everything, right. And what we learned from antibiotics is that actually, if you take too many antibiotics, eventually you’re going to have a little bug called C. diff. Because you’ve killed all your microbiome; you’ve killed your gut. I think that’s definitely established now. And people understand that: if you take antibiotics, you have a risk of killing your gut. And that’s why the whole probiotic movement came on, because if you’re killing it with the antibiotics, you have to promote your gut with the probiotics, right? And thus, the movement of the yogurts and the drinks, and the probiotics, etc. I think there’s going to be a time that we’re going to figure out the same thing with chemo drugs; if you kill the tumor, you got to work on the gut, to support the killing of the tumor because you can’t just kill kill, kill, you’ve got to replenish. And again, the same thing we were doing with C. diff. We were trying to kill kill kill with antibiotics. But instead, we got people worse. What we needed to do was add more microbes. So I think there’s going to be a time that also people are going to start looking at vaccination and seeing maybe there’s something we’re doing with vaccination that needs to be supplemented with something else to balance the benefits of the vaccination with the disbalance that could be happening in the gut, for example. Okay, and I’m not saying that there is, but I’m just saying that I think we need to look at it, because it’s never a one pill solution. And it’s always a domino effect: action leads to a reaction with everything.
Lindsey:
Yeah, I’ll just add to that though, that I’m a supporter of vaccination, I have had my children vaccinated and myself and all that. But I’m just, I just look at..
Dr. Sabine Hazan:
I vaccinated my kids, I got vaccinated…
Lindsey:
Because there’s so many people now, because of the politicization of the COVID vaccine, now that are anti-vaxxers. And I feel like it’s an important point to not completely deny that there’s ever been any problem with any vaccination, because that’s what promotes conspiracy theories.
Dr. Sabine Hazan:
Yeah. And I think, yeah, and I’m not a big conspiracy theorist. And you know, it’s so funny because on X; people think I’m an anti-vaxxer because I asked questions. Because listen: I’m a scientist. So if I’m going to have a person that comes to me and thinks they have a side effect to a vaccine, it’s my job to look, is that what’s going on there, right?
Lindsey:
Yeah.
Dr. Sabine Hazan:
So because in my world of clinical trials, when you have any investigative product and a patient has a side effect, any side effect, be it you know, pain in the mouth, be it headache, you have to document that; it’s called an adverse event. And if they end up in the hospital, or they’re having something that’s serious, like they’re paraplegic, you know, I look at the case of Mattie de Gabbé, which I got involved in looking at her; you have to pay attention to that, because that’s a serious adverse event. And serious adverse events, we cannot ignore them because they tell us something else in the future. So I think it’s our job to pay attention to everything. I think, also, you have to pay attention to the people that it doesn’t work for, right. So the people that got vaccinated and still got COVID: you’ve got to ask the questions.
Lindsey:
Yeah.
Dr. Sabine Hazan:
So just because I’m asking the questions, doesn’t mean I’m an anti-vaxxer. It just means that I’m a good scientist for asking the question.
Lindsey:
Yeah, yeah, no, I and my children were vaccinated and boosted and still got COVID, but it was Omicron. So that was sort of expected since that was less sensitive to the vaccines.
Dr. Sabine Hazan:
Yes, yes.
Lindsey:
Okay. So you mentioned that the people who were most susceptible to COVID had low levels of Bifido and I’m just wondering because actually I did Thorne’s sequencing of the microbiome, and they said I was lacking Bifido. And to take rice bran… well, they said… I can’t remember the name of the actual fiber, but it was essentially rice bran.
Dr. Sabine Hazan:
Right.
Lindsey:
So I’m taking that, but other than taking probiotics with Bifido and that, what else can boost Bifido?
Dr. Sabine Hazan:
So I have to warn on that, because I never put myself in the position to kind of say, yes, we found this. It’s research, right? So it’s my hypothesis. It’s a finding. It’s a small study and needs to be done as a bigger, larger scale, obviously. So I don’t want people like leaving this and saying, Oh, my God, I’ve got to check my Bifido to see if I’m alright. Right? Because until other doctors validate, verify, and we produce the data, it’s still research on one site.
Lindsey:
Right, right.
Dr. Sabine Hazan:
So I think if it doesn’t hurt, yeah, take whatever was suggested. But if it becomes like a heavier treatment or something that is risky, I probably would stay away from that, not necessarily trust those labs. Remember, these labs are not validated and not clinical, right? They’re just a consumer product that’s out there. But the majority of these labs are not even CAP or CLEA certified. So it’s very important when you do your stool testing. And remember, we’re in the research; we’re writing the data. And we’re not a commercial stool sample yet, because there’s so much to learn. So you got to be aware of stool companies that are selling you these tests. And then telling you, you have low Bifidobacteria, because maybe they’re trying to sell you a probiotic for one. I know, we have validated a couple of those lots, because my patients come to me and say, “Look, I just took this probiotic from this company. And you know, my Bifido was low, and then we compared it and we couldn’t find that their Bifidos were low. So you got to be careful of anything out there. It’s all research. And everybody needs to understand it’s all research.
Lindsey:
Well, it wasn’t the first low Bifido reading I’d had. I certainly had other probably 16s sequencing that showed low Bifido as well.
Dr. Sabine Hazan:
Yeah. So that’s good. So you validated yourself.
Lindsey:
Right, right. Over time. So are there any other diseases where you’ve noticed changes when incidentally you were doing the transplant for C. diff?
Dr. Sabine Hazan:
We are working on autism right now. We’re going to try to bring on a protocol for Parkinson’s and Alzheimer’s. I’m working with Dr. Sheldon Jordan at UCLA, who is the top interventional neurologist, in my opinion. We’re also working with anxiety with Dr. Sasha Bystritsky. So that’s going to be an interesting study. We feel that we see something in anxious patients’ microbiome. So we’re evaluating that closely.
Lindsey:
And are you just looking at what is going on in the microbiome? Or are you making interventions?
Dr. Sabine Hazan:
No, we’re looking and we’re making interventions. So we’re basically… remember, I’m a research center. So we have access to animal labs. So right now, we’re looking at an animal marker for Parkinson’s. So we’ll see. I mean, the future is exciting. We’re seeing some things. And we’re going after it full blast. And we’ve been lucky so far, so we’re still above the ground as far as finances, but people can support the Microbiome Research Foundation, because that’s how we make all these trials possible, and this research possible. The paper for COVID, the lost microbes of COVID, or finding COVID in the stools was paid by the Microbiome Research Foundation. So please put that on the links so that people can support that. So that’s how we advance science through research; through donations.
We’ve been fortunate; a lot of patients I’ve helped over the years that you know, I’m in Malibu, so I have an affluent population; and they’ve been coming forward and been very generous in in supporting us. So and also the patients, you know, the patients support us, so it’s been amazing to help people. And to see and to kind of go into the research with them and see what we see and saying, “Look, it’s research. This is what I see. I could be wrong, but I could be right. And this is the beginning.” You know, and having frank, honest discussion with the patients and giving them a consent because really all our research is consented. Anytime anybody gets tested with us with the microbiome, it’s all research so they have to sign a consent before they get tested or if we test their kids with autism, etc. They have to sign a consent. We are supervised by a regulatory board that overlooks all our IRB that overlooks all our research we’re doing. You know I thought Howard Young at the NIH said, “This is the way to do it.” And I’m doing it. So I wrote 52 clinical trials on the microbiome and disease. I’m looking at every disease and every skin condition.
I’m very fortunate. My sister is the top dermatologist in New York City. I have another sister who brought HARVONI and Ivermectin in the market. So we have a huge database of patients through clinical trials over the years. So we’ve been able to utilize these databases and put patients into clinical trials, to at least get a beginning of a view of what does Parkinson look like in the microbiome; what does Alzheimer’s? So we have an idea and we’re continuing slowly, slowly, and eventually, as we publish, I encourage everybody to go on the Progenabiome website, because it has publications. We’ve published about 35 papers, I think, in the last three years. So you know, it’s moving. I have 52 more papers to go. We have a lot of scientists helping me and we encourage collaboration from everyone. Anybody that wants to be involved, please, you know, we’re all inclusive. Like I said, I’m a Research Center. I’m a research lab right now, research genetic sequencing lab. I’m not a commercial. But anybody that wants to get involved and has something that they want to crack the code of, you know, can help us and together hopefully we’ll join forces. I am fortunate I have a lot of doctors, a doctor from Turkey that I’m working with. Right now, we’re looking at Crohn’s and Ulcerative Colitis together. Dr. Borody has been an inspiration and definitely a huge mentor and a huge brain and genius.
Lindsey:
Yeah, speaking of him, I would love to get him on the podcast. Any chance you would introduce me?
Dr. Sabine Hazan:
Oh, yeah, absolutely. I could do an email. He’s extremely busy right now because he’s trying… we started off that controversial triple therapy for COVID with Ivermectin, doxycycline, zinc. So he’s busy fighting the wolves, because he wants to see that going. You know, he was behind the therapy for H. Pylori. So patents is his world and combination therapy is his world. And he’s a genius. I’m so fortunate to be working with the man. And I’ve done my part, which was like doing the clinical trial with the FDA. So now it’s on to him to take it to the next level. That was not an easy trial to do, and certainly a lot of politics, controversy behind it so…
Lindsey:
Okay, well, I appreciate that. Even if he doesn’t have time, maybe he will eventually.
Dr. Sabine Hazan:
Yes, yes. Yes. For sure. I think yeah; as he kind of like figures out this whole triple therapy. What he wants to do with it? I think that probably would be the best time.
Lindsey:
Okay well, thank you so much for coming on and sharing about what you’re doing at Progenabiome and I look forward to talking to you in the future sometime.
Dr. Sabine Hazan:
Yes, absolutely. Thank you so much.
If you’re struggling with your gut health, 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 gut health coaching 5-appointment program 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’m going to describe the digestive process when it’s working well, which may help you pinpoint where things may be going wrong for you, as well as give you an idea of the symptoms when a certain part of your digestion is off. I’ll be focusing mostly on functional digestive issues, as those are the kind I work with clients on, as opposed to mechanical issues, which a conventional gastroenterologist is best equipped to handle, although I’ll mention a few. And I’ll preface this by saying that of course this isn’t comprehensive, but rather a summary of some of the most common issues I see in clients.
So first of all, before you even eat, as you think about eating or smell your food before eating it or while cooking it, this alerts your brain to start the flow of saliva in your mouth, which contains salivary amylase, which helps break down starches in your food into simpler sugars. Then next, if you don’t shovel your food down too quickly, you’ll ideally chew each bite a good 20 or 25 times so that it’s a fine mush and it mixes well with those enzymes.
Then as you swallow, your food travels down the esophagus to your lower esophageal sphincter, which will open up and let the food into your stomach. Now hopefully the pH in your stomach is ideal, meaning not too acidic and not too alkaline, although a stomach with its acid is quite acidic, with a pH usually in the range of 1.5 to 3.5.
When it’s not acidic enough, or there’s a lack of stomach acid, called hypochlorhydria, it can lead to the opening of the lower esophageal sphincter, which is sensitive to pH and closes when the pH drops under 3.0, which will trigger the escape of stomach acid into the esophagus and the sensations of GERD, or gastroesophageal reflux disease, aka heartburn. Stomach acid tends to decrease with age but can also decrease due to the presence of H pylori or Helicobacter pylori, the bacteria that causes ulcers and stomach cancer when it possesses certain virulence factors. Other factors impacting stomach acid are alcohol use, poor diet, not being in a proper rest and digest or parasympathetic state while eating, stress and food sensitivities as well as pharmaceuticals such as antibiotics, proton pump inhibitors or PPIs and antacids. Insufficient stomach acid can lead to maldigestion of proteins and their components, amino acids, which can impact the lining of the stomach leading to leaky gut, and puts stress on the pancreas to produce enzymes to complete the digestive process (which are composed of amino acids themselves). And when you have undigested proteins leaking into the abdominal cavity, that can trigger autoimmune reactions as your immune system targets the proteins and other parts of your body that look similar to the offending proteins. Low stomach acid can also lead to overgrowths of candida, parasites, and bacteria, which are normally killed off or kept in check by stomach acid, and can also lead to mineral depletions in the body.
Another possible reason for GERD, proposed by Norm Robillard who appeared on episode 41 of this podcast and created the Fast Tract Diet and wrote Heartburn – Fast Tract Digestion: Acid Reflux & GERD Diet Cure Without Drugs*, is an overgrowth of bacteria in the small intestine feeding on maldigested carbohydrates, which leads to the production of gas. That gas puts upward pressure on the stomach and causes acid to be pushed back upwards. This maldigestion can be the result of excess starches in the diet and/or excess bacteria, as well as insufficient pancreatic enzymes to help digest the starches. Upward pressure can also happen as a result of a hiatal hernia.
But back to your stomach, when the food arrives there, your stomach’s G cells release a hormone called gastrin, which triggers the stomach to release gastric juice, composed of water, mucus, hydrochloric acid, pepsin and intrinsic factor. The churning motion of your stomach helps to mix up the food with gastric juice and break it down. And then the pepsin, in combination with the acidic pH produced by the hydrochloric acid, breaks down proteins into amino acids.
