Category: Uncategorized

Adapted from episode 149 of The Perfect Stool podcast edited for readability with Terri Fox, MD and Lindsey Parsons, EdD.

Lindsey:    

So I wonder how you got into your specialty involving biotoxin illness and mold and Lyme?

Terri Fox, MD:

Yeah, sure. So biotoxin is something that is released by a living organism that’s toxic or pathogenic to humans. Some examples of biotoxin illnesses are Lyme, Lyme co infections, mold, that sort of thing. So I was practicing functional medicine for maybe 10 years. I found most of my patients really did well with the normal functional medicine interventions and studies and work on their hormones, get them sleeping, optimize their nutrition and their nutrient status, clean up the gut, and they would do better. And about 15% of my patients just didn’t budge, no matter what I did. And so I kept finding myself stuck in this, and they had some similarities in their symptomatology. After a while, I figured out most of these patients had Lyme and Lyme co-infections, and so then I started treating Lyme and learning about Lyme, which is a lot.

What happened for me was my son was eight years old, and he got really sick. He was one of those scrappy, thrill-seeking maniac little boys, climbing everything and trying to kill himself all day, and suddenly he started limping. I would ask him, “Kai, do your knees hurt?” And he would say, “No.” And then he would walk normally without limping. And I was just watching him, and he was getting stiff after a car ride, or in the morning when he woke up, he had new anxiety that he never had. He put on 30 pounds in, I don’t know, six weeks, on his teeny, little frame, and so I started testing him for things, and he turned out to have Lyme. And I tried to treat him myself, and I’ll tell you, as a mom, don’t ever try to treat your own child for Lyme.  I ended up taking him to see Dr. Steven Harris in California, who’s a wonderful Lyme doctor, and he gave us a urinary mycotoxin test for mold. So we brought it home and we did it, and Kai’s mold levels were through the roof, his mycotoxins, so at that point we knew, “Okay, there’s something else going on as well.” 

I had a good indoor environmental professional out to evaluate the house. This was the year of the Boulder flood. So I live in Boulder, Colorado, and we had this 100-year flood. Every house on our whole block got just tanked by it, and I thought that we were okay. And so this is, maybe nine months later, when the environmental professional comes in, and we have this massive crawl space under the whole house at the time. And he went into the crawl space, and he cut the vapor barrier, and there was three feet of water under the entire house, and our airborne spore traps were in the red. I don’t actually think I’ve ever seen them as bad as our house was. I didn’t know what it meant to remediate or what a good remediation was, so I had a regular construction company come out. It sort of spreads it everywhere and makes it worse, if you don’t do containment and negative air pressure. At that stage, he got much worse, and he called it a migraine. He had nine out of ten pain in his head that got worse with any movement, and he basically was in bed for six months. He dropped out of school and out of soccer, and it was pretty horrible.

Lindsey:    

And was anybody else in your house impacted?

Terri Fox, MD:

I was, but do you have kids?

Lindsey:    

I do.

Terri Fox, MD:

So you know how it is, as a mom. You focus on the kid. I was having anxiety and insomnia and I couldn’t sleep at all. I lost 15 pounds that I didn’t need to lose at all. People, they can get this unexplained weight gain or loss, my ex-husband, my husband at the time, and my other son, they were 100% fine.  We put him on a mold detox protocol, and then once we got out of the house, the marriage didn’t make it through, unfortunately, but Kai got better. As soon as we got him out of the exposure, he slowly got better, and within a few months, he was back at school, mostly full time, and playing soccer again.

Lindsey:    

That’s awesome. So did you just have to give up on the house? Or what did you ultimately do to remediate the mold?

Terri Fox, MD:

We remediated it and sold it. I didn’t believe that he was ever going to get better in that house. I mean, the mold was so significant, and the toxins stay in drywall and wood and anything porous made of cellulose.

Lindsey:    

So how expensive was the remediation?

Terri Fox, MD:

A lot. It meant that we didn’t make very much on the sale of our house. I want to say maybe 80 grand.

Lindsey:    

Wow. I sold a house. I can’t remember if it was what they said was mold, or if they just said that there was rot or something under one bedrooms worth of floor and that alone was going to be like $5,000 to tear that out and redo it.

Terri Fox, MD:

Yeah, some floors are expensive.

Lindsey:    

Yeah. Anyway, you mentioned the weight loss or gain and migraines and insomnia. What else would you see in a patient that might make you suspect mold?

Terri Fox, MD:

The common symptoms are fatigue and brain fog, cognitive dysfunction of all kinds, word recall, memory loss, difficulty, focus and concentration. And then I see a lot of headaches and migraines. I see a lot of insomnia, anxiety, sometimes depression, and then a lot of unusual neurological presentations that don’t fit into any neurological diagnosis, like asymmetrical numbness, tingling, weakness, ice pick sensations, burning sensations, crawling sensations, involuntary muscle movements, ataxia or difficulty with your balance. So those all fall under the unusual neuro-symptoms. And then we see a lot of rashes, itchy rashes, acne, hair loss, and then rapid weight gain or loss.

Lindsey:    

So I know that some of the things you said, like the crawling sensations that’s also common for Lyme or Lyme co infections. So is there anything that’s really distinguishing between those two that would make you think one over the other?

Terri Fox, MD:

Yeah, a few things there. But the things that make me think more Lyme than mold are when somebody has flu-like symptoms, so they feel like they’re coming down with something, like they’re sick, but they don’t actually get a cold, and they have joint pain that moves around. So we call that migratory joint pain, achiness, or recurrent fever. So I often think more of Lyme with those, and then the mold symptoms are really similar to Bartonella symptoms, one of the Co-infections in Lyme. Those can be hard to tease out, but if you have Lyme, you always test for mold first, and you always treat the mold first, because mold is often the reason that Lyme remains active and chronic in the system, and when you clear the mold, often the Lyme goes back into dormancy. So I actually don’t ever start treatment on a Lyme patient without doing a mold test first and treating that.

Lindsey:    

Oh, interesting. Okay, so I know mold can also present with GI issues. So what GI symptoms might you see with that?

Terri Fox, MD:

I feel like we see the whole gamut. Mold can colonize or live in your upper respiratory tract or your GI tract. So if you’re living in a moldy space for a long time, eventually you’re going to breathe a spore up into your nose or swallow it down your esophagus. And if it colonizes in your gut, you can see anything from intractable hiccups, but more commonly, diarrhea, constipation, gas, bloating, a lot of vagal stuff, burping and right after you eat, bloating.

Lindsey:    

Yeah, I’ve got someone who has a lot of those symptoms and just tested positive for mold, which is always, I think, pretty shocking because of the potential implications. So I’m curious if you recommend people, if they suspect mold, do they start with inspecting the house, or do they start with the mycotoxin test?

Terri Fox, MD:

You always have people test themselves first. Let’s just see if that’s even the right road. If it is, then we need to figure out if it’s an old exposure or where you’re living now.

Lindsey:    

Yeah. And so which mycotoxin test do you like to use?

Terri Fox, MD:

I definitely recommend a urinary mycotoxin over biomarkers in the blood and some of the other testing. And I really like Real Time Labs. I like Vibrant; the Real Time Labs probably is my favorite because I’ve just used it for so long and I trust it, but it’s very specific, meaning you won’t see false positives, but it’s not as sensitive, meaning you’ll miss a decent amount. So it has to be provoked. And I do a pretty intense provocation. I do an IV of phosphatidylcholine and glutathione, and then we wait an hour and collect the urine. And the reason is that the people that get sick from mold are the ones that can’t detox it. They can’t metabolize it and get it out, in the urine or in the sweat. And so if I just check their urine, they probably wouldn’t be sick enough to end up in my office if they were getting it out in the urine, stool, in the sweat.

So these phosphatidylcholine and glutathione will help metabolize them and detox them, so you can get a sense of what’s really in the body. And if somebody doesn’t have access to an IV, could they use those orally to provoke. So you would do liposomal glutathione, as big of a dose as you can stomach (it gives some people diarrhea), at least 1000 milligrams a day for a week. And then if you can do either a really hot bath or an infrared sauna beforehand, that’ll help as well pull it out and mobilize it. When I have people do a retest, I’ll actually have them stay on their antifungals. So if somebody has antifungals around, they could take the antifungals as part of the provocation as well. And the idea there is, if it’s living in you, and you take an antifungal medication that kills it, it releases its contents, which are those mycotoxins. So it’s another way to provoke to see what’s actually in the system, in the urine.

Lindsey:    

So they’re literally taking the glutathione right up until the testing.

Terri Fox, MD:

Yeah, yeah. And by antifungals, I mean, like pharmaceuticals like Itraconazole or voriconazole.

Lindsey:    

Would you give them phosphatidylcholine orally, or?

Terri Fox, MD:

 I’m really careful with phosphatidylcholine orally. If they are already on it and we know they tolerate it, then absolutely that’d be great provocation. I found a lot of my chronic complex illness patients and my mold patients don’t initially tolerate oral phosphatidylcholine. It can exacerbate symptoms. It releases these fat-soluble toxins. Some people can’t clear them, and they get symptomatic. So I’m careful with that one.

Lindsey:    

I imagine glutathione would do the same, wouldn’t it?

Terri Fox, MD:

I find most people tolerate it. Some people have to work up real slowly, but generally, I find most people tolerate it.

Lindsey:    

So are there any tests beyond the mycotoxin tests that you use related to mycotoxins?

Terri Fox, MD:

I like the mycotoxin because it gives me the specific strains that are in the body. And there’s different binders for different strains of mold or mycotoxins. That one, you can create a protocol that’s actually going to work for your unique mycotoxin load. There are markers in the blood that, if you have insurance that covers all your blood work, they can be sort of nice to follow to see how we’re doing without paying for a mycotoxin test. I don’t find them diagnostic or definitive, to be honest, the two big ones now, at least here in Colorado, we can’t get them processed correctly. The labs changed where they sent them, and after Covid, they changed. So it was a C4A and a TGF beta 1. And after Covid, they changed the reference ranges. So everybody’s really high from the inflammation from Covid, and so if you can get them done accurately, they can be helpful, but that’s proving to be harder and harder, right now.

Lindsey:    

Interesting. Okay, so you’d be looking for those in theory, to go down over time.

Terri Fox, MD:

You want them all to go down, except for the MSH.

Lindsey:    

Oh, is that another?

Terri Fox, MD:

That’s another one, yeah. That one you can do without a specialty lab, but it’s melanocyte stimulating hormone, and the MSH goes down. That’s often when the system fully crashes. We don’t treat the MSH directly. We treat the mold. And it’s sort of the last value to come back up into the normal place. It wouldn’t necessarily be a good data point along the way.

Lindsey:    

So if someone is in what appears to be a mold-free environment, but shows mycotoxins on the test, could they be from a previous residence? And how long would they stay in the body?

Terri Fox, MD:

When we get a positive test, that doesn’t tell me whether it’s an old exposure or a current exposure. First, we test the home that they’re at and see how that one looks and it can be from a previous exposure. If that’s the case, then they likely colonized in you, meaning it’s living in you now, releasing mycotoxins, and you brought it with you.

Terri Fox, MD:

The most common place of colonization is in the sinuses. So part of a good mold treatment program has a nasal spray aimed there.

Lindsey:    

So basically, you don’t know whether it could be in the body for years. In theory.

Terri Fox, MD:

Yes, it can. It’s always better if it’s not their current living.

Lindsey:    

Right, of course! Then you don’t have to tell them you’ve got 10s of 1000s of….. that’s why I wouldn’t want to go into mold, because that’s got to be stressful.

Terri Fox, MD:

I find mold to be a great diagnosis in that people get better. The turnaround is awesome. In a good mold protocol, you never feel worse. You feel either nothing or better the whole time, as opposed to Lyme where there’s some pain before you get better; it’s trickier. I think it’s a great diagnosis. However, if they’re still in a moldy place and they have to either remediate or move, that’s when it turns into more of a challenge.

Lindsey:    

So what should people know about getting their home inspected for mold?

Terri Fox, MD:

Well, you want to get a good environmental professional. Anybody can put up a website and call themselves a mold inspector. It’s not a regulated industry. So you want somebody good. You can start  an organization called ISEAI, the International Society of Environmentally Acquired Illness. It’s iseai.org and they have a find your physician directory and a find your IEP directory. So usually I have patients, if they’re not close by, where I know the people that are good, I have them go to start at that directory, that website, and see if they can find anyone near them. If not, they can call the one closest to them and see if they know anybody. There’s a national company called We Inspect that does most of the country.

Lindsey:    

Okay.

Terri Fox, MD:

If they have no suspicion that it’s in their current home, and none at all, which most of them don’t even when it is. But if there’s no history of leaks and any of that, then I have them start with an ERMI, a qPCR, which is a dust test for DNA of mold and mycotoxins. So you just do a little Swiffer sample of the dust in your house and send that in. We get a sense of if it’s bad and needs a thorough evaluation, or if it looks okay, then I don’t need to worry about.

Lindsey:    

Okay. How much can people expect to spend on a mold inspection from a professional mold inspector?

Terri Fox, MD:

Probably, like $1000.

Lindsey:    

And what should people know about doing remediation on their home?

Terri Fox, MD:

That’s another one that’s really important to get the right person. Because, like I said, it’s an unregulated industry, and so people can say, like, Serve Pro will come in and they’ll put fans on it, which will just blow the mold all over your house and make it worse. Again, that same directory of IEPs has a lot of remediators on it. Home cleanse is a organization that does remediations all over the country. They do a really good job. Yeah, there’s a couple other directories. I’d start there. There’s an organization called Change the Air Foundation, and they have tons of free downloads, and so they have entire guides around what you’re looking for.

And a good remediator, what does it mean to have a good remediation? What does a good remediator contract look like? They read a ton of resources. But some things is, you want to make sure that they’re going to contain the area. So if you’ve got wet, moldy drywall, and they’re going to pull it out, that has to be contained in six-millimeter plastic with negative air pressure, so a scrubber that’s pulling the air out of the house before they remove the moldy, wet material, so it doesn’t just get all over your whole house and make things worse. So you can always ask, “what kind of a containment do you do?” After all the demo has been done, where they pull out everything, you have to get a small particulate cleanup, so the mold releases these mycotoxins and other nanoparticles that are toxic to those of us that are sensitive to mold. Those can stay in the drywall, in the wood, so everything has to get wiped down and vacuumed, and then sometimes we fog at the end.

Lindsey:    

Is this one of these things where you probably need to replace your furniture and stuff?

Terri Fox, MD:

So if it’s a hard surface, you can wipe that. If it’s a fake leather or leather, you can wipe that. If it’s a fluffy couch, you’re going to probably need to get rid of it. If it was a significant mold exposure, ideally, mattresses.

Lindsey:    

Yeah, that can be expensive on top of everything else.

Terri Fox, MD:

But anything you can throw in the washing machine, you can keep.

Lindsey:    

Right. So actually, my sister and her husband are going through this right now. I’m not convinced that they have any big mold problem, but he’s got a lot of allergies.  They’re in Georgia, they said they found a dog that apparently can inspect for mold. Have you heard of that?

Terri Fox, MD:

Yeah, there’s great mold dogs out there. So we have one in Colorado named Buddy, and he’s great. It’s the same organization that trains the dogs to sniff out drugs and weapons in our luggage at the airport. So the same people train them to smell mold if you know you have it and you can’t find the source. Like, let’s say your ERMI is really high, or even an airborne spore trap is high, and they can’t figure out where the source is. That’s a nice time to get a mold dog in.

Lindsey:    

Yeah. So I imagine, when you’re getting an inspection, are they drilling holes in the wall to check?

Terri Fox, MD:

So they’ve got infrared cameras, really intense, powerful ones, like $10,000 ones, that can see dampness in the walls, and they have damp meters, and so usually somebody good can see a water damaged spot somewhere and pull back a baseboard. If you’re stuck and you don’t know for sure, is it behind this thing or whatever, then they might do a cavity sampling. They do drill a little hole to go behind a wall and do an airborne spore. But that’s a more specialty thing that you would ask for; they’re not going to come in and tear down your walls.

Lindsey:    

Right, right. Okay, so if someone can’t leave the moldy environment, is it worthwhile to treat them at all? Will you put off treatment until they move?

Terri Fox, MD:

I have a mold eradication protocol that’s two phases. So phase one is teaching your body how to detox, metabolize and get these toxins out. That part is binders and glutathione and organ detox support, that kind of thing that can be done while you’re still in the exposure. So basically, the longer you’re in the exposure, the more mycotoxins you’re going to have in the system, and they’re just going to keep accumulating until you’re out of the exposure, and then there’s more work to do. And so you can bind while you’re in and decrease that total body burden. And sometimes it’s enough to even feel a little bit better, but you might not feel that significant improvement until you’re out of the exposure. I wouldn’t do phase two antifungals and biofilm until after they’re out of the exposure.

Lindsey:    

And say, somebody can get out of the exposure. How long would somebody typically stay on binders before moving on to antifungals?

Terri Fox, MD:

If they’re not being exposed? If they’re no longer being exposed, once they’re on the full phase one for four weeks or doing it successfully, having daily complete bowel movements, because the binders are constipating, and they’re sweating, and they’re doing all of this, and they feel either nothing or better for four weeks. Then I start phase two.

Lindsey:    

And when you say they’re sweating, are you sending them to saunas and that sort of thing as well?

Terri Fox, MD:

I have a pretty lengthy handout on biotoxin relief and things that help to pull biotoxin out of the body. And those will just potentiate it, make it go faster and you’ll feel better quicker. And those are things like infrared sauna and ionic foot bath, detox baths and acupuncture and a variety of things.

Lindsey:    

Interesting. Are there particular genes that make people more susceptible to mold illness?

Terri Fox, MD:

Probably. Our number that we use in the mold community is 25% of the population is sensitive to mold. Not everybody is. I personally think that number is growing. Now I can have a really distorted view of things, because mold just walks in my door. People just come in and they go, “I have mold, help me”. But there’s a variety of factors that would make it where more people are sensitive to mold than used to be. One really easy example is the total body burdens. If you have a bucket that has been getting full throughout your life with plastics and pesticides and glyphosate and then some inflammation from Covid and then some biotoxin from Lyme, when the bucket gets full is when the system begins to crash. And I actually don’t remember what the question was now…

Lindsey:    

Oh, about genetics, whether there’s particular genes that have been identified for mold?

Terri Fox, MD:

Yeah, sorry, went on a tangent. I think there are genetic mutations or SNPs that make some of us more sensitive than others. I don’t think we really know exactly what they are yet. You might be alluding to the HLADR, which is an old test that we used to do that can look at your genetics and say whether or not you’re more susceptible to mold or Lyme or both. I think most of us in the mold community have found them not to be useful or accurate. So a lot of really sick patients that didn’t have any of the genes and people that have both the bad genes that are fine and mold and Lyme. So I don’t even check those anymore.

Lindsey:    

Is there some estimate about the percentage of the population that is mold sensitive?

Terri Fox, MD:

25%

Lindsey:    

Yeah, 25% oh, that high. Okay.

Terri Fox, MD:

Yeah.

Lindsey:    

It’s a wonder there’s people living in certain places, because, like, I’m in Arizona here, obviously we don’t have as much mold to worry about. This is where everybody moves when they’re trying to get away from it, right?

Terri Fox, MD:

Exactly.

Lindsey:    

So you use nasal sprays as part of mold treatments? I think you did mention that, and I’m wondering if there’s any non-prescription options, because for those of us who are not MDs or naturopaths, it’s kind of like, “what do you do?”

Terri Fox, MD:

Yeah, I usually start with BEI. That’s a compounded prescription, 1. Xlear* is really good. Silver is really good, nasal silver*, propolis* can be helpful.

Lindsey:    

What about Biocidin* put into saline spray?

Terri Fox, MD:

Yeah, if you put it in in your sinus rinse, they told me they were going to make a nasal spray, like five years ago. What has taken so long?

Lindsey:    

They told me that too, I know. And they’ve come out with all these dental products and all these other things.

Terri Fox, MD:

I know! I’m like, “where’s ours?”

Lindsey:    

Come on! We’re still telling people to take pliers and pry off nasal sprays and put in Biocidin drops. I mean, help us out here people!

Terri Fox, MD:

Yes, exactly.

Lindsey:    

Okay. So you go binders, and then you do nasal sprays, and then the next series is antifungals. Is that  the sequence of events?

Terri Fox, MD:

The first phase is really – to get this sick from mold, your detox pathways are not working correctly, so you make sure they’re having bowel movements. You’ve got them on all the right binders. You do it one at a time. You layer them in to make sure you’re not trying to detox more than the body can handle. And that’s one of the really common pitfalls. When people try to treat themselves, they do too much too fast. They feel more sick, and then they think they can’t get better. So you’re teaching the body how to bind with binders and pull out in the GI tract, and we’re playing with magnesium and different things to continue to have daily bowel movements, and then nasal sprays, and then liposomal glutathione, and then organ detox support, so some kidney, liver, lymph detoxification pathway support, and then get some of the other biotoxin relief things happening.

Lindsey:    

Is there a certain company’s products that you like for these things? I know Quicksilver does a lot of metal detox stuff.

Terri Fox, MD:

Yeah, they do mold detox too. I love their Ultra Binder. Activated charcoal is a big common binder that we use. And Ultra Binder is made by Quicksilver Scientific. It has activated charcoal and it has three or four other binders in smaller amounts. You’re not sure if there’s some other stuff we didn’t catch and you want to clean it up. But that one’s nice, and it’s got some aloe and some other things that make it a little easier on the belly. It’s more expensive, though, too. So if you’re on a budget, plain activated charcoal is fine as well. The glutathione you should be picky about. It’s hard to make a liposomal glutathione that you’ll actually absorb.

Lindsey:    

Yeah. Have you tried the Aura Wellness’ new glutathione spray*?

Terri Fox, MD:

I have it on right now! I put it on after my shower. I just started trying it recently. I had heard about it from a friend, Scott Forsgren, do you know him? Who does the BetterHealthGuy podcast? He told me about it. And then I was at that longevity conference, the A4M World Congress in December, they were there.  I was able to check it out and try it. Now we have it in clinic. I think it’s pretty cool.

Terri Fox, MD:

Yeah, I had Dr. Patel on the podcast recently.

Terri Fox, MD:

 Oh, nice, yeah.

Lindsey:    

The way he tells it, it doesn’t matter if you take the liposomal or the whatever, it’s not going to get in, it’s just going to break into the components and recompose, was the way he told the story.

Terri Fox, MD:

Oh yeah, if you get a good liposomal formula, it will get absorbed. I mean, there’s several that you put under the tongue that get a lot of venous absorption, and then the liposomes get through the cells in the small intestinal wall, and as opposed to having to go through a receptor, so they get absorbed into the system easier.

Lindsey:    

Yeah, What he said, though, was when they tested any kind of glutathione besides their own-obviously, he was selling products, so, you know, with a grain of salt- but he said, when they tested the blood levels, right after taking it, there was no raise in glutathione levels, and there was, a couple hours later, a subsequent raise in the levels of cysteine, glycine and glutamine. So they knew that it was breaking it into its components and recomposing it. Which is not to say it doesn’t also work in that sense.

Terri Fox, MD:

Yeah, but that’s exactly why you have to get a good one, and it has to be liposomal so that you don’t digest it, because I follow glutathione levels on all my patients, because glutathione is necessary to detox and metabolize mold. Generally, a person who’s had a big mold exposure, their levels are tanked. They’re really, really low because they’ve used it all up trying to get the mold out themselves. That’s something I follow, and they absolutely come up with the liposomal formulas.

Lindsey:    

Okay, and what marker are you using to test them?

Terri Fox, MD:

I check glutathione levels in the serum in Lab Core. I check them on – the Nutreval has the serum and the red blood cell, which is the more recent exposure glutathione.

Lindsey:    

Oh, and I was asking about whose products you liked for the kidney, liver and lymph, was there another?

Terri Fox, MD:

Yeah, so kidney liver lymph. I like Pekana, have you ever worked with those? It’s like a German homeopathic company; they have kidney liver lymph. I like, for somebody who prefers a capsule, CellCore’s Drainage Activator* [access using patient direct code: I0rdLMOm]. I like that one. Those are the two main ones I use. There are some others, but mostly I like those.

Lindsey:    

Okay. So I often see clients who have Candida and will likely go through, say, one to four courses of antifungals and binders and such. So I’m curious, is it possible that someone could still have mold issues after going through that kind of a protocol? I assume they’d have an extreme reaction as soon as they started the antifungals, if they had a big burden of mycotoxins.

Terri Fox, MD:

So the antifungal you would use for yeast versus mold are different, but where there’s mold, there’s always yeast. So mold and yeast are both fungal, and mold will create all the right conditions and pH and everything for yeast to flourish. And so even in the buildings that have water damage, there’s often yeast. We see that on the plates and on the tests that we do, and then in the body, this is mostly just from doing this for 15 years. I’ve just learned that every mold case has a yeast component; sometimes it’s a huge part of the case, and sometimes it’s a small part, and you don’t really know till you get to the yeast part of treatment, but it’s a huge part of my mold treatment is I treat yeast as well.

Lindsey:    

Oh, okay, and so what are the the antifungals for mold versus yeast?

Terri Fox, MD:

I would use itraconazole, voriconazole for mold, fluconazole for yeast. But I treat yeast, this is a more unique thing to me, I treat yeast with low dose immunotherapy. Have you ever worked with LDI? 

Lindsey:    

I’ve heard of that, yeah. You want to talk about it a little bit?

Terri Fox, MD:

Yeah sure. So LDI, it works kind of like a vaccine, or like allergy drops, where you’re giving the body a tiny bit of a thing that you want it to recognize, but also to develop tolerance to, so it’s not so much immune reactivity. They have low dose immunotherapy for Borrelia, Bartonella, for EBV, all kinds of things, but the yeast one, for me, has just been a absolute game changer in clinic. I love it. It’s always a huge part of a mold case, and it’s always one of the parts when we find the right dose that the patient goes like, “ah!”, like 12 things get better. I honestly remember when in my medical training in the late 80s, early 90s. In the 90s, I remember, there were different phases, like, “Candida is the cause of everything,” and then “there was this other thing that was the cause of everything.” And I remember thinking how silly it was, and now I’m like, “everybody has yeast,” and I treat, certainly all the mold patients and all the Lyme patients, because most of them have done antibiotics. There’s a lot, a lot of yeast.

Lindsey:    

Yeah, there’s just one provider of low dose immunotherapy, is that right?

Terri Fox, MD:

Oh, Ty Vincent, the guy that makes it, you mean? There’s one guy that makes it, and then you just have to do a training to be able to get the actual LDI.

Lindsey:    

Interesting. And so you mentioned prescription-

Terri Fox, MD:

Do you find that you can treat the yeast and get rid of it for good? I feel like I spent seven years with herbs and biofilm busters and fluconazole. You can use Voriconazole, but that’s a pretty intense med for yeast, and that they’d get better for a while, and then it would kind of come back.

Lindsey:    

Yeah, it’s hard to say, because people will sign up for a certain number of sessions, and then they’ll be better, and then they’ll leave. I don’t insist on retesting if people are feeling better. I don’t insist on seeing clean organic acids, I certainly see levels come down after treatment, but whether it stays gone forever, I mean, I know that there are genetics that make people more susceptible to Candida, and that their bodies don’t fight it as well. And so if you’re one of those people, then you just can’t have a high sugar diet and high carb diet ongoing if you want to manage it. So that’s part of it. I think if you just want to go back to eating sugar, then yeah, it’s going to come back.  So you mentioned some prescription antifungals for mold. Are there non-prescription alternatives?

Terri Fox, MD:

I use prescription antifungals. You can imagine the binders are sort of sopping up the mycotoxins that the mold is releasing in your body and pulling those out, but until the mold is no longer living in your system, it’s going to continue releasing more mycotoxins. So it’s like you’re in a boat and you’re bucketing out the water and there’s a hole in the boat, until you get rid of the actual spores. I just have really found that that’s where the needle moves, and that’s where clinically everything changes, is when you start the antifungals. Now that’s only if the system is ready. If you start them too soon, you’ll make them more sick. I don’t find the herbals to be fungicidal, meaning they actually kill and get rid of entirely. Now I have patients who don’t tolerate the antifungals, or who just won’t, they don’t want to do it, I will use them. There’s a bunch of herbal combinations that I’ll use. It seems like we get somewhere with them. It’s not quite the magical turnaround of a pharmaceutical.

Lindsey:    

Yeah. Are there particular herbs in those combinations that are the relevant ones? Or?

Terri Fox, MD:

Lemongrass, pau d’arco. I use usually some combos. Byron White makes one called A-FNG. Beyond Balance has two that are helpful, PRO-MYCO and MYCOREGEN. Yeah, there’s a few other ones. I have another homeopathic that I’ve just been experimenting with for the people who don’t tolerate antifungals or won’t take them. It was from a podcast I did with a homeopath in Australia, and she told me about this homeopathic thing that’s for yeast and mold that she has super dramatic results within clinic, and she sent it to me from Australia. So I’m experimenting with that to see if I can do something without antifungals. I’ll let you know if it works out.

Lindsey:    

 Okay, sounds good. Anything else that I haven’t thought to ask about mold treatment?

Terri Fox, MD:

Well, a couple things, if you have mold, I really feel like you should be hopeful, and you should get tested and you should get treatment. Because, like I said earlier, I really think it’s a great diagnosis. People do really well. They get all the way better. I have patients tell me they feel better than they ever have after all the detox. It’s not a terrible diagnosis. So don’t be heartbroken if you have it.

Lindsey:    

Except for the part about remediating your house, if it’s in there, that’s the terrible part.

Terri Fox, MD:

Hopefully it’s an old exposure. Get yourself tested after you move to a clean place.

Lindsey:    

Yeah, exactly. Don’t find out while you’re still there. Anything else?

Terri Fox, MD:

Oh, well, you know, if patients are interested, I have a mold treatment course for patients that I created. So as an MD, I can only really treat patients in Colorado, because that’s where I’m licensed. I get calls from people all over the world. And after many years of feeling like I should create something, I finally did, and it’s been birthed and it’s out there. I did the first live version of it last summer, and it went great, and it’s pretty affordable now, and step by step, sort of walk you through a whole mold detox protocol phase one and phase two.

Lindsey:    

Okay, so is that like a series of videos then?

Terri Fox, MD:

Yes, 35 video modules and tons of resource guides and how to find your supporting physician to write a couple scrips and that sort of thing.

Lindsey:    

Okay. And where can people find that?

Terri Fox, MD:

DrFoxMedicalDetective.com

Lindsey:    

Okay, great. Sounds like a very useful resource. Well, thank you so much for sharing all this great information with us. I appreciate it.

If you’re dealing with gut health issues of any type (diarrhea, constipation, bloating, SIBO, IMO, H2S SIBO/ISO, IBS, IBD, gastritis, GERD, H pylori, diverticulitis, candida, etc.) or have an autoimmune disease and need some help, I see individual clients to help them resolve their digestive issues or reverse autoimmune disease naturally, You’re welcome to set up a free, 30-minute breakthrough session to see if you’d like to work with me. I also have my own two products, Tributyrin-Max, which is particularly helpful for loose stool and diarrhea as it slows your motility and firms up your stool, and SBI powder, which is an all around gut pathogen binder, which is super safe and won’t harm beneficial bacteria, and is usually the first line of treatment I educate my clients about in order to avoid stronger antimicrobial herbs.

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

Adapted from episode 148 of The Perfect Stool podcast edited for readability with hist Lindsey Parsons, EdD.

What is post-infectious IBS?

Most people know what IBS is. Irritable Bowel Syndrome is a functional GI disorder characterized by symptoms like bloating, abdominal pain, diarrhea, constipation or both, often without any clear structural problem showing up on tests. It’s estimated that 10–15% of people in the U.S. have IBS, and for a significant chunk of them, their symptoms began after a bout of food poisoning or an acute gastrointestinal infection. This is what we call post-infectious IBS, which is really post-infectious SIBO or small intestine bacterial overgrowth.

You might have had some bad food, a 24-hour episode of gastroenteritis or what we often call the stomach flu, or Montezuma’s revenge you caught while traveling. You got over the fever, vomiting and acute diarrhea, but… things just never felt quite right again. Your gut developed a “new normal,” and not in a good way — with changes in bowel movements, gas, bloating, urgency and food sensitivities.

There are multiple infections that can trigger it, but the main culprits in post-infectious
IBS are:
● Campylobacter,
● Salmonella,
● Shigella and
● E. coli, (but do note that there are beneficial strains of E coli as well as
pathogenic ones)

These infections don’t just wreak temporary havoc on your gut. They can trigger long-term changes to how your intestines function. So later on in the podcast I’m going to discuss some specific research on this topic, but as a whole research has discovered that these pathogens can confuse your immune system into launching an autoimmune response.

How does food poisoning turn into an autoimmune gut disorder?

So when you get food poisoning from these 4 bacteria, your immune system makes antibodies to fight off a particular bacterial toxin present in them called cytolethal distending toxin B, or CdtB for short. But with an ongoing exposure, your immune system can get a little trigger-happy. It sees something that looks like CdtB in your own body, a protein called vinculin, which plays a role in the nerves that control gut movement, and then it starts attacking it too.

This is called molecular mimicry. In this process, the body mistakes its own tissues for invaders. The result is that you produce anti-vinculin antibodies, which damage the interstitial cells of Cajal, which are the “pacemaker cells” that keep things moving through your gut.

Without these nerves functioning properly, motility slows down or becomes uncoordinated, and you develop symptoms like bloating, constipation or alternating diarrhea and constipation. This is why post-infectious IBS is in fact SIBO. And SIBO is estimated to be the cause of IBS 60% of the time. This is more likely true in the case of loose stool or diarrhea or with a mixed presentation alternating between constipation and diarrhea, than with pure constipation, although I have seen one case of pure constipation that was post-infectious IBS.

If you’re not familiar with Dr. Mark Pimentel, he’s the executive director of the Medically Associated Science and Technology Program at Cedars-Sinai Medical Center in Los Angeles and one of the world’s leading experts on IBS and SIBO. He was the first to uncover how food poisoning can trigger long-term digestive dysfunction through an autoimmune mechanism, more specifically, how your immune system can start attacking the gut’s nerve cells after certain bacterial infections.

Because of impaired motility, bacteria entering with your food that should be swept into large intestine are never flushed into the large intestine through the cleaning waves of the migrating motor complex. So they remain in the small intestine where they ferment your food, especially fermentable fibers known as FODMAPs, and create gas, bloating, and inflammation. Think stagnant pond. This is particularly common with hydrogen-dominant SIBO, where bacteria like E. coli and Klebsiella pneumoniae tend to dominate, no matter the original offending bacteria. And if you have klebsiella pneumoniae, in addition to bloating and diarrhea, you may also experience histamine reactions, or allergic-like reactions, when eating foods with high histamine levels or that feed the klebsiella. If you want to hear more about SIBO and its subtypes, I talk about this on episode 131 for a good baseline understanding.

Dr. Pimentel’s team went one step further in investigating this. They tested the theory in reverse in animal models – injecting just the CdtB toxin (without any bacteria) and found that rats still developed SIBO and IBS-like symptoms. That was the proof they needed that the toxin itself (and the resulting autoimmune reaction) was enough to cause long-term gut dysfunction. Dr. Pimentel is also behind the development of Xifaxan (generic name rifaximin), one of the first FDA-approved antibiotics for treating SIBO. If you’ve ever been prescribed it and it wasn’t covered by insurance, you likely know about how expensive it is – the currently listed cheapest price on goodRX is $2327 for a 2-week course. I just checked and it won’t go off patent until late 2029, unfortunately. I’ll speak more later on treatments through.

How do you diagnose post-infectious IBS?

Dr. Pimentel’s lab also developed a blood test called IBS Smart, which measures anti-CdtB and anti-vinculin antibodies. Vibrant Labs also has a version of this test now, and theirs also includes candida antibodies. If you’re dealing with persistent SIBO symptoms despite treatment, these tests can help confirm whether a previous food poisoning event set off your current symptoms, which will give you clarity about whether you’re dealing with post-infectious IBS, a recent bacterial infection or just an incomplete treatment regimen. If your CdtB antibodies are elevated, your food poisoning incident was likely more recent, although these antibodies can stay elevated for years, especially if you developed post-infectious IBS. The most important question, however, is whether your vinculin antibodies are elevated. If so, this indicates that you have post-infectious IBS.

If you’re not sure whether to get the test, I generally recommend it when you have symptoms like:

● Persistent bloating, especially after meals
● Loose stools, urgency or diarrhea that lingers after an infection; or
● Alternating constipation and diarrhea
● Abdominal discomfort or cramping
● Food sensitivities, especially to high-FODMAP foods like dairy and wheat
● Sore throat, acid reflux, warmth in your chest after eating or a chronic cough
● Fatigue and brain fog (often linked to bacterial byproducts or nutrient malabsorption), and

● You have taken a round of Xifaxin or herbal antimicrobials, gotten better for a period of time, and then once again had symptoms, and you were not taking proton pump inhibitors at the time (like Prilosec or its generic, Omeprazole, or other products whose generic names end in -prazole, like Protonix, Nexium or Prevacid).

And if you’ve been listening for any length of time, you know that I have post-infectious IBS, so I can attest to the fact that this problem can last for decades, as mine started, I believe, with a food poisoning incident in Costa Rica in my mid-20’s (and I’m in my mid-50’s). I ate mayonnaise that hadn’t been properly refrigerated for a couple days and had vomiting and diarrhea for about 24 hours. Ironically, my boyfriend at the time got the same food poisoning and didn’t have any permanent issues afterwards. This is how it happens – while 9/10 people may have the same exposure, only 1/10 will develop an autoimmune reaction. I also was in Costa Rica the summer before and had a longer-term bacterial infection of some sort that I can’t recall the name of, so it could have been that one too; no way to know at this point.

So if you’re wanting some clarity on why your SIBO or IBS won’t go away, you can order the IBSsmart test online for $249, and I just noticed there’s a $100-off coupon code (IBS100, for July 2025) you can currently use.

And it looks like in addition to ordering it yourself in the US, you can also get it in Canada, Mexico, Panama, New Zealand, England, Spain, Poland and Japan, although you may need to have a doctor order it for you in other countries. One of these tests can help confirm a post-infectious IBS diagnosis, although not all practitioners are aware of or use them yet. And if you’re working with me and want to order the Vibrant Candida + IBS Profile, it’s $270 or can be part of their 3 for $700 testing deal. I’ll link to resources for that test as well in the show notes, and I know Vibrant will send tests internationally, but you have to be able to send the blood sample back in a reasonable amount of time, so there may be limitations.