There are a few things that can go wrong at the level of stomach that can cause problems. Gastritis, or inflammation of the lining of the stomach, can come about due to a poor diet, excess alcohol consumption, overuse of NSAIDs or non-steroidal anti-inflammatory drugs, especially ibuprofen and naproxen sodium, and H pylori overgrowth, which can be the result of lowered gut immunity due to stress. While virulent strains of H pylori can causes ulcers and stomach cancer, even non-virulent strains can still cause GERD and bloating after eating, stomach pain, especially on an empty stomach, nausea, and other symptoms like lack of focus, especially in children, constipation, diarrhea and even insomnia.
And while actual tests of people with symptoms of GERD have shown that hypochlorhydria is the most common cause (roughly 80% of the time), you may actually have excess stomach acid or hyperchlorhydria, which is commonly treated with PPIs by conventional doctors, whether or not the state of your stomach acid is known (which is rarely as few doctors have the ability to perform a Heidelberg test, which measures stomach acid). Hyperchlorhydria is also common in the early stages of an H pylori infection but usually turns into hypochlorhydria over time. But it’s important, even if you do have excess stomach acid, to not stay on PPIs long term. Usually a course of 2 weeks is recommended and then other causes of your issues should be investigated.
So after the stomach, the food goes through the pylorus into the small intestine or small bowel where it’s broken down further with enzymes produced by the pancreas, the primary types being amylase for breaking down starches, proteases (also called proteolytic enzymes, proteinases or peptidases) for breaking down proteins and lipase for breaking down fats, along with bile. Bile is produced by the liver and stored in the gallbladder and it emulsifies fat, meaning it breaks it down into micro-droplets. Also involved in the final stages of digestion of carbohydrates and protein are the brush border enzymes, which are embedded in the microvilli, or hairlike structures lining the small intestine, the most well-known of which is lactase, which breaks down lactose, the sugar in dairy products. Genetics determine the persistence of lactase activity, which many people lose by adulthood, making them lactose intolerant, whose symptoms are gas, painful, soft or even liquid stool, bloating, cramping and discomfort after eating and while eliminating lactose, which is highest in soft cheeses, milk and ice cream.
Issues at this level can be related to insufficient pancreatic enzymes, which can have many causes. The official name of this is called exocrine pancreatic insufficiency or EPI, whose most common cause is chronic pancreatitis or inflammation of the pancreas. This can result from alcohol abuse or gallstones in the gallbladder. Ongoing inflammation damages the cells of the pancreas, leading to a decrease in enzyme production. Other causes of EPI include celiac disease, IBD, diabetes, pancreatic cancer and weight loss or other digestive tract surgery. Symptoms of EPI are either constipation or diarrhea, abdominal pain, bloating and gas and fatty or pale-colored, oily or floating, smelly stools.
And returning to the gallbladder, you can also have issues impacting your digestion originating in the gallbladder such as gallstones, clogged bile ducts, sludgy bile or insufficient bile, which is a given if you’ve had your gallbladder removed. Although the liver produces bile, it’s stored in the gallbladder and you won’t have enough to digest a higher fat meal. Signs of insufficient bile or fat maldigestion include trapped and bad-smelling gas, stomach cramps, diarrhea, erratic bowel movements, weight loss and pale-colored stools. Having problems with fat digestion or having had your gallbladder removed leads a lot of people to avoid eating fat, which is a mistake, because it’s part of a healthy diet and is necessary for the absorption of your fat soluble vitamins A, D, E and K as well as fat soluble vitamin-like compounds like CoQ10. If you’ve had your gallbladder removed, you should continue to eat fat but support your gallbladder with something like Bile Acid Factors*. If your bile is insufficient for other reasons, you may need to stimulate bile production with bitter greens, green leafy vegetables, beets, artichokes, pickles, grapefruit, lemons, limes and their juices and zest, spices such as fenugreek seeds, cinnamon stick, turmeric and ginger or drinks like roasted dandelion root tea, lemon tea, celery juice and coffee.
There are also lots of things that can go wrong at the level of the small intestine that can impact digestion. From the bacterial perspective, there’s SIBO, or small intestine bacterial overgrowth, which is usually caused by stagnation in the small intestine due to a variety of causes. That stagnation leads to a buildup of excess bacteria and general dysbiosis, or an overgrowth of the wrong types of bacteria. This can cause painful bloating and distention of the abdomen after eating, and if the bacteria produce hydrogen, usually diarrhea or soft stool. If your overgrowth is of hydrogen sulfide producing bacteria, then you’ll likely also have gas that smells like sulfur or rotten eggs and excessive belching. Other possible signs of hydrogen sulfide SIBO include intolerance to sulfur-containing foods and supplements, weight loss, brain fog, exercise or stress intolerance, burning bladder syndrome, elevated heart rate, insomnia and low blood pressure after eating. Hydrogen sulfide SIBO is also associated with ulcerative colitis, Crohn’s disease and colorectal cancer.
Then there’s IMO, or intestinal methanogen overgrowth, which used to be known as SIBO-C, or SIBO with constipation, which is an overgrowth of archaea (which are like bacteria but of a whole different domain) including Methonobrevibacter smithii and Methanosphaera stadtmanae, which produce methane gas by metabolizing the hydrogen produced by bacteria fermenting carbohydrates. You’ll often have bloating and gas with a metallic smell when this happens.
Or you can have an overgrowth of candida, which is a normal resident of your gut but can overgrow and even become systemic in severe cases, and which can form hyphae or sort of tails that go out between cells lining the small intestine. Usually bloating after eating, food sensitivities, skin issues and brain fog are signs of invasive candidiasis.
Any of the above small intestine issues can lead to a case of intestinal permeability or leaky gut, which means that bits of not quite digested food or bacterial body parts called lipopolysaccharides or LPS can escape either through broken down cells or between cells and get into your system, activating your immune system and often leading to autoimmune diseases.
But back to the normal digestive process, after the small intestine, food moves through the ileocecal valve to enter into the large intestine. Some people have mechanical issues with this valve staying chronically open or closed. Chronic constipation and tenderness in the lower right quadrant are signs that this may be an issue and it can be a root cause of SIBO. You can actually manually reset this value and I’ll link to a video about how to do that.
And I should also mention the role of the vagus nerve in all this, because the vagal nerves carry signals between your brain and digestive system. And damage to the vagus nerve from a traumatic brain injury, diabetes, stomach surgery or certain medications, or dysfunction from emotional trauma and stress can impact your digestion, causing problems like gastroparesis, or food not moving from your stomach into your intestines properly, or SIBO. One simple way to check your vagus nerve function, described in the book Accessing the Healing Power of the Vagus Nerve* by Stanley Rosenberg, is to look at your uvula (the thing that hangs down in the back of your throat) in the mirror while saying “ah, ah, ah” and if it pulls up to the right or left, you may have issues. If this is the case, there are exercises listed in that book that can help you return to normal vagal tone.
And of course you can have autoimmune issues all the way along, starting in the stomach, where pernicious anemia is an autoimmune attack on the parietal cells lining the stomach that produce stomach acid and intrinsic factor, which allows you to absorb vitamin B12. Or you can have post-infectious IBS or irritable bowel syndrome, which is an autoimmune attack on a protein called vinculin, which helps the migrating motor complex function to remove food from your small intestine on a regular basis. Or you can have celiac disease, which is an autoimmune attack on the microvilli lining the small intestine when you eat gluten. Common signs of this are stomach pain, fatigue due to malabsorption of nutrients as the microvilli deteriorate and diarrhea. You can also have other food sensitivities and intolerances such as non-celiac gluten sensitivity or lactose intolerance, which are two of the most common.
Or you can have inflammatory bowel disease, which is an autoimmune disease that can manifest as ulcerative colitis or Crohn’s disease. Crohn’s involves plaques of diseased, ulcerated tissue anywhere from your mouth to your anus, and in its most severe form can lead to twists and strictures in the intestines, openings or fistula in the perianal area, anemia, shortness of breath and inflammation in your skin or joints. Common earlier signs of Crohn’s are pain, abdominal cramping, diarrhea, fatigue, fever, blood in the stool, loss of appetite, weight loss, food sensitivities, a sense of incomplete elimination after a bowel movement and bowel urgency. Colitis takes many forms such as pancolitis, microscopic colitis, ulcerative proctitis, etc. depending on its location and form, but always involves inflammation and ulcers in some part of the colon. Signs of colitis include abdominal pain, diarrhea, bowel urgency, blood and/or pus in the stool, weight loss, rectal pain, nausea, vomiting, loss of appetite, chills or fever and anemia.
So back to normal digestion, when the food reaches your large intestine, normally you’ll be absorbing water, minerals and some remaining nutrients from your food. And if you have a healthy, fiber-rich diet, you’ll also have lots of fiber left over for the bacteria, which are most abundant in your large intestine, to ferment. The bacteria will also be providing nutrients themselves, specifically B vitamins and vitamin K, from that fermentation process. And they will also be extracting the short chain fatty acids butyrate, propionate, and acetate from the fermentation process.
Butyrate has been the target of a lot of research recently and I’m sure you’ve heard me mention it, as it produces 70% of the energy for the cells lining the large intestine or the colonocytes and helps maintain a hypoxic or oxygen-free atmosphere in the colon. The colonocytes break down butyrate and the other short chain fatty acids through a process called beta oxidation, which requires large amounts of oxygen. When there’s a lack of fiber for producing butyrate or following antibiotic use, you can have a breakdown of this process, leading to a loss of gut barrier function, and a subsequent increase in oxygen in the colon. That increase favors the expansion of proteobacteria, a phylum of bacteria that contains many gut pathogens like E Coli, Pseudomonas and Campylobacter, which are facultative anaerobes, meaning they can live in the presence of oxygen. This helps them outcompete the beneficial obligate anaerobes, particularly Clostridia, which are butyrate producers. I’ll link to a Lucy Mailing article explaining all about this particular type of dysbiosis. But what I’ve found with clients is that if you tend to have loose, messy stool, it’s often the result of this kind of dysbiosis, and supplemental butyrate in the form of Probutyrate (find in my Fullscript Dispensary*) or Tributyrin* is helpful in breaking this cycle.
And I should probably mention constipation at this point because that’s something else that can go wrong. Having fewer than one bowel movement a day or having stool that’s very dry and hard or even to the point of rabbit pellets, hard to pass or feeling incomplete is considered constipation. You may also see breakthrough diarrhea as well in the context of constipation or what’s considered IBS-M or mixed. Constipation can be the result of dehydration, lack of exercise, a low-fiber diet, changes to your routine, an intolerance to or large amount of dairy products, stress, chronic holding of bowel movements and certain medications. This can lead to anal fissures, diverticulitis or infected pouches in the wall of the large intestine, or hemorrhoids, which can all cause pain in the colon. And anal fissures and hemorrhoids can cause bleeding, which will show up as bright red on the toilet paper.
But if everything is going well and properly with your digestion, you’ll instead have 1-3 regular bowel movements a day, around a 3 or 4 on the Bristol stool chart, that pass easily and completely and result in a clean wipe of the toilet paper most of the time.
If your digestion is not proceeded successfully as describe above and you’re suffering with any type of gut or digestive issue, 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 gut health coaching 5-appointment program 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 links are affiliate links for which I’ll receive a commission. As an Amazon affiliate, I receive commissions on purchases made from Amazon links. Thanks for your support of the podcast and blog by using these links.
Dr. James Adams is a President’s Professor at Arizona State University and he leads the Autism/Asperger’s Research Program there, where he is researching treatments for autism including nutritional supplements, microbiota transplants, probiotics, as well as yeast and antifungals. He also started a nonprofit to help parents of children with autism called the Autism Nutrition Research Center.
Lindsey:
So what have you been up to since we last talked?
Dr. James Adams:
Well, we’re continuing our research on microbiota transplants for children with autism and adults with autism. We’re also doing research on probiotics, and for treating autism. And we’ve also been looking at the use of and the role of yeast and antifungals for autism.
Lindsey:
Interesting. So I actually just recorded and published a podcast with Dr. Michael Biamonte. And he was talking about autism and yeast. So tell me more about that.
Dr. Adams:
Sure. 10 years ago, we did a study where we looked at 50 children with autism and 40 typical children; we found that about 25% of the kids with autism had a yeast infection, and about 10% of the typical kids did. And so one of the factors that can contribute to yeast infections is excessive use of antibiotics, because antibiotics can kill off your natural gut bacteria. And then when those are killed off, then there’s more opportunity for yeast to grow in your gut. And so at the time, as the difference wasn’t quite statistically significant, we did not follow up on it. But since then, we’ve learned a little bit more so we went back to look at the data a little bit more, and we found that the children with autism who had yeast infections also had significantly worse autism symptoms. Their gut symptoms weren’t necessarily worse, but the autism symptoms were. And if you think about what yeast does: yeast produces nasty toxins, things like alcohol, that people go and drink in Saturday night, but produces much nastier toxins than alcohol, that are much more damaging. And if you think about alcohol, it mostly has an effect on the brain, and so can affect coordination, but it can affect speech, it could affect executive functioning, and make it very difficult to regulate your emotions. So the bottom line is that we think quite a few children with autism have a hidden yeast infection that does not necessarily cause GI symptoms, but does tend to worsen their autism symptoms. And so because it just manifests as more severe autism then people don’t know to look for it and to try to treat it. And since then, there have been half of a dozen additional studies, which also show anywhere from about a quarter to even half the children with autism have these chronic yeast infections, and so it seems to be a very major concern.