How do you diagnose SIBO?

Now if you’ve never had a confirmed SIBO diagnosis, you may want to start with a SIBO breath test (which is specifically a lactulose or glucose hydrogen/methane test or a Trio-Smart test, another test developed by the Pimentel lab, which also includes hydrogen sulfide gas in it. Breath testing is the standard of care testing for gastroenterologists who are SIBO trained, but not many know about the Trio-Smart yet. Unfortunately, there are lots of ways breath testing can go wrong, and in my experience that’s usually with a false negative result (false positive results are not so much of an issue – if it’s positive, you likely have it).

First, you have to follow a very precise diet the day before of very limited foods, like rice, potatoes, 1 egg, a little bit of butter or ghee or olive oil, chicken breast or white fish, salt and pepper. Then you fast overnight for 12 hours, take an initial reading, then you have to drink a substrate mixed in water. If you can get lactulose (which is only available by prescription in the US), that’s the best option because it persists into the large intestine. And you only need to take 10 grams of it in 250-300 ml of water. If you can’t get lactulose, fructose is likely the next best option, based on tests conducted by Jason Hawrelak, ND, PhD, an Australian gut health specialist and lecturer at the University of Tasmania. But then you have to take 25 grams of fructose in the same amount of water. Otherwise, you may be sent a sample of glucose to take for the test, which is the least accurate option, and then you are supposed to take a whopping 75 grams in the same amount of water. But I discovered firsthand that this dosing might not be sent correctly. I got a test from Aerodiagnostics, and they included glucose in their kit and said to take it based on weight, which left me taking only 22 grams of it, and then I got a false negative result, wasting my time, money and effort and then my gastroenterologist closed his practice anyway.

Other ways the test can go wrong is if you don’t do the breathing into the test vials properly. You’re doing this every 15 or 20 minutes for up to 3 hours. If you have a test kit and bottles, you won’t realize if your breathing was wrong until the lab gets your results back. I have seen countless Trio-Smart reports that show multiple invalid responses, right at the important times for testing for SIBO in the small intestine (that is up to the 90 minute mark, whereas IMO and H2S SIBO can be throughout the small and large intestines). (Note that this has happened for me much more with the Trio-Smart than other SIBO breath tests because of the hydrogen sulfide addition I believe).

And finally, I just see people all the time who have all the history and symptoms to indicate either SIBO or H2S SIBO, also known as ISO (intestinal sulfide overproduction) or IMO (intestinal methanogen overgrowth, formerly known as SIBO-C for constipation), and they have a negative breath test result, and then we do a stool test and it shows the relevant bacteria or methanogens elevated.

The other option in breath testing is the Food Marble, which is an at-home breath testing device. It’s a little more than $250 if you go through me (and you can only get the clinical one through a practitioner). I’m most likely to recommend this if you have constipation because it allows me to track your progress as you eliminate methanogens in your gut, which can take multiple courses of treatment. But I still prefer stool tests as they’re generally more helpful overall, if money is an issue and you can’t order both.

How do you get rid of SIBO?

Now to talk about treatment strategies. What can you do about post-infectious IBS?

So based on 30 years of experience in dealing with this condition, I have my own methods.

First of all, I have found that periodically the bloating gets bad enough that you have to periodically just kill some bacteria. If you see a doctor, they will likely recommend rifaximin for hydrogen positive SIBO and rifaximin plus another antibiotic for IMO and bismuth (in the form of Pepto Bismol) for H2S SIBO. If you go the antibiotic route, I’d highly recommend taking 3-6 S. Boulardii probiotics a day and some form of butyrate while on antibiotics in order to protect your beneficial bacteria and prevent a candida infection. But if you have post-infectious IBS, most doctors will give up on you and you’ll give up on them before you’ve taken multiple rounds of a $2000+ antibiotic for every recurrence, so you’ll likely end up going the natural route eventually. Ideally you prevent SIBO from coming back, but without good motility, it will eventually come back. So the question is, what is the least harmful way to do this? At this point, my recommendation would be to start by trying SBI powder, or serum-derived bovine immunoglobulin powder, like the product I sell, to keep pathogens in check. A treatment dose is 5-10 grams/day; a maintenance dose is more like 2.5 grams/day. Studies have shown that it binds to pathogenic bacteria as well as to LPS (lipopolysaccride), an inflammatory endotoxin on the bodies of gram-negative bacteria like E. coli, as well as to other pathogens put off by E. coli, including CdtB. It also binds to candida, so it does double duty if you have some fungal overgrowth as we

Another antimicrobial/prebiotic option that is definitely safe for beneficial bacteria is pomegranate husk powder*, or if you’re in Australia, MediHerb pomegranate husk pills (which hopefully will be available sometime soon in the US through Standard Process). Pomegranate husk has shown antimicrobial effects against both gram positive and gram negative bacteria, including Staphylococcus aureus, Staphylococcus epidermidis, Bacillus cereus, E coli, Salmonella, Campylobacter, Listeria, Clostridium perfringens, and Pseudomonas putida as well asantifungal activity against pathogens like Penicillium expansum and Aspergillus niger. As a powder, it’s one of the most unpleasant tasting things you can imagine, and it doesn’t even mix well into a beverage, so your best bet is if you can mix it into a smoothie, or yogurt or kefir, if you tolerate them. There’s no standard dosing, but I believe Lucy Mailing recommends 1 tsp. twice/day as a treatment dose. But I’d start with ½ tsp. twice/day and see how much you can get down. A maintenance would be less. For the MediHerb pills, apparently the 300 mg pill is equivalent to 3 grams of the dried powder and they recommend 1, 2-3 times/day.

I have also experimented with using a small dose (1/2 tsp.) of MSM daily to kill off bacteria (only for SIBO or IMO, not H2S SIBO as MSM is a sulfur molecule). There is also a protocol I’ve heard about using doubling doses starting at 1/8 tsp. and getting up to 32 grams/day that I’ve experimented with a little that definitely works in terms of bringing down bloating. I was waiting to take a stool test to determine whether this killed off beneficial microbes in my gut, but have since taken stronger antimicrobials as that was all I had on hand while traveling, so my experiment was ruined. There is a little data out there in broiler chickens pointing towards MSM being good for beneficial species like Lactobacilli and harmful to E coli, but no data about whether it persists into the large intestine and its effect on more fragile species like Bifidobacteria and butyrate producers in the colon. However, given it is a powder and dissolves rapidly, I have felt it was safe enough for my purposes at a small daily dose, and I’m pretty sure that my dominant SIBO bacteria is E. coli. And it’s cheap as dirt.

If none of those work for you, the least harmful option remaining is high dose allicin for traditional SIBO or IMO (but not for H2S SIBO as garlic is a no go for people with this issue) for as short as possible a time to bring down your bloating.

Note that if you have hydrogen sulfide SIBO, there’s a whole different protocol, so you should check out my podcast number 114 for more info on that.

I also think it’s good to bring in probiotics to keep beneficial bacteria coming through to use the nutrients pathogens would otherwise ferment. There is definitely controversy over whether probiotics and in particular Lactobacilli are beneficial in SIBO, but I have found that using a relatively low dose of Seed Symbiotic for me with a meal (not at night as they recommend) does not promote bloating. On the other hand, I have had issues with yogurt, which makes me bloat, although I do okay with a couple teaspoons of sauerkraut each morning with breakfast.

And spore-based probiotics like Megasporebiotic*, Enterogermina* or Proflora 4R* should be fine, as well as Bifido only probiotics like Seeking Health’s Probiota Bifidobacterium*, Master Supplement’s TrubifdoPRO* or Ther-Biotic Bifido*, as bifidos tend to thrive in the large intestine, not the small intestine. Some people can have overgrowths of Lactobacilli in the small intestine once SIBO sets in, so if you sense a bad reaction to a probiotic or probiotic food, best to stay away from Lactobacilli-based probiotics. And probiotics with Akkermansia or other anaerobic large intestine strains like F. prausnitzii or Roseburia should also be fine, depending on what other strains they’re combined with. I discussed some of these options that are newly available in episode 141, so see those show notes for how to get ahold of those strains. And of course S. Boulardii*, which is a probiotic yeast, is also safe.

And people with histamine reactions, common with klebsiella, should be careful to choose probiotics without any histamine-producing strains in them. Seeking Health’s ProBiota HistaminX* and Vitanica’s Flora Symmetry* are two I recommend in that case.

What are prokinetics?

Then the second important element in managing post-infectious IBS is using a prokinetic, or a medication or supplement that stimulates gut motility. This isn’t motility in terms of constipation, but small intestine motility. They’re often used after antimicrobial treatment for SIBO to prevent relapse. There are only two with a clinical study, low dose erythromycin and something called Tegaserod, which I’ve never heard anyone using in the SIBO community, likely because it was removed from the market in 2007 because of possible cardiovascular risk, but re-approved in 2019 for women under 65 without cardiovascular disease. Tegaserod extended recurrence from 2 to 15 weeks to 11-58 weeks, used at a dose of 2-6 mg once at bedtime for people with constipation. And then low dose erythromycin at 50 mg at night extended recurrence to 1 to 39 weeks. I’ve heard current dosing up to 62.5 mg/night as well. These stats are a little wonky because it looks like they did some switching of groups from one treatment group to the other so there are two sets of extension times but the long and short was Tegaserod was the best of the possible treatments for preventing recurrence. I’ll link to the study in the show notes.

However, low dose Motegrity (generic name prucalopride) at 0.5-1 mg at bedtimeis what’s most often used these days by prescription. I’ve also heard people mention low-dose naltrexone 1.5-5 mg every night at bedtime as a prokinetic. Because it’s also successful in helping reduce autoimmunity, I decided to give it a try and have been on it for more than 6 months and I don’t think it’s made a difference for me, but it does make me very drowsy at night, which I like.

Herbal prokinetics are based on either ginger, or the herbal bitters formula Iberogast (now easily found in the US in a new formulation and I just discovered in both pill* as well as the original liquid* formula) or now some newer prokinetic options with orange peel or D-limonene, like MMC Restore*. Iberogast is dosed at 30-60 drops before bed. I’m not sure about the new pill formula as a prokinetic, but they recommend 1 pill before or during meals on the package of 30. Some of the ginger-based prokinetics contain a formulation called ProDigest, which is a combo of ginger that’s formulated to not produce that ginger burn effect but helps with small intestinal motility and artichoke extract, like GI Motility Complex*, which also has apple cider vinegar powder. Artichoke extract is known for helping with gastroparesis as it promotes stomach emptying. Motility Activator* is similar formulation but without the apple cider vinegar powder.

Some other ginger formulations also have 5-HTP, a precursor to serotonin, most of which is made in your gut and helps move the intestines. These may be more helpful for people with IMO because 5-HTP can lead to loose stool. The one I like in that category is Pure Encapsulation’s MotilPro*, mostly because it comes in a big bottle of 180 pills, which is helpful with suggested dosing of 3 at a time. It also has B6 and acetyl-l-carnitine in it.

Then there are a few more 5-HTP-added formulations like Prokine*, which has some additional B vitamins and lots of ingredients, so I rarely recommend that because of duplication with multivitamins and B complexes and SIBO MMC* which has extra B6 and a couple more ingredients. And finally, there’s Bio.Revive Kinetic, which is sold in the UK and Europe, and has some of the ingredients of the ayurvedic preparation triphala (known for helping constipation), as well as ginger, bitter orange and 5-HTP. It also has licorice root powder so it would be contraindicated if you have high blood pressure. All of those are linked in the show notes. 

While I do recommend prokinetics to my clients and generally take one of them myself at any given time, I have never been blown away by their ability to change the general course of my condition. Even while taking them, I have always needed to periodically or regularly kill off bacteria. But they may delay how long you can go without antimicrobials, so I do recommend that you use them if you have post-infectious IBS. 

What diet is best for post-infectious IBS?

I’m sure you’ve all heard of a low FODMAP diet in the context of SIBO or IBS. The biggest players in low FODMAPs are in fact wheat and dairy, and research has shown that just avoiding these two foods is about as effective as a full-on low FODMAP diet. For me, dairy is the devil. Not only am I lactose intolerant, so eating dairy leads to hot lava exiting my entrails in a most painful fashion if I don’t take lactase enzymes, but the lactose in dairy leads to the worst bloating I ever get. This is speaking from the experience of just returning from 5 weeks in Italy and eating dairy almost daily and constantly looking and feeling 6 months pregnant. In my regular life, I eat it pretty rarely and I’d recommend anyone with SIBO do the same and take lactase or a complete digestive enzyme with lactase if you do. I like a product called Lacto*.

For wheat, the issue is not in fact the gluten but rather the fructans, which are also in onions and garlic, incidentally. I have discovered over time that I personally do better with wheat than dairy by a long shot and can have a nice slice of sourdough bread with breakfast and have no bloating at all. So that’s one you can try for yourself if you don’t have gluten sensitivity or celiac. Going on a full low FODMAPs diet may be a good idea the first time you go through antimicrobials or antibiotics for SIBO, but I wouldn’t recommend living that way permanently because of the missing nutrients and fibers, in particular from beans and lentils, which support beneficial microbes. I have found that eating beans and lentils on an almost daily basis has alleviated my regular need for supplemental butyrate (I use my own Tribuytrin-Max as needed now). This has helped slow motility for me and firm up stool, and I much prefer doing that naturally to taking a pill for it. People with loose stool or diarrhea may do much better with legumes than those who have IMO.

But I do recommend using some form of tributyrin or Probutyrate* while on treatment-level antibiotics or antimicrobials for SIBO if you have loose stool or diarrhea, so as to protect the anaerobic bacteria in your colon.

What other interventions are there for curing post-infectious IBS?

So to close, there are a few other things to know about. Instead of antimicrobials, you could always go on an elemental diet. mBiota is a new option on the scene, and probably the most palatable, developed by Pimentel’s group. This is a diet with no fermentable fiber whatsoever, so it basically starves out the bacteria or methanogens. Duration is 2-3 weeks with only this liquid formula to eat.

You could also resort to a fecal transplant, but I imagine that like all the other options that change the bacteria, you’d still end up with an issue because of poor motility, so I have never recommended that course of treatment for someone with only SIBO. But if you can access it and have tried everything else, definitely do the crapsule version rather than the enema version as you want something that impacts your small intestine.

If you have constipation-dominant post-infectious IBS, then I would also recommend trying Thaenabiotic*, a formulation from human stool of everything that’s not alive, so all the post-biotic metabolites. I tried it and I would not recommend it for people with loose stool or diarrhea based on my experience.

Finally, the one big hope that I’m holding out for a cure for SIBO is fasting. In particular, the ProLon Fasting Mimicking Diet*, although you could just water fast. With ProLon your body thinks you’re fasting but you get like 500 calories/day. I have seen one report on Facebook of someone who used this diet to successfully bring down his vinculin antibodies with pre- and post-testing to prove it. This makes sense because the research on this diet shows that it helps reverse autoimmunity. As someone who needs to eat 4 times a day not to have hunger pangs, this is something I’ve dreaded trying, but I’m finally going to take the plunge. The diet has been purchased and I have booked an AirBNB in the middle of nowhere in Mexico for me and my husband in August where we can go and have no other food around us or within walking distance. So I’ll definitely report back on how that goes for me. I plan to do it again after that as I anticipate it will take several rounds, but I want to see first if I can get through 5 days, as the longest I’ve fasted before with bone broth only was short of 3 days. 

Why is it important to treat and manage post-infectious IBS?

And I just want to emphasize why getting treatment for post-infectious IBS is so important. This isn’t just about mild discomfort or less than ideal bowel movements. When left untreated, post-infectious IBS usually leads to an increase in systemic inflammation from the LPS from the gram-negative bacteria, which can lead to autoimmune diseases, like Hashimoto’s in my case (although I successfully reversed that thankfully), or much more serious ones, skin conditions and food avoidance, which can lead to nutrient deficiencies and more serious problems.

The good news is that it is manageable, and you can have an enjoyable life and even eat a variety of yummy foods while having post-infectious IBS. But the sooner you identify what’s going on, the more likely you are to avoid long-term damage or complications.

If you’re dealing with gut health issues of any type (diarrhea, constipation, bloating, SIBO, IMO, H2S SIBO/ISO, IBS, IBD, gastritis, GERD, H pylori, diverticulitis, candida, etc.) or have an autoimmune disease and need some help, I see individual clients to help them resolve their digestive issues or reverse autoimmune disease naturally, You’re welcome to set up a free, 30-minute breakthrough session to see if you’d like to work with me. I also have my own two products, Tributyrin-Max, which is particularly helpful for loose stool and diarrhea as it slows your motility and firms up your stool, and SBI powder, which is an all around gut pathogen binder, which is super safe and won’t harm beneficial bacteria, and is usually the first line of treatment I educate my clients about in order to avoid stronger antimicrobial herbs.

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

Adapted from episode 147 of The Perfect Stool podcast edited for readability with Dr. Har Hari Khalsa, holistic chiropractor Transformational Healing Universe in Los Angeles, California.

Lindsey:    

When I heard from you about coming on the podcast, I thought, well, I haven’t talked much about these alternative therapy modalities, primarily because unless you see someone in person, you can’t really access them. But I think it’s good to know about them, because sometimes people are at the end of their ropes with supplements and diets and lifestyle changes, and they’re just not making progress. So it’s nice to learn about other alternative therapy modalities. So we’re going to talk about some of them, but before we do, people might benefit from this, can you kind of take us around your clinic and show us some of the machines and just talk about what they are?

Dr. Har Hari Khalsa: 

So this is the Cyberscan.  It’s connected with the computer. This is what I do, the bioscan. It’s basically an energy scan of the entire body. I typically start treatment with patients doing this, because it really goes deep right away, and we can tell a lot about what’s happening. 

Lindsey:    

That was the thing you did with my saliva, you just set it on the machine?

Dr. Har Hari Khalsa: 

Yes, yeah, we could do this remotely, too, and it’s highly accurate. It gives us a lot of information that you otherwise couldn’t get, even from a blood test. So I love using the cyber scanner. Let’s go to the next room here. So this piece of equipment, you can see it has a treatment head on it. This is called a StemWave. This is a shock wave machine that we use for joint rehab. So it’s one of the best therapies that I’ve ever found that helps with chronic inflammation, arthritis or injury. For any joint in the body, we use it on wrists, ankles, knees, low backs, you name it, we treat the joint. We’ve had probably six or seven people in the last year that have avoided surgery with this technology. So it’s using powerful sound waves that get generated through this head, and it stimulates the repair of the tissue by activating your body’s own stem cells. 

Lindsey:    

That’s why it’s called the StemWave, right? 

Dr. Har Hari Khalsa: 

Yeah. So this right here is called an Epoch Laser. This is a class four laser that we use also for tissue healing and repair, using infrared light to penetrate very deep in the tissue. It’s primarily good for deep pain, like somebody’s suffering and they’re not getting relief from anything else. This will give them almost instantaneous relief from pain. So we use those in conjunction the StemWave and the laser.

Next room is the chiropractic room. This is where we do chiropractic. The tool I use primarily for chiropractic is called a Sigma instrument. So I use this probe. It’s a piezoelectric sensor as well as an adjusting tool. This is a very powerful way to scan the spine and then adjust the spine gently. I can do this on any patient, regardless of their age or their condition, even if they’ve had spinal surgery or whatever is going on with them. This is safe to use. So this is a highly effective tool for scanning the spine. Patients love it. It feels really good. It’s using vibration versus a hard crack that a normal chiropractor would use. It’s using more of a vibration to move the bone. I still do traditional chiropractic if a person needs it or they want it, but this is doing it from a very gentle approach, where we scan every segment of the spine. So the patient lays on this chair here, face down, this right here.

This is our EMTT. So EMTT stands for extracorporeal magnetic transduction. It puts out a very powerful magnetic field. We put this against the patient’s joint, wherever they’re injured, and this is pumping out 1000s of Gauss of energy. If I had paper clips and I put it against there, the whole thing will spark. That’s how much magnetic energy is coming off of this. So this is used for tissue regeneration, also inflammation and pain. They did research in Germany, and they showed that with magnetic energy, in order to actually see tissue change and healing, you have to have a certain amount of power, and that’s what the EMTT gives us, a high enough power where you actually can see tissue regeneration happening.

So now coming into here, this is called Theriphi. Theriphi is a pretty awesome tool. So the tubes on it are plasma tubes that are being energized by a giant Tesla coil. When the patient lays in the middle of these two things, you can see a lightbulb lights up. Imagine the patient is laying there, and their cells are getting energized by this cold plasma energy field, so a 500,000-volt field of energy, and the research they’ve done over the years with this type of device, they’ve seen many different conditions, autoimmune, cancers, anything chronic pain, acute injury, it just accelerates the healing process. Back in the 60s, they were doing experiments with lab animals, and they were reversing cancers with the plasma fields. It’s a very cool device. It’s very soothing. You can see the waves of energy it produces, but it’s a very calming, very soothing energy. People really love it, especially if someone’s suffering in pain or trauma and they lay on this thing, it just brings you into a zero-point energy state, which is very healing for the body and the mind.

I’ll take you through the rest of the clinic here. This is our yoga center. We teach yoga classes here. It’s kind of dark in here, but we have a nice yoga center where we teach yoga classes. We’re going to head back into the hyperbaric room.

Here’s our hyperbaric chamber. This is a rather big one. This is where we do hyperbaric. Hyperbaric is a wonderful therapy for healing, accelerated healing, wound healing, stem cell regeneration, all kinds of things. It’s one of the best healing modalities in the world.

So this is our pulse room. This is where we do pulse therapy. These tables are high powered pulse magnetics. So I’m going to just turn one on here. So the patients lay on the table, and then we control the inner of the table. These are giant coils that run through these paths. These are like zero gravity tables. When the patient’s laying there, they’re getting a huge energy boost of magnetic energy, which helps accelerate healing, it helps with mitochondrial function. Basically, cell voltage is raised significantly.

This is our Tesla coil. This is called a biocharger. So this is similar to the Theraphi, and then it puts out an energy field that goes out about 30 feet. It fills this entire room, and we run very specific recipes that have different frequencies, so we can target inflammation, mitochondria, brain, liver, pathogens, any kind of situation someone’s got going on, there’s a recipe for it. And then this is the chair. We have different ways of applying the magnetic energy. This is through a chair. I would consider this the foundation of all healing. In order for the body to heal, you need voltage, and a lot of times when people get stuck in their healing process, it’s because they have low voltage. So that’s, I would say, the most important. We’ve seen people with chronic digestive issues with a pulse that have had fantastic results.

Okay, this one here is called a Bioptron Light. This is from Switzerland. What this is is using a special hyperpolarized light that is shining light through what’s called C60. I don’t want to blind anyone, but you can see it has a special lens, and so when the light hits the body, it’s stimulating tissue repair and healing at the deepest level. So they use this in hospitals for third degree burns, non-healing wounds, things like that. And we use it just to help with any condition that patients got going on.

And then the last thing I’m going to show you is our spa. So we have right here. It’s called a relaxed sauna. This is an infrared sauna that patients use for sweating, because sweating is one of the most powerful therapies. In studies done in Finland, it showed a 40% decrease of all-cause mortality. So sauna is a very powerful therapy. And then this is our cold plunge. This is a commercial grade. It’s around 40 degrees in there. We have patients who go in the cold plunge daily as part of the therapy. Cold is a very powerful healing modality. So we’ll talk more about that too. We’ve got the full gambit, pretty much. We’re dealing with every aspect of energy healing. 

Lindsey:    

Okay, great. So of all those modalities that you just showed us, what do you think are the ones that are most applicable to gut health issues?

Dr. Har Hari Khalsa: 

That’s a great question, like I said when I was back in the pulse room, raising cell voltage is the primary thing for any chronic problems. Anything. Doesn’t matter what it is, so I would say that’s foundational, and everything else works towards that same goal, but it’s doing it with different forms of energy.

Lindsey:    

 So this is pulse electromagnetic fields? 

Dr. Har Hari Khalsa: 

Yeah, but it’s high power. Okay, there’s a differentiation. A lot of people don’t know. They hear the term PEMF means pulse electromagnetic field therapy, but there’s a huge difference between a low-powered machine and a high-powered machine. I’ve worked with both, and they both have efficacy, but the heavy lifter when you’re talking about something that’s very chronic, you’re going to get far better results with a high-powered machine.

Lindsey:    

So what’s a treatment cycle look like for say, I don’t know, I’m assuming this is something that might be applicable to inflammatory bowel disease.

Dr. Har Hari Khalsa: 

Well, we had a patient last year that had that condition, and he was basically coming once a week, because he was coming from Orange County, so it wasn’t practical for him to be here as much as we’d want him to be. But he came every week for six months. So you know, that’s four times a month times six. So that’s 24 sessions, and he was pretty much better after that period of time. And he ended up buying the equipment for home use after that, just because he didn’t want to revert back into where he was. Yeah, that’s typical. We tell patients that 50 hours cumulative treatment time for almost any condition, you’re going to get huge benefit.

Lindsey:    

And would that typically resolve the condition so that it could stay that resolved?

Dr. Har Hari Khalsa: 

Well, it’s always an aspect of maintenance. So once you turn something around, then you probably want to do maintenance. About once a month. I’m still doing pulse to this day. I did my initial care 11 years ago, and I still get on that machine at least once a week. 

Lindsey:    

Do you want to discuss what that was for? 

Dr. Har Hari Khalsa: 

It’s really just part of my healing. I had a chronic injury where I injured my hip, think I fractured it. I never really got an x-ray, but I had difficulty walking, and I was in chronic pain for probably two and a half years. That was definitely a huge part of the healing process. 

Lindsey:    

So compared to the low powered units, maybe the kind of thing you could buy on Amazon, I saw one for $119 that was 3 to 23 hertz.

Dr. Har Hari Khalsa: 

Yeah, there’s no comparison. We’re talking 1000s of Gauss. A low power unit is typically about one Gauss. 

Lindsey:    

What’s the word Gauss? 

Dr. Har Hari Khalsa: 

Gauss. It’s a measurement of magnetic force or energy.

Lindsey:    

How do you spell that? 

Dr. Har Hari Khalsa: 

G, A, U, S, S, Gauss. When you get into the really high magnetic energies, the measurement is in Tesla. EMTT is like three Tesla. And I think an MRI machine is six Tesla. So an EMTT is approaching the power of an MRI, which is super high levels of magnetic energy.

Lindsey:    

And so the pulse unit you have does how many Gauss?

Dr. Har Hari Khalsa: 

It’s in 10s of 1000s. They don’t publish it because it’s proprietary. But if I take paper clips and put it on the applicator from the pulse, it’ll send sparks a foot high. So it’s got quite a bit of power.

Lindsey:    

So if you have some kind of metal in your body, probably not a good idea to use it. 

Dr. Har Hari Khalsa: 

No, it’s safe to use with titanium. The only thing that’s contradicted is any kind of electronic implant. If someone’s got a pacemaker or something like that, they can’t go on the pulse machine. 

Lindsey:    

What if you have screws in your bones or something?

Dr. Har Hari Khalsa: 

Screws are okay. It’s not going to cause sparking in there, because it’s only externally. If it’s internal, inside your body, right, not directly on it. 

Lindsey:    

Okay, got it. And so the mechanism of action of the pulse? Can you explain it a little bit more?

Dr. Har Hari Khalsa: 

Electromagnetic pulse energy is a form of voltage. Every cell in your body has voltage in it. It’s about 70 microvolts of energy in a normal, healthy cell. What happens is, if a cell gets injured or if there’s toxins, or something’s going wrong, the voltage will drop in that cell, and then that’s what actually causes the disease. The lower the voltage, the cell starts becoming abnormal, and it can actually revert into a cancer cell. A cancer cell is a extremely low voltage cell, so when you start increasing the voltage of all the cells, including those cells, which, by the way, our bodies are always producing these bad cells, they’re usually not a problem, because our overall voltage is high enough where it doesn’t manifest into anything. But if the overall body of that person’s voltage goes too low, then you’re going to start to see cancers spread and grow, because there’s a part of cancer that grows because of low voltage and also low oxygen and also acidic. So cancer is like all those things, low energy, low oxygen and acidity. When you get those three things together, that’s a bad formula. The pulse is essentially reversing those conditions. So now the the healthier cells can take hold and take over the body from the lower voltage cells. Cancer is like the worst man of the station, but any disease process, anything in the gut, let’s say arthritic joint or degeneration in the brain, neurodegeneration, all of those things have one thing in common, low voltage.

Lindsey:    

So would this be a good treatment for Alzheimer’s?

Dr. Har Hari Khalsa: 

Fantastic. As a complimentary with Alzheimer’s, you also have to get more oxygen in that brain too, and that’s where the hyperbaric comes in.

Lindsey:    

Okay, so let’s talk about the hyperbaric, because I know in the intro call that we had, you mentioned that as another treatment for gut health issues.

Dr. Har Hari Khalsa: 

Yeah, it’s a huge thing, because almost anything that’s gut related, there’s inflammation. And hyperbaric is probably the number one therapy for anti-inflammation. I’ve seen that connected with autoimmune, so a lot of times when people have a leaky gut issue, they end up getting autoimmune issues as well. What I’ve seen just clinically with patients is that they get in the hyperbaric and their symptoms start going away real fast because you’re just bringing down that inflammation. And most of the symptoms people have are related to inflammation. When you’re reducing inflammation, it’s like you’re putting the fire out, like we have all these fires going on in LA right now. So when you’re going into hyperbaric it’s like bringing down that inflammation, it’s bringing down the fire so the body can function better and heal quicker. But hyperbaric is also doing a lot of other things as well. They did research on the genetics, and they found that over 8000 genes are switched on for anti-inflammation and healing, cellular healing, meaning there’s more autophagy happening, where the bad cells, the senescent cells, are cleaned out, and then the stem cells are activated. So they did a study. It’s unpublished. I just found out about this a few months ago, where in one week in the hyperbaric chamber, it triples your circulating stem cells, and a month 8x’s your circulating stem cells. So when you have more stem cells circulating in the blood, now you’ve got way higher chance of the body healing because it has what it needs, because our bodies heal through our stem cells.

Lindsey:    

And when you say one week, do you mean an hour a day for one week? Or you mean like literally being in there the entire week?

Dr. Har Hari Khalsa: 

An hour a day, for one week. Normally, hyperbaric is done for an hour, typically, sometimes a little longer, but most patients go for an hour.

Lindsey:    

Okay, yeah, what’s the normal course of treatment for, say, an autoimmune disease on hyperbaric?

Dr. Har Hari Khalsa: 

Because we stack these therapies, if you were talking about hyperbaric by itself, most functional medical doctors will tell you to do 40 hours for a real chronic thing. Brain injury might require multiple series of 40 hours. Somebody who’s had multiple concussions or a TBI or a stroke, they might need to do 100 hours. It just depends on the severity of the case. But typically, we’ve seen amazing results. For example, long COVID in 20 sessions, all their symptoms go away.

Lindsey:    

What kind of symptoms might people be having?

Dr. Har Hari Khalsa: 

The biggest symptom is fatigue. They can barely move.

Lindsey:    

Yeah. What about POTS?

Dr. Har Hari Khalsa: 

Yeah, totally, yeah.

Lindsey:    

 So I’m curious about this, you mentioned stroke. Of all the modalities that you have, are there any that could impact somebody who had a stroke years and years ago? Like, 10 years ago, 5 years ago?

Dr. Har Hari Khalsa: 

The thing they’ve shown with hyperbarics is that it really doesn’t matter when the injury happened, as soon as you get into that high oxygen, high pressure environment, the healing starts. We had patients who had, I think a stroke, five years prior to doing the therapy, and they had fantastic results.

Lindsey:    

What kinds of function was restored?

Dr. Har Hari Khalsa: 

Yeah. Well, cognitive the ability to read and write, do normal human things. You have a stroke; you lose that ability.

Lindsey:    

Yeah? Now I’m thinking of someone I know who had a stroke and has limited use of one of his legs.

Dr. Har Hari Khalsa: 

Yeah, it’ll definitely help overall, because it’s getting stem cells. We don’t ever guarantee any kind of end result, but overall, the functionality and their whole life should improve, because you’re treating the entire body. Hyperbarics is holistic treatment. So the goal is to make the whole person healthier.

Lindsey:    

And so I know also that you can purchase your own hyperbaric chambers that are made of, I guess they’re soft-shell ones. How are those compared to the kind of unit you have?

Dr. Har Hari Khalsa: 

Anything that raises the pressure, even the soft-shell ones that you’re talking about, they get results. The only difference is that it takes longer. You have to do more sessions, but you’ll still get the results.

Lindsey:    

Yeah, because I know that my brother-in-law bought one of those, so it can’t be too outrageously expensive.

Dr. Har Hari Khalsa: 

They typically run from around $7500 to about, depending on the company and the size of the unit, it can go all the way to $25,000. But a typical unit, because we’re reps for The Summit to Sea, a 32 inch, which is fairly comfortable for most people, that going to be around $13,000.

Lindsey:    

 I think he must have gotten it used. I don’t think he paid more than $1500 for it.

Dr. Har Hari Khalsa: 

 That’s very rare to find a unit, even used. They typically aren’t less than $5000 I would say for used units. 

Lindsey:    

Yeah. Well, I guess I didn’t actually know how much he spent on it. I’ll have to find out. So let’s talk about the Cyberscan technology that you used with me. So if you wanted to describe its background and how it works in theory, then I can talk a little bit about my experience with it.

Dr. Har Hari Khalsa: 

Cyberscan was developed in Germany. I would say the Germans have decades of research of bioenergetic testing. The original machines were called Vega bowl machines, and they would test the fingers, the tip of the fingers, with a probe, and test the electrical resistance. And they got fairly good results with those devices. But what they found out, though, over many years, is that when you put electricity into a meridian, it actually affects the meridian. So now you’re skewing the scan. You’re influencing it. The reason the Cyberscan came to be is they wanted a device that didn’t skew the results, and so what they figured out was a way to measure the energy field with Tesla coils. To this day I don’t know how that actually works, but I’ve seen it work consistently for a decade. So I know it does work, but the theory is that it’s using the Tesla coil to produce what’s called a scalar wave. And the scalar wave is what’s capturing the energy field of the DNA, or the what they call the morphogenetic field of the patient. That’s why we can use some saliva or their hair, because that has the energy signature of that person.

And then once that’s captured within the device, we run a scan with a database, algorithm, database that has a way to scan the energy field and detect where there is imbalance in the various organs and, then it makes a card that’s used as a remedy.  So once we’ve done the scan, we can imprint this magnetic field with the frequencies that came up from the scan, and then when the patient wears this, it’s like a form of information medicine. It’s giving the energy field the signal, signaling that it needs to remove the interference. I try to keep it as simple as possible. Think of a beaver dam. The beaver dams up the dam, and water gets backed up. It’s the same thing in our body. When we have interference in the energy flow, it backs things up. You get problems with your lymph, with your circulation, your nervous system, your elimination, all these different systems of the body. So what this energy does is it unblocks, remove the interference, so the body can just heal itself.

Lindsey:    

Okay, so let me talk about what happened. So Dr. Khalsa did a Cyberscan on me with my saliva. I sent him 2, 10 milliliter vials, and he put it onto his machine and sent me a card. And apparently you use these cards every two weeks for like, six times. 

Dr. Har Hari Khalsa: 

That’s the typical treatment. 

Lindsey:    

So I just had the one card for two weeks. We went over my results, and I’m a bit of a skeptic, but at the same time, I’m intrigued, so I’ll tell you why. You said on the call you don’t normally show the results to clients, but I did get to see the list of my conditions, but I was taking screenshots so that I could record those conditions and go through them in detail. So I looked them all up. You said I should only pay attention mostly to the conditions labeled ones, twos and threes, but primarily the ones and twos.  So I went through all the ones, and there were 42 conditions listed.  The most, and obviously maybe there’s incipient conditions in my body I don’t know about, but at the most, I went through them and of the 42, I have or have had nine of those 42. Of the twos, there were 40 conditions listed, and I have or have had 11 of them, or could conceivably have another four, which included things like parasites, mold, heavy metals that I haven’t necessarily tested for recently, so they may be possible. So overall, I wasn’t terribly impressed with the Cyberscan’s diagnostic ability in terms of actual numbers, although it’s possible, again, like I said, that there were incipient conditions I didn’t know about that it picked up on and maybe cured. I also found some conditions that were mislabeled or misspelled. For example, it said I had Bergman-Mullengracht syndrome, and I couldn’t find that syndrome anywhere on the internet, but did find a similar syndrome related to it, called Gilbert Mullengracht syndrome. But there were also things that it did accurately pick out, like thyroid nodules, reflux, stool irregularity, hair loss, Hashimoto’s, night sweats. And although I think it was a three, there was one really obscure one, which is a condition I have where your nail restarts, which is an issue I’ve had on my big toenails for like five years.

Dr. Har Hari Khalsa: 

It’ll pick that up. 

Lindsey:    

Yeah, it picked that up as a three. Now, by comparison, just for fun, I went to ChatGPT, who’s my new best friend, and I asked “if it were to randomly guess my conditions on a 55 year old female, which ones would it guess?” And it accurately guessed nine conditions I have from a list of the top 12, just based on the conditions that are most common population-wise: osteoarthritis, hyperlipidemia, Hashimoto’s, menopause symptoms including hot flashes and sleep disturbances, osteopenia, GERD, seasonal allergies, anxiety and IBS. So with that long intro, give me your experience with the Cyberscan compared to mine.

Dr. Har Hari Khalsa: 

The thing with Cyberscan is, for example, when you were saying that one thing that it didn’t spell right. What I learned because I actually went to Germany and studied with the inventor, and basically what he says is that it could be either that condition, or something similar. It’s not always a one-to-one, but it’s usually in the ballpark of what’s going on. The biggest thing I’ve seen with the Cyberscan is it’ll pick up the things that are the worst things that somebody’s dealing with. It might not pick it up on their very first scan, either, because that’s why we do six scans, because it’s typical that your body will layer these things, and you can’t get to the deeper issues until you’ve cleared out some of those more global things. So that’s what I’ve seen, when they go through that six, by the third or the fourth or the fifth scan, we’re getting into some deeper layer stuff that is way more important as far as the healing process of the patient, but I’m always consistently blown away by what it shows. 

Lindsey:    

Can you give me an example of somebody with something that it showed and that it helped with?

Dr. Har Hari Khalsa: 

There was a case once, this was the craziest story- well, I can tell a bunch of crazy stories, but the one that was the most crazy story I think I’ve ever seen. I saw it right in front of my eyes. I had this patient who had extreme allergies where the sinuses were fully blocked, and he hadn’t been able to have a good night’s sleep in over four months because of these allergies. I made him the card, he put the card on, and within five seconds, he was breathing normally. I was with a group of people when this happened, so literally like the entire group was like, “oh my God, that’s insane.” But I’ve seen that also with people with cat allergies, where they couldn’t even go in a house with a cat. And I made them the card, and they put it on, they could walk right in the house and not react to the cats. Those are extreme. I think the bigger thing I’m seeing is, over time, it just improves the quality overall of the person’s life. Then the other bigger thing for me is, when I’m with the patient, interacting with the patient is, “Oh, you’re deficient in such and such,” or, “Hey, maybe you need to do a parasite cleanse. You’ve got a lot of parasites.” So it’s picking up those things that they may need to focus on to really help their health. Above and beyond just using the card, it’s both a coaching tool and a therapy combined. I’ve never been disappointed with the cyber scan. I’ve been using it for over a decade. We started, actually 11 years ago, in 2014.

Lindsey:    

Yeah, there was one thing that came up on it. I don’t know if it comes up much. Maybe you have more experience. You sent me a list of affirmations to read. I started going down the list, and I would say all but one, in theory, could apply to me. But then I got to one that was like, “I forgive myself for leaving someone,” and I left my husband of 26 years in the recent past. And that was like, “Oh my gosh.”

Dr. Har Hari Khalsa: 

Right, yeah. It usually picks up some pretty deep stuff. 

Lindsey:    

Yeah. That one just brought me to tears, because it’s like, “oh my gosh. How could, how could this machine know that from my saliva?”

Dr. Har Hari Khalsa: 

I know, I always wonder who is really behind this text. It’s like, “how do they figure this out?” I still to this day have no clue how that happened, but I know that it works, and that’s why I am never not going to use Cyberscan.

Lindsey:    

Okay, we went by the red-light room. Tell me about that one. We didn’t get to talk about it yet. 

Dr. Har Hari Khalsa: 

Oh, that, yeah. So we have what’s called the Trifecta red light. It’s a full body below and above. So you’re getting red light, near infrared light, in the optimal wavelengths and frequency. We can control the frequency on the wavelengths of the light. When you do global, meaning the full body under that red light, what they’re seeing is that almost every major condition has improved: MS, Crohn’s heart disease, chronic autoimmune diseases, Lyme disease, all these really bad diseases that people struggle with. They’re seeing major, major benefits with the Trifecta, and it’s mainly because of the power. Because there’s a lot of red-light therapies you can just get on Amazon or whatever, but this device has about 15,000 watts of power, which is huge. There are very few devices on the market that have that much power to penetrate. So we all know that red light is super healing for your mitochondria. It’s anti-inflammatory, it increases melatonin, it accelerates the healing process throughout the whole body. So, yeah, it’s fantastic.

Lindsey:    

So how many watts in a sunset?

Dr. Har Hari Khalsa: 

My first experience in the Trifecta bed felt like I’d gone to Hawaii for a week and just laid in the sun and just totally relaxed. 

Lindsey:    

But you’re not getting a tan, I assume.

Dr. Har Hari Khalsa: 

No, there’s no tanning, because you only tan with UV, which people need UV as well. But the red and the infrared is what’s doing the heavy lifting, as far as your mitochondria.

Lindsey:    

And so what does the course of treatment look like on a red light therapy?

Dr. Har Hari Khalsa: 

For pretty much any chronic condition, they’re going to want to do it three times a week. They could even do it every day, but it’s only a 12-minute session, and if they do that consistently, even over a month period of time, usually after six sessions, most people start to feel some major results, but it could take a few months. If it’s really chronic, it’s all about consistency, being under the light at least three times a week.

Lindsey:    

Yeah, of any of the other technologies that we looked at, what is particularly applicable, that we haven’t talked about yet, to gut health or autoimmunity?

Dr. Har Hari Khalsa: 

Number one is the Plasma field, if you go on to our website, there’s a number of case studies of people that have had severe autoimmune/gut health problems that are completely reversed in three and a half months. Autism. They had a case of two twins that both had autism, and they were almost totally normal in two years. That’s a commitment, they’re going three times a week for a couple of years. But these were nonverbal autistic kids, in two years they were in a school room of their peers at the same age able to speak and read, and that’s amazing, and they’ve had cases of metastatic cancer that have they’ve seen reversed. We can’t make claims, certainly not like we’re saying it cures anything, but there’s been cases where they’ve seen examples like that. So, you know, it warrants some serious research in the future for sure. 

Lindsey:    

And so let’s talk quickly about cancer, which of the technologies that you use are most applicable for cancer? And maybe you have an example of a case that you’ve worked with.

Dr. Har Hari Khalsa: 

Well, we’re currently working with a guy right now who has a glioblastoma in the brain, but because the diagnosis is very bad, he’s doing every therapy in the clinic for eight hours a day. So he’s on the pulse machine for four hours a day. 

Lindsey:    

Must be a wealthy man!

Dr. Har Hari Khalsa: 

A lot of family and friends did a GoFundMe to raise money for this, he has two young kids, so he just wanted to do everything he possibly could do. When we did our initial training with the pulse machine, the guy who was doing our training had just recovered from stage four bladder cancer, and the only treatment he was doing was pulse. So again, it’s not a cure. There’s a lot of factors that go into that kind of condition, but it’s certainly a huge factor in helping the body recover. When you raise cell voltage, your body has the highest chance of recovery. We had one patient who was in hospice. He was in a coma. Actually, he had a brain tumor, and his wife really wanted to get him in here, and so they brought him in a wheelchair. 

Lindsey:    

He didn’t want to come before then? Once he was in a coma, she was able to bring him in?

Dr. Har Hari Khalsa: 

Well, it came on pretty quick. He didn’t know he had it. Actually, the Cyberscan picked it up a year prior, but the medical doctors disregarded it. They said, “no, he doesn’t have brain cancer.” And then a year later, he had the brain cancer. So when it came on, he went into a coma fairly quickly. He was older, in his 90s, and so they brought him in in a wheelchair, and he was in a coma. He was in hospice at that point, and they put him on the table, and with that first session, he came out of the coma.

Lindsey:    

Verify for me, was it the pulse? 

Dr. Har Hari Khalsa: 

Yeah it was pulse. He came out of the coma, and he lived another four months. They had given him a couple of weeks, and he lived another four months. He did maybe a couple weeks of pulse. That was it. It was hard to get him in here, but he was lucid and communicative till the end, whereas before he was completely gone in a coma.

Lindsey:    

Yeah, yeah, right. So I’m curious how expensive these types of treatments are?

Dr. Har Hari Khalsa: 

It’s all relative, right? Because how do you put a price on your health? But we try to keep it as affordable for people as possible. Most of the treatments, we do it as a unit, and they’re about $140 a unit. So that’s, for example, an hour in the hyperbaric, an hour on the pulse machine, a couple of red-light sessions. So typically people will buy, like, 10 or 20 or 50 units, and then they can apply it to all the different therapies.

Lindsey:    

We’re running out of time now, so maybe you can just tell people where they can find you and your clinic.

Dr. Har Hari Khalsa: 

We’re in West LA, the home of the LA fires, unfortunately. We didn’t get affected, but the whole city is definitely traumatized right now because of that. But we’re in Beverly Hills, South Beverly Hills area. Our website is THUheal.com, and you can reach us through that, and also Instagram is @THUheal.

Lindsey:    

Okay, well, I’m sure there’s people in your area, but more than that, people just who might have chiropractors or other alternative practitioners in their area who have these kind of devices and maybe could help them. So thanks for sharing about all this. 

Dr. Har Hari Khalsa: 

Yeah, 100%. They’re all over the country. I mean, if you do some searching, every major city has some form of this type of therapy. 

Lindsey:    

Okay, awesome. Well, thank you so much.

Dr. Har Hari Khalsa: 

Yeah, it was awesome. Thank you.

If you’re dealing with gut health issues of any type (diarrhea, constipation, bloating, SIBO, IMO, H2S SIBO/ISO, IBS, IBD, gastritis, GERD, H pylori, diverticulitis, candida, etc.) or have an autoimmune disease and need some help, I see individual clients to help them resolve their digestive issues or reverse autoimmune disease naturally, You’re welcome to set up a free, 30-minute breakthrough session to see if you’d like to work with me. I also have my own two products, Tributyrin-Max, which is particularly helpful for loose stool and diarrhea as it slows your motility and firms up your stool, and SBI powder, which is an all around gut pathogen binder, which is super safe and won’t harm beneficial bacteria, and is usually the first line of treatment I educate my clients about in order to avoid stronger antimicrobial herbs.

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

Adapted from episode 146 of The Perfect Stool podcast edited for readability with Zack Abbott, PhD, the CEO and co-founder of Zbiotics*.

Lindsey:  

So why don’t we start with how you got into developing probiotics?

Zack Abbott:  

Absolutely. So I started from when I was doing my PhD, I was working with bacteria, and I  really fell in love with all the things that bacteria were capable of doing as I started studying them on the cellular level. My research was really on how bacteria turn things on and off, and I thought that their capabilities were really impressive. Separate from that, being part of my program and seeing the research of other microbiologists, I saw there was a lot of really cool research on all of this, the good bacteria in and on your body and your microbiome. I think many people had been introduced to, as a kid, that bacteria were bad, they were germs. My initial interest in microbiology was really around preventing disease, infectious disease, specifically, which I do think is really interesting, but I really got my mind blown wide open to see that a lot of human health is actually dictated by the function of good bacteria that we interact with all the time, and so that got me really excited about whole new worlds and levers that we can pull for human health. So then marrying those things together, understanding how bacteria function, and thinking about ways that we could direct their functions to things that would be useful for human health, rather than purely focusing on how we could prevent infectious disease. That was how I got into bacteria and probiotics, and eventually into engineering probiotics to do specific functions.

Lindsey:  

Yeah, I was always surprised when I realized that when you say take an antibiotic or do something else to reduce the population of bacteria, you’re not getting rid of all of it. You never get rid of all of it. There’s always a little bit of it somewhere in there. Even when people have gut reports where it says “below detectable levels”, you can still bring those back; they’re hiding somewhere in there.

Zack Abbott:  

Absolutely, yeah exactly. You’ll never get rid of all the bacteria. A. That’s generally a good thing that you can’t get rid of all them, and b. it also is what creates a lot of problems with things like antibiotics, because a few selectively can persist, then they have the advantage when they grow back. And so you get this reduced diversity, which ultimately, in the gut microbiome specifically, is a bad thing. The more diversity, the better for the gut microbiome.

Lindsey:  

Right. And then, of course, those diverse microbes in that there are still some of the pathogenic ones, but as long as the diverse either are commensal, or at least some are, some have good things and bad things about them – neutral, let’s call it, bacteria. As long as that’s the majority of what you’ve got, you’re usually in good shape.

Zack Abbott:  

Exactly. I mean, I think a good way to illustrate this is the fact that you have about as many bacterial cells as you have human cells in your body. What’s interesting is that all of your human cells have the same, roughly 20,000 genes that perform the same, roughly 20,000 functions. But all of your bacterial cells are all different, and they have different sets of genes. So you actually have 150 times more bacterial genes than you do human genes, on a pure number’s basis. Functionally speaking, you’re far more bacterial function than your human function, and so when you decrease that diversity, you lose a massive amount of diverse functionality. And so all those functions that those bacteria are doing to help you digest your food, help educate your immune system, help you modulate and mediate your stress and the hormones and all the cholesterol, all these things they do, so many things for us as sort of symbionts or commensals, floating around. So the more of those you get rid of, and the fewer different bacteria you have, the fewer functions you have. You’re really reducing your own functionality, in a way. And so I think what’s important is preserving that diversity and functionality for human health.

Lindsey:  

Yeah, and producing your B vitamins.

Zack Abbott:  

That’s a huge one, sure. So many things, right? Extracting and or creating nutrients in the food you’re eating, yeah, so many things.

Lindsey:  

And so, how do you actually, literally, turn something on or off with the bacteria? What are you doing to it physically?

Zack Abbott:  

Yeah, that’s a really great question. I personally love this because this is what I studied for my PhD. So bacteria are these incredible single-celled organism covered in all these receptors and sensors on the outside of their cell that allows them to really quickly and elegantly respond to whatever’s going on, if there’s nutrient availability or not, if pH changes, temperature changes, sunlight, all sorts of things. They have, over the last 3 billion years, evolved in ways to essentially sense what’s happening, pass that signal on to their DNA, and then turn different genes on or off when they would be useful. So if there’s no nutrients around, you maybe want to turn the genes on so you can swim, so you can go find new nutrients, right? But if you’re in a good spot, you don’t want to waste your energy making proteins to swim. You want to stay put. You want to motor your boat. So bacteria, the way they do this is they have their DNA. They encode for these genes. There’s a string of DNA that encodes for a protein, but then in front of that gene is a promoter. It’s another sequence of code that says, turn this on in this situation, or turn this on a little bit or a lot. And so each promoter has its own instructions about when a given gene should be turned on. And so for a microbiologist like myself who studies that, it’s really just about the fact that this has been happening naturally for billions of years. We’re just starting to learn how they do that and understand that better. And so the better we understand that, the more we can then leverage those abilities. So we can say, “okay, well, this promoter, this sequence of code that tells the bacteria to make a lot of this protein.” And so we can use that, and we can put another protein behind that promoter and then get a lot of that protein to be expressed. Or this promoter says, “only turn it on when pH is low,” and so then we can basically leverage the bacterial promoters that already exist in order to modulate when we want a gene to be expressed.

Lindsey:  

By exposing them to a certain substance, or?

Zack Abbott:  

Oh, to change that promoter, or combine a promoter with a new gene or something? That’s where genetic engineering comes in. We can PCR, and we can amplify DNA from the bacteria, and we can stick them together using, again, bacterial processes. The bacteria figured all this stuff out. And so all we’re doing is really using bacterial, natural bacterial processes, the same as if we were to do plant crossbreeding. The plant does all the work to cross over its DNA. We just move the pollen from one flower to another, so that’s moving the DNA. And then, we facilitate the interaction we want, but then the plant does all the work to cross over its DNA. And the same is true with bacteria. If we want to get a bacteria to turn on a gene, we just, we say, “hey, here’s DNA that we want you to intercalate and deal with.” In the case of Zbiotics, the technology we use is called homologous recombination, and it’s the way that bacteria already edit their own DNA. And so we can literally just mix the bacteria with a piece of DNA the bacteria already have naturally. The bacteria has the ability to take up that DNA from its running environment, and then it can scan that DNA against its own chromosome genetic code and then swap that piece of DNA in a super precise location. All of those capabilities are already things that bacteria can do. Now we understand that they do that, and we understand how that DNA has to look for that to happen. And so we can just mix them together, same as you would do plant cross breeding. 

Lindsey:  

And it does the job. 

Zack Abbott:  

Exactly. It does all the hard work. 

Lindsey:  

Is this what CRISPR is?

Zack Abbott:  

CRISPR is sort of similar. It’s actually very similar. It’s another bacterial process. Interestingly, bacteria evolved CRISPR as a way to defend against viruses infecting the bacteria. And so basically, CRISPR has an ability to basically do “a find and replace” function like you would do in a Word document. So it gets educated by being infected by a virus, and says, “okay, this sequence is viral.” And so then it can take that sequence and then scan its genome, and then every time it finds that sequence, it can cut there, really precisely at that specific sequence. And so we can now leverage with CRISPR. We’ve sort of co-opted or changed or leveraged the function of the bacteria to very precisely cut DNA in a specific location. And then co-opted that for us is in terms of editing or inserting something new into a very precise location. So it’s a bacterial process that we’ve rejiggered or utilized in a unique way. And so homologous recombination is very similar. Also, homologous stands for homology, right? There’s a level of identity. So, if we give that piece of DNA a certain sequence, then the bacteria will match it to a very precise location where the sequence is identical, and then it will recombine or cross over, all on its own. So homologous recombination is really what that process was intended for, DNA editing, and CRISPR is more like a defense system that we’ve rejiggered for DNA editing.

Lindsey:  

And why would a bacteria choose to change its own DNA?

Zack Abbott:  

Yeah, that’s why they’re so successful. Bacteria have been around for 3 billion years, and the reason they’re able to do that is they’re able to adapt and change as conditions change. So they – and one way they do that, they play a numbers game, right? So bacteria divide very quickly. They have many brothers and sisters that are essentially identical. And so if bacteria are swimming around the environment, there’s always bits of DNA floating around everywhere. When cells die, they release their DNA and  its strategy is, “okay, I’ll grab this piece of DNA and see if it’s relatively similar to my own DNA, then it’s likely that I’ll be able to understand or express this code. So I’ll just throw it in and see what happens. And maybe it’s bad, and maybe I’ll die, but whatever, it’s okay, because I have many other brothers and sisters who didn’t take this piece of data. And so we’ll go on, but on the off chance that it’s good for me, then I’ll be more successful, and then I’ll be able to proceed on.” It’s basically a survival strategy for bacteria to constantly be editing their DNA. And they have many ways that they do this naturally and lots of systems. And so in the last 50 years, humans have just become better at understanding all the ways that bacteria naturally already edit their DNA, and then we can leverage them or guide them to make edits that are beneficial or perform some function that will be useful for us or for humanity.

Lindsey:  

Yeah. And how quickly can they do this homologous recombination?

Zack Abbott:  

Bacteria do that pretty much instantly, in a matter of minutes. But for scientists that are the director of that process, we have an idea. We have to design the DNA and order the DNA and then mix them together, and then select for the ones we wanted. So that whole process takes a few weeks or a month.

Lindsey:  

Yeah, okay, so I understand that you’ve got a couple interesting products based on this whole concept. Tell me about the first one. You started with the Pre-Alcohol* (use code PerfectStool20 for 20% off) one, because I have a couple of clients that use that, and they say it works for them by preventing hangovers. So tell us how it works. 

Zack Abbott:  

Yeah, absolutely. That’s a great lead up to that. So we took probiotic bacteria, safe, edible bacteria that you already eat every day, called Bacillus subtilis, and then using homologous recombination, we inserted a gene that encodes for a protein that can break down acetaldehyde. Acetaldehyde is this toxic byproduct of alcohol that forms largely in your gut when you drink alcohol. The alcohol or the ethanol is converted into this very toxic byproduct called acetaldehyde, and then usually that gets absorbed in the bloodstream. Its sort of rehabbing throughout the body, and then it makes its way to the liver, where the liver breaks down the acetaldehyde really efficiently, but at that point, it’s too late, and so it has already had this damage. The idea was that your liver expresses this protein and has this gene that can help combat the acetaldehyde. And actually, most life on the planet contains a homologous version or a similar version of this gene, this acetaldehyde dehydrogenase gene. We picked a version of this gene from another bacteria, and we gave it to this probiotic bacteria. And so now when you eat this bacteria, it can essentially break down that acetaldehyde as it forms in the gut, before it gets absorbed and wreaks havoc and ruins your next day. So that’s the idea with the first product.

Lindsey:  

Cool, and I know it comes in a little bottle of liquid, right?

Zack Abbott:  

Right, yeah, it’s about a half ounce liquid shot. The idea is, there’s the bacteria, add a little bit of flavor in the bottle drink this before you start drinking, then the bacteria already have the ability to pass through your stomach acid unharmed. It’s one of the reasons why we picked Bacillus subtilis, it’s this really amazing bacteria that has already come prepackaged with the ability to tolerate your stomach acid and become active in the gut. And so then once it’s in there, it starts expressing this enzyme. This enzyme helps deal with any extra acetaldehyde that might be floating around.

Lindsey:  

So when you say it’s expressing the enzyme, does that mean it’s putting it out there into your digestive tract?

Zack Abbott:  

Yeah. So in the case of the first product, Pre-Alcohol, what we actually did was, instead of having a bacteria make and then secrete the enzyme out into the lumen of the gut, we decided to actually have the bacteria because it was easy to do import the acetaldehyde. In fact, that already happens naturally. So actually the enzyme is still inside the bacterial cell, but then the acetaldehyde gets in there as well, and then the bacteria can convert that into acetate, which is essentially the short chain fatty acid. It’s essentially vinegar. It’s innocuous. So from there, other metabolic things happen. But from the perspective of detoxification, it’s the molecules been detoxified, so all that happens inside the cell.

Lindsey:  

Yeah. So it’s best to take it immediately before you start drinking?

Zack Abbott:  

Yeah. So this fundamentally is why I really was excited about the idea of engineered probiotics. These bacteria will stay active, so they’ll be able to make this enzyme continuously the entire time they’re in your gut. And so with bacillus subtilis, it typically passes through your gut in about a day. So you should have the ability to make this enzyme for about 18 to 24 hours after you drink Zbiotics. I typically take it immediately before I drink, just because that’s when I’m thinking about it, that’s when I’m with my friends. But you could they take it several hours before you started drinking and and that would also be fine, because the bacteria would already be in there, and they’d be persistent for say, about a day.

Lindsey:  

Now, I’m not encouraging heavy drinking, but maybe someone knows that when they go out, they do it up, and they’re having, say, eight drinks. I don’t know, six drinks. Should they re-up their dose somewhere after the first four? I mean, how much can it handle, really? 

Zack Abbott:  

Yeah, so as you said, to be clear, the product is built for, as another tool in the toolbox for a responsible drinker. This isn’t a “Get Out of Jail Free” card. It breaks down acetaldehyde, but that is only a part of why you might not feel great the day after drinking. The ethanol itself, a lot of that is absorbed into the bloodstream, which is kind of the point, and then it has the effects it has. And then most of that ethanol is processed by the liver, and that ethanol is processed goes from alcohol to acetaldehyde, and then subsequently, immediately from acetaldehyde to acetate. So you don’t get a lot of acetaldehyde formulation formation in the liver like you do in the gut, but the liver is still dealing with a lot of ethanol, and that’s a challenge. And the ethanol itself cause causes poor sleep. It monkeys around with some of your hormones, like your hunger and satiation hormones and your ability to process sugar and insulin regulation. So there’s a lot of things that are happening that this product has no effect on. So you still have to drink responsibly, but especially as we get older, many of us probably, anecdotally, have noticed that two to three drinks when you’re 45 hits a lot different than two to three drinks when you’re 25 and that’s in part because we get worse at dealing with that acetaldehyde, we have a bigger inflammatory response. We have less ability to tamp down inflammation. And so being able to target that acetaldehyde even after a few responsible drinks is valuable and still making sure we’re pacing ourselves and getting plenty of sleep, those are all really, really essential. But more directly to your question, is there a limit? Do you need to re up? The answer to that in terms of gut derived acetaldehyde is no you don’t have to re up. There’s enough bacteria in a bottle to handle as much acetaldehyde as you’re likely to be exposed to in the night of drinking. That being said, there are many other things you’re dealing with, so the more you drink, the more those other things might have impacts that start to get more and more magnified. And so we can deal with the acetaldehyde, but you’re on your own for the other stuff, so it still requires responsible drinking, but you definitely will feel better either way. So if it happens to be one of those nights, you’re going to a bachelor, bachelorette party, you’re going to a wedding, you’re having a celebration, and you know you’re going to drink more than you normally would, and you know that that’s going to result in you not feeling great the next day, having Zbiotics will help make sure that when you wake up the next day you feel better than you would have otherwise. And your results in terms of what better means is going to be variable from person to person, and how sensitive they are specifically to the acetaldehyde. For some people, anecdotally, they say that they feel great, they feel nothing. And then others say, well, I definitely still feel groggy or a little sluggish, but the majority of what I’m dealing with is is gone, or is much better. 

Lindsey:  

Yeah, I’ve actually never had a hangover in my life, I don’t know why.

Zack Abbott:  

Well, you are one of the chosen ones. 

Lindsey:  

 I think part of it, though, is because my own body will not let me drink too fast. I’ll just get to a point where I need some water. I have to keep flushing it out. I cannot force myself to take another sip until I’ve I’ve diluted it a little bit. It’ll help my body process it.

Zack Abbott:  

Totally. That’s a big thing that you’re hitting on there, which is that one of the biggest determinants of how you feel the next day is the rate of alcohol consumption,  how much alcohol per unit time, and so pacing yourself is one of the best things you can do to set yourself for a good next day. 

Lindsey:  

Yeah, and I’m drinking a lot of water with it. 

Zack Abbott:  

Yeah, so, water is good because it increases your blood volume and it basically allows more flow through of your liver and your kidneys, which are the organs that are dealing with these toxins, alcohol and acetaldehyde. So the more flow through you have there, the better your body’s going to be able to handle this exposure time you’re going to have with these toxins. So definitely, drinking water is also really good for pacing yourself. So yeah,

Lindsey:  

Yeah, okay. Let me ask you this. So some clients pointed out, and I know that when you have an overgrowth of Candida in your gut, it produces acetaldehyde as well. So I’m curious whether this might be a good treatment for people who really have an invasive candidiasis and have all the concurrent symptoms like brain fog.

Zack Abbott:  

Yeah, I think it’s a really interesting and reasonable hypothesis. We didn’t test for that specifically, so I couldn’t say for certain, but the bacteria are intended to deal with gut derived acetaldehyde. So I think that the most common reason that we experience gut derived acetaldehyde is from consuming alcohol. But of course, theoretically, another source of gut derived acetaldehyde would potentially be a target of this as well. But I couldn’t say for certain, because the dynamics are different. So I’m not certain, but certainly a reasonable hypothesis. 

Lindsey:  

Okay, so then your other product is called Sugar to Fiber* (use code PerfectStool20 for 20% off), which comes as a prebiotic drink mix. So tell me about that one. 

Zack Abbott:  

Yeah, so I’m really excited about this. We just launched this one a month ago. So we launched pre alcohol back in 2019, and, 

Lindsey:  

Oh, it’s been that long?

Zack Abbott:  

Yeah, yeah. And it’s been really fun these last, five plus years of us learning what it’s like to try and tell people about the product and get people interested in all those sorts of things that I had to kind of learn on the fly. But yeah, with the second product, I’ve just been so excited about the fact that we’re able to tell a bigger story. Having one product was great. It’s a really fun product, and people really understand the use case and the problem. But I hated the fact that all our conversations were always around alcohol. There’s so much more we could do. And so I’m really excited that we have another product now to tell the broader story of all the cool things we can do.  But our second product, as you said, it’s called Sugar to Fiber, and so we’ve engineered this bacteria, same bacteria, Bacillus subtilis, so we’ve engineered it now to express an enzyme. Instead of breaking down acetaldehyde, this enzyme can convert sugar into fiber, again, in your gut. So fiber is just a long string of sugar stuck together. This enzyme is basically able to take table sugar or sucrose, and so Sucrose is just a glucose and a fructose stuck together so it can break that apart and then take the fructose and stack a bunch of fructose together make a long chain of fructose fiber, and that fiber is called Levan. Levan is a fermentable fiber that helps feed your microbiome. And so that’s the idea behind the second product.

Lindsey:  

Okay, and when it feeds your microbiome. Does it produce butyrate or is it what kind of what kind of fiber is it?

Zack Abbott:  

Yes, the kind of fiber Levan is, as I say, a soluble, fermentable fiber, and so it’s a prebiotic fiber. It’s primary goal this product is about increasing the amount and diversity of fiber that’s hitting your microbiome and that’s exactly right. Though, there’s good studies already on Levan and other oligofructans that their ability to support short chain fatty acid producing bacteria, short chain fatty acids like butyrate, we already know that having this fiber is going to be good for short chain fatty acid production and diversity first and foremost, just like the first product, it’s not a get our of jail fee card. You can’t just go out and eat a bunch of cotton candy and then have a healthy gut, we’re talking about 5 to 10 grams of sugar being converted into 5 to 10 grams of fiber a day. So 5 to 10 grams of sugar is not a lot, but it’s not really about sugar reduction so much. 5 to 10 grams of fiber is a meaningful amount of fiber. What is cool about this product specifically, is that by building that fiber directly in the gut, there’s a lot of advantages relative to maybe taking a fiber supplement. One of them is that we can build really long chains. So the longer the chain of fiber, the more beneficial it is. So when you eat fiber supplement, that’s usually a processed fiber, and so the chain length is already relatively short, and then when it passes your stomach acid, it gets chewed down even further. And so by the time it hits your colon, it’s still beneficial, but the benefit has been reduced. And so we can build a longer chain fiber. And then another cool thing is that when you eat a fiber supplement, for instance, a scoop of fiber, and it’s around 10 grams of fiber, you’re getting that all as one bolus all at once,  10 grams that goes through and hits your gut all at once. It’s sort of a feeding frenzy, and your body don’t necessarily get the full benefit as it passes through. This is distinct from our product, where we’re making a slow drip of fiber all day, we’re pulling small amounts of sugar out of each meal, converting that into small amounts of fiber. So it’s a slow drip of fiber that kind of hits the gut and maximize utilization. So maximize utilization. So there’s some really cool advantages here. But ultimately, the goal for anybody who’s investing in their gut health, and I’m sure your audience knows this is is really about, as we talked about, beginning diversity. Diversity of microbes means give them, giving them diverse food for bacteria, the food is fiber, so a diversity of all different kinds of fiber. And so the best way to do this is lots of different kinds of fibers from the foods you’re already eating. That’s the best way. So it’s not just about the absolute grams of fiber, because fiber is not all one thing. You need to have a wide diversity. And so one of the things when I designed this product was that we wanted to make a fiber that you likely weren’t going to be already getting from other parts of your diet. So we picked a rare fiber. Levan is a fiber you’re really unlikely to get from your food. It’s really uncommon. Pretty much the only food source of Levan is a fermented soybean food called natto. So that’s the only way you are really likely to get any meaningful amount of Levan from your diet. So this way, by taking this product, we’re not only giving you more fiber, which an absolute value is good, it also is giving you a fiber that you’re unlikely to be getting elsewhere. So it’s kind of increasing the diversity of your fiber as well.

Lindsey:  

 That’s interesting because I just got a nattokinase supplement for my husband because of fibrolinic activity of nattokinase and breaking down a fibrin in the blood vessels to try and prevent clots and calcification of the arteries, etc…..

Zack Abbott:  

Oh interesting. Yeah, exactly. So that nattokinase is an enzyme that’s made by bacillus subtilis. And of course, it’s called nattokinase because it was discovered in natto which is the bacillus is the fermentative agent of natto. The fiber, Levan, it’s the string of sugars. And then the nattokinase is a protein made by the bacteria. So different mechanisms, different functions, different mechanisms. But nattokinase is a really interesting enzyme in that, yeah, they can break down fibrotic tissue, and so they’ve all kinds of really interesting studies on heart health, as you mentioned, atherosclerosis, things like that, but lots of really cool things about bacterial biofilms and all kinds of interesting stuff that nattokinase could potentially have an impact on. So we’re really excited about it, it’s already a protein that bacillus subtilis makes. So for us, it would just be about engineering the bacillus to be able to make that more reliably. We’re really excited about the potential of nattokinase in its own right. 

Lindsey:  

Yeah. So how, when you’re creating genetically modified bacteria, can we be sure they’re not going to take over a microbiome and do something they weren’t intended to do, or, even worse, mutate and do something else. How long was that studied? And don’t bacteria mutate pretty easily?  

Zack Abbott:  

Yeah, that’s what we’re talking about, the beginning of bacteria do mutate all the time. That really isn’t a problem, because that’s happening no matter what. So if you eat a native bacteria, it’s got to be mutating and changing all the time in response to its environment the same so take our first product as an example, what we’ve done here is  we’ve basically taken a bacteria you already eat every day, and then the only difference is that now we’ve inserted a gene that encodes for an enzyme that breaks down acetaldehyde. But acetaldehyde is a molecule that doesn’t really provide a competitive advantage for the bacteria. There’s no advantage for the bacteria to be able to break that down. It’s not a very common molecule. You’re only really being exposed to it while you’re drinking and and even then, the ability of the bacteria to break it down doesn’t provide any advantage to the bacteria, so there’s no real benefit. And not to mention that, in addition, 70% of all life on the planet, including many of the bacteria already in your gut, you’re already expressing an enzyme to break down acetaldehyde, including many of the cells in your body. So all we’ve given you is by giving you this bacteria, we’re just making sure that you have enough of that enzyme at the right time. We’re not actually introducing anything new. If it were to mutate it, you know, the only things that could really do would be to mutate, to make less of that enzyme, and in which case, you’re basically just reverting back to what it was before or making more of that enzyme. But again, that’s not really going to provide it with any advantage. It’s unlikely to mutate that direction. But even if it did, it wouldn’t really be a problem, because that enzyme just breaks down acetaldehyde, which is a molecule you should have none of. It’s a very toxic molecule. It’s not like in trace amounts, this is valuable in some way. We’re not really introducing anything new, so therefore there’s not really any unknowns. And I think that’s one of the biggest risks. When you’re genetically engineering something, you’re making something new, and something new doesn’t inherently mean that it’s unsafe, but it means that there are unknowns. At Zbiotics, when we think about how we do our genetic engineering, we put very strict guardrails on what we will and won’t build. What we will build are things where we’re not introducing anything new to the ecosystem of your gut, or the ecosystem of the environment, the toilet after it passes out of your gut. All these things are really common. So this aciddehydrogenase gene came from another, so bacillus subtilis is a soil microbe, that’s why you eat it every day. It’s on the surface of fresh fruits and vegetables. And we took this gene from another soil microbe. So this gene is already in these ecosystems. It’s already in your body, and so that’s how we think about it. And then with the second product for Sugar to Fiber, this enzyme that converts sugar into fiber, this Levan sucrase is the name of the enzyme, this is already a native enzyme of bacillus subtilis. All we’ve done is increase its ability to express enzymes so that it will reliably express it when you eat it and when it’s in your gut. But other than that, we haven’t really introduced anything new, so there’s not really any reasonable expectation that this will provide any challenges or problems for you.

Lindsey:  

So if there was already a bacteria that converted acetaldehyde to is it acetate? 

Zack Abbott:  

Yes, yeah. 

Lindsey:  

Why not just make a probiotic with that bacteria? 

Zack Abbott:  

Well, because, and this is sort of the state of the probiotics industry as it is, we scour nature, and then we say, “here, we want to deliver to you as the function, the ability to break down acetaldehyde” And so we say, “oh, here, here’s a bacteria that can do that, you should eat this,” we have no way to be sure that even if you were to eat it, that it’s going to first of all survive your stomach acid at a reliable amount. And the bacteria that’s already your gut is probably very likely an anaerobe, so manufacturing would be very difficult. And then once it gets into your gut, it doesn’t necessarily turn that gene on in a reliable situation. So even though it has the ability to do that, and occasionally it will turn that occasionally it will turn that gene on, it’s really doing it for the purpose of for whatever reasons the bacteria determine that they need that gene, not for the reasons that you need that gene. So what we’re doing here is just giving you a bacteria where we know reliably it’s making this gene at the time that you need it, as opposed to time that that it might need it. So that’s where engineering is valuable. When we genetically modify something in the context of Zbiotics, what we’re doing is just delivering reliability of that function, essentially about the function that already exists.

Lindsey:  

So how do you know that while it’s sitting in the bottle getting delivered, it’s not already turning off that gene?

Zack Abbott:  

So we engineer it so that it makes that gene all the time constitutively, and so when it’s in the bottle, another reason why bacillus subtilis is such a really great probiotic and really great bacteria that I love is that it forms a spore, which is a dormant form of a bacteria. So basically, when it’s in nutrient limiting conditions, it can hunker down in this hibernation state where it’s totally inactive and it’s also incredibly resilient. It can pass through your stomach acid. It can deal with extremely high or extremely low temperatures. We’ve pulled bacillus spores, we meaning the science community, not me personally, pulled bacillus spores from ice cores in the Antarctic that are literally hundreds of 1000s of years old. And those bacillus spores are still alive, so they’re in that spore form, and then we can put them in media with a bunch of nutrients, and they just wake up and nothing happened. It’s the same thing here. So when the bacillus is in the bottle, it’s in the spore form. It’s very resilient and happy to be in there chilling for however long, how long it’s in there, as long as I don’t put any nutrients in that bottle. So the bottles just got water in it, it’s fine. And then you drink it, it passes your stomach acid, and so that low pH keeps it in the spore form, because it senses that that’s a hostile environment, and then once it passes through your stomach and gets into your intestines, it senses there’s a bunch of nutrients around now, and the pH is more friendly, and it wakes up or germinates out of that spore, and and bacillus already naturally does this. It came with this prepackaged that’s part of its normal life cycle, right? It’s on the surface of some vegetable, and it’s in spore. You eat it. It passes through stomach acid. It wakes up in your gut. It floats down the river for about a day, it enjoys the nutrients, and then it passes out the other side, back out of the environment. And so we just took advantage of that life cycle that already existed and then engineered it. While it’s passing through that river, it expresses 1000s of enzymes. And so we’ve just engineered it to express one additional enzyme, additional all the other things it’s doing. And we know that that enzyme and that function is beneficial to you, but the rest is all the same for the bacteria.

Lindsey:  

Yeah. So for the Pre-Alcohol, we’ve got long intestines. What is it something supposed to be the length of a tennis court, or the covers an entire tennis court? I can’t remember what the analogy is, but, what’s to say that if you take it at 6pm, that what’s coming into your intestines isn’t going to absorb into your bloodstream and already cause damage before it gets to the spores?

Zack Abbott:  

Yeah, great question. So this is an important part too, is that I think in terms of alcohol metabolism, the vast majority of the alcohol you drink, the ethanol is is going to be absorbed very quickly. As you say, it’s going to be absorbed in your mouth, in your stomach and the small intestine, and then that ethanol is then absorbed into the bloodstream, and it circulates throughout the body. It has the effects that it has, and then it makes its way to the liver, where it’s broken down in two stages, from alcohol to acetaldehyde, and then acetaldehyde to acetate. Both those steps are really efficient in the liver, a small amount of alcohol that is not absorbed very quickly like you described, is going to make its way to the colon, and in the colon, that’s where most of the bacteria that are in your gut live, and that’s where a lot of this ethanol is going to be converted into acetaldehyde. We know that reliably, the colon is where, when we look, for instance, that after a night of heavy drinking, you’ll see that colonic acetaldehyde level specifically, specifically, the levels of acetaldehyde in the colon are 10 to 100 times higher than the acetaldehyde levels in the blood. So we’re not saying that we’re going to get every molecule of acetaldehyde, but we know that if we can target that colonic sink of acetaldehyde, that’s going to have an impact, because that colonic acetaldehyde doesn’t stay in the colon. It’s a highly soluble molecule, so it forms there the initial sink, but then it will get absorbed and it will diffuse out into the bloodstream, recapitulate the body, make its way to the liver and then get broken down, but at that point, it’s too late. So we’re really targeting that major source and trying to have impact there.