Lindsey:
Interesting, and how are you measuring their yeast infections? How are you diagnosing it?
Dr. Adams:
Yeah, so we’ve looked at it in a very simple way by doing a yeast culture of the stool. So taking stool samples in our study we send them to a lab. Doctor’s data, it has a standardized stool test, and it tells you approximately how much yeast is present. One of the things I like about the test is that they also can do a sensitivity test. So after they culture the yeast, then they try killing it with different antifungals and that way you can know which antifungals are most effective against the particular strain of yeast that you have. Because some yeast can eventually develop resistance to one or more antifungals.
Lindsey:
So you know, I talk with a lot of practitioners about yeast and see clients myself. And I’ve noticed that on stool tests, it often doesn’t appear, but when you simultaneously run an Organic Acids Test, the Arabinose marker is elevated and often, you know, off the charts. And I’ve heard from a lot of people that the stool is not the most accurate way to test it. So if I see yeast on a stool test, I think, wow, they must have a lot of yeast.
Dr. Adams:
Yeah, they can set different levels. So different labs can set different levels for yeast as to how much is needed to be a positive. So we found that even a plus one on Doctors Data tests was associated with the worst neurological symptoms. And most of the kids were just a plus one, but again, that was enough to differentiate them from those who did not have significant yeast infection. But one of the other major clues that we found out, which I think is very important, is that body’s main defense against yeast is Secretory IgA, the antibodies that are excreted in the gut. And we found that there was an inverse correlation that if you had high amounts of yeast, you had low amounts of Secretory IgA and vice versa. The reason this is important is that yeast produces proteases that attack Secretory IgA. So basically, once yeast is present, once it’s formed a culture in the body, it then excretes these proteases that destroy the body’s defense against it. So it’s a vicious cycle once you have these yeast infections, they can be very hard to get rid of.
Lindsey:
Interesting. And then of course, if you have low Secretory IgA, then your gut defenses are down, and you’re probably prone to a lot of other gut pathogens.
Dr. Adams:
Exactly. And then as time goes on, the yeast within typically 24 hours will form a biofilm, and that biofilm and associated yeast will start dissolving part of the GI tract where it’s landed. It’ll also start damaging the GI tract and caused increased intestinal permeability or what we call leaky gut. So the bottom line is, I suspect that many children with autism have yeast infections for many years, worsening their autism symptoms, and they don’t know it. And so my recommendation would be for every child and adult with autism to have an evaluation of possible yeast infection using a stool test and see if it’s positive, and if it is, treat it with an antifungal. The problem is that, it seems based on the anecdotal reports I’ve had from many physicians is that after you stop treating, it’ll just come back. So some people are an antifungals for years and it seems that going on an anti-yeast diet seems to be important to help keep that gone.
Lindsey:
Right. Yeah, I have definitely seen that people who just go right back to eating a lot of sweets and white carbs will just grow it right back. It won’t take long.
Dr. Adams:
Exactly.
Lindsey:
Yes. So how have you incorporated that into your research studies?
Dr. Adams:
So we’ve proposed to the federal government to do a study of yeast levels in children with autism. And to do the first major treatment study. Up until now there’s been only one small treatment study that had a lot of limitations to it. It was a great start, but there has not been a formal major study of the effects of detecting and treating yeast infections. So I think it’s very important to do but unfortunately, the NIH does not feel that it’s very important.
Lindsey:
So it wasn’t funded?
Dr. Adams:
It was not funded.
Lindsey:
That’s a shame. And who did the other study that you’re referring to? Can you send me a link for that one?
Dr. Adams:
So there are about half a dozen groups around the world that have done studies of yeast in autism and found higher levels. But we seem to be the only group that’s looked at the correlation with more severe autism symptoms, and we haven’t even published that yet. I don’t have time to publish everything we find, but that’s together an important piece that we need to investigate further. But if we think about the effect of alcohol on the body, and the effect it has primarily on neurological functioning, I think that it’s very plausible that that could be contributing to a lot of the neurological problems, a lot of the behavioral problems that are seen in autism.
Lindsey:
So when we last talked, I think you were trying to get funding, you were starting Go Fund Me for a study that was involving younger children, I believe, and microbiota transplantation or transfer therapy…
Dr. Adams:
That’s right. And so we were doing two studies, we did receive funding from the federal government to do a study of microbiota transplant for adults with autism. And that study now is almost completed. We’ve enrolled the last participants, and we’re following them now. They’re in by mid spring. That study, the first part of the study, the treatment portion of the study will be completed. And then we’re still going to follow participants for another 18 months beyond there, because we found in our first phase one study that although we saw great improvements in GI symptoms right away and some improvements in autism symptoms, we saw even more improvement in autism symptoms at a two year follow up, two years after we stopped treatment. So the feeling of many families is that the treatment was very effective in helping their child learn but it then took time for them to learn language to learn behavior, to learn social interactions.
Lindsey:
And so for the adults, I assume you’re using the same source material that you were using for your previous studies, which is like a purified fecal transplant, essentially.
Dr. Adams:
Yeah, we took a very similar approach. The difference is now we’re using a capsule form. That’s essentially like a typical probiotic that comes in a pill. But the difference, of course, is it’s 1,000+ species of bacteria from very healthy human donors. But other than that, the treatment approach is very similar. So we pretreat with vancomycin to kill off bad bacteria. We use a bottle of cleanse to get rid of bad bacteria. And then we do the microbiota capsules. We’re experimenting in this study to see if longer dosage is more beneficial. We’re also using a higher dose to see if we’ll see more benefit. And we’re also experimenting where some of the people do receive the pretreatment with vancomycin, and some don’t, to see if the vancomycin is needed or not.
Lindsey:
And how long do you use the vancomycin for?
Dr. Adams:
We use the vancomycin pretreatment for two weeks in both the child and adult study. It’s what we used from a previous study. There was a study 20 years ago where they used vancomycin for eight weeks, very long time. A normal course for vanco was 10 days. In the eight week study, they used it because their hope was to kill off not just the bad bacteria, but also prevent any regrowth from spores. Unfortunately, when they stopped the vancomycin, within a few weeks, all the GI benefits, all the autism benefits were lost in almost all participants. That just the opposite in our study, it seems that by doing a short course of vanco, and then replenishing with the microbiota capsules, we have not seen any significant loss of benefit.
Lindsey:
And when you said bowel cleanser, we’re talking about a colonoscopy prep type of thing?
Dr. Adams:
Yeah, we do a very complete bowel cleanse. A lot of Miralax or equivalent. Along with a lot of liquids and bottom line is we try to do to just as complete as for a colonoscopy,
Lindsey:
And then how many capsules or how much is in a capsule? And for how long are people taking it?
Dr. Adams:
For the microbiota?
Lindsey:
Yeah.
Dr. Adams:
So we do a high dose for two days. And then we do a maintenance dose for eight to 12 weeks. Well, in the adult study, we’ve been going up to 16 weeks to see if that matters.
Lindsey:
Okay. And when you say a high dose, how many capsules are people having to take?
Dr. Adams:
12 capsules a day for two days, and then one capsule every several days. And this is a highly purified form that’s basically 99% gut bacteria. And because it’s in a capsule, it’s specially designed to not be affected by stomach acid. It’s a very high dose that we’re administering.
Lindsey:
Right. So enteric coated type of thing?
Dr. Adams:
More or less, more or less.
Lindsey:
Okay, so you mentioned donors, and I’m wondering whether this is a pooled donor situation, or a single donor, or just a couple donors that are going into creating these?
Dr. Adams:
Our philosophy is to use just a single donor for each batch of capsules that are produced. And the reason is, if you think back to when blood donations where used, they used to pool blood donations. Well, both my mother and my brother developed hepatitis C, when they didn’t know to test for hepatitis C, and my brother almost died from it and my mother did die from hepatitis C. So when you pool donations, you increase risk.
Lindsey:
Right.
Dr. Adams:
And so we like using single donations, single donors for each set of capsules. That way we minimize risk. And if there is a risk, we know which donor they came from.
Lindsey:
Yeah.
Dr. Adams:
I mean, in general, we’ve screened extremely carefully, just like you would for a blood donor for the Red Cross with additional questions about GI health. We also make sure that they have a lean body mass, not overweight, or underweight, which we think is also important for the microbiome.
Lindsey:
And do you have an age limit for your donors?
Dr. Adams:
Good question. Our donors are characterized by the University of Minnesota. So we use adults as our donors. I don’t think we have an age cap. But I don’t think we use anyone who’s particularly old either. So it’s a good question. I haven’t had been asked that before.
Lindsey:
Well, I’ve had a lot of people on here who have talked about what a good stool donor would be. And they seem to think an age cap of something like 25 is necessary, which kind of seems crazy to me, because, well, there’s got to be some people with great microbiomes, who somehow missed the antibiotic craze, who are older.
Dr. Adams:
Yeah, yeah, if I had to guess I would say going up to 65 would seem very reasonable to me. Again, depending on the individual’s health. The advantage of older donors is that will you know if they’re likely to be someone who’s developing GI cancers or not. With young donors, you don’t know if they’re prone to or not in the future.
Lindsey:
And so if you only have one donor, can you really say this therapy modality is effective? Or can you only really say that this particular donor had a great microbiome?
Dr. Adams:
Well, we’ve used many donors. It’s just that for any batch, when we’re dealing with a patient, that patient would receive a microbiota from just one donor. Or possibly, in our first study, we used two donors, one for the initial batch for the high dose, and another one for the maintenance. So different donors have different microbiota, I think there may be some benefit to using, say two donors. Because each donor will have their own set of healthy bacteria, but then two donors together, have somewhat more species. So there might be an advantage to that; you might get greater diversity. And in general, higher diversity is associated with higher gut health.
Lindsey:
So given that you’re doing a study with adults, are you working primarily with adults who are high functioning enough to be choosing to be in the study themselves or are they typically being enrolled by guardian parents?
Dr. Adams:
Both. So we do have a few individuals who are high functioning enough that they’re working, living on their own and they’re able to handle the questionnaires in the process. We still have an evaluator to evaluate them. But in other cases, we have some very severe individuals, nonverbal, very limited, who are also undergoing the treatment.
Lindsey:
And do you have any preliminary sense of what’s going on with the…
Dr. Adams:
I’m blinded, but I will say – so I don’t know who has received the real treatment who receives the placebo – but eventually, anyone who receives the placebos switch to the real treatment. So I’ll just say that we’ve seen a lot of good improvement, but until we publish the work, I don’t want to say more than that.
Lindsey:
Fair enough. Okay. And then the study with children, where is that right now?
Dr. Adams:
Yeah, so both our studies were hit hard by COVID in a couple ways. In one way, simply because we had to stop using the capsules that had already been produced. Because we had not tested the donors to see if they had COVID. So we had to stop and then implement a new process and also the university we’re working with, University of Minnesota, their research labs were closed for many months because of COVID. And then they had to restart them, which took many months. So we had a big delay there. And then we had to also develop new standards to test the donors for COVID. And also test their tools for COVID or SARS CoV-2, but now we’re in good shape with both our studies, and for our child study, we have treated about half of the participants, and we’re getting ready to start treating the other half over the next several months.
Lindsey:
What was the age on the second study?
Dr. Adams:
For the child study, we’re doing a little bit younger now. So our first study was aged 7 to 17. And now we’re going down to age 5.
Lindsey:
Okay.
Dr. Adams:
Again, being a little cautious because most FMT studies have been done for adults. But because we saw really no adverse effects in our Phase 1 study, and we haven’t seen any significant adverse effects in our Phase 2 studies, we’re glad to see the FDA allowed us to go down to age 5.
Lindsey:
And so was that was that all you were asking for? Or did they choose that cut off?
Dr. Adams:
We asked to go down to age 5 based on what we figured the FDA would allow.
Dr. Adams:
Okay.
Dr. Adams:
But I’d like go down to an even younger age, you know.
Dr. Adams:
Of course.
Dr. Adams:
Interestingly, when we asked these families about when the GI problems began, in almost all cases, we’re hearing that the GI problems began in infancy. It’s a little hard to detect exactly when they occur because infants don’t have normal stools, but it seems that in almost all cases, these GI symptoms have begun in infancy and have lasted many years.
Lindsey:
And so we were talking in the last podcast about FDA approval for use of microbiota transplantation for autism. And you were saying you have to go through the Phase 1, that you’re in Phase 2 and then you’ve got to go through the Phase 3. Where are you in that whole process, then?
Dr. Adams:
Yeah, so we’re in our Phase 2 studies now. One of our Phase 2 studies for adults is almost complete. And the study for children we’re about halfway through. So we’re making good progress. We were slowed down, as I said, quite a bit by COVID. That also hurt our finances quite a bit, too. But now that we’re past those problems, we’re able to be making good progress. At the end of these, we will then ask the FDA for permission to go ahead and do Phase 3 studies.
Lindsey:
And Phase 3 is different from Phase 2 in what way?