Lindsey:  

Yeah. So that’s why it’s important to get it in first, to get to the colon first.

Zack Abbott:  

Exactly, yeah.

Lindsey:  

Yeah. And did you test people? Can you test people for their acetaldehyde levels? Is that something?

Zack Abbott:  

So we didn’t test people directly for acetaldehyde levels because it’s hard to do that. It’s pretty invasive. Specifically, we’re targeting colonic acetaldehyde. To take colonic samples from people requires a level of invasiveness that not a lot of people will volunteer for. Ultimately, though, reducing acetaldehyde was a means to an end, and so even if we did reduce acetaldehyde, if it didn’t result in people feeling better the next day after drinking, then it doesn’t even matter, right? Because the whole purpose of the product is to provide this end benefit. And so ultimately, that’s the end point that we care the most about. We’ve done a lot of things to validate that taking this product or not taking this product has a very different outcome the next day for people when they take the product.in terms of perception of pain and the amount of things we’re able to get done, and all that kind of stuff. So those are the things that we targeted when we looked in humans.

Lindsey:  

Okay, so what kinds of studies did you do on it? 

Zack Abbott:  

There were several things we did internally that, because they’re not clinical trials, can’t really talk in detail about, but ultimately, I’d say that where we see what’s consistent with hypothesis, and things that we did internally to convince ourselves, was we look at basically consumer satisfaction. We see that the vast majority of customers that use the product, that’s more than 95% say that they feel better that they have to drinking. And so 95% is an extremely high number. And then we look at repurchase rates, and those are also consistent with the fact that people really like the product. So none of these things do we report as definitive clinical proof, we’re not a drug company, and so we don’t have the ability to run lots of human clinical studies, but we say that all these things are at least consistent with the hypothesis that the product is providing value, and we allow people to experience or try that product for themselves. We also offer a money back guarantee, which we always honor, .3% of customers ask for a refund. So it’s really uncommon, but of course, we’re more than happy to do that. And so all those things are consistent with the idea that product is working. There’s definitely more that we can do to show that definitively in a clinical study. And as a scientist, I would never claim that we have clinical proof today, you know? So there is an element of consumer experimentation with, in terms of how it affects you.

Lindsey:  

Yeah. And so what about the Sugar to Fiber? What would you see that would tell you that was working?

Zack Abbott:  

 Yeah. And so that one is a lot more straightforward. We have very clear, we don’t have to go into the colon on that one, right? You provide a sample every day. Most people do, right? So we can use stool samples to look at shifts in the microbiome, and the key outcome there is increased microbial diversity. And then we also can look at the transcriptome, so that the genes that the bacteria are expressing. What we want to see is upregulate. Ultimately, we want to see diversity, but we actually want to see increases in function. And so, in short chain fatty acid production and fiber degradation, we should see a shift, increased shift in those genes and their expression levels. This is a very straightforward thing to do, and these are so we’ve already done preliminary studies that show that these things are it’s very consistent with those hypotheses. We’ve taken those and are designing clear endpoints that we can do human studies that we that we’re going to publish. So we’re starting those studies in the next few months. So I’m really excited to get that data in. But the good news is here that we also have validated, obviously, and with first product as well, we’ve done a lot. We’ve done as much possible in vitro work as we can and ex vivo work, so simulating the gut environment in a test tube where we can more easily sample and so we see that with first product that we get the breakdown of acetaldehyde at a physiologically relevant rate and physiologically relevant conditions. And then with the second product, we see sugar conversion into fiber, again, in physiologically relevant conditions. We know how much fiber we’re making. We’ve characterized the degree of polarization. So I think the chain length of those fibers ensure that they have a really long, really valuable chain lengths. And so all those things we know. And then we already have a lot of data that says that if you give somebody Levan, you’ll see these changes.  We have bacteria that we know is making Levan. And so yes, the two dots have not perfectly been connected yet, but it’s a pretty small leap from A to B that we can and we are excited to show those in human studies. 

Lindsey:  

Okay. So you mentioned that within a day or so you think both of these products will pass through people’s guts?

Zack Abbott:  

Mhm. 

Lindsey:  

So they won’t settle?

Zack Abbott:  

Right.

Lindsey:  

Have you done the shotgun sequencing on peoples guts who have been using them to see if they’re there and how long after they’ve completely disappeared? 

Zack Abbott:  

Yeah, yeah. Again, this is something where we can tap into a lot of existing issues. Bacillus, subtilis is one of the most well studied bacteria on the planet. There’s lots of data on transit times of bacillus. One of the things is that you likely eat this bacteria every day of your life. It’s everywhere. And even though that’s true, when we sequence people’s microbiomes, just generally, we rarely see this as a member of the microbiome. So we already know that even though everybody’s ingesting it every day, it’s something that’s just passing through. And then specific studies with bacillus as a common probiotic bacteria for people and for animals, lots of studies have been done to show how long it persists, and nothing we’ve done or nothing about that should affect its transit time. So we’re already leaning on a lot of data.  That being said, with the studies we’re looking to do on the effects of microbiome, we also look to see is our bacteria there, how long is it there, and preliminary results are consistent with what we see in the scientific literature already on that is that it’s gone within a day, yeah, the majority is gone. Yeah, you might be able to detect it for a few days, but you’re taking however many million or billion CFU, the vast majority, that 99.9% of that is out within the first day.

Lindsey:  

Yeah, so people can’t hope to be able to see their own community of this and keep being able to drink their alcohol without rebuying the probiotic.

Zack Abbott:  

Yeah, exactly. I mean, it would just be really inconsistent.  I think that this is another area where I, as a microbiologist, feel that the probiotics industry is sometimes predicated on some false hopes around the idea that these bacteria are going to A. that they can see the gut reliably, and B. that that’s even a good idea, that that they should, be trying to see the gut. One of the analogies I use is the life of the party, you know, a college frat party. And then picture somebody walking into that party and that the total life of the party very valuable to that community. And then now picture that same person going to a hipster party in Brooklyn. That person will no longer be the life of that party. They will be bad for that community, probably in those situations. So the idea is that everybody’s microbiome is totally different. Your microbiome and my microbiome are two totally different parties, totally different communities, the idea that this probiotic bacteria is going to come in and just uniformly beneficial to everybody’s microbiome is not a really strong hypothesis, microbiologically speaking. And if you could cram it in, and you could force it into that community and have it persist for a long time, that would probably disrupt the network of interactions that are happening in your microbiome already. And so having a transient passerby that overlays a single function is a much more safe and responsible approach to trying to deliver benefit to the microbiome, rather than trying to force in a bacteria wholesale forming 1000s of functions. You’re probably taking it because you either want something very specific to happen, or you want this sort of generalized gut health benefit, which you can’t deliver with a single bacteria. You have 1000s of different bacteria in your gut all performing all kinds of different functions. And so it’s not really silver bullets with gut health. 

Lindsey:  

Mhm. I was just thinking about glutathione, and because it’s depleted, probably typically after drinking, that might be a good way to measure the effect of Pre-Alcohol* (use code PerfectStool20 for 20% off) is to see if levels are depleted or not after using it.

Zack Abbott:  

It probably still would be, because glutathione is really recharging the enzymes. The vast majority of your oxidative stress is happening from the ethanol. So you’re still having to deal with all that ethanol, and glutathione is still recharging those enzymes to deal with ethanol. And so we’re really just targeting specifically this small amount of dose makes the poison here, a very small amount of acetaldehyde that’s being formed in the gut. It’s not really meaningful in terms of alcohol and intoxication, but it has a really outsized effect on how you feel the next day, because that small amount can really affect you. So we’re really just dealing with that.  I think that there are biochemical or physical readouts we could do. I just think that ultimately, people care about is whether or not they’re going to feel better the next day. And so I think that that’s the valuable outcome that we can show.

Lindsey:  

Yeah, and what are people saying with the Sugar to Fiber?

Zack Abbott:  

I mean, it’s too early to say, we just launched it a month ago. So far so good. I’ll say the difference between the two products is really this conversation has been a microcosm of that, a lot of skepticism, a lot of questions, a lot of, how does this work with the first product and the second product’s more “okay, yeah, I get that, sugar into fiber.” So we’ve had, we’ve had a lot of positive feedback on the product so far. A lot of people say, “how’s that possible, “that seems too good to be true” and understanding the basic biochemistry of the relationship between sugar and fiber can really help with that. And so in terms of people’s experiences, we did a lot of beta testing before we launched several months and we saw that with those people, that the most common benefit that people were excited about was that it was just such an easy way to start. We see this a lot, that it was a way of crystallizing a good habit. You do this one little thing, which is just pour this powder into your breakfast cereal or your morning coffee or whatever, and then it’s like, “Hey, I just did something for my health. “Then I actually started pouring into a glass of water, so I get another glass of water, so now I’m getting more hydrated, and then started making sure that I ate more fruits and vegetables to make sure that I was stacking more fibers on top of it. So we saw that it crystallized a lot of good behavior for people, because it was such an easy way to get started. I think that that’s one of the things I’m most excited about, because, as I say, the goal of the product is not to be a fix all. It’s meant to just be something easy to do to help your health, another tool in the tool belt. And so I love that it was a crystallization point, or nucleation point, for other related habits, which is what you want.

Lindsey:  

Yeah. You have to mention that these are not cheap products.  Particularly the Pre-Alcohol,  a 12 pack is $108 so $9 a bottle, so it’s basically like buying another cocktail.

Zack Abbott:  

Yes, yeah. So yeah, that’s exactly right. It’s the cost of a drink, right? I would argue that for our customers, and people who are excited about products, how much is your next day worth to you? For the cost of one extra drink, you get your day back the next day. And I think that that’s the real benefit. It’s not so much about pain avoidance, getting away with something. It’s about, look, I want to be able to enjoy drinks with friends or celebrate in this way, but I also I have my morning workout, or I want to meet up with friends for a hike, or, you know, I want to be fully resent at my kid’s soccer game. It’s these things, it’s not like they’d be impossible without the product, but the opportunity to ensure that you’re going to be able to maintain all those healthy habits and routines and those obligations is is worth it for the costs, like you say of a cocktail, at least for our customers. 

Lindsey:  

Yeah, yeah. 

Zack Abbott:  

Yeah. That’s an ad hoc product, and that’s giving you a day back with the other product that’s really more of a habit or routine. It’s meant to be a daily. And so obviously the daily price had to be different. And so we had to think of ways to make that possible. They’re manufactured differently and other things to make sure. It’s the second product it’s about $2 a day, which is, I think, more in line with people, people can afford on a daily basis. 

Lindsey:  

Yeah. I see if you subscribe, it’s $60 for 28packs, I guess, yeah. You could also subscribe on the other one. And then I think it was what, $86 for the 12 pack?

Right, yeah. A little over $7 a bottle, yeah.

Yeah. It’s not for an alcoholic. They’re not going to be taking this every day, or they’d have to be rich alcoholics.

Zack Abbott:  

Yeah, right, right, you know. And that’s not the point, right? The point of product is…

Lindsey:  

Right, right. It’s for it’s for the responsible drinkers. Okay, anything else you’d like to share with us? Any new products on the horizon or?

Zack Abbott:  

I think that the mission and the vision of Zbiotics, and why I’m really excited about it, is just all the incredible things we can do. There’s so much excitement around the microbiome and around probiotics, and I think that that’s all well placed excitement. We’ve discovered this other organ system of the body that’s so foundational to all of human health. That being said, I think that the products that deliver on that are rudimentary. Often most probiotics are kind of the leftovers of the dairy industry, bacillus and stuff, and that we’ve kind of like hoped, will provide some tangential benefit for us. The opportunity to refine that thing that we pulled out of the ground and shape it into a very specific tool with a very specific function, I think, is a really exciting promise. I’m just excited about this new category of genetically engineered probiotics that have very specific benefits. This is the first two of what I hope to be many by us and other companies. We’re approaching this understanding that people are really concerned around GMOs, and for good reason, there have been some applications of that technology that have been unsavory or that don’t align with people’s values. And understand that, as a scientist, it’s been really tough for me to see is that, unfortunately, the technology is being conflated with the applications of the technology. People say, “I really don’t like Roundup Ready corn, and so therefore all GMOs are bad.” And that’s just really not a nuanced approach to a technology. With most technologies, the technology itself is not good or bad, it has mixed products which can be good or bad or align or don’t. And so one of the things that I’m excited about doing antibiotics is, like the conversation we had explaining how we’ve used genetic engineering, what it is, I think a lot of people just hear genetic, genetically modified or GMO, and they just say “that that sounds scary, that sounds bad” and by just explaining that we’re simply directing normal bacterial evolution to give a function that is very safe and so and by and then, by building product that actually provides a benefit to you that you want, and saying that the reason that benefit exists is because we engineered the bacteria to be able to perform that benefit, we hope to kind of elevate the conversation about good or bad  into something more rational and nuanced and acceptable, because I think that ultimately, genetic engineering and biotechnology in general, are really important tools in humanity’s toolbox. We deal with a lot of existential crises facing this planet. I think that when we look at climate change and feeding a growing population of people, and dealing with emerging infectious diseases, Biotechnology is going to be an incredibly important tool for us to use to combat these problems that in large part, we’ve created for ourselves. There’s no going backwards. We have to move forwards. And so I’m excited about helping to present another facet to this conversation so that we can ideally, hopefully move forward. And I’m not certainly advocating to say all genomes are good. It’s just as irrational as saying that they’re all bad. I think it’s more what can we do with this that aligns with our values and that we believe is safe and responsible? I think that’s a really important question to ask.

Lindsey:  

That gives me an idea for your next product, a bacteria that eats glyphosate and turns it into something harmless.

Zack Abbott:  

Well, you know that would be a really interesting idea. I think that there’s some really cool companies out there that are engineering bacteria, that’s what I thought you’re going to say, engineering bacteria to basically eat or fix greenhouse gasses and turn them into very useful products. So we can literally turn pollution into useful products that are more sustainable than how we typically make them with, which is with oil. There’s all these incredible things that people are doing with GMOs, and unfortunately, that shouldn’t be a bad word. What should be a bad word is whatever application people don’t like. Hopefully we can decouple the two, and that’s one of the things that’s one of our goals, is really advocating for a really, really amazing and powerful, beneficial technology, if used correctly.

Lindsey:  

Okay, well, thank you so much for sharing about this with us. This was really interesting, and I’ll put links to your homepage and your products* (use code PerfectStool20 for 20% off) on the show notes.

Zack Abbott:  

Thank you so much. I really appreciate it, Lindsey

If you’re dealing with gut health issues of any type (diarrhea, constipation, bloating, SIBO, IMO, H2S SIBO/ISO, IBS, IBD, gastritis, GERD, H pylori, diverticulitis, candida, etc.) or have an autoimmune disease and need some help, I see individual clients to help them resolve their digestive issues or reverse autoimmune disease naturally, You’re welcome to set up a free, 30-minute breakthrough session to see if you’d like to work with me. I also have my own two products, Tributyrin-Max, which is particularly helpful for loose stool and diarrhea as it slows your motility and firms up your stool, and SBI powder, which is an all around gut pathogen binder, which is super safe and won’t harm beneficial bacteria, and is usually the first line of treatment I educate my clients about in order to avoid stronger antimicrobial herbs.

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

Adapted from episode 145 of The Perfect Stool podcast edited for readability with Will Bulsiewicz, MD, gastroenterologist and Adjunct Assistant Professor of Medicine at Emory School of Medicine and the Founder of 38TERA*, a gut health supplement company, and the bestselling author of “Fiber Fueled*” and “The Fiber Fueled Cookbook*”.

Lindsey:

I’m sure my listeners would be interested in hearing how your own health issues brought you to where you are now in the search for root causes for gut health issues. Can you tell us about that?

Will Bulsiewicz, MD:

Yeah. I think that this is an important part, it informs many of my personal motivations in terms of the way that I approach health. So, I think, as a background an allopathic medical doctor, it was my lifelong dream to become a medical doctor, and I went through medical school and residency basically looking up at these people who were before me as. These are my heroes. This is what I want to be like. And then it all was quite sobering when I started to have health issues myself. Essentially, what happened is that the things that were bad patterns, bad habits that I had from my childhood and carried into adulthood, that I think I doubled and tripled down on during times of stress, or when I was short on time, or things like this, which I frequently was in my 20s going through my medical training, it ultimately came to a head where I found myself in my early 30s and I was unwell and I was having a crisis of health, and I was 50 pounds overweight. I had high blood pressure and high cholesterol, but even more importantly, I didn’t feel well, I was depressed, I was anxious, and also I had tremendously low self esteem, and I knew I wanted to feel better.

Yet in that moment when there I was, I was a board certified internal medicine doctor. At that point, I was in my specialty training as a gastroenterologist. I had won many awards. I was the top award recipient at Northwestern among 60 doctors. And yet, I didn’t want what I was trained to do for myself. I wanted something that would address, “Why do I feel this way? Why do I have these issues?” I don’t want to take a blood pressure pill for blood pressure, and take a cholesterol pill for that, and then, take something else for these other feelings. I want to repair the person, starting with the inside and working my way out and I didn’t really know how to do that, because that’s not what I was trained for. I tried to exercise my way out of things. There were definitely things that were beneficial from exercise, but it didn’t really fix the problem, to be honest.

Lindsey:

I always say you can’t exercise your way out of a bad diet.

Will Bulsiewicz, MD:

That’s exactly right, and I didn’t understand that, right? This seems obvious. It seems obvious, and yet there I was in it, living it, and not seeing it. And anyway, it was changing my diet that really changed everything for me, and the realization that, oh wow, not only do I feel better, my gut feels better.

Lindsey:

What was your diet? And what is it now?

Will Bulsiewicz, MD:

This period of time that we’re talking about, I’m now in my mid 40s, right? And we’re talking about a period of time that was on the on the order of 12 to 15 years ago. And leading up to that, when I was in high school, my parents were divorced, my mom was at work, and I would come home from school, and I had two brothers, and we grilled hot dogs almost every single day. And we loved going to fast food joints and drinking soda.  If you had some money, that’s what you would spend your money on. Then I went to college and medical school, and I’m independent now I have my own life. What do you think I ate? Exactly, wow.

Or imagine this, I work a 30 hour shift, right? This is, literally what would happen every fourth night during my residency in my 20s. I would work a 30 hour shift, not sleep, come home around one in the afternoon, completely exhausted, stop at Taco Bell, grab $15 worth of food, which is a lot for Taco Bell back then, and basically, devour it and then pass out and wake up the next day and go back to work. I had a very unhealthy lifestyle, but again, I didn’t see it or understand it, and so, anyway, you asked me, how do I eat now? I want to give the caveat that, how I eat now is a build. And I’ve always been working on ways to try to improve little things, not trying to be perfect, trying to tweak and work my way up. I feel I’m in a great place now in terms of the balance between it all. But where I started was the first thing was drinking smoothies. And it was almost drinking smoothies as a supplement. And it had fiber and polyphenols, phytochemicals and all kinds of good stuff. But that was my way of having something that I could prepare quickly, effortlessly, and still feel I was doing something decent for myself. That’s where I started, and it really, made a difference.

Lindsey:

Yeah. Where did you end up now? What do you do now? Do you cook for yourself? Do you eat lots of fiber?

Will Bulsiewicz, MD:

I eat lots of fiber. Yes, I try to cook for myself when I can, on the weekends. I’ll have breakfast. Breakfast for me could be avocado toast. That’s one of my favorites. And also, I should say I have four kids, and my kids, the age range is between, right now, once she turned one, my youngest, and then my oldest is 10. And anything that I prepare for myself, I have to prepare for my kids at the same time, right? I’m looking for solutions that are quick and healthy and also delicious, because that’s what my kids want. Avocado toast is a family favorite. Yogurt, I might do a plant-based yogurt, but I’m not opposed in any way to regular dairy yogurt, if that’s what people prefer. And a yogurt with nuts and seeds, specifically hemp seeds and berries, that would be a classic on the weekend. During the week, I typically don’t consume breakfast. I usually don’t, to be honest. I probably should, but I don’t, and I drink coffee and then I have lunch.

For lunch, soups, salads, sandwiches. A big kick that I’ve been on recently has been to take soup and add an entire can of beans to it. And I choose the beans based upon which type of beans fit the soup profile. Certain ones, I’ll use garbanzos. Other ones I might use kidney beans or black beans, depending on what the style of the soup is. But, again, I’ve worked my way up to this. If you have gut issues, this is not a starting point. This is where you get to eventually. And then dinner time varies, we cook for the family, and it varies by day of the week. We have typical family foods. Taco Tuesday as an example, and we’ll put out the taco spread, and then the key is, we have all the accouterments, and you pick and choose which ones you, and then add it to your taco, and it’s pretty nice. Another example of something that I would do for dinner is, I love making a bowl and including some whole grain and some legume or lentil, and then adding toppings. Depending on the flavor profile, whether it be Mediterranean or a burrito bowl, you put out that spread, add that stuff in, make it taste really great, and then acknowledge that this is a healthy meal.

Lindsey:

Yeah. I’m hearing the emphasis on the beans and the lentils, which is what I tell all of my clients who are eligible for that. There are some that are not, but all of the ones that are ready for beans and lentils, I would say, quarter to half a cup a day minimum, because you’re never going to hit your fiber requirements without it.

Will Bulsiewicz, MD:

They’re powerhouse foods. When it comes to the gut microbiome, there’s nothing more densely packed with fiber, resistant starches, and they also have polyphenols too. We’re talking about something that was strategically designed by nature, basically, to feed the gut bacteria. And I totally agree with you. They’re not for everyone, and for people who do struggle with gut issues, the starting point could be something like, for example, lentils which are soaked and typically, the smaller ones will be a little more tolerable.

Lindsey:

Yeah. One of the things we wanted to focus on today is Crohn’s disease, which I haven’t had anybody speak about in a while. Can you talk about the different types of Crohn’s and how you might approach them differently?

Will Bulsiewicz, MD:

Yeah, so we think of Crohn’s in terms of phenotypes, and I think in the future, we may be able to get more specific with this, because we’re taking this label of Crohn’s disease, which for the listeners at home, this is a form of inflammatory bowel disease. You can think of it in the same family as ulcerative colitis, but to me, as a gastroenterologist, these are distinct health conditions, and with Crohn’s disease, what makes it unique is that it can affect anywhere from your lips all the way down to your bottom, anywhere in between, and it can be in one spot and nowhere else, or it could be in different locations and skipping around and be involved. Some people are just the small intestines. Some people are just the large intestine. Some people are both.

That’s very different than ulcerative colitis, where ulcerative colitis is the colon, and how much of the colon is involved, is the question. But it’s always the colon, and it always starts in the rectum, with ulcerative colitis. Now, when it comes to Crohn’s disease, given this varied presentation, I think that in the future, we hopefully are going to be able to get more specific at looking at these specific types and then studying them and unpacking them further. But the main distinction that we will make is that there’s some people that have what’s called stricturing Crohn’s disease, where they form scars, and those scars within the intestines get tighter and tighter and tighter, and it closes off, and it affects the ability of food to flow through. And the issue with this, with the type of dietary pattern that I recommend, is that this can be trouble for a person who’s eating a lot of plant based foods, particularly the skins. In my mind, I’m thinking about an apple and a pepper and things of this variety that have a skin. Those skins don’t digest and they remain intact. You might chew them, but they’re still quite large. They can bunch up like a meatball and cause a blockage, right?

Now, on the flip side, if we’re talking about a smoothie, it’s a completely different thing, because the smoothie is so particulate, so small, it’s not going to form a clump inside your intestines. That’s not possible. We tend to, with these people, be very cautious with how we approach fiber, but I hope that the listeners are hearing me when I make this distinction between highly refined, particulate, plant-based foods versus things that are closer to whole foods that have a skin and therefore may be problematic for a person who has one of these strictures. I’m happy to talk more about the strictures because there’s two main elements to strictures that people need to know. One is inflammation, and inflammation, if you properly treat it, that will go away. And the second is scar tissue. Scar tissue is not going away. If a person does have a blockage, in theory, it may be possible to resolve the blockage in the hospital. The patient, treating the condition, getting the inflammation under control, you may be able to do it, but there are some people that do require surgery for this.

And then the second major type is what we call penetrating Crohn’s disease, which basically means that the inflammation is severe that it may make connections to other parts of the body, and when it forms a connection, we call that a fistula. A fistula is an inappropriate connection between two parts of the body, so, Crohn’s disease may connect to the bladder, or it may connect to another part of the intestine, or it may connect to a woman’s vagina, and all of these things then will have potential manifestations and consequences. These two types, though, stricturing and penetrating, these are different phenotypes, typically people aren’t both at the same time. Typically they’re one or the other.

And when it comes to penetrating disease, I don’t share the concern that I mentioned a moment ago with the skins and fiber of that variety. All patients with Crohn’s disease have deep dysbiosis. What that means is a very damaged gut microbiome and fiber is unique, because while it is incredibly healthy, it also is the food that requires our microbiome in order to process and digest it. This creates an issue for people that have a very deeply damaged gut. The thing, paradoxically, that they need the most, is also the thing that’s hardest for them to receive. In both cases, I apply rules, but I take them to an extreme. I apply rules that I would use for people that have irritable bowel syndrome or other forms, other manifestations of dysbiosis, but with the acknowledgement that in inflammatory bowel disease. These are typically the people with the most damaged microbiome. The rules are that I use typically, when it comes to these types of foods, are I will start very gentle, and then I will slowly ease into it. I tend to use, in this context, a low FODMAP diet. And Lindsey, I know that your listeners are quite facile, FODMAPs, is this something that I should explain? Or how do you feel about that? Do you want me to get into that?

Lindsey:

Briefly. I’m sure they’ve heard about it on another podcast.

Will Bulsiewicz, MD:

FODMAPs, it’s an acronym. It’s super nerdy. It stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. And basically what this is referring to is the fermentable parts of our food, and specifically fermentable parts that are carbohydrate. They’re carbohydrate based. Now this doesn’t make them bad. In fact, they’re good. They’re good because the vast majority of them are what we would describe as prebiotic, meaning they feed and fuel our microbiome.

But that being said, anytime we use the word fermentation, it’s never a human biological phenomenon, that’s always our microbes. Microbes are what ferment things, whether it be in a jar and we’re making some kimchi or sauerkraut, pickles, or whether that be inside of our own intestine, and our gut microbiome is processing and digesting these foods. Fermentation is done by these microbes. The point is that for people that have a damaged gut, their microbiome, those microbes, they’re not in a good spot. And by going low FODMAP, it allows us to give them the space that they need to heal and be gentle. We don’t want to do low FODMAP in perpetuity, right? But for a period of time, you make this play. And the intent is to gently ease into feeding the microbiome, as opposed to aggressively doing it and stuffing it.

And there’s been data for many years on irritable bowel syndrome. Anytime we talk about irritable bowel syndrome, if you have inflammatory bowel disease, you almost certainly also have irritable bowel syndrome underlying it. It’s an overlap. There’s data with irritable bowel syndrome, but now there’s also data more recently, with people with inflammatory bowel disease. Two things. One was a six-week study where they had people with inflammatory bowel disease follow a low FODMAP diet, and they improved the measures of gut inflammation. That’s a beautiful thing.

And then the second was, among these people with inflammatory bowel disease, they discovered that they had improvements of their symptoms and improvements of quality of life. The point being that if I were to take a person who has Crohn’s disease and I look at them, and what I see from my perspective, is a person who has a damaged gut microbiome, because their gut microbiome is damaged, their gut barrier is broken, and this has activated the immune system inappropriately, and the immune system is on the attack. And when the immune system goes on the attack, people think about things like autoimmune disease. What’s interesting is that inflammatory bowel disease, I don’t consider to be autoimmune.

Lindsey:

Really?

Will Bulsiewicz, MD:

Very similar, but I think worth pointing out, because it’s more than semantics. It’s understanding what’s happening. In an autoimmune disease, your immune system is attacking you, in inflammatory bowel disease, your immune system is attacking your microbiome. It’s a rejection of your own microbiome, and your intestines get stuck in the middle.

Lindsey:

Interesting.

Will Bulsiewicz, MD:

And the inflammation that manifests is the result of the inflammatory process manifesting in the lining of your intestines. But your immune system is not trying to attack your intestines. It’s trying to attack the microbiome. And the way that we heal this broken, damaged gut microbiome, broken gut barrier and confused immune system, the way that we ultimately want to heal, this is by healing the gut microbes. Because if we can do that, if we can reverse dysbiosis and move back to a normal, healthy, balanced microbiome, which the term is eubiosis for that, if we can do that, then that balanced, healthy microbiome will allow us to repair and restore the gut barrier, which is how we accomplish that. And when you repair and restore the gut barrier, then you simultaneously are going to give the immune system the space that it needs in order to manage itself, to heal, to stop attacking.

Lindsey:

Yeah. And are you using comprehensive stool testing to assess the microbiome?

Will Bulsiewicz, MD:

So with Crohn’s disease, I haven’t found comprehensive stool testing to be something that I would allow to lead; I find it to be a complimentary piece. I don’t yet believe that these tests are in a position of being ready for prime time, in the sense that what I want to know, with a patient with Crohn’s disease, I want to know how they feel. The expectation is that symptoms are present as a result of their condition. And, I should say it’s not universally true, but generally speaking, symptoms are present in response to their inflammation. When the symptoms improve, it is because you are improving the inflammation. I want to get them into a symptomatic remission. That would be the first step. And then the second step is to get them completely free of disease so that you can’t tell them from another person who doesn’t have inflammatory bowel disease.

Lindsey:

And are you talking about interventions with diet, or are you talking about using the immunosuppressive drugs?

Will Bulsiewicz, MD:

So, the way that I see this interplay is, I guess, let me put my general philosophy as a medical doctor out on the table, which is that what I care about is people being better, right? And to the best of our ability, addressing the root of the issue and not covering it up. Because I feel like when you cover it up, you might get them better temporarily, and then they get worse again. With this in mind, the answer to your question depends a bit on the intensity of the of the health condition. For people that have mild Crohn’s disease and it’s not severe in terms of the effects of inflammation or in terms of the symptoms, then we have more. We wait. We have more give, rebuilding and repairing the gut microbiome. It takes time. To me, what we’re talking about here is not a four-week process. I don’t even know that it’s really a four-month process. In my mind, generally, people that have inflammatory bowel disease, to really get to where I would want them to be, we’re talking about something on the order of, minimum of six months, most likely 12 months, somewhere in the range of 12 to 18 months, to truly get there.

I won’t sit back and have a person progress to the point of requiring surgery with Crohn’s disease while we’re waiting for diet and these things to kick in. When it’s appropriate and medically necessary, absolutely I would treat them with medication. My issue with medication is not the fact that they exist, because I’m glad that they’re there and they can really help people. My issue with medication is that we have built a healthcare system that almost entirely is focused on providing the medicine with absolutely no acknowledgement that these other aspects, which are the root issue, are relevant. That to me is the problem. And this is an interesting thing, which is that I would have drug reps that would come into my office, and they did not like me, and the reason why is because I literally said to them, I know that’s not you, but your company has created a drug that they’re charging people 1000s of dollars per month, and you’re asking me to prescribe this, but then you don’t teach me or provide the clinical study necessary for us to know how to stop and I don’t think that’s fair, because you’re making a ton of money. You should be not only funding a study to start the drug. You should be required to fund the study to stop the drug.

Lindsey:

Yeah, that’s not their business model.

Will Bulsiewicz, MD:

That’s not what they’re going to do, right? But that’s a problem because at the end of the day, I feel that should be a requirement for approval of particularly these drugs. The issue with Remicade or Humera, right, Infliximab, those are the two classics when it comes to treatment of inflammatory bowel disease. The problem with these things is that if you stop it, and you’re wrong, they will form antibodies to the drug, because the drug is a biologic, the immune system can react to it once you withdraw it, and then you won’t be able to put it back on board. And that’s a serious issue, because the data are very clear that the first medication that you receive that’s in this class is the best that you’ll ever do, and then the second one will be not as effective. And my point is that I understand why doctors don’t want to withdraw these drugs, because they’re afraid of losing the drug and not being able to bring it back. But it’s not fair, because the drug companies, they know how much money they’re making.

Lindsey:

As you’re intervening in the meantime on diet, how are you correcting microbiome? Are you familiar with the research of Mahmoud Ghannoum at Case about the plaques and Crohn’s and the presence of Candida and H. pylori in some of these plaques and such?

Will Bulsiewicz, MD:

So I am familiar with Mahmoud Ghannoum and to me when it comes to Candida, and I believe that he would agree with this, it’s been a couple years since I couple years since I talked to him, but he and I used to be in contact. I think that he would agree with me saying that when it comes to fungal infections, this is at least what I see in the data, that when we empower the healthy bacteria, they suppress the inflammatory yeasts. And we can see this quite readily, because for the vast majority of people, thrush, which is candida infection in the mouth, or esophagitis from Candida or vaginal yeast infection, these manifestations of yeast, they are number one when the microbiome is weak, right?

And classically, number two, occurring with antibiotics, because of course, the microbiome is non-existent in that moment because you’ve suppressed it and they come up, they flourish. From my perspective, the solution is not necessarily to attack the Candida. I believe that the solution is to focus on building the beneficial bacteria. Because when we do that I believe that the key to inflammatory bowel disease and many of these dysbiosis-based conditions, is ultimately to restore healthy microbes and then feed them with prebiotics and allow them to release the short chain fatty acids, butyrate, acetate and propionate, because then those are what help to suppress inflammatory microbes, help to suppress inflammatory yeasts, rebuild and restore the gut barrier, and also simultaneously, they have direct effects on the immune system.

Lindsey:

And at what point in the Crohn’s healing process is it safe to add fiber?

Will Bulsiewicz, MD:

I believe that it’s very early in the process, but I think that there’s a strategic approach. I guess let me, let me talk through. Let’s pretend that we have a person for a moment who has moderate to severe Crohn’s disease. All right, if they’re actively flaring, right now, I am not trying to put out their flare with fiber, right? And because they’re actively flaring, the addition of fiber is going to be a mess and may make their symptoms worse, because they’re not in a position of being capable of handling that. Ultimately, we need to get this person into remission, which may require medication in order to do that. When they get into remission, this, to me, is when our process of healing begins.

And the analogy that I would make Lindsey is, gosh, and I feel weird even saying this. I hadn’t even processed this until now, but, we obviously have the fires that are happening in California, I hate that, but I feel this is still the best analogy for me to describe this, please forgive me. And let’s separate from that, if we could, but if you have a fire that’s burning, you don’t plant new trees in the midst of a fire, right? You have to put the fire out, right? That’s step one. You put the fire out, and then when the fire is put out, there is damage that’s there, and the forest has been reduced down to not much. But there’s also an opportunity to regrow, acknowledging that opportunity to regrow does require time and patience, but it’s possible. And you put the fire out, and then you replant the seeds, and you allow those seeds to grow and mature, which takes time. With that analogy and applying it to Crohn’s disease, a person’s having an active flare, I want to use medication when appropriate, put the flare out, whatever is the least medicine necessary once they’re in remission.

That, to me, is when we really start to introduce the fiber-based approach. And my preference would be going back to what we were discussing a moment ago. I would generally start with a low FODMAP diet, and then over time, progress from low FODMAP to moderate FODMAP, and then working our way up to less restriction over time and simultaneously, from a fiber perspective, I would absolutely use a fiber supplement within that context. And so, Lindsey, I started a company called 38TERA*, right? And I’m happy to talk about 38TERA supplements. But I think there’s also this broader conversation that ignoring for a moment that I have a prebiotic supplement, acknowledging, what is the role of a prebiotic supplement within this setting? The answer is that it’s targeted for the microbiome. It’s not the same as food. It’s not meant to be the same as food. It’s not meant to be a replacement for food. It’s meant to be a way in which you can confidently influence the microbiome and have control over that dial. You can start with a very small amount, and then you can work your way up slowly over time. And what I would opt for within that setting is I would absolutely opt for a low FODMAP prebiotic, because low FODMAP once again, still is prebiotic, still feeds and fuels the microbiome, but is going to be more gentle to this person who has a damaged gut.

Lindsey:

Yeah. In terms of foods, you were talking about smoothies, and how, if they’re blended up, the fiber is not difficult for somebody. Is that an early way of introducing fiber? Would higher FODMAP foods that were in the context of a smoothie be acceptable where they might not be otherwise?

Will Bulsiewicz, MD:

Ultimately, it depends on how they feel. Yeah. If they if they were to do higher FODMAP and they feel totally fine, cool, you’re good. And if they struggle with that, then we have to back it down and move towards something that’s more simplistic. And while we’re in FODMAP content . . .

Lindsey:

Is the struggle going to look pain in the context of Crohn’s, or is it going to be loose stool or diarrhea or constipation? What are the primary symptoms that people are going to be suffering from?

Will Bulsiewicz, MD:

It really depends on the individual. And it depends, because the issue is that the disease can manifest in many different locations with varying degrees of intensity. Small bowel disease manifests in a rather different way. For example, the discomfort with small bowel disease will typically be felt around the belly button. If you have small bowel Crohn’s disease and you’re having intensification of discomfort around your belly button, what’s going on there? Whereas colonic Crohn’s disease, the colon basically frames the abdomen around the outside. Right, lower quadrant, right, upper quadrant, left, upper quadrant. These are different places depending that could manifest.

And again, I think it’s understanding your own disease, where you typically manifest it, and and what symptoms you experience. The lowest, most common symptom is bloating. Anytime the gut is struggling to process and digest food, you get bloating. And it’s not to say that the smallest amount of bloating should be something that scares you. That’s not the way that I feel about that, but it’s the acknowledgement that ultimately, what we’re trying to do is get you to a place where you’re comfortable, and then grow from there. Because if we can start with you being comfortable, then we have our baseline, and then from the baseline will continue to push over time.

Lindsey:

You mentioned the crossover of IBS with IBD. In some of these cases, this bloating could be caused by SIBO, conceivably?

Will Bulsiewicz, MD:

Definitely.

Lindsey:

All right, are you testing for SIBO then and treating that?

Will Bulsiewicz, MD:

Potentially, but SIBO, I guess the thing with SIBO is I’m a bit sensitive when it comes to SIBO. And I’ll admit that my fear is over treatment, because typically the treatment for SIBO is antibiotics, right back to overgrowth. Therefore, we must reduce the volume of the bacteria. We must cut them down. And antibiotics are a routine part of care with these people that have inflammatory bowel diseases, including Crohn’s disease, and they’re highly effective. But the issue, though, is that ignores the root of the issue, which to me, is dysbiosis, a damaged gut. I believe that dysbiosis is at the heart of Crohn’s and other forms of inflammatory bowel disease. I believe that it’s at the heart of irritable bowel syndrome. And I believe that SIBO is quite simply a manifestation of dysbiosis. It’s a form of it. And my concern with this particularly, is that I don’t want to rush to be put into a position where I feel that I have to treat a person with antibiotics because the test is positive. There are people who need antibiotics. There is no doubt. There are people who definitely have SIBO, and ultimately we have to get there. But my fear is that we’re paying a price where in the short term they are better, in the long term, not making them better.

Lindsey:

Yeah, but there’s definitely approaches that don’t involve antibiotics, serum bovine immunoglobulins or herbal antimicrobials that are more selective, like pomegranate husk or, gosh, there’s heaps of them, like turmeric, andographis, lots of things. How about those approaches?

Will Bulsiewicz, MD:

Those approaches, it depends on, to me, I would have to take a look at the specifics of what we’re talking about. An example oregano oil, I would have concerns about.

Lindsey:

Oh, yeah.

Will Bulsiewicz, MD:

So, because if we’re talking about broad spectrum anti-microbial, and I understand it’s not an antibiotic, it’s the same thing from my perspective, right? Whereas when we’re talking about something that’s more on the spectrum of garlic, or you mentioned pomegranate husk, or you mentioned turmeric? The thing that’s interesting with these things is that’s not an isolation antimicrobial; that’s in combination with prebiotics. Curcumin is a polyphenol and the health benefits that we receive from turmeric are the result of the gut microbiome and the effects that turmeric has on the gut microbiome. And the same is true with pomegranate in terms of ellagic acid and other prebiotic polyphenols that exist naturally. I have less concerns about those things, because basically what we’re talking about here is a prebiotic being packaged with something that we talk about being anti-microbial, right? But more selectively, and I’m seeing this not as an anti-microbial. I’m seeing this as a prebiotic building, right? Because my fear is that we’re not building; that’s my fear, right?

Lindsey:

Yeah, so the building process is ultimately going to take care of the cutting process? That you’re going to feed the good microbes, and they’re going to outgrow the bad ones without having to break down the bad ones.

Will Bulsiewicz, MD:

Yeah, and there’s healthy foods, as you’ve already pointed out, and then I would put my stamp on that there’s healthy foods that do have anti-microbial or antiviral effects that have been demonstrated, yet that’s not in isolation. We wouldn’t characterize them as an anti- microbial. We would say that they have that effect. It’s in combination as part of a package that also is many times prebiotic and therefore good for the microbes.

Lindsey:

Tell us about your supplement and what’s in it and how it’s helpful? And is it helpful, in particular, in Crohn’s? Was that in your mind as you developed it, or was it generally developed for building up good microbes?

Will Bulsiewicz, MD:

The way that I was thinking about this is, I guess, to frame the context, I have had incredible success treating people with prebiotic supplements for many years, but the thing that always troubled me is that the standards that I hold, I’ve never felt the supplements were there, never fully fulfilling those standards. And this led me to want to create my own because I, with confidence, believe that there is a role that exists for optimizing the gut microbiome and then receiving the effects and the benefits that come from the production of short chain fatty acids. To me, the general approach was, I wasn’t necessarily thinking about a specific disease state, per se. It’s more to say that, what we know, with 100% clarity, is that when you put prebiotic fiber or resistant starch or polyphenols in the mouth and swallow, we know where they’re going to go, we know what they’re going to do, right? It’s the because there’s no place else for them to go that you’re going to come into the context with the microbes.

Then those microbes will ferment them and create short chain fatty acids. But what I felt was missing is that many of the fiber supplements that exist are mono fiber, one single type. And in some cases, people advocate for using them at ridiculously high doses, 15 or 20 grams. And what happens when we only consume one type of fiber? You only feed certain microbes, and there is such a thing as too much, and this is part of my concern with, for example, inulin. Does it have studies to say that it’s beneficial for a microbiome? Yes; there’s also studies that say that it can be inflammatory and problematic if you do too much. I wanted to create balance. I wanted to create something that had multiple different forms of prebiotics, different types of fiber, also resistant starch and also polyphenols, and I wanted them, whenever possible, to come from something that has been clearly studied in humans with randomized control trials demonstrating that.

Number one, if you take this product at this particular dose, here’s the effect that it’s shown to have on your microbiome. Number two, it will affect your bowel movements, right? That, to me, is part of the proof that we’re achieving something of benefit is if you’re if your bowel movements are not the same, the proof is in the poop. And then number three, benefits beyond this, such as the improvement of gut symptoms, bloating. As I pieced together the formula, there’s seven different prebiotic ingredients, and they include resistant starch, which comes from potatoes. By the way, it’s a bit of a unique thing. It’s not the same resistant starch that you get by heating and cooling the potato. This is the resistant starch, RS2 that’s innate to the potato if it’s uncooked, and kiwi fruit, mango, beets, lingonberry and acacia and baobab. So, all right, it’s seven different and again, it’s a combination of fiber, resistant starch and polyphenols. And I see these as being synergistic together.

We have a clinical study that’s occurring right now that we should have the results in the next few months. And part of what we’re doing with this study is to demonstrate the synergy that exists when you take resistant starch and you add fiber and then subsequently polyphenols, because my expectation is that this is priming the pump, getting the microbiome organized and preparing to basically create these short chain fatty acids. Right now, as it relates to Crohn’s disease or these different health conditions, irritable bowel syndrome or even small intestine bacterial overgrowth, a few of the things that we did specifically and strategically. Number one, it’s low FODMAP. This is uniquely and strategically formulated, and it’s certified as low FODMAP. It’s intended to be gentle on the gut. Number two, it is certified glyphosate free. But it’s also taken much further than that. One of my concerns with, for example, gluten containing products, or oats or many of the things that people worry about is maybe it’s not the actual plant itself. Maybe it’s what we’re putting on the plant, glyphosate. Because to me, if you go to Italy and you can eat the food, which a lot of people say, it’s not the actual wheat. That’s the problem. It’s the way we’re treating the wheat. The product is certified glyphosate free.

But then beyond that, I’m really proud of the fact that we have extensively tested every single batch for more than 50 different pesticides, and it’s been negative every single time on every single test. We third party test far beyond this. This is a big part of what I was hoping to accomplish by creating my own brand, is that we’ve run over 100 different tests. That includes heavy metals, it includes microbes and pesticides. It also includes unique things that I literally have to get the laboratory to figure out how to get this done, histamine and salicylates and methyl salicylate. In essence, what we’re doing is we’re basically looking at things that can cause food intolerances that are specific to people with gut health issues. And for any batch that you purchase, you can find on the packaging, on the bag, here’s the lot number. You go to our website, you enter that lot number, and entire report is downloadable for you to see the results specific to that batch.

Lindsey:

Yeah. I’ve been trying it since you sent it to me, and I will vouch for the fact that it is light and fruity, and you add to some water, and it makes a light fruity beverage that tastes good and isn’t overly sweet. What sweetener is there in there? Is it stevia or something?

Will Bulsiewicz, MD:

It’s got monk fruit.

Lindsey:

Monk fruit, okay. Because I normally don’t like monk fruit. Monk fruit, to me, can be overbearing and sometimes weird, but it I didn’t detect any bitterness or bad aftertaste at all. It was light and pleasant and not too sweet. A lot of these things, the electrolyte formulas and whatever, it’s way too much. It was not that. I will vouch for the taste, and also the fact that if it didn’t come up, it wasn’t a typical fiber supplement.

Will Bulsiewicz, MD:

Yeah, it dissolves pretty well. You’ll see a little bit of white granular powder, and that white granular powder is the resistant starch. And that’s because resistant starch is unique, because it’s not soluble fiber yet. It’s still prebiotic fiber.

Lindsey:

Yeah. One thing I was wondering about, though, on the label, it says, I think was it maybe 5.9 grams of fiber per two teaspoons. But then it breaks it down, and it says 2.6 grams. I was confused. Which is it?

Will Bulsiewicz, MD:

Yeah, yeah. The actual serve is 5.6 grams, all right. And when you dig into the amount of actual fiber, it’s less than this, which, by the way, to me, is reassuring. And the reason why is because these are whole food ingredients. This is taking whole food ingredients, deriving a powder and then putting it into the formula, as opposed to some chemical extraction process where you are isolating the fiber and nothing else. What you end up with is that you end up with less than the 5.6 grams as actual grams of fiber. But the key, from my perspective, to addressing our fiber deficiency is not about grams. To me, it’s about a variety of different foods and feeding and fueling the microbiome to an adequate level. What we have, for example, is we have two ingredients that have human clinical trials to show what they do. And the cool thing about it is they both have been shown to improve the health of the microbiome. An example is Solnul™, which is the resistant starch, increases akkermansia levels by 317%

Lindsey:

Wow. At what dose, at 3.5 grams?

Will Bulsiewicz, MD:

Per day, which is the dose that is in a single serve of this product. Basically, we wanted to meet the standard of that trial, we included that precise amount of Actazin, which is the kiwi fruit. A very small dose has a very powerful effect. So 600 milligrams of Actazin per day, because the kiwi fruit fiber is quite powerful, is able to achieve an improvement in Faecalibacterium.

Lindsey:

prausnitzii?

Will Bulsiewicz, MD:

Faecalibacterium as a genus, not necessarily prausnitzii specifically. And then they also, more recently, published a paper discovering that it also increases Akkermansia levels, and now Akkermansia, I’m sure that your listeners have heard about Akkermansia, but this is a powerful, anti-inflammatory bacteria that protects people from inflammatory bowel disease, and there are companies that are selling probiotics, and those probiotics may be alive or they may even be dead, and they’re extremely expensive. And my argument is nothing against those companies. If they help you, they help you. That’s what I care about. But my argument is that if we could feed target and feed our own Akkermansia and help that to grow, that’s ultimately what we want. We don’t want something from the outside that passes through us. We want something that sticks. Yeah,

Lindsey:

Yeah and interestingly, I have seen clients and you see on a stool test, or on a metagenomic sequencing that they have no Akkermansia, no Faecalibacterium prausnitzii, and then it’ll come back. And sometimes this will be having not, of course, taken a probiotic for a Faecalibacterium prausnitzii, and sometimes not having taken the Akkermansia probiotic, but it can come back by feeding it even though it was below detectable levels. It doesn’t mean it’s not in there somewhere. It’s hiding up in there, maybe in the appendix somewhere, right?

Will Bulsiewicz, MD:

Oh, I totally agree. Yeah, that’s a great point on the appendix. I hadn’t even thought specifically of that. That’s a good point in my mind. The way that I thought about these things, is that because it’s not detectable doesn’t mean it’s dead, doesn’t mean that it’s totally gone but that it is below the ability of our tools to detect, which have their limitations.

Lindsey:

Yeah. Are there any other lifestyle or supplement or non-conventional interventions that are your regular go to’s in Crohn’s.

Will Bulsiewicz, MD:

I think that there’s other supplements that can be beneficial in Crohn’s disease. You mentioned the turmeric. I’m of the belief that turmeric is something worthy of consideration for all people that have inflammatory bowel disease. The starting dose can be as gentle as 500 milligrams once a day, but that’s a starting dose, and then we start to ramp it up, and quickly get to 1000 milligrams a day, and potentially more than that, potentially up to 2000 milligrams per day. I also am a believer in vitamin D. And the beauty of Vitamin D is that it can be a test-informed and targeted approach; you’re not blindly taking the supplement. You test and then you address the level. Yeah, and the goal for people that have Crohn’s disease, typically for me, I would target numbers of 40 to 60. And my observation is that vitamin D levels are consistently low in people that have dysbiosis, because there’s a connection between vitamin D and gut barrier function.

Lindsey:

My observation is that they’re consistently low in anybody who’s not supplementing, because nobody gets enough sun.

Will Bulsiewicz, MD:

Yeah, that’s true. Most people don’t get enough sun. But I also think that we are living in an epidemic of dysbiosis these days, and I think that’s part of what feeds into this as well. The other thing too, that’s interesting about vitamin D is it’s a fat soluble vitamin. Vitamins A, D, K and E are fat soluble vitamins. What that means? A few things. Number one, when you take your vitamin D supplement, take it with a fatty meal, it will improve absorption. But number two, in the context of obesity, you can have lower vitamin D levels as a result of obesity, because basically it spreads out throughout the body, and it can end up in fat cells, where it’s not even functional. It’s not helping you. Yeah. Vitamin D, again, I would target 40 to 60. But if a person were not doing testing, then I would probably, most people talk about 2000 international units per day. I’m more of the belief that we need to go higher and harder than that, because I don’t think that’s adequate. I typically would probably go at 5000 and as high as potentially 10,000 if there were a need, per day, yeah, and . . .

Lindsey:

Then testing every six months, every three months? How often would you test it if you were supplementing at that level?

Will Bulsiewicz, MD:

Trying to get them up to goal, then I would test more frequently, probably three months would be the target there. Once I have them at goal, then you make an assessment, how hard was it to get them there? Yeah, if it was hard, then you might test them a little more often, to make sure you’re maintaining it. But, over time, you hopefully settle in, you find the amount that you need, and then you stick with it. And then I also am a believer on some level, on the importance of adequate Omega 3 intake, specifically EPA and DHA. And, unfortunately, the vast majority of people; this is again, another one that you can test. It’s the Omega 3 index. And the Omega 3 index, basically, it’s a percentage, and it tells you what percent of the total body fat that’s detectable is made up of these types of omega 3s. A few things on omega 3s, real quick. Omega 3s are anti-inflammatory fats. They’re polyunsaturated fatty acids, PUFAs. When I hear people trashing PUFAs, I get a little bit bothered, because omega 3s are PUFAs. They’re good for you, whereas Omega 6s it’s a different story. And we can talk about that if you want to, we get plenty of omega 6s.

Most people don’t get enough omega 3s, and it leads to an unhealthy balance between those two fats. We want to reduce our omega 6 intake, but we really want to increase our omega 3 intake. There’s three main types of omega 3s: ALA, EPA and DHA. And the issue is that if you eat seeds, which, by the way, can be a source of Omega 3, it’s chia seeds, flax seeds, hemp seeds and walnuts, it gives you ALA, but the conversion rate is extremely poor. And ultimately, I’m of the belief that, look, if you can get your Omega 3 index up to goal, which, for a normal person, is eight to 12% and if you have Crohn’s disease, I would want you at 10 to 12%.

If you can get there up to goal without a supplement, I’m happy for you, but a lot of people cannot. This is where the choice that’s on the table is, we want an EPA and DHA supplement, and you can do fish oil, which is less expensive, or you can do an algae-based supplement. I tend to, when possible, opt for a high quality, algae-based supplement. I tend to favor the algae-based supplement for purity reasons. You can create that and it’s the Omega 3. And the problem is that when it’s fish oil, it’s not the fish that’s creating the Omega 3. It’s storing it, but it’s also storing other stuff. Unless we know that it’s pure, I have concerns. Anyway, the dosing for a person that has complex inflammatory conditions like Crohn’s disease is very high. Typically, we would start off in the range of 500 to 1000 of EPA plus DHA. But with these complex inflammatory conditions, you work your way up to two or 3000.

Lindsey:

And are we talking about krill oil now at this point, or what is the algae based one?

Will Bulsiewicz, MD:

Krill oil could suffice, basically all these things come from the ocean. Yeah. This is the long chain Omega 3s, but algae-based is not krill. Krill is an animal, and it’s own, unique thing, Whales eat a lot of krill. Algae, though, is the plant, and it could be grown in a farm and still produce high quality EPA and DHA.

Lindsey:

Yeah, so, I know with the vegan sources, it’s really hard to get much EPA or DHA without taking tons of it. It’s really expensive to get there.

Will Bulsiewicz, MD:

I think it’s becoming increasingly available, the ability to get the vegan, long chain. Again, what I’m looking at is, I’m going to turn the label, I’m going to look at it, and I want to see how much EPA and how much DHA, and I’m going to add those two together.

Lindsey:

Yeah. Is there one that you are familiar with that’s high because I’ve looked for this for clients who are vegan, and I can’t find anything that’s more than like 300 of the two of them in a whole pill.

Will Bulsiewicz, MD:

I mean, I don’t know the brand off the top of my head, I have seen them that are about 1000*.

Lindsey:

Oh, really?

Will Bulsiewicz, MD:

Yeah, no, yeah, it might be two. It might be two pills per serve, and that gives you 1000.

Lindsey:

Yeah, I use the ProOmega 2000* a lot, because one pill is 1000 EPA and DHA. It’s done.

Will Bulsiewicz, MD:

No, that’s great. And for these people, so 1000 EPA and DHA for the vast majority is a sufficient amount, but for people that have complex inflammatory issues, you’re looking for an anti-inflammatory dose, and that’s where you have to push it a little bit higher.

Lindsey:

Yeah, this has all been super interesting, but unfortunately, we’re running out of time. I do want to ask number one, where can people find your supplement, and mention that they did make a discount code for my listeners, that was PERFECTSTOOL for 10% off.

Will Bulsiewicz, MD:

Yep, the code is PERFECTSTOOL, and caps or no caps. It should work either way. If you have trouble, let us know. Yeah, if anyone’s looking to try out 38TERA, use that code. You’ll save 10%. Our website is 38TERA.com*, and you’ll find it there. And, on our website, we have a ton of resources if you want to check it out. We have a Science page, we have laboratory results. We also have a product guide that walks people through the specifics of how best to get the most out of our product. But nonetheless, go to the website, check it out. And honestly, I hope that it helps people, and if it doesn’t let us know.

Lindsey:

Awesome. Thank you much for coming here and sharing your knowledge with us.

Will Bulsiewicz, MD:

Thank you, Lindsey.

If you’re dealing with gut health issues of any type (diarrhea, constipation, bloating, SIBO, IMO, H2S SIBO/ISO, IBS, IBD, gastritis, GERD, H pylori, diverticulitis, candida, etc.) or have an autoimmune disease and need some help, I see individual clients to help them resolve their digestive issues or reverse autoimmune disease naturally, You’re welcome to set up a free, 30-minute breakthrough session to see if you’d like to work with me. I also have my own two products, Tributyrin-Max, which is particularly helpful for loose stool and diarrhea as it slows your motility and firms up your stool, and SBI powder, which is an all around gut pathogen binder, which is super safe and won’t harm beneficial bacteria, and is usually the first line of treatment I educate my clients about in order to avoid stronger antimicrobial herbs.

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

Adapted from episode 144 of The Perfect Stool podcast edited for readability with Dr. Carmen Fong, MD, Co-Director of the Hemorrhoid Centers of America – Atlanta, double board-certified surgeon in General Surgery and Colorectal Surgery, and the author of the 2024 book: Constipation Nation: What to Know When You Can’t Go*. 

Lindsey:  

So let’s just launch right in and let me ask you what the official definition of constipation is and how common it is.

Carmen Fong, MD:  

Yeah. So it’s estimated that about one in five to one in three people in America have constipation or have experienced constipation at some point in their lives. The official definition by the medical textbook is that if you have difficulty evacuating, feelings of incomplete evacuation, hard or firm stools, or you go less than three times a week. And for the other ones, it has been like more than 25% of the time you’re feeling those things. That is the official definition of constipation. Now whenever I ask patients, have you had constipation, and if I say those things, they’re like, really no. But if you’re like, do you feel like your poop is hard? Sometimes they’ll be like, yeah. I think our bodies don’t go by the textbook at all.

Lindsey:  

So three times a week, I’ve got to push back on that a little bit, and I know that is the official definition, but surely someone who’s not having at least a daily bowel movement couldn’t be optimally healthy, or eating the optimal amount of fiber, or drinking the optimal amount of water, or getting enough movement, or something’s got to be missing, right?

Carmen Fong, MD:

Exactly. So I usually go by the rule of thumb that most people in the normal, average range, have one to three bowel movements every one to three days, right? So it’s like, if you’re within that range, you’re doing pretty well, but if you’re going less than three times a week, right? That’s every two or three days, there’s definitely something that can be optimized about 89% of the time. 85 to 89% of the time, it’s actually something that we can change with behavioral and lifestyle modifications, it doesn’t require surgery or medicines and stuff like that. 

Lindsey:  

Yeah. Okay, great. So how do you think that we have as a society shame people about this basic biological function, and how can we undo this training? 

Carmen Fong, MD:    

Yeah, I think it starts from birth. So I have to tell you, like when I was writing this book, I was pregnant, and now that I’ve had two kids, I can totally see where potty training and potty shaming is a very real thing. So in my household, so even when we have different nannies and babysitters, I’m like, we do not poop shame, right? We don’t say that poop is stinky, we don’t say that it’s yucky, we don’t say that it’s gross, like it’s a normal human function. Everybody does it, and I think that the sooner we start from birth, the better. My daughter is about to turn two, and already she has this weird thing, and I don’t know where she got it from, like, being my kid, that she’s like, oh no, I have poop in my diaper. It’s yucky. I don’t want to have it changed, because I don’t want to smell it. I don’t want to have to go. And I’m like, where did this come from? Because I’m always like, hey, it’s normal. You got to go. And I think it’s some of our babysitters and some of our nannies have been like, ew, stinky, yucky. So it starts from birth. It starts from normalizing pooping behaviors from birth, and then it extends into your teenage years and adulthood, where one of the quoted articles in my book is The New York Times article about women being poop shamed and going to great lengths to not poop in public, right? So they will run to the next building so that they can go somewhere where nobody knows them. And all these things have been invented, like Poo-Pourri and a sound machine so that you basically extinguish the smell and sounds of having to poop.

Lindsey:  

Yeah, I actually had no idea that people did that until I found out a relative of mine had that issue and absolutely could not go in the same house as her boyfriend . . . well she had to have overcome that obviously when she got married.

Carmen Fong, MD:    

Yeah, exactly, yeah. And, what do you do when you get married? They’re going to find out that you poop.

Lindsey:  

Yeah, if they didn’t know already!

Carmen Fong, MD:    

Exactly, all right, yeah. It’s like there is a true fear of it, but I think most of the time it can be overcome, and societal norms can be adjusted to accommodate for the fact that everybody poops. 

Lindsey:  

Yeah. So we’re going to get into diet and supplements and medications later, but let’s start with basic bathroom habits. What should people be doing with regard to using the bathroom, sitting on the toilet, etc., if they’re constipated? 

Carmen Fong, MD:    

Yeah, so everybody should be spending two to five minutes on the toilet, max. No more, like 10 minutes in the bathroom, 20 minutes in the bathroom, reading a book, scrolling through your phone. They actually used to say in the old days, like a generation older than me, keep your library out of the bathroom. And now I’m like, keep your phone out of the bathroom. I know plenty of my patients will be like, hey, that’s my 20 minutes of me time where I can play Sudoku, Candy Crush or whatever. I’m like, can you do it somewhere else? Do it on your porch or whatever. And I get it, right, like it’s where you can hide from your kids. But at the same time, the more minutes you spend in the bathroom, the more that pressure is causing swelling in your perineum and causing anal rectal problems like hemorrhoids, fissures and whatnot. So two to five minutes on the toilet, max.

The other issue that I commonly run into is itching, itching around the anus, pruritus ani, and this is usually caused by over-wiping, where people will be like, oh, I’m having all this itching. And so I’m using hemorrhoid wipes, witch hazel wipes, baby wipes and whatnot. Those actually tend to be a little more irritating on the skin, and so usually, to break that vicious itching, wiping, itching, wiping cycle, I tell people, stop everything, but use Vaseline or Aquaphor. Treat it  really gently like it’s a baby’s butt, like you wouldn’t be scrubbing it so much if it were a baby, so don’t do that to your own butt. 

Lindsey:  

Yeah or get a bidet thing.

Carmen Fong, MD:    

100% get the bidet. Christmas is in two weeks, and I’ve actually told a lot of my patients, get yourself a Christmas present. Get a bidet. That’s actually one of my 10 bowel commandments, “Bidet is the way”. In our country, we just do not use the bidet enough, I think. And it does take care of so many problems, and really does help with feeling clean afterwards. So you’re not avoiding the bathroom, because some people also have a little bit of poop avoidance and being like, I don’t want to go the bathroom because I want to pretend that I don’t poop.

Lindsey:  

Yeah, yeah. But if somebody is having a messy enough bowel movement to have to be wiping multiple times, then they’re also not having an optimal stool.

Carmen Fong, MD:

Agreed, yes, 100% and that’s where I’m like, I love talking about the perfect stool. There is a perfect stool that is achievable. And if it’s so messy that you’re wiping eight times, it’s too sticky, you’re having too much fat or whatever.

Lindsey:  

Yeah. What are the first line interventions for constipation, meaning the least potentially harmful and most potentially beneficial interventions?

Carmen Fong, MD:    

So the first things I would start with are always fiber and water. Rule of thumb, 25 to 35 grams of fiber, a good mix of both soluble and insoluble fiber a day, and then two to three liters of water. So fiber wise, this was one of the reason why I wrote this book, is that I felt that I was telling patients 25-30 times a day how much fiber to take and what kinds of fiber. And I realized that in medical school, we really don’t discuss what kind of fiber and how much fiber. You go to the ER with a hemorrhoid, and they’ll be like, eat more fiber. And they’re like, what does that mean? And then I found that soluble and insoluble fiber is really ideal.

So a good example is an apple, right? So an apple has both soluble and insoluble fiber. The soluble is in the flesh. It’s in the pectin, which forms the gel in your colon, and then you have the skin, which is the insoluble part, the roughage, that causes a little bit of colon irritation and makes things move through. So I really think an apple a day does keep the doctor away for the most part, or at least helps with your bowel movements. And then water wise, two to three liters, and they traditionally said about eight glasses a day, which is a lot for most people, but it’s going to be even more if you’re active, if you’re in a really warm climate, or if you’re pregnant, where you’re a circulating blood volume increases by about 40%.

Lindsey:  

So I actually read in your book that for women it was less. It was something like 6.67 or . . .

Carmen Fong, MD:

Correct, yes. So it’s slightly less for women. So if you’re on the smaller female side, you can be on that lower side of 2.2 liters. I would still say, when I’ve seen pregnant women in the office, they should be closer to three liters.

Lindsey:  

Yeah, drinking for two. 

Carmen Fong, MD:    

Exactly. 

Lindsey:  

Okay. And so for fiber you’re talking about through the diet, or you’re talking about supplemental fiber?

Carmen Fong, MD:

Yep. So mostly through the diet, and I would say having a good mix of good variety of fruits and vegetables is best. So if you can, apples and oatmeal for breakfast, and lunch, just some kind of a salad. I actually hate salads; that’s my secret. I really do not like salads, but I really like cooked vegetables, because I just think that you have to have so much lettuce for there to be an adequate amount of fiber.

Lindsey:  

Yeah, it’s like an entire bowl is like a gram or two.

Carmen Fong, MD:

Exactly. So Iceberg lettuce really does not provide the fiber that you think you’re getting. And so I’m like, if you have to do cooked spinach, cooked kale, cooked broccoli, green leafy vegetables are always better. And then my go to whenever I recommend to my patients is actually sweet potatoes. So again, a good mix of soluble and insoluble fibers. It’s easy to digest, relatively low in calories, and has a lot of vitamins with it. And it also provides that bulk that some people need, because if they’re otherwise dieting or eating, but only protein shakes throughout the day, you actually don’t have the bulk to form a good stool.

Lindsey:  

Yeah, I like to say beans, because those bang for your buck, you’re not going to get more fiber.

Carmen Fong, MD:    

You’re right. That is also true. So legumes, lentils are a great source. I just know that a lot of people shy away from beans.

Lindsey:  

Yeah, they do. And I was shying away from them for various reasons. I started eating a lot more lately, and I soak them overnight, stick them in my Instapot for five minutes. They’re done. They’re ready to go. Keep them in the fridge. Just throw them on salads, make a soup, eat them as a side dish, whatever. I just did it, and I can’t tell you how much this transformed my stool.

Carmen Fong, MD:    

100% like, I’ve had patients who are like, I just started eating lentils every day. And it does work.

Lindsey:  

Yeah.

Carmen Fong, MD:    

The other thing though, is that your body gets used to the gas. 

Lindsey:  

Oh yeah, there was no gas.

Carmen Fong, MD:    

Yeah. Or, if you have a little bloating, your body actually adapts to it.

Lindsey:  

Yeah, yeah, no, I had no gas at all when I started them, given that I was soaking them and doing it properly. 

Carmen Fong, MD:    

Yes, exactly, right. So you were already soaking off the starch, yeah.

Lindsey:  

What about exercise and movement, how that relates to constipation?

Carmen Fong, MD:    

Yeah, having some exercise is important. So I usually like the moderate activity level of 30 minutes three times a week is great. But what I do warn people, because I see this more and more, is that too much exercise can actually cause a little constipation, because you’re stimulating a fight or flight response in the body. So basically, it’s a sympathetic response being like, hey, there’s a line. You have to run away. And so when all the when all your blood flow is being diverted towards your muscles and you’re trying to run away, it’s not doing the rest and digest that your stomach needs. So moderate exercise is good, but too little exercise, and you’re too sedentary, and you’re not simulating that GI motility that your body needs. And actually gravity helps too and then too much exercise is bad. So everything in moderation, including moderation.

Lindsey:  

I’m a personal fan of just moving around the house, doing the basic things like cooking and doing dishes. I don’t regret the time I spend doing those things, because that’s time that I’m not sitting on my butt.

Carmen Fong, MD:    

Yeah, I love that. And it’s just me playing with the kids or being outside doing yard work, and even just taking a walk is totally enough. I’m not saying you have to go run five miles every day.

Lindsey:  

Yeah. So if somebody just can’t seem to manage to get the fiber from their diet, are there supplemental fibers you like?

Carmen Fong, MD:

Yeah, I actually have a few that I like. And brand wise, there’s actually Coloflax*, which is a great one. It’s actually a flax seed supplement, but it has both soluble and insoluble fibers. Otherwise, most of the over-the-counter ones that you can get are fine. I think it’s just important to make a distinction. Or like, when you’re looking at the label, Metamucil tends to be psyllium husk, Benefiber tends to be wheat dextrin, and so if one of them doesn’t work for you, switch to a different one, or try one that has a combination of fibers. 

Lindsey:  

Yeah, I like to send people to just plain psyllium husk, because Metamucil has additives, it’s got food coloring and stuff you don’t really need. The psyllium husk is gross, but it’s probably gross in Metamucil too. 

Carmen Fong, MD:    

It is gross in Metamucil, most people don’t like mixing it in water and having it turn into a gel. So I’m like, if you’re going to do that [take it in less water or as a powder], just drink two glasses of water after it. I love flax seed and psyllium husk. So both ground flax seed and psyllium husk, on top of salads and smoothies, works really well. Again. I think it’s pretty good bang for your buck.

Lindsey:  

Yeah. And, of course, the flax, alpha linolenic acid. If you take enough of it, it’ll turn into your good omega threes, your EPA and your DHA. 

Carmen Fong, MD:    

The other one that I’ve heard is actually chia seeds, which is great, but having too much chia seeds can also be a problem. So I try to stay away from that. Because when you tell people one thing is good, they try to do a lot more of it.

Lindsey:  

When it comes to over-the-counter medications for constipation, which are the least harmful versus the most potentially harmful, or the ones you shouldn’t be using long term?

Carmen Fong, MD:    

Yeah, so this is always a good question. And technically, evidence wise, MiraLAX is the least harmful. It’s an osmotic laxative. So really, it just drawing water into your stool. In theory, you can take it long term without really negative effects. Obviously, people who have kidney problems, heart failure, should not be taking things that are osmotic laxatives, that are drawing too much water out of your body and causing electrolyte imbalances. But that’s the one that’s pretty safe. Senna is thought to be natural right? And so therefore it is considered to be pretty safe. It does work. But with Senna and Dulcolax, these are stimulant laxatives, and those do have an addictive potential, and so therefore those are ones that you would not want to use for long periods of time, generally, six months or more. If you’re using for the short term, once in a while, you’re like, on vacation, haven’t pooped in five days, and you really need something, sure. And in those cases, I would always try to do a suppository before you do something systemic, because you’re actually just stimulating from the rectum versus taking it from the top down, and who knows if it’ll even get down there.

Lindsey:  

Would the suppository be a stool softener? Or what would that be?

Carmen Fong, MD:

No so you can actually do either a glycerin suppository, which has both stimulating and lubricating effects, or Dulcolax comes in a suppository.

Lindsey:  

Ah okay.

Carmen Fong, MD:    

So you can actually have a stimulant laxative as a suppository. And then last but not least, you have magnesium oxide, or Milk of Magnesia. And in those cases, that is also very good as a laxative. It tends to be gentler on the stomach, but you would also not want to take those when you have electrolyte imbalances.

Lindsey:  

Okay, yeah. And what about magnesium citrate, using that longer-term.

Carmen Fong, MD:

Same, yep. So you wouldn’t want to do that with an electrolyte imbalance. But people who can’t tolerate MiraLAX, you can use a bottle of magnesium citrate, and it’ll clear you out. Now, that’s different when you’re taking the concentrated bottle, versus if you’re taking a supplement, if you’re taking Natural Calm* or something, that is okay. And actually, I love Natural Calm. I usually do recommend it. That’s the one I always recommend, too. I’ve been taking it since 2009 or something like that, when I first discovered it, and this was before I even did any poop or constipation work. And I’ve always loved it for sleep, for relaxation, and then for your bowel habits.

Lindsey:  

Yeah I find that people are very successful with that. And it’s funny, because I’m thinking, how did you not try anything like this? Like, this is everywhere. It’s all over the internet. How did you not hear about this?

Carmen Fong, MD:

Yeah, it’s really funny what people see and what people don’t see. Yeah, most of my patients have not heard of Natural Calm now that you mentioned it, yeah.

Lindsey:  

How do you feel about vitamin C or using a vitamin C flush in particular, if you’re totally backed up.

Carmen Fong, MD:

So I think that vitamin C has potential, because we know that it has antioxidants that will help with simulating the rectum. I just don’t love flushes in general. So either a total cleanse, or a high colonic, you’re going to be disrupting some anal rectal mucosa. You’re going to be causing some mild trauma or injury. And then the problem with long-term use of these things is that it disrupts the microbiome and so you might have more problems in the future with irritation, with having mucus production and things like that.

Lindsey:  

Yeah. So what does somebody do? If I’ve heard of clients who’ve said I went to the hospital and they said my entire colon is full, I’m just completely backed up. What do you do at that point?

Carmen Fong, MD:

Yeah. So say it’s that patient, it’s been like, nine days, you haven’t pooped, like, literally, on the X ray, it’s like, full of poop. And you I do a top-down approach, but then a top-down and bottom-up. So I would do MiraLAX from the top, provided they can tolerate it and they’re just not vomiting everything back up. And then I would do Dulcolax suppositories times two, and then an enema. So then you’re going to do a short, rectal enema, usually just tap water or saline, and then on more than one occasion, you might actually have to do some manual fecal disimpaction just to get that firmer ball of stool out to let everything else through.

Lindsey:  

Okay, so this is when you’re getting intervention with a medical professional?

Carmen Fong, MD:    

Exactly. Don’t disimpact yourself, please.

Lindsey:  

Are there any probiotics that you recommend to patients who are constipated? 

Carmen Fong, MD:    

So I actually love and, based on my research, this was one of the most exciting areas for me, was that there are certain strains that work better than others: Lactobacillus, Bifidobacterium, L. casei, L. rhamnosus. But it’s funny, because there wasn’t much research until after the book came out about Lactobacillus acidophilus, and it seems like that does work too. I usually recommend a good mix of strains as well. You don’t want a probiotic that’s just a few strains, and then you want more than 100 billion CFUs. The ones that I like are Physician’s Choice* or I use, I just take the Costco brand, trunature one, and lately I’ve actually really liked the brand by Seed*, which is created by Emeran Mayer, or he’s part of the board, and it has a coating that doesn’t get digested in the stomach and makes it to the colon.

Lindsey:  

Yeah, I take that one, DS-01. Yeah, I can’t take it at night, though. I tried; they say to take it at night, and I felt all gurgly and uncomfortable when I took it at night. So I just take one with a meal. They’re also kind of expensive, so I just take one a day. I don’t go for two.

Carmen Fong, MD:

They are expensive, and I think part of it is the branding. But I’m hoping that in the future, we’re going to have a lot more of these probiotic strains that are like, what do they call it now when they name the certain combination of strains, like DS-01, and then there’s one that’s like, GS-111 or something.

Lindsey:  

Patented ones. 

Carmen Fong, MD:    

Yeah, they’re patented combinations of strains. I feel like they probably shouldn’t do that, but, you know.

Lindsey:  

Yeah, yeah, it would certainly make research better if there were patented combinations. But of course, if you’ve got the patent, you don’t want to sell it to everybody else. You just want to keep it.

Carmen Fong, MD:    

Exactly but wider availability to the public.

Lindsey:  

Yeah, I don’t know if they can. I guess they can patent them . . . if they’re just a natural substance, I don’t think they can be patented. You can’t patent a bacteria because you didn’t create it. If you genetically modify it, then you could.

Carmen Fong, MD:

Right, and then if you patent the certain combination, is what they’re doing.

Lindsey:  

Although I do know that there’s definitely, maybe it’s a trademark. Yeah no, I think what they do is they trademark like PyloPass for H. pylori is trademarked, right, I think. But not patented.

Carmen Fong, MD:

That’s not patented, correct? Oh, interesting. Yeah. 

Lindsey:  

Anyway, so what about prescription medications for constipation? Which ones do you like the best?