Dr. Adams:
It’s usually the same study design; you might make some differences to the study design, if you wish, so you can use your results of Phase 2 to help you choose better assessments or choose better treatments. So for example, for adults, we now know that we need to treat them a little bit longer than the children. Our guess is that because they’ve had these GI problems longer, they take a little bit longer to improve. And also because we’re seeing minimal adverse effects, we’ll probably consider going to a higher dose in future. And so those would be a couple of the types of changes you might consider making. But the main difference is just larger studies. So multiple sites and more participants. So maybe a study with 500 to 1,000 people would be typical for an FDA study.
Lindsey:
And for your studies is having GI problems one of the inclusion criteria?
Dr. Adams:
That’s a great question. At the moment, yes, it is. But that’s simply again to be cautious, that is the group that we think of most likely to treat. But in some of our earlier work, I guess it was eight years ago, we saw that low diversity of gut bacteria was present, even in the children with autism who did not have obvious GI symptoms, but they still had abnormal gut bacteria. So we suspect that in the same way, you could have a hidden yeast infection that we think is worsening autism symptoms. We think it’s very possible to have a bacterial infection whose primary effect is releasing toxins that affect primarily the brain and not the gut. So I think it’s very possible that there will be some children who don’t have obvious GI problems, who would also benefit. And that’s why we’re doing the microbiota evaluations to try to figure out exactly what biomarkers are the problem, exactly which bacteria are the problem. Is the lack of beneficial bacteria, in some cases? Is the presence of pathogens? And others, and in some cases, both,
Lindsey:
And how are you evaluating the microbiomes?
Dr. Adams:
My collaborator, Rosie Krajmalnik-Brown, is doing that. So we’re using some different approaches. Primarily, she’s been working with 16S. She’s also doing some metagenomics analysis as well. And we’re looking into some additional methods as well.
Lindsey:
So even though it’s not part of the study design, you could easily do a post hoc analysis of yeast, because you have those if the 16S is used.
Dr. Adams:
Yeah, you can’t use 16S for yeast, you use different things for yeast instead. But yes, with the samples, we have lots of samples in our freezer, that we would love to do yeast testing on. We just lack a budget to do that.
Lindsey:
Right. Right. But if you have a metagenomic sequencing, then you’d have yeast.
Dr. Adams:
Yes.
Lindsey:
Yeah. So since not everybody who listens to this will want to go back and listen to the other podcast, can you just give me a summary of if you are a parent of a child with autism, short of trying to get them into one of your studies: what can you or should you do right now, if you have a child with autism who has gut issues?
Dr. Adams:
Yeah, it’s very important to point out that microbiota transplant is viewed by the FDA as an experimental method. And so we’re researching it, but it’s not publicly available. The people that have a proven C Diff infection, the FDA allows them to get a fecal transplant, but it’s not approved yet by the FDA, so the difference is you can’t use it off label. So the pills that we produce, we’re not allowed to give to the general public until we have FDA approval.
So there are many other things that can be done though. So as I mentioned, I think every child with autism, regardless of whether or not they’ve GI problems, should be assessed for a yeast infection, because about a quarter to a half of them seem to have a hidden yeast infection that’s worsening their neurological symptoms. But for gut symptoms, I think there are many things that can be done. We did a comprehensive diet and nutrition study where we looked at giving our vitamin-mineral supplement that we’ve designed, in addition, followed by fish oil, followed by several other nutritional supplements, and then finally, a healthy diet. And so switching children to a healthy diet, I think is very important: a diet that’s rich in fruits and vegetables, and good sources of protein, and minimal junk food. And then testing. Some children need to go on dairy-free or gluten-free diets, and the best way to know if it’s helpful is just to try it for a month to three months. Probably about half to two thirds of individuals with autism may benefit from this allergen-free diet.
Lindsey:
Can I stop you just for a second? Because I imagine a lot of parents of children with autism listening will think: I can barely get my child to eat anything but these three or four foods, much less the idea of a diet rich in fruits and vegetables. Any advice there?
Dr. Adams:
I’d say… the example I’d give is, you know, not giving your child fruits and vegetables, it’s like not putting gasoline in your car. Your car is designed to run on gasoline. Your child’s body is designed to run on fruits and vegetables, so you are nutritionally depriving them of critical nutrients that their body needs. So it is just critical to try to get vegetables and fruit into them. But if you can’t, the major nutrients that the body needs, our vitamins and minerals, essential fatty acids, and protein – you can live without carbs, with limited amount of carbs, most kids with autism are getting too many carbs. If you can’t do a healthy diet, and certainly many children can’t, then that’s why we’ve created a vitamin-mineral supplement. We’ve done four research studies on it now. And that’s why we’ve made it available through our nonprofit. So the first step of our NRC protocol is to put them on a vitamin-mineral supplement, because even if they are on a good diet, our latest study of 160 children shows even if they are on a good diet, they can still very often benefit from the supplement. Kids with autism just need higher amounts.
Lindsey:
But what about other shortcuts like smoothies, or greens powders or reds powders? You know, are there any of those successful?
Dr. Adams:
I’m a very big fan of smoothies. I love to do smoothies with vegetables, and some fruit; start out with more fruit so it’s more palatable and tailor back, but I drink a vegetable/fruit smoothie at least once a day. So I think that’s a very good way to go and if the children are needing protein, you can add in protein powder, or even free form amino acids. A few kids with autism cannot digest protein, so they need free form amino acids instead. So I think those are very important. But beyond diet, there’s more that can be done.
Remember that the main factor in GI health, the main food that the gut needs, comes from fiber. So when your gut bacteria digest fiber, it produces butyrate and that’s 60 to 70% of the energy for the cells that line the GI tract. So most women are getting only half the amount of fiber; most men are even worse, they’re only getting a third the amount of recommended fiber. And so literally there’s cells that line their GI tract that are starving for what we know to be the critical nutrient. So the best form of fiber is your fruits and vegetables. So instead of drinking orange juice, eating a whole orange. But there are fiber supplements, those may be helpful. But once the GI symptoms begin, it seems that calling it a high fiber diet, although it’s probably helpful for preventing these problems, doesn’t seem to be as helpful in those cases for treating them.
We are experimenting with probiotics. We’re doing a very large, I think the largest ever study of probiotics for children with autism. We’re working with a company called Sun Genomics. And what we’re doing is a metagenomics analysis; we’re looking at 1,000s of species of bacteria in each person’s gut. And based on that, we have an algorithm to try to determine or guess, which are the most likely of the standard commercial probiotics; which particular species of strains might be most helpful. This is very early stages. We have a lot to learn, but we think it’s better than just picking a probiotic off the shelf instead trying to use an analysis of the microbiota in the store, to try to estimate which bacteria is most helpful.
Lindsey:
So you’re just at the point of analyzing, not yet of giving them probiotics?
Dr. Adams:
We actually already have several hundred individuals who are in the treatment study. But I’ll say the algorithm is early stage, and we hope from the data that we will be able to learn how to improve it.
Lindsey:
And are they all getting the same probiotic? Or is it tailored to their own gut?
Dr. Adams:
It’s custom, the whole point of this study is to customize it for each person.
Lindsey:
Wow. Okay.
Dr. Adams:
I think of it this way: the analogy I like to give is that your gut is like a village and in your village, the village needs to be diverse. The village is not going to be very functional if you have 10 farmers, and no doctors. It’s also not going to be very functional if you have 10 doctors and no farmers. You need a balance of the members in your village; you need a balance in your microbiota. So if you’re very high in one species, you don’t want to be giving more of that. You want to be trying to promote diversity.
Lindsey:
And you’re working pretty much with the aerobic strains that are available, like the lacto, bifido and spore-based?
Dr. Adams:
Yeah, so with Sun Genomics, we are limited to the probiotic strains that are available, but they also use some special probiotics as well.
Lindsey:
Okay. Are you using spore-based as well as the lacto/bifido types?
Dr. Adams:
Depends on the individual.
Lindsey:
Okay. And now it is exciting that there’s beginning to be some products out there with some anaerobic bacteria. I’m taking Akkermansia muciniphila* myself.
Dr. Adams:
Yeah. So again, we’ll see what is most helpful for people. There have been about 10 probiotic studies for autism and there’s some design issues with some of them, but in general, it’s suggested that some individuals can be helped. And I think rather than trying to say what is the best probiotic, the better question is what probiotic is best for me.
Lindsey:
Right. Okay. And what about butyrate supplementation? Have you looked at that at all?
Dr. Adams:
I think it makes a lot of sense. I have not seen any research studies on it. But I think it seems like a very intriguing approach to do.
Lindsey:
Yeah, that’s actually one of my favorite supplements right now, tributyrin. Okay, and what about oxalates? Have you looked at that at all?
Dr. Adams:
I’ve looked at the limited research on it. I think it’s an intriguing theory. I’m not convinced yet that a low oxalate diet is necessarily beneficial. I think the data on it that I’ve seen so far – I haven’t seen much. I think it’s an interesting theory. Needs more work.
Lindsey:
Okay. So, at the moment, if people want to find out more about just getting help for their kids the autism… what’s it called, Autism Research Center?
Dr. Adams:
No, they can go to our website, the Autism Nutrition Research Center. And we have there both the vitamin-mineral supplement we’ve developed, and, again, I don’t receive any royalties or salary from them, I just served as a volunteer there. But we also have our NRC protocol, which follows four of the six most important treatments that we used in our 12-month treatment study. And so that begins with the vitamin-mineral supplement, followed by high dose fish oil. Fifteen studies now showing kids with autism are low in omega 3’s. And several studies showing it helps a little bit. But I think they’ve been underdosing. In our study, we found that 80% of kids seem to benefit from the vitamin supplement and also from the fish oil. And then carnitine. We did one study. Another group did a randomized, double-blind study showing that a subset of individuals with autism benefit from high-dose carnitine. So pharmaceutical level dosing.
Lindsey:
Okay, how much of that would that be?
Dr. Adams:
It’s in the protocol. So it depends on the person’s body weight as to what should be used. So you can look it up on our website to see. Again, it’s all dosed by body weight. And in the first study we did, we used one dosage, and another group followed up on the stud. Instead of three months, they’ve treated for six months, and they use twice our dosage, and they saw even more benefit. So we have a recommended dosage on there; it could be some individuals benefit even more. I think the best clues for who is likely to benefit from carnitine are people who have low carnitine in their diet, because you get about three quarters of your carnitine from your diet. And pretty much the only dietary source is beef, and to a much lesser extent pork. There’s not a lot of carnitine in other food sources. Your body can make a limited amount, but it seems kids with autism need more. And then the other treatment, the fourth treatment, as I mentioned, the healthy, allergen-free diet. I’ve seen too many families go from eating regular Oreos to gluten-free Oreos. I find that not very good. I want to see them going from Oreos to broccoli.
Lindsey:
Yeah.
Dr. Adams:
So that’s my radical recommendation is to eat your fruits and vegetables: whole fruits, whole vegetables, that have all the fiber; all the rich vitamins and minerals and vital nutrients in them.
Lindsey:
And then and if possible, to include that beef in the diet.
Dr. Adams:
Yes, I think a modest amount of beef is very good for carnitine for the subset of individuals who need it. The other clue as to who needs carnitine is children who seem to have very low endurance, who fatigue very easily. The extreme example we had was a young girl who could not climb into the family van. She could not go up steps and she could walk only short distances like a quarter mile before they’d have to put her in a wheelchair. And then after treatment with carnitine she began skipping around the house, she learned to bicycle, she went on long walks with her families. They put the wheelchair in storage; it was thrilling.
Lindsey:
Wonderful.
Dr. Adams:
And so it wasn’t just physical endurance, but also mental endurance because the organ in your body that needs the most energy is the brain. So the carnitine is important for boosting energy for the body and the brain.
Lindsey:
Right? Yeah, it’s actually something that a lot of my clients end up taking because it shows up low in their Organic Acids or they have indications of problems with beta oxidation of fatty acids and creating energy from fats. So it’s a useful supplement.
Dr. Adams:
Yes, yes, we think it is very important.
Lindsey:
Okay. Anything else you’d like to share with us before we get off about your current work or future directions or how families can get involved?
Dr. Adams:
I think those are the major points that we’ve covered about what we’re doing with those areas. We have a few new studies that we’re working on, but not ready to announce them yet. We are doing another trial of a vitamin-mineral supplement to try to better understand who seems to benefit. But from our latest analysis, it seems to benefit children and adults, both genders, doesn’t seem to matter if you had regressive autism or early onset. And surprisingly, to us, it doesn’t seem to matter if you had good or poor diet quality. So that it seems that even if you’re on a good diet, children with autism just seem to need extra amounts of these certain important vitamins and minerals.
Lindsey:
Interesting. And in terms of staying up-to-date on studies, for people who might want to enroll their children or themselves, where would people go?
Dr. Adams:
They can go to our website autism.asu.edu. But our studies on microbiota transplant are overwhelmingly filled, we’ve had over 2,000 people apply and be on the waitlist for those. So we don’t have any openings there. But a probiotic study is currently open. It’s an unequal study, because families have to pay to purchase the Sun Genomics, but then to participate in the ASU part of the study is free.
Wonderful. Well, thank you so much for coming on for this update. And I’ll just encourage people to go back and listen to the other episode so they get the full scoop on what you’re doing and what you’ve been doing. And this can be a good follow on.
Dr. Adams:
Very good. Thanks so much, Lindsey.
Lindsey:
Thank you.