Carmen Fong, MD:

Yeah, I would say I generally try to stay away from them as much as possible. But then when we do have to use them, either Lubiprostone or most of the time it’s actually Lubiprostone because Lubiprostone has a generic form, and so I would say that tends to work. Obviously, there’s a bunch of newer ones, and I just don’t think that they’ve really proven their value yet. 

Lindsey:  

What’s the brand name of Lubaprostin? 

Carmen Fong, MD:    

Lubiprostone is Amitizia, I think.

Lindsey:  

Oh, okay. I hear people mentioning IBSrella. 

Carmen Fong, MD:    

Ibsrella. I actually don’t even think I’ve heard of that one. 

Lindsey:  

Or maybe it’s IBSrella, I don’t know. 

Carmen Fong, MD:    

IBSrella. A lot of people take Linzess. 

Lindsey:  

Linzess, yeah, that one I’ve heard a lot about.

Carmen Fong, MD:    

Yeah, yeah. So a lot of people will come in and they’ll be like, oh, I had constipation for one day, and, you know, somebody threw me on Linzess. The problem with Linzess is that it does take a while to work, right? So it’s not like you could take it for one day and it starts working, and then once it starts working, it almost works like an osmotic laxative, draws all the stool in and then some draws all the water in too well, and then starts giving you diarrhea. So then you have to titrate the dose. So I wouldn’t say that it doesn’t work. It’s just that you have to titrate a little bit better. And then in some people, if you’re not drinking water, it still won’t work for you. 

Lindsey:  

So lots of people tell me they drink coffee, and that immediately stimulates a bowel movement, and often a loose one. Is coffee good for us in this respect?

Carmen Fong, MD:    

Yeah, yes. You know, that was the whole chapter in the book. And there’s technically no research that says coffee makes you poop. But there are certain compounds, the phenyls in coffee actually can simulate your GI tract motility. And there’s also the added effect of warm water stimulates better GI tract motility. And so I tell people, if coffee works for you and you drink one cup in the morning, or it’s a Pavlovian that you smell coffee and you immediately have to go the bathroom, then that’s great. But otherwise, if you’re drinking coffee, only coffee exclusively five times a day, and not drinking any water, it almost has, I call it a negative water effect. You’re minus one cup of water that day, because the caffeine is actually dehydrating you, and you actually need to drink more water to compensate for it. So bottom line is, I would say coffee is great. I love coffee, one cup a day, if you can. We use it for both the simulating effects and the warm water effects of going to the bathroom. But you can’t drink only coffee, and can’t drink only iced coffee. But people would be like, Oh, I only drink iced coffee all day. And I’m like, There’s no nutrition in that. What do you think about coffee? 

Lindsey:  

I don’t drink coffee, so it’s not an issue for me. I just never was a coffee drinker. I never liked the taste.

Carmen Fong, MD:

Yeah, no. And I love green tea. And honestly, I think green tea is very good for you.

Lindsey:  

And any number of illnesses, I’ll be like, oh, I wonder what supplements go with that. And I’ll look it up. And I’ll be like, oh, green tea. EGCg, yeah, so many good things. 

Carmen Fong, MD:    

Exactly, yeah. 

Lindsey:  

And I happen to have a cup of it every morning, so I’m like, yay for me. Okay, you mentioned that colonics and such might be bad for us. What about the colonoscopy prep? I always thought, I don’t want to get a colonoscopy because I’ve been working so hard on my microbiome, I don’t want to wash it all out. Is that dangerous to our microbiomes or do they recover?

Carmen Fong, MD:    

They do recover. I’ve seen where sometimes it takes almost six weeks to recover and you go back on probiotics if you were on them, or you start taking probiotics if you weren’t on them. It’s actually like a post colonoscopy prep syndrome that is starting to become more recognized. Because at first, people would be like, what are you talking about? You can’t poop after your colonoscopy, but that’s not a thing. First of all, you have the fact that you’ve been completely cleaned out, so you have no solid substance in your colon right? So if you can’t poop for two days afterwards, that’s totally normal. But then your body goes into this mode of being like, hey, we don’t know what we’re doing anymore. There’s nothing in here and all that regular microbiome is gone, been totally washed out. So I just usually tell people, resume your regular diet as soon as possible.

And if you can actually see if you can find a gastroenterologist or colorectal surgeon who does colonoscopies, allowing either soft foods or bland foods the day before, so you have some substance. There’s actually a brand called Happy Colon Foods. I don’t know if you’ve heard of it, but they actually make a bowel prep that’s gentler on the stomach. It’s mostly Senna based, so stimulant laxative, but they allow you to have crackers and then clear soup and stuff like that, things that are low fiber, so that it can be washed out slowly or completely, but that you can also have something in your colon, and it is gentler on the colon, on the intestinal tract.

Lindsey:   

Okay, good luck with that, with insurance and everything else, picking and choosing your doctor on the basis of the colonoscopy prep. But I love it in theory.

Carmen Fong, MD:    

Yeah no, when I talked to them, it was actually a huge thing. I was like, if insurance doesn’t cover it, nobody’s going to use it. I wish that insurance would cover these things, but I wish insurance would cover a lot of things. So that’s a whole different issue.

Lindsey:  

Yeah, so you might actually just disobey your doctor and go buy it on your own. Is it available over the counter?

Carmen Fong, MD:    

Yes, you can buy it online. I think it’s 38 bucks. You can buy it online. And then what you can actually do, though, is tell your doctor and say, hey, are you okay with this prep? This is the evidence for it. I would allow it 100%.

Lindsey:  

And what about using a colonoscopy prep if you’re totally backed up?

Carmen Fong, MD:    

Yes, you can do that. So polyethylene glycol actually is the same stuff that MiraLAX is made out of. It’s just that MiraLAX comes in 17 gram powder form and GoLYTELY, comes in four liters. So if you’re going to be drinking four liters of any fluid, you’re probably going to get cleaned out anyway. I would say, if you’re that backed up, you can try colonoscopy prep, but start with MiraLAX and just up the dose.

Lindsey:  

So I have a confession to make. I had a colonoscopy about a year ago. Didn’t finish the prep stuff. I just I was like, listen, it’s been pure liquid for the last eight hours. I’m not taking any more of this. This is absurd. Yeah, no, and that was fine. It was totally clean.

Carmen Fong, MD:    

Yeah, it’s really a lot. It’s actually a little bit of overkill. But when I was a fellow, I can’t tell you how many times people called me at 3 am being like, please, I cannot finish this prep. Like, I’m throwing it up, I’m pooping all over the place, and I’m like, It’s okay. Most of the time it’s going to be okay. Four liters is more than the amount you need, but they also make some better in divided doses now, like two bottles or something, and then you add some Gatorade in between. So there’s options, less torturous options.

Lindsey:  

I did not tend towards the constipated, so I knew I was going to be fine. And I was like, this is the end. I’m done with this.

Carmen Fong, MD:    

I wouldn’t think you were, that you tended toward constipated.

Lindsey:  

So, I saw you had a chapter about fecal incontinence in your book. Can you talk about why that may happen in someone who’s constipated,

Carmen Fong, MD:    

The most common reason is that you have overflow incontinence, and that means that if you’re backed up and you have a stool ball inside your colon, if you try to eat other things, drink a lot of liquid, do MiraLAX, the liquid stool will actually just flow around it and flow out of your anus. And so it seems like you’re incontinent because you have some mucus and stool leakage, but you’re really backed up. You can usually tell this by history, though, that people are saying, okay, I’m having some incontinence, but I’m also super bloated. I feel like I haven’t had a full bowel movement in days. It’s more likely going to be overflow incontinence, rather than true incontinence. The other things that would distinguish it would be on an intenal exam, when I’m feeling and your sphincter tone is completely fine and there’s no signs of damage or whatever.

Lindsey:  

Okay, so if you were having that and you weren’t constipated, then that would be the time to see a doctor and find out about your sphincter tone.

Carmen Fong, MD:    

Yes ma’am, yep, exactly. So, the most telling thing is if you sneeze and you end up having an accident and or you’re having accidents at night.

Lindsey:  

Okay? And what can one do about loose sphincter tone? 

Carmen Fong, MD:    

The first thing is actually add fiber, which is weird, right? But I always tell people that people think that you take fiber for constipation, but it firms up loose stool just as well as it softens hard stool. So start with a fiber supplement. Start drinking a lot of water, especially if you’re losing a lot of fluid, bulking up will work. And then we start going into the medications and stuff, which is like adding ammonia, adding to again, slow down the stool. But then after that, it’s a couple of things, pelvic floor physical therapy, usually, to assess the muscles and strengthen the muscles. If you see me in the office, I might do anal manometry, which is a test of a sphincter tone and the nerves around it, to see if there’s really any damage that can be repaired.

And then, in the old days, you either would have to do a sphincteroplasty, which tightens the sphincter and/or some other major surgery, but these days, we actually put in a sacral nerve modulator, an SNM or an SNS device, which stimulates the s3 s4 nerves and helps that muscle contract. It actually works really well. It’s shown to work about 92% of the time. It works better for people with incontinence than constipation, but there is some evidence that also works in constipation, and especially mixed constipation and incontinence.

Lindsey:  

So you mentioned mucus in the stool, and I know you know that excessive mucus coming out and often with blood, is very common in colitis. But what else could be causing it in people without IBD, and is a certain amount, like enough for the poop to slip out nicely, normal?

Carmen Fong, MD:    

Yep, exactly. So IBD, bloody ,mucusy stool is a sign of ulcerative colitis, but your body actually physiologically produces mucus in the rectum, and that’s what makes a stool slippery. That is also one of my other favorite chapters, which is how much mucus it takes to make your stool slip out. All mammals poop in 12 seconds because of this mucus layer in the rectum. So normal mucus is physiologic, is normal, but you shouldn’t be seeing a ton of it. When you see a ton of it, there’s usually one of two reasons. And the most common one, I think, is over wiping. And so when people try to wipe the inside of the anus, it actually stretches that mucosa out a little bit. It causes mucosal atrophy. And since that pink layer is on the outside, you actually see more mucus on the outside. And then the other thing is either using enemas or colonics, because you’re disrupting that mucus layer and literally ripping it off, and so you’re dripping mucus out.

Lindsey:  

Okay. And what about if somebody’s not done those things? Could it be just inflammation?

Carmen Fong, MD:    

It could just be inflammation. You can have a small amount of mucus if you’re sick too, if you have a viral illness and some inflammation in the colon.

Lindsey:  

And what about, so often people are using biofilm busters, is that something that causes mucus to come out?

Carmen Fong, MD:    

I think that biofilm busters tends to be, it really shouldn’t, but I think that if you are using it very frequently, then yes, because anything that disrupts that that microbiome layer in the rectum and anus.

Lindsey:  

Okay, so what causes hemorrhoids and anal fissures and how are they treated?

Carmen Fong, MD:    

Yeah. So hemorrhoids are free bundles of blood vessels that are in the human body. Everybody has them. Everybody’s born with them. When they become symptomatic is when we start to treat them, when they become a problem. So internal hemorrhoids are above the level of the sensory nerves or above the dentate line, which generally means that they tend to be painless bleeding, but they can do a couple things. They can prolapse, so they can pop out of the anus, and then they can bleed, and generally, again, painless, though.

External hemorrhoids are below the level of the dentate line, and so they tend to be more painful, but not bleeding, because they form a little blood clot on the outside, and it feels like a blueberry or a grape. So it can be extremely painful, but usually no bleeding. And then you can have fissures, which are somewhere in the middle, and these tend to be both pain and bleeding. Most of the time, people will come to see me and they think that they have hemorrhoids, but it’s really a fissure, right? Because pain prompts people to go see the doctor more than anything else. Things that make hemorrhoids worse: constipation, but also diarrhea. So constipation, because you’re straining, you’re sitting on the toilet. Any amount of intraabdominal pressure, or you’re putting more pressure on the perineum, will make those blood vessels engorge, to swell to the point where they might pop out and bleed. Diarrhea, because you’re going so often that it’s irritating the anal and rectal lining. Technically, it’s the anus. And then you’re wiping more often as well. So I’ve actually seen patients where they’ll be wiping often because of going to the bathroom seven or eight times a day. Sometimes people with IBS, they’re causing external hemorrhoid thrombosis, you’re tearing that skin in that blood vessel.

Fissures are the same thing, sitting for too often, more than two to five minutes on the toilet. But the one other thing that causes fissures, which is a little bit different, is actually stress. So young people, and actually, I think all people these days, we hold our stress in our pelvis. So literally, we walk around squeezing our butt so tight, and we don’t realize it, and when you’re squeezing that butt tight, it actually constricts the blood flow, so that if you do have a little cut or a tear in there, it can’t heal. So one of the primary treatments we do for that is actually apply a topical ointment that gently relaxes that internal sphincter, that smooth muscle, so that the overlying tissue over it can heal, yeah. So basically, everything that causes hemorrhoids and fissures are similar, except for the stress. So sitting too often, long plane rides, long car rides, sitting on the toilet.

Lindsey:  

Pregnancy for hemorrhoids. 

Carmen Fong, MD:    

Pregnancy! Yes, the gift that keeps on giving, pregnancy. Yes, for hemorrhoids.

Lindsey:  

So when should someone seek out the help of a pelvic floor therapist? Is that something they would be referred to always from a doctor? Or is that something they can do on their own?

Carmen Fong, MD:    

You can actually go on your own these days, if you feel like this is something you need. A lot of places I’ve talked to, you can just walk in and tell them the problem you’re having. I refer a lot to pelvic floor PT for a variety of reasons. It used to be mostly for fecal incontinence, because they can strengthen the muscle. But these days, it is for a lot of pelvic floor pain and anal fissures that are a chronic pelvic floor contraction, or levator ani problems. 

Lindsey:  

What’s that?

Carmen Fong, MD:    

Yeah, so levator ani syndrome is where you either feel pain in the butt when you’re having a bowel movement, or it hurts for hours afterwards. Classically, it’s always on the left butt cheek because there’s a little trigger point right there. It usually comes from sitting too often. So you’re just actually putting a lot of pressure on this muscle, and the muscle is just continuously contracted. Things they can do to help that at pelvic floor physical therapy are leg stretches, hip stretches, back stretches, but then also some internal massage, some biofeedback, which is where they put a either like a balloon sensation, like a little probe inside to say, hey, you should breathe like this, and when you relax, you’re expanding your intra-abdominal cavity and relieving the pressure on your pelvis.

The other thing it does is actually retrain your brain how to go to the bathroom. When you go, some people will have what’s called a paradoxical contraction, where, over time, we were talking about poop shaming before, you actually just hold your muscle in so tight that it forgets how to relax. And so even when you go to the bathroom, most people, their anal canal and their anus should open when you go to the bathroom. Some people, when they try to push, it actually closes, so retraining your brain to open that when you go to the bathroom. Yeah, that’s actually one of the main things I send for.

Lindsey:  

Okay, so when should someone be concerned that their constipation could be indicative of something more serious, like cancer?

Carmen Fong, MD:    

Yeah, it has to be a constellation of symptoms. And I would say that constipation, in and of itself, is not a great symptom. But if it’s been chronic, if it’s been over like three to six months or so, I would say, definitely get a colonoscopy. If you have other concerning symptoms, like obstipation where you’re not farting at all, that tends to be a pretty late stage tumor where it’s completely obstructing, then go to the ER. Do not pass go. Do not collect $200. But the other thing, if you weren’t completely obstipated, would be blood in the stool. 

Lindsey:  

If you weren’t completely what?

Carmen Fong, MD:    

Obstipated, so not passing gas either. 

Lindsey:  

Okay.

Carmen Fong, MD:    

Yeah, yeah. If you’re not passing stool and gas, go directly to the ER, but if you are passing stools, passing some gas, but still chronically constipated, if you have blood in the stool, unintentional weight loss or a strong personal or family history, then I would seek some earlier medical attention and say, get a colonoscopy.

Lindsey:  

Yeah, and constipation is, in and of itself, a risk factor for cancer, right? Not just colon, but other cancers.

Carmen Fong, MD:    

It’s funny, because it is a sign of inflammation, right? And does cause some colonic irritation. As far as I know, there’s no direct link to colon cancer, but I think that’s going to change. We know that there’s a two-hit hypothesis for colon cancer, which is that you have to have the genetic predisposition and then a second factor, and if constipation and chronic irritation is a second factor, you have a good chance. I think our society’s diet and exercise does not help our cause at all.

Lindsey:  

Yeah, no, I thought that it was a risk factor for breast cancer, because you just have these toxins sitting there and not getting out of the body.

Carmen Fong, MD:    

Correct, yes, for breast cancer, it is. It’s not a direct risk factor for colon cancer, though. 

Lindsey:  

Okay.

Carmen Fong, MD:    

Yeah, yeah. I know I’ve looked and looked because I really thought it would be and there’s no evidence for it. 

Lindsey:  

Okay, they changed the age that you’re recommended to do a colonoscopy to 45 didn’t they?

Carmen Fong, MD:    

Yes, they did. Yep, it’s 45 now.

Lindsey:  

What was that about?

Carmen Fong, MD:    

So this was about, I think it was two or three years ago. Now, remember, it was just after COVID. It’s been about three years. It’s changed to 45 from 50. So it’s 45 if you have no other risk factors. So 45 is when you start screening and getting a screening colonoscopy. If you have any family history of cancer, colon cancer, it’s going to be 10 years before the youngest age of diagnosis in a first-degree family member, which means that if your mom was diagnosed with cancer at the age of 45, you would go get screened at 35.

Lindsey:  

Okay, and given you only get screened every 10 years, right, is it that it’s just super slow growing, or why so infrequently?

Carmen Fong, MD:    

Correct. It used to be that we have our adenoma hypothesis, which is that these polyps turn into cancer, and so by the time it’s 10 years, you could conceivably catch it again. I think a lot of it is changing, though, in clinical practice. Most providers will do every five years even, because we’re finding a lot more young people with colon cancer. So actually, it’s been in the headlines lately that people younger than age 45 are getting diagnosed. They’re the fastest growing population of people with colon cancer in the country. Again, I think diet and exercise and calcium and vitamin D levels, but the other things I should add are, generally, if you have any polyps on a previous colonoscopy, you’re going to be three years before follow up screening, if you have three polyps. Five years for one or less polyps, and then usually between 5 and 10 years if you have a history of IBD. So 8 to 10 years of IBD is a high risk factor for developing colonic dysplasia.

Lindsey:  

Okay, yeah, as I said, I didn’t really want to do the colonoscopy, so I did the Cologuard first, because I thought, I’ve never really been regularly constipated, so maybe just get away with this. And then I thought, okay, Lindsey, suck it up. You’re a gut health specialist. Just get your colonoscopy.

Carmen Fong, MD:    

Was your Cologuard negative?

Lindsey:  

Yeah, the Cologuard was negative, but I waited three years, and then I did the colonoscopy. 

Carmen Fong, MD:    

Ah, okay, okay, yeah, I think that when you have low risk, Cologuard is totally fine as a screening test. Again, 92% sensitive, right? So it’s really not bad. It’s just that if you do have a positive Cologuard, you end up having to get a colonoscopy anyway.

Lindsey:  

Yeah, but a poop sample. This is not a big intervention. That’s not a big ask. I’m not like, oh, I ruined that whole thing by getting the Cologuard. 

Carmen Fong, MD:    

I know, you know, what’s funny, though, is that I have sent Cologuards, and patients will be like, I do not want to put a poop sample on a card. And I’ve had patients who left it. They’re like, oh, it’s on the kitchen counter. It’s been there for nine months. And I’m just like, can you please do it and send it in? Whereas, if I schedule a colonoscopy, you have to come in on this date and do a prep, they will come in and do it because there’s a deadline. Maybe I have to put a deadline on the Cologuards.

Lindsey:  

Yeah, yeah. This will explode if you do not use it by this date.

Carmen Fong, MD:    

Correct, yeah. They should put that on the box.

Lindsey:  

Yeah, that’s true. No, my own husband, said he went through the Cologuard process, and he’d rather just do the colonoscopy the next time.

Carmen Fong, MD:

See? Yeah, people are like, I don’t want to put poop on my card. 

Lindsey:  

Yeah.

Carmen Fong, MD:    

In Europe, in the UK, they’re actually starting to screen a little bit sooner, which I think is totally necessary. There was one study where they tried to screen kids who are 25 to 35 with just the stool-based immunohistochemistry testing, FIT tests. So again, like a little bit of a poop on a card, where if it’s a positive, then you get a colonoscopy, and if it’s negative, then you can continue on for a few years. And then scope or do the test again later. But at least it’s a low-cost intervention, and we’re screening earlier because of these earlier incidences of cancer; I think we need to go to that.

Lindsey:  

Yeah, yeah. Certainly no reason we should be getting colon cancer these days. I wish I could say that about any kind of cancer, but at least we have some interventions that aren’t too hard for diagnosing colon cancer compared to some of the others.

Carmen Fong, MD:    

Agreed. Yeah, yeah, 100%.

Lindsey:  

So anything else you would like to share with my audience before we go?

Carmen Fong, MD:    

Yeah, I think because this is called the Perfect Stool podcast, I’ve been thinking about it a lot; the perfect stool is achievable. I think that a little bit of tinkering, a little bit of knowing your body, but generally the ideal stool actually, you go to the bathroom two to five minutes, it’s out. It’s not sticky, it’s not too wet. You don’t have to wipe 18 times. It’s not too hard and irritating, and it comes from a good diet of fiber, soluble and insoluble fibers, water and generally, some probiotics. And once you get to that point, I actually am a firm believer that your body will go on autopilot and will be like, okay, most of the time. Like you have one hiccup now and then, but it’s much easier to get back on track when you’re doing good, and it has to do with the microbiome. And then last, but not least, my one bowel commandment is go when you have to go and don’t go when you don’t have to go.

Lindsey:  

Okay, great. And your book, I will just do quick show. I’ve got mine here, Constipation Nation.*

Carmen Fong, MD:    

Did you like it? 

Lindsey:  

Yeah, yeah. It’s been great. I’m about halfway through, I have to confess, but I did start paging through to get the questions ready, because I have a book club that’s been taking up my reading time. So I don’t have much time for work related reading.

Carmen Fong, MD:    

I totally get it. I think it’s actually been doing pretty well on Amazon, but the only person I know who finished it is my dad. And actually, one of my patients told me she read the whole thing the other day because she was asking me really specific questions about my wife being pregnant. I was like, wait, how do you know that? And she was like, it’s in your book. And I was like, what?

Lindsey:  

Yeah, that is unusual, because most people don’t know anything personal about their doctors.

Carmen Fong, MD:    

Oh, I know it is weird, but also, I knew this going into it, that my patients will be like, oh, the book, it just sounds just like the way you talk, and that’s how I wanted it to be. 

Lindsey:  

Yeah. 

Carmen Fong, MD:    

Yeah. Well, thank you so much for having me.

Lindsey:  

Yeah. Thank you so much for being here. I really appreciate you sharing your knowledge. 

If you’re dealing with gut health issues of any type (diarrhea, constipation, bloating, SIBO, IMO, H2S SIBO/ISO, IBS, IBD, gastritis, GERD, H pylori, diverticulitis, candida, etc.) or have an autoimmune disease and need some help, I see individual clients to help them resolve their digestive issues or reverse autoimmune disease naturally, You’re welcome to set up a free, 30-minute breakthrough session to see if you’d like to work with me. I also have my own two products, Tributyrin-Max, which is particularly helpful for loose stool and diarrhea as it slows your motility and firms up your stool, and SBI powder, which is an all around gut pathogen binder, which is super safe and won’t harm beneficial bacteria, and is usually the first line of treatment I educate my clients about in order to avoid stronger antimicrobial herbs.

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

Adapted from episode 143 of The Perfect Stool podcast edited for readability Juanique Grover, founder and owner of Provo Health Clinic in Provo, Utah, host of the Gutsy Health Podcast and owner of Gutsy Health Academy.

Lindsey:  

So one of the things we talked about in our pre-interview call was about how you came to be involved in functional medicine and found your own clinic in Provo, Utah. So, can you share about that for my listeners? 

Juanique Grover:  

I definitely can, just so listeners know I am not a doctor at all. I am actually a college dropout. And how I formed a clinic, it’s a long story, but I’ll try to shorten it. My history is I grew up in South Africa, and my mom, she was a practitioner of complementary medicine, which is like a homeopath, and we immigrated to the United States. So natural healing is in my blood, it’s in my bones, right? Like I watched my mom teach many students how to be practitioners of complementary medicine, and she was always using essential oils and herbs and supplements and whole foods and whatnot. So that was just a part of my life.

And so my story is, I got Grave’s disease with my first child, and the doctor was like, “you have to be on all these medications”. And I was like, “wait a second, give me like six months, and I’ll reverse this”. And I had one doctor laugh in my face. He was like, “that will never happen. You can never reverse Grave’s disease.” And I was still young and very naive. And I was like, “of course you can” right? Like, I’ve seen people heal from things all the time because of my mom’s history. So truly, in six months, I reversed my Grave’s and got back to normal again.

But a year after that, after my Grave’s healing story, my husband was diagnosed with stage four colon cancer. He was 33 years old. I was pregnant with my second child. I was 20 weeks pregnant, 21 weeks pregnant, and for people that have had a diagnosis like that, especially at such a young age, it is such a shock to your body, your soul, your heart, your nervous system. You’re absolutely wrecked because you did not see this coming, and there were no symptoms other than he had a difficult time pooping. Turns out he had a giant tumor blocking his rectum, and so that’s why he had a difficult time pooping. But health-wise, he seemed fine, normal.

So we did the mainstream route, even with everything that we knew, we were so scared. He had four surgeries in a year. He did 40 rounds of radiation on the tumor. He had an ileostomy bag, so he had an ileostomy and an ileostomy reversal surgery. He did chemotherapy, but he only did six rounds, because it was creating severe neuropathy, and so he stopped halfway through. And after all of this work and all of this mainstream medicine, a year later, we find out that it’s not working, that his cancer is spreading to his lungs. And it was stage four all this time, because they were hoping it was only stage three, and the spots in his lungs were just nothing, but it turns out the spots started to grow. And so they’re like “so you get to do chemotherapy for the rest of your life. You don’t have a lot of time. Sign the papers, sign your life away.” And my husband was about to sign this paperwork when I was like, hold the phone. I was like, let’s go home and talk about this, like there are other options. And that’s when my brain turned on, and I was like, “let’s go,” like, “they’re giving you this horrible death sentence of chemo for the rest of your life until you die, that will, for sure, kill you, there are other options.”

And so we started to research other options. And as I’m diving in my research and literally days and hours of research, I’m looking at these clinics outside of the country, and I’m seeing what the common denominators are, and I’m seeing hyperbaric and research around hyperbaric keep popping up, hard shell hyperbaric, the real kind, not soft shell kind. And we’re looking at ozone therapies, and we’re looking at nutrition and herbs and supplements. And I was like, I think we need to buy you a hyperbaric chamber. And then he’s doing research, and he’s like, maybe we should buy this ozone sauna. And then we start doing supplements and CBD, and we’re buying all of these things. We’re like, why don’t we just create this tiny little clinic for other people with your diagnosis to utilize these therapies for a very affordable price? So that way we get to service the community, and we get to create a community. So we did. We had this little hole in the wall where we had our little hyperbaric chamber, and our ozone sauna, and one hyperbaric chamber turned into two. And then we started doing blood work. And we started doing – once you own a clinic, all the companies open up to you, right? They’re like, oh yeah, come to our training. Come to our seminar, come to this and I didn’t have any credentials, mind you, like my husband, he had a PhD in psychology, or he was finishing up his dissertation, he was six months away from finishing his dissertation to get his PhD. So they took him on his credentials and his master’s degree, and I just tagged along. So I was not self-taught, because I obviously went to all these trainings, but pretty much self-taught.

And so we created this incredible clinic, and my husband, I started a podcast with him, because he was such a genius, like Tristan Roni was probably one of the most brilliant people in every room that I entered. He was so intelligent, maybe borderline spectrum intelligent, like he just understood – he was a walking, talking encyclopedia. He was AI before AI was actually a thing. You could pick his brain about anything, and he had the answer for you. Like he was this beautiful human with this beautiful mind. And so we started this podcast where we’re learning all these cool things. People need to know it, right? So we just started a podcast to service people, and it grew. It became a top 10 podcast within six months. It was insane. And again, not a lot of people had podcasts back then. 

Lindsey:  

What was it called? 

Juanique Grover:  

The Gutsy Health Podcast, the one that you were on. 

Lindsey:  

It’s the same name, okay, 

Juanique Grover:  

Yeah, so it’s the Gutsy Health Podcast. And so, long story short, that’s how we started a clinic. Truly we fell into it, and it just grew and grew, and people just really resonated with the story of these people, me and my husband, fighting for autonomy over our bodies, like self-empowerment, healing on all levels. Unfortunately, Tristan didn’t live. He died, but he lived a lot longer than they were expecting, and he had quality, and that’s the thing, he had quality. And so we had this beautiful life together. We lived 10 lifetimes in the five years that he survived his cancer.

And so that’s how, I told you, it was a long story, and I’m sorry but, I just want people to realize, your limitation on how you can learn and grow and heal yourself doesn’t begin and end with your doctor, and it doesn’t begin and end with someone with credentials. You have everything at the tip of your fingers. You can access any course, any information to learn how to heal yourself, because hundreds, if not thousands, or hundreds of thousands of people have done it before you, and they’re not doctors, and they’re not MDs; they’re just people like you and me. So I love the story and the origin story of Provo Health, because really, anyone can do wonderful, miraculous things, right? Again, college dropout here, and yet I started, miraculously, one of the largest clinics in Utah, and it’s still going strong. And now we have a doctor on site. We have a nurse practitioner, five coaches, and it’s fun. It’s a fun journey.

Lindsey:  

That’s amazing. And when you started the podcast Gutsy Health, were you talking about the gut, or was it just “gutsy” as in courageous?

Juanique Grover:  

Gutsy as in courageous, although we did specialize in digestive health, so it was like a double entendre. Get gutsy about your health, and also, let’s talk about gut health, but we spoke about thyroid and hormones and cancer and treatment; we spoke about everything and anything, and we still do.

Lindsey:  

Yeah, yeah, that’s amazing. So your Grave’s disease, how did you reverse that? And did you have gut issues along with that?

Juanique Grover:  

So my Grave’s disease, what I did, I don’t think I had gut issues. I had nervous system dysregulation. I wasn’t sleeping, I wasn’t eating a nutrient dense diet. And so really, when I learned that I had Grave’s disease, I read this book, I can’t remember the title, but it was all about hyperthyroidism and Grave’s disease, and so it was my Bible for six months. And I was like, cut out gluten, done. Cut out dairy, fine. Take these supplements, okay. So I really just decreased my inflammation. I prioritized rest and sleep and doing less. Because I was like this type A personality, and so I was like, oh, I can’t keep going.

What’s interesting is, when you have Grave’s, you actually don’t sleep. You have energy for days, your heart rate is like 120 to 148 beats per minute, and you feel like Superman, right? You’re like, I can do everything. So I was going 10,000 miles an hour, and I realized, oh, I can’t, because I’m actually getting weaker and sicker. So instead of it being like, this is my superpower, I was like, oh, this is going to kill me. So I forced myself to slow down. And then again, nourishing my body, trying to regulate my nervous system. Doing less is really what it took. And this is one thing that I don’t talk about a lot, but I one million percent believe that I was going to do it. And so I did, right? There were no messages given to me as a child of, oh, the body’s just designed to break down. From young I was taught the body heals itself. The body can do miraculous things when you give it the right food. And so that was my course, and that was my belief system. And I was like, let’s go, let’s just reverse this the way other people do. So I feel like that was a little bit of a superpower, right there. I was like, I didn’t get caught up in the naysayers that were like, oh, you will never do that. I one million percent believed I was going to reverse it.

Lindsey:  

Yeah, that’s funny, because I have very similar story with Hashimoto’s. I thought the same thing, and I’m not sure why I had that thought, but I guess I’ve always thought that there was certainly power in nutrition, but I hadn’t been deep into the functional medicine community but had dabbled in like reading about FMT and those kind of things. I was thinking that it was going to be my salvation, but did not turn out to be my salvation in particular, but in any case, yeah, I also found a book and just healed myself.

Juanique Grover:  

You’re like, yeah, here’s the path, let’s go. It’s funny because my nurse practitioner, when I came back, she’s like, oh, you’re fine. She’s like, you should write a book. I’m like, no, there’s books already written. I’m not going to reinvent the wheel. They exist. Just go read them.

Lindsey:  

Exactly. So I understand you’ve got a particular order of healing that you follow when working with people. Can you share about that and how you developed it?

Juanique Grover:  

Yes, so after all these years of researching and podcasting really brilliant minds, it truly just hit me like overnight. It was like everything- you know how in your head, you just keep thinking about things, and it just, it was almost like presented to me after one night, maybe in a dream, I don’t know, but I started writing down this order of healing, not fully understanding all that it meant, and I wrote it down, and then I just started researching every little bit. And I was like, this all makes so much sense. And so ever since writing down this order of healing, I’ve created an entire course teaching people the order of healing, because I was realizing that people were getting lost in the details. And they’re like, well, I have hormones, and I have this and but I’m starting at my hormones. I’m like, no, no, there’s an upstream process. And if you start upstream, everything else becomes easier.

And so the order of healing, I feel like it was just given to me. And so what it is number one is mindset. The reason why mindset is number one is because if you are in sympathetic dominance, you’re stressed all the time, your brain is going to sabotage any kind of healing modality or supplement you ever try to put in your body, right? So, this is the person that has two steps forward, two steps back, two steps forward, two steps back. They’re jumping around from doctor to doctor to doctor, doing all the things right, and I put that in air quotes, right, like they’re doing everything right, but nothing is working for them, and they’re spending tens, if not hundreds of thousands of dollars in treatments, and they’re still stuck, and that’s because you’re doing all the right things, but your brain is literally in a sympathetic dominant response, which is going to signal every single cell in your body to shut down and hibernate and be in this inflammatory state where it’s not producing ATP and your mitochondria are not working optimally, and that’s a problem long term, right? And so if you can, one, get your brain on board to signal every single cell in your body to be in a healing response, to not feel endangered, to not go into hibernation. Then when you do the treatments, when you do the supplements, when you do the cell care exercises, everything actually starts to work. And so it’s not two steps forward, two steps back, it’s two steps forward, two steps forward, two steps forward. But again, you have to get your mind on board for that.

Now, mindset is way more complex, because there’s limiting belief systems and their subconscious patterns. And so I want to share, can I share an example of mindset? I had a dad come in. He has young children, and his wife sent him in to come see me last week, and he’s a workaholic, and he’s always so stressed, and he’s always in fight or flight all the time, and he doesn’t sleep well. And I was looking at his blood work and he’s pre-diabetic, metabolic syndrome, even though he eats well and he has curbside appeal, he looks great on the outside, but his metabolism is slowing down, and his hormones are getting more messed up, and so on and so forth. And so I was talking to him about how he can eat better, and he’s like, yeah, I don’t know why I self-sabotage though, and I don’t know why I start going to the gym to take care of myself, but I always end up just working like a workaholic. And I was like, well, who was it, was it your mom or your dad that taught you that to love your family is to be a workaholic? And he was like, whoa. No one’s ever asked me that. And he took a second, and he was like, my dad was a workaholic, and that’s how he showed up in love for us, and I’m like, so that’s your work, right? It doesn’t matter what I tell you and how to live your life, that subconscious belief pattern is going to hijack everything that you try to do. So you have to work on that belief system that I work myself to the bone, because that’s how I love my family and so healing and mindset and turning the brain into a different machine to work for you sometimes takes looking back at your patterns and looking back at what beliefs were given to you that you are unconscious of, and re-patterning your brain to do the opposite.

And that can take months, if not years, because we’re creatures of habit, and we are in a habit of acting a certain way, because that’s what our parents did, or that’s what someone we looked up to did, or a spouse or a sibling. And so that’s why mindset is key in any healing journey, because it will sabotage any efforts you do if you do not get your mind and your nervous system on board with your healing. So mindset is number one. Did you want to add anything to that before we move on?

Lindsey:  

I did want to throw in a few comments. That was amazing insight that it’s at the top of it, because I often will be working with people and we’re just knocking off the physical stuff. I’m like, okay, we’ve done so many rounds of antimicrobials. You’re now sleeping better, you’re exercising, like everything, your diet’s in place, etc., but you’re still not getting better. And I’m just like, I think it’s the fact that you’re under constant stress, and often it’s the nature of the person, like that is just the kind of personality they have. Then that’s when I start to say, okay, look at these other programs, or look at the Gupta program, or look at hypnotherapy, or look at Trauma Informed Counseling of some kind, because you may have some work to do there that I’m not going to be able to do with you.

Juanique Grover:  

You’re 100% right. That’s why we do Neurofeedback at our clinic. We’re bringing in something called Gamma Core, which helps to tone your vagus nerve so people with gut issues, people with migraines, people with nervous system dysregulation, every time they come in for a treatment, they’re going to do Gamma Core to help relax their nervous system.

Lindsey:  

Tell me about that, what is that? 

Juanique Grover:  

So Gamma Core, it’s an FDA-approved device that you just put it here on your neck by your vagus nerve, and it’s supposed to calm it down. So it works similarly but different to neurofeedback, whereas neurofeedback works on the brainwave activity in your brain to either calm down overactive responses in your brain or wake up underactive responses in your brain, to bring you back to parasympathetic states and calm and neutrality. Again, it’s all about working with the brain, working with the nervous system to be calm so that when you are embarking on your healing treatments and protocols, you’re getting the biggest bang for your buck, because now your nervous system is on board and your brain is on board.

The thing about our fast-paced system, and our American culture, is just it’s go, go, go. We glorify the people that are the workaholics and the high achievers, and we really don’t know that’s embedded in all of our nervous systems. I remember, because I was that person until I got seriously ill after my husband died, which I haven’t spoken about. But my illness forced me to slow down, and when I was slowing down, I judged myself so much because my value was based so much on productivity and showing up and creating courses and running myself ragged, even months after my husband died. And so, yeah, of course my body broke because I was under so much stress, and I still had this A-type personality, but there was so much judgment with having to slow down. And so a lot of people that are like, oh yeah, I’m not a stressed person, give me 30 minutes in a room with them, and I will figure it out. I’ll be like, oh, you 100% are. You’re just used to going 100 miles an hour, and you call 100 miles an hour baseline, right? And it’s actually not baseline. Our common culture of fast-pacedness is actually not healthy. There’s a reason why the entire nation is embarking on a mental health crisis right now.

I saw this Instagram post where someone was asking, if you are watching true crime investigations and Law and Order before bed to calm your nervous system, you need to ask yourself why violence is relaxing to you, and it’s so true, right? Like we watch politics and we watch the news and we get all riled up, but it’s creating violence in our mind, but our nervous system can’t tell the difference, right? So we’re watching intense movies and we’re listening to intense music and we’re listening to intense news, and we’re like, this is normal. This is fine. I’m fine. But yet our nervous systems are wrecked. That’s why we’re so sick. That’s why your gut is wrecked. That’s why you’re not healing, even after all the antimicrobials. Because we’re so used to the analogy of a frog in a pot of boiling water. Do you know that analogy? If you put a frog in boiling water, it’ll jump out. But if you put a frog in a pot of water and slowly turn up the heat, you’ll eventually boil them to death, because they just get used to the heat, and they don’t think, oh, this is bad for me. This is wrong for me. It just stays there until they’re boiled to death. And that’s us. We’re so used to this increase in violent news and violent media and violent TV shows that it’s just that we’re used to the hot, boiling water and it’s destroying us. 

Lindsey:  

I’ve never described myself as a type A personality, but I’ve always been a perfectionist, and it was only my health coaching course that really taught me about ‘don’t let the perfect be the enemy of the good’, and being able to do that, especially when you’re running a small business. If the newsletter slips by with a typo, who cares? The vast majority of people don’t even read the words on the newsletter, and only the crazy perfectionists like me will even notice. 

Juanique Grover:  

It’s wonderful that you can recognize that. And again, you don’t know what you don’t know and you can’t see what you can’t see. And so if someone has health issues and they’re like, I’m not stressed, they’re probably stressed and they can’t see it.

Lindsey:  

Yeah. So what’s the next step in order healing?

Juanique Grover:  

So, next is mitochondria. Everyone should know what the mitochondria is, but they don’t. It’s ignored. It’s like the middle child, the red-headed, middle child that gets ignored and it has to fend for itself. Mitochondria are the powerhouses in the cells that give the cells energy, like ATP. And what people don’t realize is that your mitochondria are actually, as powerful as they are, they’re actually extremely sensitive. So if you are exposed to heavy metals and chemicals and EMFs and radiation and parasites, you are going to have this wear and tear and damage on your mitochondria. But not only that, if you’re not eating a nutrient-dense diet, if you’re not eating antioxidants or getting your high doses of B vitamins that are methylated, your mitochondria cannot make ATP.

One other thing about mitochondria is that artificial lighting truly damages mitochondria, whereas red light and infrared helps to restore mitochondrial function and helps them to produce ATP, which is why red light therapy is such a hot topic right now. And the reason why you want functioning mitochondria, the reason why you want healthy mitochondria, is because if you want your body to heal, it’s going to take an enormous amount of energy to do that, and so you want mitochondria that are pumping out a ton of ATP so it can fuel your cells to replicate or replenish or heal whatever damage or inflammation is in your body. So pretend someone gives you a toy that requires batteries, but you didn’t put the batteries in. Now you have this toy that doesn’t do anything, and it’s useless, right? So you want to put the batteries in the toy so that the toy can do its job and make music or whatever it is the toy does.

So that’s the mitochondria. We want to make sure that our mitochondria are turned on, and they’re functioning, and we’re protecting them so that they are doing their job and they’re fueling your cells with tons and tons of energy. Healing can’t happen if you don’t have ATP. Cellular function doesn’t happen unless you have ATP. And the thing that provides the ATP is the mitochondria. People are like, what supplements should I take? And I’m like, hold on, let’s not jump to supplements. What about just waking up and going for a walk and watching the sunrise and then walking and watching the sunset? That can help boost your mitochondrial function. Switching off your Wi Fi at night, not plugging in your cell phone next to you, that can help with mitochondrial function. Stress damages mitochondrial function, again, telling us why mindset is number one, right? Because, again, if you are trying all these healing modalities, but you’re stressed out and you have high adrenaline and high cortisol, that’s going to damage your mitochondria. And guess what? You’re not going to make energy to heal your body. You’re not going to make energy to help with hormone production and synthesis. You’re not going to produce enough energy to help your liver detoxify all the toxins and heavy metals and gunk that your body’s trying to filter out. Right? So mitochondria is so important, and that’s why it’s number two, because you can’t do anything without energy. Period. It’s like trying to go on a shopping spree, but you have no money. Did you want to add anything to that?

Lindsey:  

Only the question of, how are you determining that mitochondria aren’t working well? And what kinds of things are you testing for, to see if it’s toxins or mycotoxins, heavy metals, etc.

Juanique Grover:  

So there are certain tests that are pretty expensive that you can do to see the efficiency of your mitochondria, but signs and symptoms of poor mitochondrial health is you have brain fog. You have a full night’s sleep, but you wake up and you’re exhausted, right? You have neurological issues and twitches and tremors and like just numbness and tingling. Those are signs of mitochondrial dysfunction. You’re wired, but tired all the time. I know it sounds a lot like adrenals, but a lot of this actually, it has to do with mitochondria. You don’t heal quickly or efficiently, so you get bruised, but it takes forever for that to heal. General fatigue. Brain fog is a huge determining factor of mitochondrial function. So brain fog, muscle weakness, neurological issues, problems detoxifying. So, you’re sensitive to chemicals and whatnot, and here’s why that is. So what’s really cool is, we think that our muscles have a huge amount of the mitochondria in our muscle cells, right? But your brain and your liver have almost the same amount of mitochondria in them as all of the muscles in your body.

So let’s say you have 120 pounds of muscle, right? And it has it houses about 30% of your mitochondria. Well, your five-pound brain has the exact same amount of mitochondria in it. Your seven-pound liver has the almost the exact same amount of mitochondria in it, because that’s how hard they are working. They’re working as hard as your muscles throughout your entire body, to keep you alive, to have you think, to have you process information, to help your liver detoxify chemicals and process all the vitamins and minerals and fats and everything that goes in your body. It has to be filtered through your liver, so your mind, your brain and your liver work an enormous amount. And that’s how we can see if your mitochondria isn’t working well, because you have all that brain fatigue and brain fog and you just can’t get out of bed. It feels like you’re moving through molasses because there’s not enough energy to power your brain on right? So it’s like a laggy computer. So if you feel like a laggy computer, chances are you probably have mitochondrial issues.

Lindsey:  

Okay, cool. So what’s the next one? 

Juanique Grover:  

So next is gut, which is probably your favorite and my favorite, right? So the gut is the root system to the tree. If you look at a tree and you look at the roots, you can tell the health of a tree by looking at the roots. The roots are thick and robust. They absorb all the vitamins and minerals in the water that really services the rest of the tree. If you have a root system of a tree that is rotting and dying, the tree is going to follow suit and die as well. So your gut is the root system to the rest of your body. It absorbs all the vitamins and the nutrients that your cells and your tissues need in order to heal and repair themselves. Your gut absorbs all the amino acids and fatty acids and vitamins and minerals that it needs to help detox your liver to help synthesize hormones, sex hormones, adrenaline, cortisol, thyroid hormone. Your gut absorbs all of that from your food and fuels everything. If your root system is inflamed, if your root system is leaky, if your root system is not healthy and not optimal, you’re going to feel really, really sick.

But not only that, your gut, your root system, it houses 80% of your immune system. So if your gut is inflamed and it’s leaky and it’s not happy and it’s not absorbing, chances are it’s very inhospitable for your bacteria as well. And now not only do you have an absorption issue, but do you have an immune response issue. So it’s like a double whammy. So this is why the gut is right after mitochondria. One, we have to have robust mitochondria in the lining of your intestines for your intestines to heal and repair themselves. Because what I think is really interesting is your skin cells turn over every thirty days, but your gut lining turns over every two to three days. So that’s an enormous amount of energy and an enormous amount of protein and vitamins and minerals for that high tissue turnover. So that’s why you have to have your mitochondria on point to fuel that tissue turnover in your gut, right? If your mitochondria are not optimal, you’re not having that turnover in your tissue, which means it’s starting to get inflamed, and it’s starting to get leaky, and it’s starting to have problems, and now it’s inhospitable to your bacteria. So now you have your bacterial issues, your absorption issues, and you’re just not a happy, healthy body period. You’re not absorbing your nutrients.

Let’s say you work hard every month. You work forty hours a week, and you get paid at the end of the month. You’re supposed to get ten grand, but they only give you five and you’re like, what? I got cheated, I worked really hard for my ten grand, and you’re only giving me five grand. That’s a gut that isn’t working optimally. We’re eating all this high nutrient-dense food, but you’re not absorbing it. So how many people eat nutrient-dense foods? Maybe they have some gut issues. So they’re cooking or steaming their food to help break down the fiber, and they’re eating these high nutrient-dense foods, lots of collagen, lots of bone broth, and they’re still nutrient depleted, and their blood work still shows low proteins, low vitamins, low minerals, low everything, right? That’s a gut system that is just not turning on. It’s not working, and it’s so important if you want to have a healthy liver, healthy sex hormones, healthy adrenals, you have to make sure your gut is working for you and not against you, that your mitochondria are turned on so that they can help fuel that tissue turnover and that your brain isn’t sabotaging your gut, because when you’re in sympathetic dominance, when you’re stressed out, that directly signals your gallbladder, your stomach, your hormones.

So your stomach is supposed to produce an X amount of hydrochloric acid to help break down and emulsify your foods. But if you are stressed, you decrease hydrochloric acid content, which means you’re not breaking down your food. So you want your $10,000 but you’re only getting $5,000 and so we want to get you in a regulated state, in a parasympathetic state, so that your gut not only heals itself, but it releases all of its enzymes and its hydrochloric acid for you to optimize on food digestion and nutrient absorption. So that’s why gut is number three, do you want to add anything to that? Because you’re a gut pro.

Lindsey:  

Well, I just want to add that I do a lot of testing on people about nutrient statuses, especially if I suspect there might be a nutrient deficiency. And inevitably, all of my clients have some nutrient deficiencies, be it iron or zinc or occasionally you even see copper, of course B vitamins, you see those, vitamin C, a whole slew, vitamin A, vitamin E, D. Everything. And, admittedly, I’d been supplementing my husband for a while on vitamins, but I tested all of his nutrients, and I was just like, unbelievably, you have virtually no nutrient deficiencies. I’m like, I guess that’s because your gut works well. 

Juanique Grover:  

His nervous system. 

Lindsey:  

Well, not his nervous system because his nervous system’s a mess, but his gut worked so he does have the nutrients on board. I’m like, I don’t know how, because he only eats two meals a day, and some of them aren’t too great. But I’m like, I guess if we have a functioning gut, it does the job.

Juanique Grover:  

It does the job. If it’s functioning and it’s healthy, it will do its job and it will absorb. 

Lindsey:  

And if you don’t have a functioning gut, it doesn’t do its job. Like if you were taking acid blocking medication, you’re going to be protein deficient because you don’t have what it takes to break up our protein.

Juanique Grover:  

100%, and I think PPIs (proton pump inhibitors) are the most prescribed medication in the United States. So as soon as you get a PPI, guess what, like you said, you’re not going to break down your protein. You’re going to be nutrient-depleted for eons, for decades. And what’s really scary is there are providers that don’t tell their patients that PPIs are a short-term drug. You shouldn’t take them for longer than two weeks. If they have you on a PPI for more than five years, they have to screen you for stomach cancer, because that’s the risk. You take away that hydrochloric acid, that means that you’re now nutrient depleted, and also hydrochloric acid depleted. I call it the bouncer to the nightclub. It keeps bad dudes out. So now you got rid of your bouncer, and now you have all these bad dudes entering your club, meaning you’ve got H Pylori, you’ve got bacteria, you’ve got staph, you’ve got everything growing in your body. You are basically a nest for bad bacteria to live off now, and not only that, but parasites too. So you’re a walking, talking buffet for bad things. Of course, you’re going to get sick. Of course, you’re going to be at a higher risk for diseases, right? Because you got rid of the thing that helps you absorb your nutrients and keeps bad things out. I think hydrochloric acid just gets a bad reputation, and it really is, like the most important. I call hydrochloric acid the holy grail to digestion. If that’s not optimal, you’ve got problems.

Lindsey:  

Yeah, I’m on it, despite the fact that I would hope that I could have gotten off it by now, I’m still on it, because I’ll go off for a while and I’ll be like, yeah, unfortunately, my blood still shows me that I’m still deficient in it. Perhaps it is that top level I haven’t addressed. But anyways, what’s the next level after the gut?

Juanique Grover:  

So after the gut is liver, and so your liver is not only important for detoxing everything, but it synthesizes all your vitamins, minerals, and it also biosynthesizes all of your hormones. So if your sex organs or your adrenals are making hormones, they get packaged properly in your liver, unless your liver is deficient. And as I mentioned before, how do we have an efficient liver? Well, we have to have efficient mitochondrial function, and we have to have efficient gut and absorption, right? So if your liver isn’t being powered properly, and if it’s not being fed properly by your gut, you’re going to have liver issues. You’re going to have a sluggish liver. You’re going to have toxin buildup, where you’re just reabsorbing all of your toxins and chemicals and everything, and then you’re not going to feel good.

For people that have liver stagnation, they’re often tired, they have brain fog, they’re sensitive to chemicals and perfumes, and they have skin outbreaks, like eczema, rosacea, etc., like all of these kinds of autoimmunity and skin issues. And again, it’s because it’s working in conjunction with an unhealthy gut, right? So it’s not just a liver dysfunction. It’s like a gut-liver dysfunction. So if you have sensitive skin, if you’re sensitive to chemicals, if you get headaches very easily, you probably have a liver stagnation issue, so you want to support your liver tremendously by eating the right diet and absorbing by having proper mitochondrial function. But for many people that are in a health crisis, they will oftentimes need to take binders and do sauna and maybe coffee enemas to just help get toxins out of their system, because someone that has a health crisis and has chronic health issues that’s been decades in the making, or years in the making, where they have, slowly, over years and years, had this toxin accumulation, and now their whole body is sick, and that’s why liver is number four is because you have to have a healthy liver to have healthy cells. You have to have a healthy liver to biosynthesize healthy sex hormones and all hormones period.

Lindsey:  

And will you necessarily see elevated liver enzymes when this is happening, or could they look perfectly normal?

Juanique Grover:  

I love this question, because everyone asks that. No, it’s actually very tricky. I will actually see high cholesterol numbers. Because if you see high liver numbers, that actually means that your liver is now damaged because of very extensive periods of inflammation and nutrient deficiency and problems. So if you see high liver enzymes, you have a lot of work to do, because now it’s really a problem. So beginning stages of liver stagnation and liver dysfunction are like weight gain, high cholesterol, achy joints and everything that I kind of mentioned, like skin issues, chemical sensitivities, brain fog, you name it, and let’s use this example.

Let’s say you have a house, you live in a house, right? And you have to pay your mortgage, and you pay for a cleaner to come and clean your house, and people live in it, but we take care of the house. There’s energy in the house, and it’s all taken care of, and it runs beautifully, right? Let’s say we stop paying our cleaning lady, and we stop paying the garbage person, and we stop taking care of the house. At first, we’re not going to see decay in the house. The house is going to look fine. We’re not going to see junk piled up in the backyard, because it’s piling up in the house. And on the outside, we’re not going to see the rats that are starting to live in the house, because it doesn’t happen overnight and it doesn’t happen over a few weeks or a few months, right? So the house is going to start smelling and it’s going to start having signs and symptoms of neglect, but we’re not going to see damage to the house. So the house has curbside appeal, but there’s dysfunction happening because there’s rats living in there, and it’s getting infested and it’s stinky and people are not happy. So there are small signs of neglect, but it’s not a physical sign of neglect. Now let’s say over years you neglect the house. Now we’re seeing that the roof is getting chipped, the windows are breaking, and people are not fixing it, the driveway is all cracked and there’s weeds, and it looks horrible on the outside now, but that’s because of years’ worth of neglect, not weeks or months.

And so liver enzymes are the years’ worth of neglect, that means your liver is literally deteriorating. And that didn’t happen overnight. That happened over a very long period of time of nutritional deficiencies and inflammation. Did that translate? Because I want people to understand that so many people are like, my doctor said my liver enzymes were fine. Why do I feel sick? I’m like, this is why you feel sick. Because even though your liver enzymes are normal, it doesn’t mean they’re optimal. So look at your cholesterol, look at your blood sugar, look at your homocysteine. Those are better indicators of problems in the body for me.

Lindsey:  

And are there things you particularly like, supplements for the liver, or I guess you mentioned sauna and coffee enemas? 

Juanique Grover:  

Yes. So the liver requires an enormous amount of nutrients. If you need to detox, there are binders. I love Cell Core Biotoxin Binder* (access with Patient direct code: I0rdLMOm). Cell Core, it helps you get the gunk out. Functionality of the liver, you need high doses of methylated B vitamins*. You need an enormous amount of amino acids. So eat enough protein, drink enough collagen*. What really terrifies me and irks me is when people are doing a “liver cleanse”, and I put that in air quotes for people that can’t see, but they’re drinking fruit juices. And the problem with that is you’re, one, sugar is really hard on your liver, so you are creating more damage by drinking fruit juices. Yes, it’s from fruit, but there’s still fructose in there. And fructose is a very hard sugar to metabolize in the liver. One of the byproducts of fructose metabolism in the liver is something called JNK1, which is an extremely inflammatory molecule, but also aldehydes. So the more fruit juice that you’re putting in there without fiber, the more damage you’re creating in the liver. And so people go on these fruit juice cleanses, and they actually create more damage and more inflammation in the liver, when what the liver actually needs is lots of fiber, lots of protein, lots of antioxidants, lots of B vitamins.

So for people that are really sick, don’t do a liver cleanse. Your body probably can’t handle it right now. Just feed your body high nutrient-dense foods, lots of bone broth, collagen, take methylated B vitamins. Milk thistle* is very supportive of liver and liver detoxification. So there are herbs and supplements that are gentle, but still very supportive, but get the nutrients in. And then when you actually have energy and reserves where you’re feeling functional. That’s when you’re ready for a big detox. But these detoxes should include binders and fiber and protein and vitamins and minerals and antioxidants. If you try to detox without those things in place, you’re going to feel very, very sick, and I actually have a whole liver cleanse. It’s a three-week detox program where it utilizes a ton of supplements that help support the liver and detoxification, but if you do it wrong, you’re not going to feel good. And some people are in bed for days, if not weeks, because they try to detox their liver before they actually have the nutrition on board and the mitochondria on board.

Lindsey:  

Yeah. I mean, at the base of it, you need to be able to make glutathione, and you need amino acids like cysteine and glutamine and glycine, which are going to come from protein foods.

Juanique Grover:  

Exactly, all of those things. So, yes, I hope that answered your question.

Lindsey:  

So yes, so fifth level.

Juanique Grover:  

So fifth is adrenals. And adrenals, if you did everything upstream right, your adrenals should be right on board. So your adrenals are these glands that produce cortisol and aldosterone and adrenaline, and they signal every cell in your body to do something, to be in a stress response, or they can stimulate your immune system to be heightened or diminished. And so if we have mindset on board then your adrenals are not being overstimulated. If we have mitochondria on board, then your adrenals are not being deficient in energy production. If we have your gut on board, then your adrenals have the nutrition necessary to produce the right amount of hormones. And if the liver is on board, then the adrenals produce certain hormones that get biosynthesized in the liver properly.

This is what’s important about adrenals. So your adrenals make something called DHEA, and that’s a precursor to sex hormones. However, if you are in a stress response, your body is going to steal that DHEA from sex hormones and produce cortisol, which is the stress hormone, and the fight or flight hormone, and long term, cause inflammation throughout the body. So if you did all your work upstream and you took care of the first five parts of the order of healing, your adrenals are going to be fine, and you’re not going to have this overproduction of cortisol to an underproduction of sex hormones. It’s like a teeter totter. So if one is high, the other is low. So if your cortisol is high, your sex hormones are low. If your cortisol is low, your sex hormones aren’t necessarily high, that’s a different story for another time. But if you want to make sure that your cortisol stays normal and balanced, so that the next step in line, which is sex hormones, or hormones, those are being produced at a normal rate and not underproduced, which is what a lot of people experience.

And the one thing that I want people to understand about the adrenals is that there’s three stages of adrenal fatigue. The first stage, I want you to think of a Ferrari right, where it’s like, go, go, go, go, go, go, go, A-type personality. You’re waking up early, you’re exercising hard, you’re taking caffeine, you’re getting your to do list done. You’re getting your second cup of caffeine in the afternoon. You’re picking up the kids, you’re getting reports done in the middle of the night. You’re sleeping very little, and you’re doing it all over again, right? So think of the Ferrari going 120 miles down the freeway. That’s stage one of adrenal fatigue.

Stage two, think of the mom minivan where it’s like, it can do the things, but it’s struggling a little bit. It’s not the Ferrari anymore. And so stage two looks like this. You’re getting up in the morning, and it’s really hard, and you have to drag yourself out of bed, but you have a cup of coffee, and now you can go and now you’re hitting lunchtime, and you’re getting that afternoon slump, especially after eating meals. So you’re going for another cup of coffee, and now you’re 600 milligrams of caffeine in, and you’re just barely getting out the door to get your kids and get your stuff done, and you’re feeling this like second wind in towards bedtime. So you’re tired all day long, but right before bed, you’re energized, and you’re like, let me work on projects now. And now, you work until like twelve, one or two in the morning, and then you do it all again, and you just have this slump throughout the day, and you’re relying on caffeine and stimulants to get you through. So think of again, the mom minivan just getting on with all this messiness in the minivan. But hey, it got you from A to B.

Stage three of adrenal fatigue is you get out of bed, and you can barely function. You can’t form words, or it’s hard. You drink caffeine, but it doesn’t do anything, if anything, it gives you a panic attack now, or it gives you anxiety. So you’re drinking caffeine, but it’s just no longer working because there’s no more energy in your reserves. Everything is in the toilet. You have to take a nap at around one or two in the afternoon, because that’s when you get your second slump. Caffeine isn’t working for you, so you have to sleep before you pick up the kids from school, and then by bedtime, you are dead to the world. You’re falling asleep at five o’clock, but you’re also wired, but tired, it’s restless sleeping, and then you’re just doing it all again the next day. When you’re in stage three, everything’s in the toilet. All reserves are empty. You are non-functioning now. You’re alive, but you can’t function. Nothing’s turned on. So be aware of whether you are in stage one, are you in stage two, or are you in stage three?

The further on in stages you are, the harder it is to reverse and heal. And so when it comes to adrenal fatigue, one, you have to get on top of that control center, which is the mindset, and it’s your stress response and it’s your nervous system dysregulation. Two, you have to feed your adrenals. Your adrenals require an enormous amount of vitamins and minerals, sodium, potassium, to be specific, and vitamin C. So there’s something called Adrenal Cocktail* that I put almost all my clients on that has the perfect ratios of sodium, potassium and vitamin C to it. Make sure every time you drink water, you’re drinking water with minerals in it. I love Just Ingredients. So make sure you’re getting that. Make sure you’re getting your B vitamins. And please don’t push yourself at the gym, you need rest, heal your adrenals is not the time to go to the gym. A lot of people will be like, I’m so tired, but I’m pushing myself at the gym, and I’m drinking my caffeine and I’m putting on more weight and I’m getting more tired, and I don’t know why. And I know why, it’s because your adrenals are tanked. You’re trying to force your body to do that, which you cannot do right now. And people are like, but if I don’t go to the gym, I’ll just keep putting on weight. And my answer is, you’ll put more weight on forcing your body at the gym. Right now, you can’t build muscle at all, period. You need to rest and heal and repair and live to fight for another day, right?

So rest your body, recover, regulate your nervous system. I promise you, the gym will still be there, but right now, you have to heal your adrenals and your nervous system, because you’ll be in bed for decades if you don’t do that. And we deal with all of those people at our clinic, we see the worst of worst. And these people have to take steroids to just to wake up their adrenals, to be functional, to show up to work. And trust me, that’s not a life that you want to live. So adrenals are number five.

Lindsey:  

There are six levels?

Juanique Grover:  

There’s seven, actually. 

Lindsey:  

Oh seven. Okay.

Juanique Grover:  

So sex hormones are really simple. If you do everything upstream, sex hormones will work for you instead of against you, because your sex hormones, I call them the icing and the sprinkles on top of the cake, right? Everything else is the cake. The sex hormones just optimize everything. So think of it this way, your body, if you’re under stress, is not going to prioritize procreation and making babies. It’s going to prioritize survival. So when people are like, my sex hormones are in the tank, it’s like, yes, because you don’t have energy, you don’t have nutrients to build sex hormones to make you feel good. So here’s the kicker that nobody wants to hear. You can live and survive without any sex hormones. Do you feel good? Absolutely not. You feel like garbage. But you can survive, and you actually don’t need sex hormones to live. And so if your body is going to sacrifice something because you’re too stressed and you don’t have enough nutrition, guess what’s the first thing to go?  The sprinkles and the icing. Your body is trying to preserve the cake. It’s trying to preserve your organs and your vital organs, right? The sex hormones are not vital.

Our sex hormones are vital to us because they make our hair lush. They make our skin look good, they give us energy, they give us sex drive. But we don’t need those things. We want them, but we actually don’t need them. So that’s the first thing that the body sacrifices, is all the sex hormones when you are not feeling good, when you’re overstressed and when you are undereating a nutrient-dense diet. So if you want to feel sexy and you want the good hair, and you want the good skin, and you want everything else, everyone’s like well, give me the stuff to support my hormones, and I’m like, you have to look upstream at everything else, because, again, you have to fix the cake, and then the sprinkles will come, I promise you. But if you have a broken cake, the sprinkles won’t be there. So fix everything upstream, and your body will just naturally regulate and balance your sex hormones. So that’s why sex hormones are dead last, even though everybody wants them to be first.

Lindsey:  

Okay, are they number seven? Because I don’t think we heard number six.

Juanique Grover:  

So sex hormones were number six and then number seven is brain function. So if you’ve fulfilled everything, your brain should be healthy. It should have good neurotransmitters, good blood flow, good oxygenation. If you do everything right, as we know, sex hormones, if you have proper progesterone and estrogen levels and testosterone, they actually preserve your brain function. So we don’t want high stress, we don’t want high cortisol, we don’t want too high adrenaline, because all of those diminish brain function and damage the brain. And so if you take care of your gut, if you take care of your mitochondria, as we learned before, if you take care of your liver and your adrenals and your sex hormones, all of those things combine together to make sure that you have a very young, healthy, anti-aged brain. Now, if you still have brain function, that’s probably a good time to go and get a brain scan to see if maybe there’s like, some benign tumor that may be be on your pituitary. But that’s again, everything prior helps your brain function properly, and so if it’s not, then we just say, okay, let’s look deeper. Get an MRI, get a brain scan, get a brain map to see what’s happening in your brain and how we can support it, because everything else should be supporting it optimally. And so that’s it. That’s the order of healing.

Lindsey:  

Okay, that was amazing. We’re running out of time. And I guess maybe one other thing I’d love to ask about is just the neurofeedback that you use in your clinic, and what it’s about and what conditions it’s useful for.

Juanique Grover:  

Yeah, so neurofeedback is really cool. So what it’s used for is anxiety, depression, ADHD, ADD and autism. So for kids are on the spectrum, it helps with their autism brain function. So teachers will remark, oh my gosh, he’s sitting down and he’s not having as many tantrums or meltdowns. So it really helps to just calm your nervous system and your brain that is over-firing. And so how it works is because your brain has certain waves like delta, gamma, beta, alpha, and so it retrains the waves to work optimally. For instance, everyone has intrusive thoughts. If you have a health problem, you’re like, oh, that’s cancer. I’m going to die. That’s the job of the brain to constantly analyze things, whether it’s correct or not. With a brain that is in hyperdrive and hyper-sympathetic dominance, when you have that intrusive thought come, then the brain latches onto it and you have this full-blown panic attack, right? Because that’s what the brain wave activity has been trained to do over time.

But with neurofeedback, it changes that brain wave activity. So when you have a thought or when you have a scenario come into your life, your brain responds to it completely differently, right? So you could have that intrusive thought come and you’d be like, oh, that’s interesting, and then it just passes and you’re not having this panic attack. Or for people, a lot of adults that have PTSD or depression or a hard time verbalizing their emotions, when they do neurofeedback, they’re like, huh, that’s easier to do, or, huh, I don’t feel so depressed anymore, or I don’t feel so anxious anymore, even though nothing in my life has changed. So we’re just changing brain patterns to not be so reactive or so underactive. And so that way you can live a very functional life with stress, but not having the stress affect you on a brain chemistry level. I don’t know if that was a good explanation of it.

Lindsey:  

Yeah no, I mean, I’ve heard about different kinds of neurofeedback, and there are some in our town, but it wasn’t the kind that I’d heard about. Is yours the kind where somebody might be watching a movie, or playing a video game, and if they get the right kind of brain waves, then they’re rewarded by it keeping playing, and if they have the wrong kind of brain waves, it stops until they have the right kind of brain waves?

Juanique Grover:  

So ours works with the screen dimming and getting lighter, so it rewards you with a brighter screen. So that’s how ours works. It goes in and out, so you’ll watch it like it, and we always want calming, like Disney shows, nothing that’s too energizing or intense, right? And so when they’re watching it, the screen will get dim, and so it’s trying to provoke the brain to think a little harder. And when the brain corrects, it brightens, and then it works on a different area. And so it does that. And our sessions are only 30 minutes, so a lot of people do one hour, but we’ve seen that an hour fatigues the brain a little too much, and so we do the 30 minutes.

Lindsey:  

Okay, so I think we are out of time here. But can you tell people where they can find you and about your courses and that stuff?

Juanique Grover:  

Yes. So my clinic is called Provo Health, and so you can find us at provohealth.com or on Instagram @Provohealth. If you want to become a self-healing advocate, let’s say you are having health struggles and you’re tired of depending on doctors, and you’re like, I want to be the expert. Now I have a bunch of free classes as well as paid classes at mygutsyhealth.com. We do an academy enrollment every year. In 2025, the enrollment is going to be for September. So look for us during the summer time for open enrollment to become a student of the Gutsy Academy, where you get access to our courses teaching you every step in the order of healing, the science behind the order of healing, the homework that you can do to improve those areas in your life, the protocols, the supplements, the lifestyle changes.

And then every week in the academy, all of our academy members have a Zoom call, so you come on and we help you integrate the information. It’s like coaching, where you’re like, I’ve tried this. What else could it be? What we have found is that one, community, being around people that are struggling or going through the same thing that you’re going through, is really nourishing. But not only that, you’re learning from each other’s experiences, and you’re seeing what works for them and what doesn’t. And when you can hear people verbalize what they are struggling with and what the solutions are, you learn from their cases. I call it, like you know how doctors have rounds or certain doctors have to shadow other doctors. We’re all kind of shadowing each other in our health issues. And so they get to learn from each other, and they get to hear, oh, this is how Juanique and Gina are asking them questions about their health, because they’re trying to figure this out, or they’re trying to figure out a, b and c.

And so what’s really cool is all of my coaches at Provo Health and my nurse practitioners, they all have to learn the order of healing and take the coursework in order to become coaches or nutritionists at Provo Health, because we utilize all these modalities and all of these skills and all of this science to help coach our patients and our clients at Provo Health. And so it’s basically teaching you how to become your own health coach, how to become your own nutritionist. And what’s really cool about the academy is I’ve had nutritionists and coaches do other courses that were like five to ten grand, and they’re like, it was missing stuff, and then they joined the Gutsy Academy, and they’re like, the Gutsy Academy was everything I was hoping to learn at this course. And they’re like, this is what I wanted to learn. This is how I wanted to learn, how to integrate the information. And now my knowledge is no longer lacking, because you guys have put it all together.

And so if you’re struggling in your health journey and you just feel so lost, the academy can really teach you how to become your own self-healing advocate so you no longer feel lost in your healing journey, so that you have clarity and you have direction and you have hope, because hope is truly one of the most important things when it comes to a healing journey. 

Lindsey:  

Well, I think that’s a great note to finish on. Thank you so much for sharing your incredible knowledge with us. 

Juanique Grover:  

Thank you, Lindsey. Thank you for having me on your podcast.

If you’re dealing with gut health issues of any type (diarrhea, constipation, bloating, SIBO, IMO, H2S SIBO/ISO, IBS, IBD, gastritis, GERD, H pylori, diverticulitis, candida, etc.) or have an autoimmune disease and need some help, I see individual clients to help them resolve their digestive issues or reverse autoimmune disease naturally, You’re welcome to set up a free, 30-minute breakthrough session to see if you’d like to work with me. I also have my own two products, Tributyrin-Max, which is particularly helpful for loose stool and diarrhea as it slows your motility and firms up your stool, and SBI powder, which is an all around gut pathogen binder, which is super safe and won’t harm beneficial bacteria, and is usually the first line of treatment I educate my clients about in order to avoid stronger antimicrobial herbs.

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

Adapted from episode 142 of The Perfect Stool podcast edited for readability with Dr. Tracy McCarthy, MD, a board-certified psychiatrist and Institute of Functional Medicine certified physician with Lindsey Parsons, EdD.

Lindsey:  

So I think you’re the first psychiatrist I’ve had on the show. And I have heard of integrative psychiatrists, but I’ve never talked to one. So I’m curious what the practice of a functional medicine trained psychiatrist looks like, and how you got into functional medicine from psychiatry?

Tracy McCarthy, MD:  

Yeah, well, it’s a story. There was a time where I didn’t understand if one could be a functional medicine psychiatrist. So, you know, let me go back and tell you how I got into functional medicine in the first place, and how I ended up in doing what I do now. So, you know, I was a regularly trained allopathic medical doctor. I went into medical school really excited about finding out what goes wrong in the body and how we can fix that and how people heal. And the first few years of medical school were pretty satisfying. That way learning a lot of pathophysiology, and it was really interesting. But then as it went on and my training progressed, things became much more about identifying constellations of symptoms, and labeling that with the diagnosis, and then matching that to a pill. And the asking of why is something is going on became less and less part of it. A lot of that is because people said, We don’t know why, but the pharmaceutically-driven focus, is part of why. I think that question gets pushed to the side too much, because if you look in the research, there often is some hint about why, and there are people doing great research well.

So this was increasingly frustrating to me and my patients, who often were saying, hey, well, why do I have this or do I have to take this pill for the rest of my life? Or maybe medications were helping only part way, or they’re having a lot of side effects, so a lot of scenarios where that wasn’t satisfying. Luckily, around that time that that was happening for me, I came across the research on the role of inflammation on so much chronic illness, and I got really excited, and I got very interested in the role of nutrition and lifestyle in changing that inflammation. I started to make changes in my own life, and was like, wow, I feel like so much better after I eat. I don’t have to unbutton my genes or my energy is staying better, and then as I learned more, I started to hear about these doctors using these approaches and these philosophies and this research called Functional Medicine providers. And I ended up training with the Institute for Functional Medicine and have gone on to do tons of additional trainings in integrative and functional medicine.

But it did confuse me in my early days in functional medicine, because I also hadn’t met any psychiatrists doing this initially, and I kept asking myself, well, will this work in psychiatry? And now I kind of laugh that I thought that. But it was really a result of my training. Our conventional medicine is very siloed. People don’t talk to each other, right? You’ve got your gastroenterologist over here and your cardiologist over there and your neurologist over there, and it’s very separate, as if the body is in these separate zones. We know that’s not really true, and so now I’m at the point, we joke in functional medicine that we know everything causes everything. So it’s like in any one person, a constellation of triggers can show up as a different set of symptoms compared to somebody else, right?

So of course, inflammation can manifest as depression or anxiety, and there’s tons of research to support that. So as a functional medicine psychiatrist, I am focused on finding the root causes of the patient’s symptoms. What are the imbalances in the body? What are the nutrient deficits? What are the microbiome imbalances? What are the toxin exposures like, what’s not working right? And really focusing to address that as well as relieve symptoms. People need urgent help with symptoms often, but then you want to go deeper and ask why, and help them resolve that and empower them to be healthier. And that’s what’s so fun about it. It’s a partnership. They get to really learn what helps them be healthier and  and make changes that result in just feeling much better. 

Lindsey:  

Awesome. So were you practicing as a psychiatrist when you were in allopathic medicine? 

Tracy McCarthy, MD:  

Yes, I got real interested in functional medicine as a resident psychiatrist. So I was going through my traditional psychiatric residency at that point. And I think I did my first Institute for Functional Medicine training when my second kid was, like, one year old. It was a couple years after residency. By then, I had had an interest for several years in nutrition and had been reading and consuming everything I could on the topic. But that’s when I got serious about it. And, yeah, I was a hospitalist, a hospital-based inpatient psychiatrist, so my focus was working with pretty severely mentally ill, usually involuntarily committed, patients who were experiencing psychosis or mania and really needed stabilization to be able to access basic things like food and shelter, and so that was the focus of my work. But this led me in a really different direction. I would have loved to have been able to help them with these tools, but the system was not set up for that. I could not really change what they were feeding them in the hospital. You know, I would have liked to have done so. I learned pretty early on, as I was training, that I needed to open a practice so that I could actually apply what I was learning and help bring that to my community. And it was the beginning of another journey.

Lindsey:  

Awesome. So I’m going to start with the general, which is, how does gut health impact mental health and vice versa? 

Tracy McCarthy, MD:  

Yeah, oh my gosh, hugely. And I’m sure that we still only know the just the tip of the iceberg on this. You know, there’s so much research coming out all the time about the microbiome and its roles and and when we talk about gut health, we’re talking about several things, right? We’re talking about the microbiome, which I’m sure your listeners know. But just in case, it’s all the bacteria, fungi, viruses, even parasites in our gut, but it’s also our digestion and how well the gut is functioning. In that sense, are we absorbing our food? Are we breaking it down? You know, the gut has a lot of components to it, so it affects mental health in a number of ways, and indeed, overall health, if we are not able to break down and assimilate our food and our nutrients, then we’re definitely operating at a deficit, right? Like neurons need certain things to function well, like B vitamins and magnesium and zinc and cholesterol, all kinds of things. And if we aren’t getting those in the diet, so if we’re not eating them, we’re not going to have them, but we might be eating a great diet, but not actually absorbing it well or breaking it down.