If you’re suffering with SIBO or any other gut issue, 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 gut health coaching 5-appointment program in which I recommend lab tests, educate you on what the results mean and the protocols used by doctors to fix the problems revealed. Or if you’re ready to jump in right away or can just afford one appointment at a time, you can set up an 1-hour consultation with me.
*Product and test links are affiliate links for which I’ll receive a commission. Thanks for your support of the podcast and blog by using these links.
Heidi Turner, MS, RDN, CD is an Integrative Registered Dietitian Nutritionist at her telehealth-based private practice, FoodLogic located in Tacoma, WA. She specializes in complex health issues including SIBO, autoimmune conditions, histamine intolerance, Mast Cell Activation Syndrome and food chemical sensitivities. She spent 12 years at The Seattle Arthritis Clinic at Northwest Hospital-University of Washington where she counseled thousands of rheumatology patients on ways to reduce inflammation through dietary change and manipulation of the microbiome. She is the co-creator of the “Low Histamine Biphasic Diet” with Dr. Nirala Jacobi, and sits on the medical advisory board for the Ruscio Institute. She has guested on multiple podcasts and professional conferences discussing histamine and chemical food intolerances. Heidi earned her Master’s degree from Bastyr University in Kenmore, Washington and completed her dietetic internship at Virginia Mason Medical Center. She lives happily in the Puget Sound area of Washington State with her husband, son and devoted cats.
Lindsey:
So my readers should be pretty familiar with SIBO, which is one of our topics today, but when we last focused on it in particular was probably the episode with Nirala Jacobi in November of 2019 in Episode 17. Also had episode 36 on IBS and episode 41 with Norm Robillard. But anyway, could you just give us a brief overview of what SIBO is, and some of its common root causes.
Heidi Turner, RDN:
Oh, sure. So small intestinal bacterial overgrowth, see-bo, sibo, S I B O, or however you choose to say it, is basically a situation where there is an overgrowth of bacteria located in the small intestine. We basically should have very few bacteria in our small intestine, and the majority of the bacteria that we house should primarily be in the large intestine. So when we have too much bacteria, located in the small intestine, it can start to create a level of inflammation. And that inflammation can start to express itself in a number of different ways. We might get different symptoms that we might deem to be very like IBS, things like gas and bloating, diarrhea or constipation, sometimes heartburn, sometimes abdominal pain, really just depends upon the person and what their specific situation is. There are many potential underlying reasons why SIBO might be present. Iit is usually considered an issue of dysmotility. So we rely upon these peristaltic waves to move the contents of our food as well as the bacteria through our digestive tract. And so when that system becomes more stagnant, things aren’t moving as effectively, we can start to collect more bacteria in that space. And that can be due to a number of different causes that can be from a history of food poisoning that can actually impact something called the migrating motor complex that actually helps us to move our nerves and move those peristaltic waves. It can be related to certain medications; antibiotics can cause this. It can be from high levels of stress. I see this quite often, very high chronic stress, that can impact motility, thyroid issues, long-term proton pump inhibitor use, and then other environmental factors such as living in moldy conditions. There’s lots of different reasons that can feed into this dysregulation of the digestive tract and start to accumulate more bacteria.
Lindsey:
Thanks. So there are a couple that just come to mind too, that are more physical causes, like adhesions after surgery.
Heidi Turner, RDN:
Yep.
Lindsey:
Or Ehlers Danlos Syndrome?
Heidi Turner, RDN:
Absolutely.
Lindsey:
Yeah. And what was the other one? I was thinking about… Oh, traumatic brain injuries?
Heidi Turner, RDN:
Sure. Absolutely. Yeah. Anything that gets in the way of those neurons in the gut from really fully expressing and fully moving and communicating with each other can really get in the way. I’d also say, you’d mentioned adhesions, so that can be from say endometriosis.
Lindsey:
Right.
Heidi Turner, RDN:
So that can be from any abdominal injuries that you’ve experienced. So there’s lots of different things that can lead to those adhesions as well that block that bacteria in the area and make it something difficult to move through.
Lindsey:
Yeah, I didn’t know what an adhesion was. And I’m not sure everybody does. But I went through endometriosis. So can you just explain that briefly?
Heidi Turner, RDN:
Yeah, it’s just a basically like scar tissue that’s in our digestive tract. Well, it’s not even necessarily in the digestive tract, so it could be on the outside and impacting other organs. And so if we have a considerable amount of scar tissue, it can actually adhere to our digestive tract, which is quite large in our abdominal cavity, and so we can see those adhesions basically wrap themselves around our small intestine, especially. And so we can see that and it just creates this narrowing. Not necessarily a blockage, because that would create something different, like an actual blockage where things couldn’t get through. It’s certainly a narrowing where it’s more challenging for things to move through these very small spaces.
Heidi Turner, RDN:
Okay, great. So second topic for today is histamine intolerance. So let me ask what is histamine intolerance? And when should people suspect that they have it?
Heidi Turner, RDN:
Okay, so these run parallel sometimes. So I’ll run over the histamine intolerance. So first, before we talk about what it is, let’s just talk about what histamine is first so we’re all on the same page with what that is. So histamine is basically a chemical that our body just naturally produces. We might think of it in relation to allergies. So if we’ve been exposed to say pollen, and we get a snotty and sneezy and allergic type of thing, we take an anti-histamine. And so histamines are involved in that allergic reaction. So that’s one area where histamines show themselves, but histamine is really involved in a lot of other biochemical processes. It regulates our digestion, it helps us to build stomach acid. It is actually a neurotransmitter that regulates other neurotransmitters like serotonin. It’s involved in our sleep cycle; it helps us to wake up. It’s involved in our menstrual cycle, our circulatory system. So it’s really an incredibly important chemical that our body produces. It regulates inflammation as well. So it doesn’t just create inflammation, it also regulates inflammation. So histamine is a really, really critical compound that’s vital and important to who we are.
Lindsey:
That makes me stop and say, “Wait a second, if I’m taking an anti-histamine, that’s all my bodily systems!” Because I do that on a daily basis.
Heidi Turner, RDN:
Okay, all right, but we’re not there yet. So like in a normal average situation, we are building histamine, we’re using histamine, and then we’re breaking histamine down. And so that’s the key piece in all of this. So if we are building histamine, utilizing our histamine, and then we actually can’t break it down, and we’ll get into why that might be. And usually, it’s because we’re overwhelming our enzymatic pathways. So if we build histamine, in order for us to break it down, we need enzymes to help us do that. So we’re deficient in the two major enzymes that our body uses to break histamine down. One is called diamine oxidase or otherwise known as DAO, or Histamine N-methyltransferase, or HNMT. So if we are deficient, and usually DAO is the one that we’re thinking about more when we’re working with SIBO, just so you know. So if we’re deficient in any one of those enzymes, what can happen is we build a histamine, we can’t break the histamine down. And so we end up with a lot of a lot of circulating histamine and we have more histamine than our body can manage. That’s where we start to see problems. That’s where we start to see symptoms where there’s just an excess of histamine, that’s where we might feel more allergic, or we might feel more anxious and awake, our sleep cycles might get impacted, we might get a lot of digestive issues like heartburn or bloat or diarrhea. So anywhere where histamine regulates different areas, we might see an uptick of those symptoms. And so that’s where things become more problematic. And that is a situation of histamine dysregulation, building too much histamine, don’t have enough enzyme to break it down, I got too much circulating histamine, it’s binding to all these receptors in my body where histamine typically works and it’s agitating and aggravating and making those symptoms much more. That’s histamine dysregulation.
Lindsey:
Okay, so I’m hearing symptoms that range from allergies to digestive issues to anxiety.
Heidi Turner, RDN:
Absolutely. Yeah.
Lindsey:
So are there any of those that you could say, are very, like you’re not going to see histamine intolerance without seeing them, like an typical allergy reaction, like a runny nose or itchy eyes or things like that?
Heidi Turner, RDN:
I mean, we can have those symptoms without having histamine dysregulation. And let’s talk about what histamine intolerance is specifically, because that’s different. They’re similar, but it’s sort of a different answer to your question there. So histamine intolerance is a situation. So this is going to bring in that SIBO here for a second. So let’s step back. When our gut produces a lot of that diamine oxidase, that DAO, and we use up a lot of that to help to break down the histamine that comes in from our food supply. So we have all of these foods that contain histamine and typically these are foods that are usually aged or fermented, like sauerkraut or wine or aged meats or foods that have been spoiled or hanging around for long periods of time, or just other foods that contain natural amounts of histamine or biogenic amines like avocado or spinach or tomatoes. When we eat those foods, our gut produces all of that diamine oxidase to help us break down those histamines that are in our foods. And if we don’t have adequate amounts of diamine oxidase, then what’s going to happen is the histamine that’s in the food is going to be absorbed into our bloodstream and create more systemic histamine. And it can also exert just a more inflammatory effect in the gut. So if we don’t have adequate amounts of that DAO, it’s going to cause a histamine intolerance, and that’s where we just don’t tolerate the histamines that are in our foods. So there’s the histamine intolerance, and then there’s the histamine dysregulation. I’ve got too much histamine. I’m building too much histamine. My enzymatic system can’t keep up with it. And I’m eating too much histamine. And my enzymatic system can’t do much with that. That’s the difference. Histamine intolerance versus histamine dysregulation.
Lindsey:
Okay, so is it essentially a spectrum and one is more extreme?
Heidi Turner, RDN:
Oh, not necessarily. If you have histamine issues and back to your question, it’s like, if you’re super allergic and snotty, sneezy, you could have other issues going on and feeding into that. It doesn’t necessarily mean you’re histamine intolerant. However, if you do have a history, I mean dysregulation going on, and your body just isn’t making adequate amounts of enzymes to help you break it down, I think looking at other things that could be feeding into that, like gut bacteria, histamines and the foods. That’s where we want to start focusing in on other areas, because it’s possible we could help to reduce some of the symptoms that we experience from allergies by looking elsewhere at other places where the body produces too much histamine.
Lindsey:
Got it. Okay.
Heidi Turner, RDN:
That makes sense.
Lindsey:
Yeah. So how can SIBO lead to histamine intolerance?
Heidi Turner, RDN:
Yeah, exactly. So bacterial overgrowth is a situation, there’s actually a couple of reasons. So you know, the bacteria, if we have too many bacteria in our digestive tract, it’s inherently creating a lot of inflammation. So they produce something called lipopolysaccharides. Those lipopolysaccharides can induce more mast cell release in the digestive tract. And those mast cells contain a lot of histamine, and that triggers more reactivity. So if we have a lot of inflammation from bacterial overgrowth, then we’re using up a lot of that diamine oxidase that our gut is producing. So we’re using a lot of that up. So if we’re using up all that DAO and we take in a lot of dietary histamine, you might not have enough DAO available for that dietary histamine. So that’s the first way. The second way is that we know that in the more recent research, the type of bacteria that are often implicated in SIBO are histamine producing bacteria, so things like E. coli, or Klebsiella. Both of those are implicated as star actors in SIBO. And both of those produce a lot of histamine. So we have an overgrowth of bacteria in our gut that produce a lot of histamine. That too is going to use up all that diamine oxidase. And it’s going to get in the way of our histamine tolerance.
Lindsey:
Oh, okay. That’s interesting. So how can you address histamine intolerance through your diet?
Heidi Turner, RDN:
Right. So there’s a lot of different ways you can do that. And I think we should probably bring the SIBO into this as well…
Lindsey:
Because you want to get rid of the SIBO.
Heidi Turner, RDN:
You want to get rid of the SIBO, right? Because I just want to make sure that we all understand that whenever you have any dietary intolerance, it’s usually secondary to something else.
Lindsey:
Right.
Heidi Turner, RDN:
Some other dysregulation going on, so we want to make sure that it’s not just about, we’ll take all of these hundreds of foods out of your diet, and then you’ll be fine. Because you might take those foods out of the diet, and you might actually feel a lot better. But that’s not really the answer, because staying on a highly restricted diet for a long period of time is very uncomfortable, and socially isolating, and all of those things that can come with dietary restriction. So let’s just make sure that that’s said before we jump into what do you do with a diet. So before we get there, there’s a number of different things that you can do with a diet. But let’s bring the SIBO back onto the table. Because ideally, if we can treat the SIBO effectively, then we can reduce a lot of that intestinal inflammation, which then buys back a lot of your diamine oxidase, in which case, we don’t necessarily have to eliminate too many foods from the diet.
So ideally, in a perfect world, we’re going to be able to manage that SIBO, reduce the intestinal inflammation and we don’t have an issue from a histamine perspective. So that alone, we just want to make sure that that is covered. Now, let’s say you need to do a little bit more with the diet, though, because often times, when we are working with SIBO, what’s generally indicated in a SIBO diet is more of a low FODMAP type of diet. So oftentimes, we will do antimicrobial, and then once we’re finished with the antimicrobials or the antibiotics, we will usually follow that up with a low fermentable diet. And so these foods aren’t necessarily high in histamine. But we do know that a low FODMAP diet can actually reduce intestinal inflammation. And again, you reduce intestinal inflammation, you can build a little bit more diamine oxidase back. And so that can actually help you with your digestion of higher histamine foods. So sometimes, just by reducing things, if you’re going to work with SIBO, sometimes by reducing the bacterial concentration, and then actually incorporating a low FODMAP diet, we can actually see a better regulation of histamines in the diet. And we don’t really have to do too much more than that. So that’s one of the first things we can do with our food or just see how it goes for us. That’s number one.
Now, let’s say that doesn’t work for you. It doesn’t work for everybody. Let’s say hey, I cannot kick the SIBO and I’m doing this low FODMAP diet and it does absolutely nothing for me or it’s actually making things worse. So a low FODMAP diet, which is low in Brussels sprouts and cauliflower and onions and garlic and things like that, is inherently high in histamine foods. So, in some cases, if we’ve got really significant histamine dysregulation in the gut and even though we’re doing all the things we know to do to combat our SIBO, if we’re eating a lot of high histamine foods, because we’re doing all of these practices, what can happen is we don’t have any diamine oxidase. And so we’re going to end up with more intestinal inflammation because of it. So then what we can actually do is go on a low histamine diet. And that’s where we really pull out a lot of these aged foods, the avocados and spinach, and tomatoes and all sorts of different fermented foods that we might be eating because we’re trying to feed our microbiome and bone broths all these different things that are aged or fermented or old, can actually be impacting us adversely. And so sometimes we need to take those histamines out to give the gut a chance to heal and not just reduce symptoms that we’re experiencing, like abdominal pain, or bloat or things like that, but also just give the gut a chance to heal. So yeah, so these are all just different things. I’ll just say, there’s a lot of different dietary strategies that you can make that can impact or actually reduce your histamine intolerance that don’t necessarily just limit you to like taking all the histamines out of your diet. So even like a paleo type of diet, like a low starch diet, or a low sugar diet can actually improve your diamine oxidase and reduce your histamine intolerance as well. So there’s lots of different ways that you can approach the diet. Reducing histamines is one of them.
Lindsey:
And they serve to do that because they reduce inflammation.
Heidi Turner, RDN:
Yeah, absolutely. Any time you’re reducing inflammation, you’re allowing the body to support more diamine oxidase production. That’s the key thing. That’s your key guy, diamine oxidase.
Lindsey:
Yeah. So what I’m hearing is that you’re typically dealing with the SIBO first, and then you’re putting people onto the low FODMAP diet, for example.
Heidi Turner, RDN:
Yeah, absolutely. I really try to spare the diet. I’m a dietitian. And I try not to take foods out of people’s diets, because it’s a challenge, especially things like FODMAPs, things like histamines. It’s not just one food. It’s not just gluten or dairy or starch. It’s like there’s 100 different histamine foods that we’re when we’re working with the lists, and there’s 100 different FODMAP foods when we’re working with the lists. And so it can get really challenging really fast. And so I really try to listen to my clients in terms of what’s possible. Ideally, we’re going to be making some dietary modifications in the short term. And I think that that’s the most important thing for us to highlight, if you’re going to be making any dietary modification, it is for a very short period of time to manage symptoms, and to support healing, right. It’s not to stay on for the rest of your life. Because if you have to, if you have to take FODMAPs out or you have to take histamines out and you can’t get them back in, there’s something we haven’t fixed.
Lindsey:
Yeah.
Heidi Turner, RDN:
There’s something else that needs to be done. So, from my perspective, back to your question, is that, do you do work with the SIBO first? Sure, absolutely. It’s like, what can we do to manage that? Because if that’s all we need to get at in order to reduce the intestinal inflammation, then how much more do we need to do from a dietary perspective from there?
Lindsey:
So how long would it, and do you tend to use herbal protocols for SIBO or Rifaximin, or…
Heidi Turner, RDN:
I’ve used it all. So yeah, so you know, I’m a dietician. So I don’t prescribe medication, but I usually do work with other practitioners who do so. I have worked with antimicrobials. I’ve worked with Rifaximin and neomycin or metronidazole. I’ve worked with elemental diets. And then also every other possible dietary strategy you could possibly imagine. We’ve used fasting, you know, there’s lots of different strategies to manage the SIBO.
Lindsey:
Right.
Heidi Turner, RDN:
It’s just a question of, there’s a lot where do you start? It’s a question of tolerance. Maybe the person might not tolerate herbal antimicrobials? Well, it’s a question of expense. Rifaximin can be $1,000 investment.right?
Lindsey:
Right. Yeah, it’s one of those things that has got to be covered by insurance. There’s no logical reason to take that over herbals.
Heidi Turner, RDN:
That’s exactly right. And so if cost is an issue, then your herbals are going to be a better option for you. Elemental diets are also quite expensive. So you always have to just navigate someone’s personal bent, their personal belief structure. Some are just like, I don’t want to do herbals. I’m not going to fast for two weeks. So I’m going to go and get my Rifaximin and I’ll spend my $700 or $1,000. And that’s what I’m going to do versus the next person who might be “No, I’m not taking antibiotics for nothing”. And I’m going to go the antimicrobial route, right so really I do a lot of counseling around it when really trying to figure out what’s going to be the best strategy and working with their SIBO. And then also what’s going to be the best strategy in working with their diet. Because having done this for a long period of time, there’s never one road for one person, everybody is different. And I think that’s the challenge in the US. Practitioners that work with SIBO, or work with dietary restrictions, and not only is it challenging for everyone, but everyone’s so different, right? Everyone’s so different. So you just have to have a lot of tools at your disposal, rather, and then help your client make the right choice. Weigh them in the right direction.
Lindsey:
Right. So assuming a typical client is doing an antimicrobial regime of some sort, be it Rifaximin or herbals. I’m wondering how long that typically lasts, and then how long you would typically put them onto, say a low FODMAP diet? Or are you using the biphasic diet? And maybe you can just explain that a little bit?
Heidi Turner, RDN:
Oh, wow. That’s a big question. That’s okay. So it depends upon the person, depends upon their test results as well, their breath test results and how strong the SIBO is. It is like, what gases are we working with? If we’re borderline SIBO, then we might place them on a protocol for a shorter period of time before checking back in. If these gases are quite high, or methanogenic overgrowth, then it might take a little while longer and really depends upon the person and how they’re doing and how they’re tolerating everything as well. So it’s going to take, it could take anywhere from a month at best to several months. At the very worst, or the very longest, it could take several years, it really just depends upon the person and how they’re responding. So as far as treatment goes, it just depends. Unfortunately, I can’t give you like a, because everybody’s so different, give you like one that’s going to take this long, so it can be a challenging thing.
The diet I try to make for as short a period of time as possible with FODMAPs. I’ll usually keep a little bit of FODMAP in during the actual treatments. Allow the bacteria to feed. They love to feed on those FODMAPs and then once they’re finished with their antibiotics or antimicrobials, I will then remove those FODMAPs for a period of anywhere from two to four weeks, sometimes six weeks depending upon how long this is taking, I might just use a standard FODMAP diet. There’s lots of different diets out there. There’s Nirala Jacobi, she has the Bi-Phasic Diet, which I think is terrific. Allison Siebecker has more of a specific carbohydrates, low FODMAP diet where you take out both FODMAPs and starches as well. I think you’ve had Norm Robillard on [his Fast Tract Diet]. There’s lots of different types of diets. Cedar Sinai has a different type of diet as well. And then still, Dr. Jacobi and I also developed a low histamine, low FODMAP diet. And so for those who are doing a little bit better on low FODMAP, but we really do feel like there’s a histamine intolerance, that’s pretty severe. And we might place them on that one as well, which is quite restrictive. And even though I helped co-create them, I’m not a big fan of it, because it’s so restrictive, but it can be quite effective if we’re really, really, really inflamed, and we just can’t get that fire out. In which case, again, back to your question. It might be anywhere generally from two to six weeks. And again, if I have to go longer than that, then something else is going on. So I got to keep looking: what’s driving the SIBO, what’s driving the intestinal inflammation, what’s driving the histamine production. You always have to keep digging more and more if you must rely on dietary elimination to be asymptomatic.
Lindsey:
Right. And is there with low FODMAPs there’s a reintroduction. That’s supposed to be category by category, but with histamines is there categoric reintroductions, or how does one go back into reintroducing them?
Heidi Turner, RDN:
So I guess my short answer to your question is no, there isn’t really any formal introduction, because it is a threshold issue. It can be with FODMAPs as well. But you can also have certain tolerances to different categories of FODMAPs and not to others, whereas histamines, it’s like a threshold, like how much histamine do I tolerate in a given day or even a given week? In which case the question is how much diamine oxidase do I have available? So what I usually like to start with is keep out the foods that are really high histamine like wine or beer or high fermented foods. I’ll usually keep those guys out for a while because they’re going to use up a lot of space. They’re going to use up a lot of DAO. So I like to maybe start with more of the vegetables or the fruits that they might be missing or nuts or things like that they might be missing. And we’ll just start first with like: What do you miss the most? And you know, you miss your avocado? Do you miss a little tomato? And you know, they come up with the answer pretty quickly. So if there’s something that they’ve really dialed down on, then I might introduce those in first. I’m always a little bit judicious with tomatoes to start, because they’re not only high in histamine, they’re high in a lot like acids and things like that, that can be just irritating to the system. So I usually don’t start there but I’ll usually start with maybe a little spinach, maybe a little avocado and just get a sense of what their bodies can tolerate. And then we just slowly build from there. And if they reach a threshold at a certain point where they start to get a little bit more reactive, we’ll keep those histamines in because we know that we’ve got some level of tolerance, and then we’ll just stay below a threshold while we continue to heal the gut.
Lindsey:
Okay, so I know that there are foods that have histamine versus histamine liberating foods. Can you talk a little bit about that?
Heidi Turner, RDN:
Yeah, sure. So yes, there’s foods that contain histamine and those are usually the ones that have been fermented by bacteria like our sauerkraut or kimchi or wine or things like that. So those are the ones that are particularly high in histamine specifically, but histamine is under an umbrella of a category of chemicals called biogenic amines, and there are a number of them things like tyramine, putrescine, cadaverine, spermine, spermidine. There’s lots of different types and histamine is one of them and so most of these actually will use up diamine oxidase; they require diamine oxidase in order to get broken down. So these foods, things like oh let’s say banana isn’t necessarily high in histamine but it is high in other biogenic amines so if we’re eating the banana sure we’re not putting in more histamine but we are putting in more of the I believe it’s cadaverine in the banana, I could be wrong perhaps. So we’re putting more of that biogenic amine in and it’s using up DAO. If anything is using our DAO, it’s a problem because we do bring in those other high histamine foods. It’s looking for the DAO as well and so in order to break down, there’s lots of foods that have this ability to use up diamine oxidase; those are your histamine liberators also known as biogenic amines.
Lindsey:
That’s interesting. So if you were really careful about just the foods that actually have histamine, then you probably could be okay with eating the other ones.
Heidi Turner, RDN:
Yep, you got it? Absolutely. And sometimes we’ll just do that. So if I see the taking all of these histamine foods out and/or histamine liberators because most of the lists that you find online, and there’s like 30 different lists, they all say different things.
Lindsey:
Yeah.
Heidi Turner, RDN:
Maddening, but what they can all agree upon are the foods that are high in histamine like no one’s going to say that sauerkraut is low in histamine. No one’s going to say that wine is low in histamine. You know, it’s all of those things, so fermented, aged foods are all high in histamine. Where it gets a little murky is in the biogenic amines, but the majority of these lists contain all of them. So if I’m working with someone, and I suspect they’ve got a histamine issue, and I see that they’re drinking bone broth, and they’re taking in sauerkraut, and they’re drinking wine, and they’re eating charcuterie every night and smoked salmon every night and canned tuna all the time, then I’m going to start to think, you know, do we need to take out all of these foods, or is it enough just to dial it down? Let’s make sure your meats are as fresh as possible. Let’s lay off the sauerkraut. And sometimes just making those shifts is enough to reduce their symptoms to reduce that histamine intolerance. And then we didn’t have to take out all of the biogenic amines.
Lindsey:
Okay, so the diet that you developed, that’s not the same as the Bi-Phasic Diet.
Heidi Turner, RDN:
No, so the Bi-Phasic Diet was developed by Dr. Nirala Jacobi in Australia, right? And so that’s more like straight up SIBO.
Lindsey:
Okay.
Heidi Turner, RDN:
Right. You incorporate that, you treat the SIBO. So it’s very low FODMAP, low fermentable. Basically, it’s a low fermentable diet. When we came together, what we did is recognize that when you’re doing a low fermentable diet, you’re just naturally increasing the level of histamine that’s in there. So like tomato is low fermentable, but it’s incredibly high histamine. Spinach is low fermentable, but it’s incredibly high histamine, in biogenic amines. So what we looked to do was to acknowledge that for those who have both things going on, there’s so much intestinal inflammation going on that they’re not tolerating fermentable or fermented foods. Let’s come together and really give them something where the gut can completely calm for a period of time. And then start going through an introduction process. So it is a bi-phasic diet. It’s just it’s the Low Histamine, Low Fermentable Bi-Phasic Diet.
Lindsey:
Okay.
Heidi Turner, RDN:
And so it takes off Phase one, Phase two. Exactly. You got it.
Lindsey:
And they can find that on your website or…
Heidi Turner, RDN:
On my website and on Dr. Jacobi’s websites, both of us have it there.
Lindsey:
Okay. So, say somebody begins treatment with antimicrobials. And they have an immediate bad reaction. What might it look like if it’s related to histamines, as opposed to say, be a Herxheimer reaction?
Heidi Turner, RDN:
Well, if it’s a Herxheimer reaction, because they look really similar. Herxheimer reaction, you know, it can be pain, it can be fatigue, and Herxheimer is when you’re going through a level of die off, you’re killing off a lot of stuff. It’s all going through your liver, your liver is having a hard time catching up, your body’s having just a really, it’s going through detoxification, basically, that’s what a Herxheimer reaction is. I typically will see Herxheimer reactions not last that long. So usually, if it’s a Herxheimer reaction, you’re going to see symptoms start to increase, usually within like maybe two to four days, they’ll intensify and then typically after like a week or more, we’ll start to see things calmed down a little bit. So that would be more of your typical arch of a Herxheimer reaction, they can go longer, certainly, depending on how much bacteria you have to kill off. I might put in something to help support the liver help to reduce inflammation, if it is a Herxheimer reaction, I might put in a little N-acetylcysteine, I might put in a little vitamin C, I might try to put some things in there. Even glutamine, if you know, we just need to calm some inflammation. So I might put some things in there and see if that works and then if it does, then we’re likely working with a Herxheimer issue. If it’s a histamine reaction, which can also be a part of that whole, in that soup. But if it’s just a reaction to the actual antimicrobial, I don’t see it abating. I see it happening quickly, usually within the first day, because the body is going into an immediate reaction. And then I just don’t see it fading. So I will often pull back and maybe start a lot more slowly and see if we can gather a little tolerance with time. But that’s usually the difference if there’s just no tolerance at all. And my clients will let me know. It’s very common with things like oregano or Berberine, which are pretty intense antimicrobials, but we use them all the time for SIBO. And they just know, I cannot do this, there’s absolutely no way I’m going to be able to do this, then there’s lots of other antimicrobials we can use. And I’ll just shift over to different things and see if there’s better tolerance. And if there is then I know that that was probably a histamine reaction, inflammatory reaction that they were having to the antimicrobial itself, versus Herxheimer.
Lindsey:
And so are you saying that Oregano and Berberine in particular have histamine in them?
Heidi Turner, RDN:
No, they don’t. It’s just that they’re fairly . . . Remember, we’re always working with a level of intestinal inflammation. So if you’re someone that, when you put in an antimicrobial like berberine or oregano, they’re pretty caustic on that gut lining. And if your gut’s just like, I can’t even do that. I can’t do FODMAPs. I can’t do histamines. I got all this bacteria in here. It’s just too much on my system, that it’s more than that. No, they are not necessarily high in histamine.
Lindsey:
Okay, so the histamine reaction that’s coming with them, then is inflammatory. Okay. Got it. So once people heal their SIBO, are you seeing this histamine intolerance tend to go away?
Heidi Turner, RDN:
Yeah, often, in most cases, I would say if it’s just related to the SIBO, if their histamine intolerance is just related to the SIBO. And you’re able to manage the SIBO and then get in there with some supportive healing strategies after you’ve cleared out the bacteria. And we helped to regain that microbiome a little bit more. Yeah, absolutely. Because the histamine intolerance should not be a forever thing. It is really just dependent upon the immune system dysregulation in the gut. So if it doesn’t go away, and I see this sometimes where we have SIBO, we have histamine intolerance. We treat the SIBO. SIBO has gone with histamine intolerance is still there, then it’s a question of like, what else is going on?
Lindsey:
What else might be going on? What are the other possibilities?
Heidi Turner, RDN:
Well, I mean, you can just have general dysbiosis. So you can have fungal overgrowth or yeast overgrowth that wasn’t managed, particularly if you did just antibiotics.
Heidi Turner, RDN:
Right.
Heidi Turner, RDN:
You can have other types of probably H Pylori, you could have other problem actors in the colon like you could have other things going on in the gut that are problematic. You could be massively stressed out and I know that that’s going around. So if we have considerable amounts of stress going on, and we’re really consistently off, that really sends a signal to the gut that all is not well. And we know that there’s a strong correlation between really high chronic stress levels and not just dysbiosis, but SIBO, as well as mast cell activation of the gut. So you know, we always have to be thinking about our hormones. Some women who are estrogen dominant, or even men who are estrogen dominant, that can trigger more histamine production in the body. Your environment, if you are eating pretty a highly processed diet, or exposed to a lot of different chemicals or exposed to mold, all of these things can impact how much histamine your body produces. So we always have to be thinking about other players that could feed into why your body is making a lot of histamine and using up all of those enzymes that are necessary to break it down. Yeah, so start with SIBO. Hopefully that’s it, but if it’s not, okay, what else is that?
Lindsey:
Right. Now, you mentioned mast cell activation syndrome. How does this differ from histamine intolerance?
Heidi Turner, RDN:
Well, histamine intolerance is just I have diamine oxidase deficiency, and I can’t tolerate the histamines in my food. Okay. And so that’s histamine intolerance. And it’s on the same spectrum as mast cell activation. But mast cell activation is a little different. It’s, you know, the mast cells are these vesicles that carry histamine. We store most of the histamine that we produce in mast cells. We store it in different parts of the body as well, different cells in the body. But we really do store the majority of our histamine in mast cells. And mast cells are the ones that regulate that immune system reactivity. So we have mast cells in our gut, we have mast cells basically in nearly every area of the body. So they’re there to protect us, they’re the ones that basically get stimulated. If we do have an allergic reaction: we have an allergy to peanuts, or to pollen or something like that, we’re going to get a mast cell activation, and that’s going to secrete histamine as well as other inflammatory mediators throughout the body. We also have those mast cells that do line the gut. And so oftentimes, when we do have inflammation going on, from dysbiosis, we can see a mast cell activation. So the mast cells are in this constant state of release, degranulation, release, degranulation, and they’re secreting histamine into the body. And those mast cells can respond to stress levels, they can respond to environmental, they can respond to allergies, they can respond to any number of different activators, sometimes real, like peanut allergy, and sometimes benign, like smells or tastes in the mouth. We can see those mast cells become more susceptible to benign stimulation, and all of a sudden, we’ve got the mast cells exploding all the time and releasing histamine all the time. That’s mast cell activation. That’s very different on the same spectrum, because we’re working with histamine. But on a much more serious note, I would say.
Lindsey:
So in terms of knowing that someone has this, is there any testing they can do?
Heidi Turner, RDN:
For histamine intolerance or for mass cell activation?
Lindsey:
Both.
Heidi Turner, RDN:
So histamine intolerance? I mean, yeah, you could, if you didn’t want to take all the histamines out of the diet, you could certainly, there are a few labs that will just measure your diamine oxidase production versus the amount of histamine that is in your blood. So if you’re building a lot of histamine, you don’t have a lot of DAO, then you can extrapolate from that. I never use those. I usually just do the elimination because I find it to be the easiest thing. If I take the histamines out, how do I feel if I add them back in? How do I feel? And so that I think is good enough without having to spend a lot of money on testing. Mast cell activation is very different. You’re really looking for all of the different mediators that are released by those mast cells. And so one is histamine, but really, they’re looking at other mediators as well. Things like tryptase prostaglandins, PGD-2, PGF-2, chromogranin A, we’re sort of looking at all the different kinds of heparin, you might just look to see if there’s an elevation of those many mediators that mast cells release into the blood that would indicate that there’s some activation going on.
Lindsey:
Is dealing with mast cell activation similar to dealing with histamine intolerance?
Heidi Turner, RDN:
Sometimes, yes, it is. Not everybody who has mast cell activation has histamine intolerance. So some people who have mast cell issues, they can tolerate, their gut is making plenty of diamine oxidase, which means they can eat as many histamines as they want. It’s not going to feed into the systemic histamine that they’re producing. I’d say that that can happen. A lot of people with mast cell activation, do have histamine intolerance. Oftentimes, it’s a good place to start. Take the histamines out, see if it helps. And you can take it from there. Mass cell activation and dealing with that, it’s a different protocol because first of all, if your mast cells are leaky and they are exploding all the time, then you’ve got to get that under control. And so you really need to – so stabilization becomes the first thing that you do. And stabilization can come from dietary elimination. It can come from different medications like over the counter: histamine blockers like Allegra or Zyrtec, H1 blockers, or H2 blockers like famotidine. So we can bring those in to see if we can stabilize, and then mast cell stabilizing medications like Ketotifen or cromolyn sodium. There’s lots of different medications that we can use just to stabilize those mast cells from just telling them to just chill out, so that we can get a sense of what’s going on, what’s our underlying cause, what’s driving this mast cell activation, because it isn’t just unto itself. There’s always going to be something that’s driving that mast cell activation.
But stabilization is important to get the person through the day because it is a miserable condition. And so the more that we can just help to calm the system, calm the nervous system, calm people down, it’s really very beneficial. We can also use supplementation as well for that. We can use quercetin, we can use vitamin B6, we can use vitamin C, we can use zinc, we can use lots of different things that help to build diamine oxidase or help to stabilize mast cells. So we can do a lot to calm that mast cell activation. And once we’ve stabilized as best as we possibly can, through medication, diet and supplementation, then we start to look at, alright, what’s driving the situation? Does this person have SIBO? Does this person have fungal overgrowth? Has this person been exposed to mold? Is this an environmental issue? Like, is this a trauma that they’ve experienced? You know, what are all the pieces? Is this high levels of antibiotic use? And that has led to severe dysbiosis? Often it is a combination of all of those things. And it’s a question of how do we address and treat?
Lindsey:
Got it? Okay, so obviously, there’s some complexity here.
Heidi Turner, RDN:
Super complex.
Lindsey:
So I’m not going to go too deep into mast stuff. That’s a topic for another day.
Heidi Turner, RDN:
Yeah, as you see, like SIBO and histamine intolerance are actually a little bit more, I would simple is the wrong word. They’re just a little bit more clear.
Lindsey:
Yeah. Yeah.
Heidi Turner, RDN:
In terms of how to manage mast cell activation is its own beast that we have to take on.
Lindsey:
That might be a topic for a whole other podcast.
Heidi Turner, RDN:
Right.
Lindsey:
Okay. So anything I haven’t asked about that, that one should know about this?
Heidi Turner, RDN:
Let me think. Well, yeah, I’d say that for the at home person who’s dealing with their histamine intolerance, these are just some things that you can work with. There’s… okay, so let’s have a bacterial overgrowth. You want to work with a practitioner who really understands SIBO. I think that’s the first most important thing that someone who who’s dealt with hundreds or 1000s of SIBO cases can really help you to navigate. Really, really important. So that’s the first thing. If you do have a histamine intolerance issue and are looking for, let’s just talk about the symptoms that you might experience because SIBO can be gas and bloating, constipation, and diarrhea and things like that, and so can histamine intolerance, but if you’re experiencing a lot of GI stuff, and you have SIBO, but you’re also experiencing other symptoms, and those symptoms can be more those allergy type of symptoms like itchy skin or eyes or sneezy or sore throat or congestion, or you’re just really anxious. It causes a lot of anxiety, headaches, sometimes dizziness, temperature regulation issues, insomnia, tachycardia, that fast heartbeat or blood pressure issues or temperature issues. And you could have one of these things you could have all of those things, just depends upon the person. If you are having gut stuff, but you’re also having these other things start thinking about histamines.
And I also put it for the long COVID person who’s still experiencing a lot of symptoms after their COVID diagnosis. And you know, after they’ve recovered, if they’re having a lot of those issues, we’re seeing a lot of mast cell activation, but also histamine issues with that population. So if you’re experiencing all of that, to consider doing a low histamine diet and just see how it feels. And then you know, there’s some supplementation that you can do for yourself to help support your diamine oxidase production. I always start with vitamin B6 – first place I always start. Vitamin C as well, zinc and copper. Those are all things that are really helpful in terms of helping you to build more diamine oxidase and then help to reduce histamine in the body, things like quercetin or other bioflavonoids like luteolin or lutein, stinging nettles, these can all be really beneficial to you and again, it’s just symptom management, but they can just help to abate some of the symptoms that you experienced.
Lindsey:
I’m guessing there’s probably some products that put together all these things in one…
Heidi Turner, RDN:
That’s right, absolutely.
Lindsey:
What are some of those?
Heidi Turner, RDN:
One that I like and it depends, sometimes I’ll just start with one thing, and then see how you do. If you’re super sensitive, I’ll just go with single ingredients. But if you’re not, you can tolerate all those things. There’s one called Aller-All from Protocol for Life Balance (find in my Fullscript Dispensary*), and it has all those things in it, which I so appreciate. So that one I use quite a bit, and then the last thing I’ll say is your microbiome, that there are bacteria that produce histamine in our gut. There are bacteria that break down histamine in our gut. And so if you’re going to be working with safe probiotics, you really want to work with those that contain bacteria that help you to break histamine down, that can be really beneficial and can also improve your tolerance to probiotics if you don’t typically tolerate and if we can use names, things like Vitanica has a great one called Flora Symmetry (find in Fullscript*). And another one from Seeking Health is called HistaminX and Probiota HistaminX Probiotic (find in Fullscript*) and another one from Custom Probiotics – D Lactate Free Probiotic Powder. So these are some of the ones that I might use just to help to regulate that histamine in the gut a little bit more. Just be aware that if you don’t tolerate probiotics well, be aware that there are certain strains that do produce histamine that are found in a lot of these formulations. And if you’re super sensitive, you might just react to those. So do start with some of the ones that are more specific to histamine reduction. And then you can always expand out from there as your gut heals, and starts to tolerate more.
Lindsey:
Got it? Where can people find you? And are you practicing virtually or in person?
Heidi Turner, RDN:
Yes, I’m not practicing in person. I am practicing virtually. You can find me at foodlogic.org. And right now, I’m a little limited in terms of my availability, but you never know. You never know. I am in the process of creating classes that help to educate people on all of this. So check back frequently. I’m in production now. And so that can just give you some good useful tips on how to move forward with these conditions.
If you’re suffering with SIBO or any other gut issue, 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 gut health coaching 5-appointment program in which I recommend lab tests, educate you on what the results mean and the protocols used by doctors to fix the problems revealed. Or if you’re ready to jump in right away or can just afford one appointment at a time, you can set up an 1-hour consultation with me.
*Product and test links are affiliate links for which I’ll receive a commission. Thanks for your support of the podcast and blog by using these links.
So recently a potential client asked about my success rate in helping clients deal with their gut issues, and being a data-driven, evidence-based person myself, I wanted to give a clear, honest answer, which I didn’t have at the time. But after thinking about it for a while, I realized that an answer to that question is complex. But it seemed like the kind of question I would ask of someone I wanted to work with and have asked of many of my guests, with less than satisfying answers, especially as it pertains to functional approaches to various gut health conditions. And after working with clients for a few years now I understand why.
But being a hard core data nerd who loves creating and playing with databases and spreadsheets and running queries and working on statistics, I thought – I’m going to find an answer to that question.
And in thinking about how to give a fair, honest answer, I realized that I’d have to understand and label what went wrong when I didn’t succeed in helping someone. Which led me to the whole concept of how to be a good client or patient, which will ultimately help you in fixing your gut health issues, which is why this could be a helpful blog for you and not just a giant advertisement for my services, because I’m truly not that shameless. ( :
And overwhelmingly what I discovered as I went through the data on my prior and current clients, there were concrete reasons why I wasn’t able to help some of the people I’ve worked with.
So let’s start with the first and biggest reason I wasn’t able to help the biggest chunk of people, which represented about 40% of my former clients (excluding those who are still in progress) and that was lack of follow through. So looking over the list of names, I see some who only set up one appointment. Maybe they were working with another practitioner who wasn’t addressing their complaints adequately, or maybe I resolved their complaints and they never told me about it, but in any case, when I followed up with them, they didn’t let me know how things were going and I didn’t know if they followed through adequately on my recommendations. So in reality, some of them may have been doing better but I don’t know.
Another subgroup of that 40% came to me in very fragile health with very complex health issues, like chronic fatigue, debilitating and very advanced Crohn’s disease, mold illness, multiple autoimmune diseases, or breakdown of multiple body systems. In that group, many were unable to follow through with my recommendations due to their fragile health, being on the conventional medical rollercoaster and not wanting to mix what I was recommending with their doctor’s treatments or an adverse reaction to something I recommended. This can happen often when treating long-term dysbiosis, especially when it involves H pylori or candida. Unfortunately, for someone who only signs up for one appointment, when that happens, they often disappear rather than coming back to try something different. Sometimes the body needs to be ready to handle the killing of bacteria or yeast, and we need to address detoxification ahead of time, go more slowly or try a different product. But if a client doesn’t communicate with me about what’s going on or come back to see me, it’s hard to help them. When you have long-standing, complex health issues involving multiple bodily systems, sometimes there are multiple false starts before you find what’s going to work. So communication with your practitioner and persistence are really key in finding solutions. I’m 100% committed to finding solutions that are workable for my clients, in changing directions, or in trying something new if what we’re trying isn’t working, but you have to be completely honest about what you can and can’t do and how you’re feeling.
Another subgroup of the people I would describe as not following through are people with complex conditions like IBD who weren’t willing or able to make the dietary changes I recommended, or follow supplement protocols that I educated them on. This occurs for different reasons from eating disorders, vacations, family and other life things getting in the way, lack of faith that dietary changes are as key as they are, or not being the person most committed to your own care, which has happened in cases where spouses or parents approach me about helping their loved ones.
Another subgroup of the non-follow throughers were people with really high anxiety. I’ve had a few people who fit this description, and because of their anxiety, they found it hard to follow my advice, because of fear of side effects of a taking a certain or really any supplements, or being too attached to the conventional medical paradigm and not trusting that alternative treatments are safe or effective. Or when it came to gut stuff they trusted my advice but weren’t willing to try out my advice when it came to other health issues. And almost everyone who sees me has other health issues, usually precipitated by gut health issues, so I have a good bit of experience at this point with those other issues. And when someone has anxiety, if they’re not already on an SSRI, I usually try to start with amino acids to bring up serotonin levels and calm them a bit before dealing with gut issues, because that’s an area where you can have pretty quick impact. And once you’ve brought down anxiety, follow through is much easier for people. But sometimes I just can’t get that far with a client because their anxiety is standing in the way.
Finally, there’s one more subgroup in that 40% of people who didn’t follow through, and that’s the folks who for whatever reason disappear and don’t use up the appointments they paid for. I have to say I’m really sad when that happens and I usually follow up at least three or four times over time to see what happened and why they disappeared. I know that sometimes there are major life issues going on that need to be addressed before being ready to address health issues. But I also imagine that sometimes there’s a mismatch in my approach and people’s expectations, which is a shame because my approach is totally flexible. If you come to me and want to work primarily through diet changes to address your issue, I’ll do my best to help you do that. If you are open to and willing to take supplements, as most people are, I’m also willing to teach you about that. But at minimum, when I suggest a protocol, speaking up for yourself and advocating for what you’re willing and able to do is so important in being able to help you. Sitting quietly then leaving and never saying why doesn’t really help anyone. I have no ego invested in your treatment. All I care about is helping you get better, so if you think we’re going in the wrong direction for whatever reason, I’m all ears about changing it.
So to summarize the lessons I can impart to you from the folks who haven’t followed through are:
Before signing up with a practitioner, count the cost – are you at a point in your life, mental health and medical care where you can follow the recommendations of a practitioner, make hard changes to your diet and lifestyle, afford natural supplements to address your condition and stick with them long enough to know if they’re working?
Can you advocate for yourself and speak up when things aren’t going well or do you just give up and switch to another provider when something gets hard or overwhelming or you can’t follow through?
Does the practitioner that you’re seeing have a flexible approach or are they focused on one solution to everyone’s problems?
So back to the question of success rates, pulling out the people who didn’t follow through, I was able to come up with a list of people who came to see me for gut health issues and followed through with my recommendations. I calculated that 82% of those people had their gut health issues completely resolved or significantly improved, including diarrhea and soft stool, constipation, bloating, gas, stomach and intestinal pain and cramping, excessive burping, IBS, SIBO, candida, H. Pylori and ulcerative colitis. The ones where it didn’t resolve only saw me for 2 or 3 appointments, and I’m not really sure how their gut is doing but in the short time we worked together we weren’t able to resolve it. Or in another case, it’s still in progress following a final appointment but this is a case with IBD and I find those require a lot of trial and error to bring into solid remission.
So as I mentioned above, most people come to me with more than gut health issues. I calculated the percentage of people who had other significant health issues and it was 83%. Those included things like anxiety, depression, bipolar disorder, schizophrenia, eczema, psoriasis, rashes, autoimmune diseases of all types, including Hashimoto’s, Rheumatoid Arthritis , MS, POTS, spondyloarthritis and dermatomyositis, joint pain, chronic fatigue, low energy, extreme food sensitivities, incontinence, prostate issues, frequent urination, frequent UTIs, brain fog, type 1 and type 2 diabetes, hormonal imbalances, gum inflammation, arthritis, sleep issues, nasal polyps and congestion, excessive allergies, headaches and migraines, asthma, COPD, mold illness, rashes, infertility, dizziness, heart issues and osteoporosis just to name a few.
Now some of these things are related to the gut and can be dealt with through dealing with gut health issues but of course others are not, so I don’t claim to be able to help people with all those issues. But of the folks who followed through, half of the people with other issues saw resolution or improvement of at least one of them, including headaches and migraines, dizziness, joint pain, depression, anxiety, fatigue, food sensitivities, inflammation, including in the gums, psoriasis, frequent UTIs, sleep issues, blood sugar dysregulation, hypothyroidism and remission or a decrease in symptoms of autoimmune diseases, including Hashimoto’s, RA and dermatomyositis. And in some cases, I helped people identify potential health issues and recommended tests to have their doctor do that led their doctor to diagnose and treat issues that were underlying their health complaints.
So if you’re considering looking for an alternative or functional medicine practitioner, I’d give you these few pieces of advice. First, if you haven’t yet seen your PCP or a gastroenterologist about your complaints, that’s the first place to start. Go through the conventional medical system first because it will be covered by insurance and will rule out physical issues and give you a diagnosis. It’s a lot easier to work with people when you know what they have. But don’t let that drag out too much. If you’ve been through that system without positive results, been told there’s nothing else they can do, or been put on a medication for life you’d like to get off, that’s when it’s time to seek out an alternative practitioner. Then look for someone with expertise who is evidence based (meaning they don’t latch onto every new unproven woo-woo thing out there), use peer-reviewed studies to make treatment decisions, and charge reasonable fees for their services. But you have to understand that most of us who are in the field of functional medicine and coaching are self-employed (meaning we have to set aside money for payroll taxes and our own benefits) and spend a lot more time with you than a doctor. For me that means typically around 1.5-2 hours in preparation and follow-up for 1-hour client appointments, checking in every few weeks to see how you’re doing, email support whenever you need it. So keep that in mind when you look at hourly or program fees. And really, you should think of it as an investment in your health because that’s what it is. Because without your health, you have nothing. Nothing else in life is enjoyable when you feel miserable or are in a constant state of anxiety about your health.
Now if seeing an alternative practitioner is completely out of your league financially and you need to try to self-treat, here are a few pieces of advice.
Do one thing at a time and follow through for a reasonable amount of time. So for example, if you’re going to try an elimination diet, if you have serious health complaints or autoimmune issues, I’d recommend a very thorough elimination diet like the Autoimmune Paleo protocol, and spending at least 30 days on elimination then systematically reintroducing things. If you have more minor health complaints, you may get away with a smaller set of foods to eliminate and test, but gluten, dairy, soy, processed food, sugar, caffeine, alcohol, nightshades and processed seed oils are some of the big ones you’ll probably need to eliminate and test. The part where people tend to get sloppy is usually on the reintroduction because they’re so tired of deprivation they just restart eating their old diet. I wouldn’t recommend that. Even if you don’t feel significantly better when eliminating, you may forget how bad you felt before and only on reintroducing systematically will you realize what you’re sensitive to. But if you end up only eating 3 foods, then you’ve gone too far and likely you need to address gut issues beyond what you’re eating.
So second, if you have significant gut issues like excessive bloating, soft stool, constipation, etc. it’s not likely that just making diet changes alone is going to solve them, although I have seen people on pretty bad standard American diets eliminate those problems when they started eating in a healthier way. But if you’re already eating plenty of fruits and veggies, organic and pastured meats and wild caught seafood, sufficient fiber in the form of whole grains, root veggies, beans, lentils, etc., healthy oils like olive, avocado and coconut oil and your diet isn’t too high in carbs especially white flour and sugar and you’re still having issues, then I wouldn’t say just a basic diet cleanup will take care of your issues. If you determine that you likely have SIBO or candida, then you could try to find and put together a protocol or find a product online or in a health food store to treat your issue. Just don’t listen to every single podcast out there and throw in everything but the kitchen sink. Sometimes I find people on 30 different supplements and when it’s like that, it’s almost impossible to determine what is useful and helpful. But at most 2 or 3 carefully selected things can help you. Just be careful that when you start taking antimicrobials of any sort, you can have die-off or a Herxeimer reaction, which can feel like the flu as parts of dead bacteria and yeast flood your system. If you get really sick, stop taking your supplements and let your body process it out before continuing. Typically herbal treatments for SIBO are relatively quick, say 6 weeks, twice that at the worst, H pylori a couple months, whereas treating bad candida can drag on for 6 to 8 months, so don’t give up.
And then finally, if you aren’t getting anywhere and want a little guidance but can’t sign up for a whole program of support, know that most practitioners will do one-off appointments, including myself. For me, that includes follow-up support via email to see you through whatever protocol I recommend.
And if you think gut health testing will help you know better what to do, you can of course take my gut health quiz that will help you determine which gut health or functional medicine tests are most appropriate for you.
And as always, you can sign up for a free, 30 minute breakthrough session if you want to talk through what’s been going on and see if it’s something I can help you with or you can jump right to a single, 1-hour consultation if you’re ready to get working right away.
I just hope that you all persist in trying to be as good clients or patients as you can for whoever you are working with so you can see your way to a solution because I do believe that most gut health issues have solutions and that you can get better. And whatever terrible state of affairs you’ve been living with does not need to continue indefinitely. That there are solutions. And I know this from my own life and from my clients so I just want to give you encouragement and hope that you can find the solution to your problems.
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