Well, that’s something I see quite a lot on testing I do with patients. And so, you know, the gut is not doing its job there adequately, then your your brain’s going to suffer. It’s not going to have what it needs to work right. You won’t have the hormones you need, or you won’t have the amino acids you need for neurotransmitter production. So that’s one way you see it impacts. But the microbiome is the biggie here. You know the bacteria that we acquire through vaginal birth and then through breastfeeding, and then as we grow with time, we are acquiring this very diverse microbiome. Ideally, it’s doing so many jobs for us and these bacteria make a number of compounds, and many of these are signalers to our own immune system and to our nervous system.

Some of the things they create are actually neurotransmitters like GABA. GABA is a relaxing, calming neurotransmitter. The right bacteria could be producing this for your benefit, they make cytokines, which are inflammatory messengers, and some of these are going to turn up inflammation in the body, and other ones are going to turn it down. So the level of that’s going to be important. They can be producing toxins, like endotoxins, like something called lipopolysaccharide, which, if that’s getting through a leaky gut into the bloodstream is going to be extremely – it’s like putting lighter fluid on things. It’s going to be very incendiary and light up your immune system. So they communicate a lot with our whole body through the production of different compounds. These can be absorbed across the lining of the gut into the bloodstream, and fascinatingly, these compounds can also travel up the vagus nerve to the brain.

This part always just blows my mind, that there’s this chemotaxis, they call it, where the chemical is actually traveling up a nerve. So you know, there’s multiple ways in which the microbiome is impacting our body. And that our gut in general, is impacting our body and our brain is not in a special glass case, immune to what’s going on, right? I mean, yes, we have a blood brain barrier, but many, many things get it through that, and the gut has a massive impact on it, which is why they call it that gut-brain axis. It’s a it’s a two way street. It’s communication between the gut and the brain.

Lindsey:  

 Yeah, so I’m pretty sure you addressed very much what goes from the gut to the brain? What about from the brain to the gut? 

Tracy McCarthy, MD:  

Yeah, great question. So that vagus nerve that I mentioned, where the chemicals can be traveling up it, this is the primary way the brain communicates with the gut. It’s a cranial nerve, which means it comes out of our cranium, out of our head, from the brain stem, and it innervates our entire thorax, you know, our chest and our abdomen. So all of our organs are innervated by the vagus nerve. So it’s in charge of hormone production in your endocrine glands. It’s in charge of slowing heart rate and slowing breathing. And most importantly to this discussion, it’s in charge of digestion and gut motility, meaning moving things along at the proper rate in the gut, and the gut squeezing correctly at the right time. That’s very important. And so that vagus nerve is not on line. And I’m afraid in lots of people with serious stress and trauma, that vagus nerve has been really impacted in the tone. We say the vagus nerve is not good, then you’re operating at a deficit. You don’t have that great brain input that’s needed for optimal functioning of those organs.

Lindsey:  

Okay, so I’ve been trained on the Organic Acids Test and how it can show issues like deficiencies of serotonin, which is known to be one of our feel good neurotransmitters, and the idea behind SSRIs, or selective serotonin reuptake inhibitors, which keep more serotonin in the brain. But lately, I’ve been hearing on my functional medicine podcasts that anxiety is not a serotonin deficiency. So my question is, is anxiety ever a serotonin deficiency, or is it for certain people?

Tracy McCarthy, MD:  

That’s a great question. I think anxiety is something that’s very heterogeneous, and there’s a lot of reasons that people have it. And I don’t tend to focus on neurotransmitter imbalances as a root cause, because I feel like first of all, that theory about SSRIs has really been debunked, that we have a chemical imbalance, and that’s what they fix. When people respond to an SSRI, we see that certain inflammatory cytokines have been reduced. So there’s something happening with inflammation getting reduced in people who are responding. But the other reason I don’t tend to focus on that is because that’s not really the root cause. Even if you’re having too much serotonin or not enough, or too much dopamine or not enough, why is that imbalance occurring in the brain? What is the trigger for that? Is it lack of raw materials, like not enough amino acid precursors for making those neurotransmitters. Is it inflammation, affecting the regulation of these, is it microglial activation, which is like an immune response in the brain? So that’s how I tend to focus. So I’d say probably it could be anything, really, because it’s people. It’s going to be different in different people, right? 

Lindsey:  

So if somebody does show up with, say, a tryptophan deficiency, is that something then you would supplement?

Tracy McCarthy, MD:  

if it was very clear that that was a deficiency, sure, I do tend to look more globally like I will tend to see, hey, you aren’t really, all of your precursor  . . . Well, I would say on an organic acids test, you’re looking at metabolites in the urine, right? So I would say, if I see low neurotransmitter metabolites across the board, I feel like there’s a problem with protein breakdown and digestion, right? That’s where I tend to focus is on that breakdown in digestion, obviously ensuring they are also getting enough protein in the diet. And I might encourage them to use something like collagen peptides as an easy way to augment that. Or sometimes we use amino acids as well. It depends.

Lindsey:  

So getting back to that whole root cause question, then, so what root causes do you find are common with anxiety?

Tracy McCarthy, MD:  

You know, one of the number one things I find is blood sugar. That’s a really big issue. So many people are running around with blood sugar swinging up and down. They have no idea they’re riding the blood sugar roller coaster I call it. This is a real common problem in our society where we have a lot of insulin resistance, and people can have levels of insulin resistance that aren’t obvious enough to show up when they get testing, like hemoglobin A1C or their fasting insulin. And if that’s all anybody’s looking at, then you won’t see sometimes the whole story.

So I’m a big fan of doing continuous glucose monitoring in my patient and actually trying to help them see what happens after a meal. You know, you might get a huge spike in blood sugar after a certain meal, and then half hour later, that blood sugar’s plummeting. Guess what happens when it plummets? You release adrenaline because you have to rescue a low blood sugar then, and that feels terrible. That’s anxiety producing. It’s when people get tired often after a meal, then they can get shaky. And it’s also a reason that a lot of people wake up at night. It’s a common trigger for insomnia, and I’ve really seen that in working with my patients. I say, look at that glucose monitor in the morning, and watch what happened overnight. Like, take a note of when you woke up. Oh, I woke up at two. And then you look and you’re like, Oh, your blood glucose spiked at 1:30 and then it dropped. And then that drop is what woke you up when the adrenaline was released. So that’s a big one.

And you know, there’s such simple steps you can take to fix that. It’s wonderful when you can help somebody shift that, because suddenly they’re feeling so much calmer, like getting them eating protein with each of their meals, making sure they’re digesting that, if that’s the issue, making sure there’s adequate fats, and then just really adjusting the carbohydrates for that person individually, like, how much can they tolerate, making sure that those glucose spikes aren’t going too high after a meal? You know, there’s other tools we can use to, like resistant starch and there’s blood sugar sensitizing supplements, but really it’s mainly about the food, and then also stress will do the same thing.

Stress can cause the blood sugar to spike and drop. So just that awareness really helps people make different choices. I’ve definitely seen people where they say, you know, my gosh, as soon as I cut the sugar out, my anxiety completely flattened. And this is a person I’m thinking of had had decades of anxiety treatment and a very intensive anxiety center she’d gone to multiple times, and it was the sugar. It was so simple for her. It’s not always that simple, but sometimes it is.

Lindsey:  

Any other root causes that come to mind, beyond the sugar?

Tracy McCarthy, MD:  

I mean, a lot of things, toxins. Mold is a huge source of toxin that I see. I wish I could say that’s rare, but it’s really common. Lots and lots of buildings have some kind of water damage, mostly unbeknownst to people. And these mycotoxins or mold toxins can accumulate in the body, and they dysregulate nervous system functioning, immune functioning. They just dysregulate your detoxification pathways. And so as they accumulate, they start showing up as a lot of weird symptoms, and absolutely, anxiety is one of those. It’s a real common one. 

Lindsey:  

Yeah. Okay, so this applies both to anxiety and depression, but how can you tease apart the physical causes of mood disorders like anxiety and depression versus the circumstances of a person’s life that are setting them off, like when I had some serious health concerns and no primary care physician. I was in a new location. I started having panic attacks at night, but as soon as my concerns were allayed, then those panic attacks went away. 

Tracy McCarthy, MD:  

So, yeah, I never want to downplay the role of the psychological factors. They’re enormous, and these really aren’t separate, right? Like when we have stressors, these are mediated through hormones in our body. They’re even mediated through what happens in the gut. Our gut changes, our microbiome changes when we have stress. So these are huge factors. We all can think of situations where someone had the depression that was really situational, it was very clear what the trigger was. So those are always important to look at. But I think the other thing to think about is like, Hey, are you doing the things to address that and you aren’t getting better? That’s my mission, really, is to help people understand the overlooked physical causes, because they may be going to the doctor.

I think really common scenario is they’re going to the doctor about their depression and anxiety. They’re given a medication, and they’re hopefully encouraged to get therapy. Hopefully they do that. You know, all of us benefit from therapy, but are they still stuck.  Or do they want to be on the pill? Maybe they’ve done a lot of therapy, but guess what? Therapy is not going to fix their B12 deficiency. So it’s like, if you’re making certain progress, but you’re plateauing, or you want to look at all the areas at the same time, okay, I’m going to address these stressors, because I do know they’re important, but what else can I do to support my system? Because the thing is, if we have these physical issues going on, we’re more vulnerable to the psychological stressors. You know, we’re less resilient. I mean, we can be much more irritable when we have the wrong microbiome, and then everything’s harder. So they interact a lot.

Lindsey:  

Yeah. So how can you help somebody who has debilitating anxiety or depression that has a legitimate and ongoing cause, like a serious health issue, for example?

Tracy McCarthy, MD:  

Well, I think you’ve got to meet them where they are first of all, and then you look for the lowest-hanging fruit, and are they getting the support they need for that health issue? I mean, a lot of times, really, one of my most important roles is seeing someone and validating what they’re actually going through. And sometimes they’re not even having that happen with their serious health condition. So that’s the beginning part of healing, right? There is like acknowledging this is really happening. I’m not going to gaslight you, you know, I see this. What are we doing to do to help build your resilience? And there’s so many great tools out there that we use just for the mindset part of this, and for the nervous system calming and so helping them up their resilience and their resources, and at the same time beginning the process of the appropriate place to start testing what are the pieces that are missing?

And here’s the thing, when you’re talking about some of them going through a significant health crisis, the things that are driving their depression may be the same physical causes driving the other health issue, or is overlapping. That is very common. You know, I work with lots of patients where maybe they’re coming in for the depression or the anxiety, but when we work on the underlying issues, now their energy is better, their hormones are more balanced. You know, their periods don’t hurt in the same way, their gut is feeling better. These are all connected. So it to me, it’s always about the holistic view and looking at the whole person and seeing where are the gaps that we can intervene on most easily first, and go from there.

Lindsey:  

Okay, so what would you say are the underlying causes of depression that you see most commonly?

Tracy McCarthy, MD:  

Well, I think inflammation is huge here, and some of that is real nutrient deficiency. Deficiency is one piece of that. The most common nutrient deficiencies I see that trigger depression are lack of certain B vitamins. I mentioned vitamin B12. That’s a really important one, because people are much less able to absorb B12 with age because of issues with their stomach and producing something called intrinsic factor that’s required for absorbing B12. But also, lot of medications deplete B12. So here’s a really common one, Metformin. That’s a great medication for diabetes. Lots of people are on that for their glucose. Has some longevity benefits, but it depletes B12. So you’ve got to take B12 if you’re on it. And I’ve had patients absolutely like, I’ve worked on my blood sugar, I’ve been doing so much better. But then the last two months, I’m so super depressed. You know, this is when I’m meeting them and I find out what they’re taking. I’m like, did anyone ever tell you to take B12 with your Metformin? Well, no. And you know, two weeks later, they’re feeling a whole lot better with that B12. But it’s not just B12. It can be B6 it can be folate, which is another B vitamin. These are big players.

And then, besides the B vitamins, minerals are really important, magnesium, zinc, plays a major role here, and also omega 3 fatty acids, they’re really critical. And this comes back to that theme of inflammation. I know I sound like I’m repeating myself when I talk about inflammation, but it’s such a common issue here that, you know omega 6 fats, they’re everywhere. We don’t have any problem getting enough of those. We need both types, right? But Omega 6s are everywhere. They’re ubiquitous because they’re in every seed oil, canola oil, corn oil . . .

Lindsey:  

. . . every restaurant meal, every take out meal, every chip, except for the three that have avocado oil,

Tracy McCarthy, MD:  

Yeah, you just cannot . . . it’s very easy to find them, and most people are overburdened with them. And I always describe it to people as like your immune system is like a car, and the omega 6 fats are like the gas pedal, and the omega 3 fats are like the brakes. And you need both, right? If you say you’ve sprained your ankle, you need to mount a response with inflammation, and then you need it to go away when it’s healed. So you need to turn it on and turn it off. But most Americans are driving around in a car with like, pedal to the metal, and they don’t have any brakes at all because they don’t have any omega 3, because they’re not eating the fish that contain those. And that’s really the main source for that, and so that’s what we’re working to balance. So if you can really increase your omega 3s and work to reduce the omega 6, that’s the part a lot of people forget about, right? They might take fish oil, and usually not enough, I would say, but they’ll take it, and they don’t realize they need to work on those processed foods that you’re talking about and really eliminate those. And at least at home, choose the fats that don’t have those to cook with to control it right there. Boy, people feel a lot better when you get that oil change done. You know, switching that really is going to lower inflammation.

Lindsey:  

An oil change, I like that. Think about the car. So do you have any stories of past patients with anxiety or depression who got better that you could share? 

Tracy McCarthy, MD:  

Oh, yeah, I think of one of my early patients was a real dramatic case and a cool functional medicine case, because there were several pieces. But this is a lovely lady who came to me with anxiety, and she actually had panic attacks, and she also had irritable bowel syndrome with diarrhea, and she had been someone who loved to travel, and because of her panic attacks and because of the irritable bowel syndrome, she never knew when she was going to need a bathroom. That combination just ended her travel, and it really bothered her, and she was on, I think it was Lexapro, which is a common antidepressant, anti-anxiety medication, and she’d stayed on it because it had kind of helped, but not enough. She still obviously had a lot of symptoms. So she came to me about this, and we found a number of things. We found that she had an overgrowth of yeast in her gut. We found that when I looked at her timeline, which we take in functional medicine, we go back and say, like, hey, when did these symptoms start? When were big events in your life? When did you have all these? When was surgery? When did your parents get divorced? Whatever these things were, we map it out so we can see the connections. And it became really clear that her anxiety had started like a year or so after she’d had her gallbladder removed, and so she had followed the standard recommendations of a low fat diet after removing the gallbladder.

But what this meant was she began to really lose out on fat-soluble vitamins like vitamin D and K2 and this had a big impact on her functioning. Vitamin D is huge for mood. And this also really shifted her microbiome, because now we’re not having the same foods coming down the pipe, and she had that overgrowth of yeast. We treated that overgrowth. We worked on the digestion. We supported the digestion of fats. We kind of made up for that missing gallbladder. We were able to get fats back in the diet, which she definitely needed for her neurons to work right. There were a few other changes I’m forgetting right now, but those were the big ones. And really, within a couple months, her anxiety was totally gone, her panic attacks were gone, and her diarrhea had resolved. And then she was telling me she was flying with her grandson, taking trips, and it was like her life was back, and that was it. She knew what to do to stay healthy after that.

Lindsey:  

Awesome, cool story. So are there particular tests you like to use to diagnose the things going wrong, digestively, or the yeast? 

Tracy McCarthy, MD:  

Yeah. So there’s so many tests out there, but the panel I like to begin with, with patients is I do a very comprehensive blood test that looks at inflammatory markers and some nutritional markers and blood sugar and hormones, zinc, copper, things like that. And then I use an organic acids test, like you mentioned. I like that a lot, in particular for the yeast or for molds. It does a good job of telling us about colonized fungal species much better than a stool test does. And I like also that the organic acid test tells me about mitochondrial function and some of the detoxification pathways. That’s helpful. And then I do do a comprehensive stool test, which is always interesting to see people’s results, where you really can see if there’s digestive impairment, you see the imbalances in bacteria, sometimes you find some interesting parasites.

Just today, I saw a tapeworm from a dog in a patient. So she wasn’t too happy to see that. That’s rare, but these things do show up, and we can treat them. It’s helpful to find out what’s triggering the inflammation, because there were inflammatory markers on that test because she was having this pathogen. So that’s where I start. Sometimes it makes sense to go further down certain pathways, like like evaluating mold toxins, for example, or other environmental toxins, or to look at metabolism of hormones with something like a Dutch test. And sometimes it makes sense to do some additional genetic testing.

Lindsey:  

Whose stool test do you like? 

Tracy McCarthy, MD:  

I have used them all, I will say, and they’re all pretty similar. I really have used most recently, for a long time, I was using Genova’s GI Effects, and they were taking so long to get the test back that I ended up switching to the Gut Zoomer from Vibrant America, which does have a bit more pathogens on it. And I like that. I used to use GI Map in the past. Didn’t like the way they reported calprotectin, though that wasn’t standard. So, and the Doctor’s Data 360 is very good as well. I mean, you can get good information from all four of those tests. 

Lindsey:  

Yeah, I actually started using the US Biotek GI Advanced Profile, because it’s got everything that’s on the GI Map, everything that’s on the GI Effects. And it’s sort of in between price wise.

Tracy McCarthy, MD:  

That’s good if it’s an in between price wise, yeah, yeah.

Lindsey:  

And I’ve started using the Tiny Health PRO, because they do a full metagenomic sequencing, plus then they have all the digestive health markers. So it’s kind of like the best of all worlds. And again, it’s very reasonably priced. 

Tracy McCarthy, MD:  

I like that it’s reasonably priced, 

Lindsey:  

Yeah, yeah. And you can get it on Rupa. And whose organic acids test do you like?

Tracy McCarthy, MD:  

Oh, well, the I use Mosaic, which was Great Plains.

Lindsey:  

Yeah. Okay, what portion of anxiety and depression do you think is genetic?

Tracy McCarthy, MD:  

Oh, I love this question, because I think a lot of people feel like they’re doomed because of their genes. And I beg to differ on that. I think we all have our predispositions, the things that we’re most likely to get, like, you know, we say, okay, my family might really tend to get diabetes or autoimmune disease or depression, but these things are epigenetic. There are things turning these genes on and off. And so your genes are not your destiny. You hear different numbers, like, oh, genes are like, 10% of the puzzle. I don’t know. You know, in any one person, it could be different. I’ve also heard a sort of morbid amount analogy, like, the genes load the gun, but the environment pulls the trigger. It’s a little violent. I don’t like that, but it is, I think, putting it in perspective that it is just one piece, and that we should not feel like we have to settle because of our genes and in fact, there’s so much we can do to influence the expression of those genes.

Lindsey:  

So I see a lot of people, and obviously a lot of kids are diagnosed with ADHD these days. Are there root causes that you see for that?

Tracy McCarthy, MD:  

Oh, yeah, that’s a really interesting one and complex to me. I think there’s some really good research to suggest that there’s a zinc and copper imbalance occurring there. That if you’re interested in knowing more about that, I would look into the Walsh Research Institute. They have a huge database, and then a lot of research on that, and I had a lot of success with correcting that zinc copper ratio and helping ADHD patients. 

Lindsey:  

Dominant in which one? 

Tracy McCarthy, MD:  

They tend to be low in zinc with high copper. And there’s evidence also about metals playing a role. And there are some ADHD patients where it looks like dairy intolerance is part of the problem. I think it’s another heterogeneous group, you know, that I think we have these common end points of a label, but people arrive there differently. You know, different things to look at, but there are common themes.

Lindsey:  

The podcast that published today was with someone who looks at genetics and just helps people figure out how their genetics might be playing into their health issues. I had her look at mine because she had a unique set of skills that I was interested in. And she asked me, based on my genetics, do you have trouble focusing? And I’m like, No, I can focus. Well, you know, I get my work done. I’ve done well in school and all that. And then my husband was like, Are you kidding me? You’re like, “squirrel, squirrel, squirrel.”

Tracy McCarthy, MD:  

Don’t you love it when the spouse is like, what? I know, I’ve had that moment before, too.

Lindsey:  

I am a little easily distracted, so she suggested I take dopa macuna, which I’ve been playing with. Is that something you use?

Tracy McCarthy, MD:  

I have not that exact product. No, how are you liking it? 

Lindsey:  

Maybe I’m focusing better, but it was one of these things where it didn’t feel like a disability of sorts. 

Tracy McCarthy, MD:  

Yeah, well, that’s the question too, right? About, like, neuro divergence and neuro tribes? Like, there are a lot of questions there, too. Like I think about kids with ADHD, and sometimes I feel like this is trying to put a square peg in a round hole in our school system. 

Lindsey:  

And they’re creative and they have different. . . 

Tracy McCarthy, MD:  

Right, exactly, and you don’t want to squash that, but if somebody is really having neuroinflammation, then you want to support them with that, right? So, I think it’s right. First thing, I think it’s really heterogeneous.

Lindsey:  

Yeah, yeah. I think that it’s possible I’m concentrating better. And it’s one of these things where if I’m talking about something, and then something else comes up, I will not know where I was, like I will need somebody else to bring me back to the original topic. Or go on to tangents when I’m telling a story. So I think it’s something I could use a little help in. So if it helps, we’ll see. We’ll see. But anyway, yeah, just tobring up my dopamine. Do you use any things like amino acid precursors to bring up dopamine? Or is that, again, not root cause enough for you?

Tracy McCarthy, MD:  

It’s not my focus. Like I do tend to go deeper because, again, I’m like, Well, why are you low in that? Like, what’s the thing? But I mean, if somebody truly, like genetically runs that way, that they’re always going to be low. I mean that zinc copper situation is kind of like that, where sometimes genetically, they will really just need higher levels of zinc supplementation, you know, or people really need higher levels of methylfolate, for example. So there is a place for that, for sure, but I don’t want to miss the underlying drivers of the imbalances, you know, which is usually some kind of toxin, infection, combination, trauma. It’s all part of it.

Lindsey:  

Yeah, yeah, I always ran low on organic acids. I think I’ve done  two tests, and both times, my dopamine was low, but I never again felt like there was any – my serotonin was low too – I never felt there was any issues with me. 

Tracy McCarthy, MD:  

Yeah, and it’s complicated with the urinary organic acid test, you’re looking at metabolites in the urine, right? They are not telling you the brain concentration right? We are having to infer, you know. And it can give you some ideas of things to try and then see, but then you really have to see clinically. How did it go? 

Lindsey:  

So I’ve heard some functional medicine doctors talk about certain root causes of schizophrenia that may be treatable. And I’m curious whether you’ve found that there are some typical root causes for schizophrenia, or if you’ve had any patients who’ve recovered to any extent.

Tracy McCarthy, MD:  

Great question. And I’m excited that more people are talking about that. Some of the most interesting work has been done on Zonulin. You’re probably aware of Zonulin, it’s a leaky gut marker, and the work by Alessio Fasano on this. A pediatrician who’s done a bunch of the research on this, we think about celiac on his research, but then a lot of the research was also done on schizophrenia. And no one ever talks about that. And I’m always thinking, Okay, this is an autoimmune disease. Why don’t we treat it as such, you know? Why don’t we look at that? And what’s interesting is, if you look at some of the original work from Dr. Abram Hoffer, before we had Haldol and these medications, the anti-psychotics, they would do different kinds of fasting treatments or elimination diets, and people would clear. So there was some trigger in those cases, dietary trigger, that was playing a role. So, I’ve always been very interested in that, and now we’re seeing some emerging research about the role of mitochondria. And the ketogenic diet being impactful, not just for bipolar, where I’ve long expected to see it, and that’s because, hey, ketogenic diet works for seizures.

The medications for bipolar are anticonvulsants, just like for seizures, they raise ketones. Like, why wouldn’t that work? Well, those studies are coming out now, and it’s really exciting. But this same approach is working in schizophrenia in these studies, and it’s really about brains that are unable to utilize glucose properly, and getting them a fuel source that they can utilize. And it’s another example of how a common trigger will express differently in different people, different symptoms. The patient who has schizoaffective disorder, so essentially, both bipolar and schizophrenia, and gluten is a major trigger for her. She gets much more psychotic if she has gluten, it also triggers  projectile vomiting in her. She has numerous reactions to it, so her learning that has been really, really helpful in starting to control symptoms. Those are some of the my thoughts about that.

Lindsey:  

Okay, and anything else to say about bipolar and root causes?

Tracy McCarthy, MD:  

Well, I do think this brain insulin resistance is a big one that we’re going to see more and more about. But then there’s some other cases where it’s really, like infectious like Lyme can cause mania, and people are not realizing it’s that. Or NMDA encephalitis; there’s other causes that can manifest as mania. There is encephalitis that can do that too. But here what the thing I think is kind of funny, is we’re like, Oh, these are the exceptions. I don’t really believe that, because there’s always a reason somebody’s having this. It’s not like there’s just run of the mill bipolar, and then there’s these special ones that have a cause. They all have a cause. We just haven’t figured it out, you know? 

Lindsey:  

Yeah, right. In other words, bipolar is not a thing. A bunch of underlying stuff creates the symptoms that we call bipolar. 

Tracy McCarthy, MD:  

Yes, exactly. They have that symptom cluster, they have that mania, they have the depression and this cycling. But what’s causing that brain malfunction basically.

Lindsey:  

Yeah. So how do hormones play into mental health issues? 

Tracy McCarthy, MD:  

Hugely, is what I would say. I see that every day. I mean just looking at menstruating women in the degree of like premenstrual symptoms, whether it’s PMS or it’s PMDD, which is premenstrual dysphoric disorder, which is a more official psychiatric diagnosis where you really have extreme, much more strong mood symptoms or irritability in the week or so leading up to your period, I see a lot of that. It’s related to estrogen dominance. So too much estrogen, not enough progesterone or both. There’s lots of reasons for that. The gut comes into play here again, where the gut is impacting metabolism of estrogen, and so estrogen isn’t getting taken out of the body properly, and it gets recycled, and you get high levels, also xenoestrogens from plastics. You know, parabens and phthalates, these toxins are contributing to the estrogen burden, and then we deplete our progesterone through high stress, not enough sleep. And so imbalance is just really common, and it shows up for a lot of women.

That’s just one example, but I see it a lot. PCOS is another hormonal imbalance in women, polycystic ovarian syndrome, where they tend to have high androgens and irregular cycles. A lot of problems with hormone levels there. But you know, when we’re talking hormones, we’re not just talking sex hormones, right? We’re not just talking estrogen and progesterone. Also, testosterone is one of the sex hormones, and low testosterone absolutely will cause depression in a man. But we’re also talking about thyroid and cortisol and insulin. All of these hormones are key and are part of the picture, and they interact. And DHEA, there’s another one, you know, that’s a precursor for testosterone and made in the adrenal gland along with cortisol, and affects immune function so much. So it’s about for me looking at that full picture. And in my training with functional medicine, you really work on the cortisol and the insulin first, before you do much with sex hormones That said, I’m a big fan of hormone replacement therapy and menopause, I think is a game changer for women. A disservice was done to them with the Women’s Health Initiative study. When everyone stopped their hormones, I just see how they are, how much better people feel. 

Lindsey:  

I heard a podcast recently where they were talking about not just hormone replacement therapy, like the estrogen patch that your OB/GYN is going to give you, but like, going beyond that, like supplementing estrogen to the point where you’re back where you were when you were menstruating.

Tracy McCarthy, MD:  

That is a great question. I think there’s a lot of research that really needs to be done here, but I don’t know if it’s all going to get done. The hormone research is rife with issues like for example, you look at a study on progesterone, and a lot of it will actually include progestins, which are synthetic and not progesterone, and with estrogens, you run into this problem. That study may include oral progesterones And not just transdermal. Like I feel strongly transdermal is much, much safer and better than oral, or that will include Premarin, which is the horses estrogen, not human estrogen. So these are complicated, and with the current practices in what I see is a woman may come to me on HRT (hormone replacement therapy) that was sort of titrated to her symptoms. So she was doing menopause, she was having hot flashes, and symptoms, and she was given a patch, and they arrived at a dose that felt good, and that’s where she’s at. No one ever checks a level. That’s not what they do in OB/GYN practice, but I always do check the level, and so I’ll see them be at like, 34-40, I feel like, that’s the common number I see when people are kind of like, I feel better. But if you look at the functional medicine research going on with reversing cognitive decline, they’re using much higher numbers of estrogen for those people who need that, what we call trophic support, or that growth support for hormones from estrogen.

Lindsey:  

Yeah, what should people be shooting for? 

Tracy McCarthy, MD:  

Well I don’t think we can say what any one person should shoot for, so I don’t want to say that, but I will say that, like in these studies, they’re often somewhere between 50 and 80, for example. Obviously it’s got to be right for that person and be balanced out by the progesterone and not be causing symptoms. But I think there’s a lot of room for study here. I think these are very important compounds, and they have huge impacts. Progesterone’s a potent neurosteroid; we don’t treat it that way. It’s really awesome what it can do. So I think it’s an area that I hope we’ll see more and more research done, and I am happy to see the sort of grassroots resurgence of people saying, I want my hormone replacement. And there’s some good people in the forefront advocating for that. There’s some great OBs out there writing about it. So hopefully we’re going to see people’s brains and bones and bodies protected a lot more now.

Lindsey:  

Yeah, it’s sort of a funny issue, because in every way with functional medicine, we’re talking about  restoring what would be our natural health if we didn’t have such terrible food and environment, et cetera, et cetera. But in this one area, it’s not really natural that after somebody goes through menopause, that you then put them back on hormones, but at the same time, it’s going to probably keep them alive longer and healthier longer. 

Tracy McCarthy, MD:  

So yeah, you’re so right. And I have two thoughts about that. One is really, in functional medicine, we look at everything is just a tool. So is it a good tool or a bad tool, like the shades of gray. I’m certainly not anti medication, right? There’s some medications that are wonderful tools. For example, low dose naltrexone, right? But other medications are really terrible. These are tools, and we can be agnostic about them. I am not trying to recreate the Paleolithic era here. We don’t live in that time, and that’s not what we need to do. However, I did go into functional medicine, my introduction to it really was from the ancestral health movement. I was like, Well, what’s natural? That was my paradigm, because it made sense to me. And so I was like, why would you keep taking hormones later? But then, as I trained with people, and I learned, and then I saw the impact, I could not help but have my mind vastly changed. I cannot tell you how helpful hormones can be for patients, like game changing, for their brains and their functioning. To me, it’s like, if this can be done safely, and well, this is protecting people’s cognition and their bones, and the benefits are usually outweighing the risks. Obviously, everybody’s an individual, and that has to be worked on with their own doctor. But yeah, that’s where I’ve come to.

Lindsey:  

Yeah. So I understand you have a freebie for my listeners. Do you want to tell them about that? 

Tracy McCarthy, MD:  

Yeah. Like I said, my goal is for people to be aware that there’s these overlooked causes of depression and anxiety because no one talks about them. You go to your doctor and you’re told to take a pill and maybe get therapy and a discussion. And I want people to be empowered to know what else to look for. So this is my free guide about Top 10 overlooked causes of depression and anxiety. 

Lindsey:  

Yeah, wonderful. 

Tracy McCarthy, MD:  

And that’s just the place to get you thinking, Where might I be having a gap that I can start working on,  and it’s just a really good place to start.

Lindsey:  

Okay, and then so your website is DrTracyMccarthy.com. 

Tracy McCarthy, MD:  

Yes. 

Lindsey:  

Any final thoughts before we close?

Tracy McCarthy, MD:  

Just it’s been a pleasure to talk with you and to geek out on these favorite topics of ours here.

Lindsey:  

Indeed!

Tracy McCarthy, MD:  

They are worth people knowing about that. You know, I think you are like me, where it’s like people can be empowered and make so much change in their life when they have more knowledge and I just feel like people deserve to know what’s up. 

Lindsey:  

Yeah, I’ve had friends with the debilitating anxiety, and I really wish they would have followed the functional medicine route, and maybe they did to some extent, I don’t know. Because you have people saying, well, I did everything, I tried everything. And you’re like, did you try everything in the allopathic medical system? Or did you really try everything?

Tracy McCarthy, MD:  

Yeah, because if you tried everything outside of it, it is an amazing long list. We didn’t talk about a ton of different modalities, you know, is from tapping to psychedelics to, I mean, there’s just so many things, right? You know, we focus on the functional medicine components, which I think need to be looked at. But there is so much, so don’t give up. People don’t give up. 

Lindsey:  

Yeah, yeah. Well, thank you so much. I think there’s a lot of good tidbits here for people. 

Tracy McCarthy, MD:  

Well, you’re very welcome. Thank you so much for having me.

Lindsey:  

My pleasure.

If you’re dealing with gut health issues of any type (diarrhea, constipation, bloating, SIBO, IMO, H2S SIBO/ISO, IBS, IBD, gastritis, GERD, H pylori, diverticulitis, candida, etc.) or have an autoimmune disease and need some help, I see individual clients to help them resolve their digestive issues or reverse autoimmune disease naturally, You’re welcome to set up a free, 30-minute breakthrough session to see if you’d like to work with me. I also have my own two products, Tributyrin-Max, which is particularly helpful for loose stool and diarrhea as it slows your motility and firms up your stool, and SBI powder, which is an all around gut pathogen binder, which is super safe and won’t harm beneficial bacteria, and is usually the first line of treatment I educate my clients about in order to avoid stronger antimicrobial herbs.

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

Adapted from episode 141 of The Perfect Stool podcast with Dr. Shayne Morris of Systemic Formulas and Alimentum Labs, sponsors of this episode, and edited for readability with Lindsey Parsons, EdD.

Lindsey:

Before you reached out to me about the podcast, I had not really heard of Systemic Formulas and Alimentum Labs. So can you just give a very brief background about those two entities and how and by whom your products are developed?

Dr. Shayne Morris:

Yeah, the Systemic Formulas products have been around since we started in 1984, and this gave us a really early entrance into the direct-to-clinician model, or the niche. It was started by my grandfather. He, in fact, started it back in the ’70s. Of course, it evolved, and it ultimately landed on Systemic Formulas* (use Doctor Referral Code: AZPA11 to access products). Clearly there was a need for some clinician-trained use for what we call dietary supplements or nutritional components, as well as herbal mixtures—therapeutic herbs. Ultimately, that led to the science of it all. My grandfather started in what we call ethnobotanical medicine, where he was traveling the globe learning about how these various herbs and other natural products were being used medicinally, mainly from native people of South America, the Polynesian islands, and Asia. He brought all that back.

What was exciting for us was that it was early. We say it was early, but it was only early for us—these things have been around for millennia, and yet they had really lost favor, being replaced by other, more modern approaches. But they were so powerful, and that’s kind of what led me into it. I started as a young child working with my grandfather, but I went back to school and really pursued the sciences—the hard sciences of natural products: biochemistry, molecular biology, genetics, and microbiology, which is now the microbiome.

Each and every one of these products benefits us through processes that are designed within us. These herbs have a particular medicinal benefit because of the way our body interacts with them. For anybody that doesn’t really gather that concept, you simply have to look at psychedelics. Natural product psychedelics clearly have an impact on our physiology. Some psychedelics can create hallucinations in our brain. So there’s this really intimate relationship between us and microbes and plants and fungi.

That’s what led me into this path as well, and Alimentum became a brand within the Systemic Formulas family that focuses on human genetics—the impact of nutrition on our genetics, on our cells. We call that cell-based nutrition, as well as the microbiome. The microbiome covers things like prebiotics, probiotics, and many of these really important nutrients that microorganisms need in order to maintain our health, protect us, manage our systems. We have all these axes—we refer to gut-brain, gut-lung, gut-heart. All these axes have to be well maintained. That’s really where Alimentum was born, about 12 years ago.

Lindsey:

And are you the one that develops the products?

Dr. Shayne Morris:

I do a lot of it, yes. We have a number of really amazing people here. We also have a research branch. So, there’s the family of Alimentum and Systemic that’s on the education, product, and sales side—which includes our sales team, marketing team, manufacturing, and education. There are some incredibly brilliant people in that area. But we also have a research and testing branch with a separate lab. It handles a lot of QC and R&D testing, and the scientists over there help me develop a lot of these things.

Lindsey:

Okay, cool. So today we’re going to be talking a lot about these keystone probiotics. Can you talk about what keystone probiotics are and how they differ from traditional probiotic strains found in typical supplements?

Dr. Shayne Morris:

It’s a really phenomenal topic. Whenever we talk about the microbiome, it can be understood in two ways. We’ve all heard it’s the collection of microorganisms that colonize us on every surface—sometimes even systemically. These amazing communities, or ecosystems, help keep us healthy. They support immune function, manage mucosal systems, and even impact neurological function through hormones and cellular signaling.

But there’s just so much information that people often simplify it down to “eat properly” or “take probiotics” or “eat fermented foods”—all great things, but they don’t always address the deeper issue. What’s the difference between a healthy, average, or dysbiotic microbiome? And that can apply anywhere in or on the body.

Keystone species have only been identified since we gained access to next-gen tools—ones that analyze not just microbial genetics, but also metabolites: what these microbes produce, what they’re doing, and how they benefit us. Keystone species are generally low in number—they don’t dominate—but they regulate the entire community structure. They’re essential to the structure of a healthy microbiome.

They’re necessary even in small amounts and produce compounds that are functionally important—not just for the other microbes but for us as hosts. They have a disproportionate impact. When you lose one, you often see surrounding organisms collapse.

My best analogy is a coral reef. Introduce one or two invasive species and it can collapse the whole ecosystem—destroy coral, push out fish, predators leave. But bring back the keystone species, and the whole thing rebounds: coral, invertebrates, fish, and so on. Over the past century, we’ve tried to reduce pathogen exposure, but in doing so, we’ve wiped out many keystone species. We want to bring them back to restore diversity and ecosystem stability.

Lindsey:

Yeah, in my experience looking at stool tests, I often see species disappear after people go through multiple rounds of antibiotics or strong herbal antimicrobials. Akkermansia muciniphila and Faecalibacterium prausnitzii are big ones. I was blown away to see F. prausnitzii in one of your probiotics—I didn’t even know that was commercially available. I’d love to hear more about that and the other keystone species you’ve got in your probiotics.

Dr. Shayne Morris:

Yeah, we’ve got a number. It’s taken us—really since about 2009—when we got heavily involved in microbiome projects. We knew about some of these species academically, but we didn’t yet know the future of probiotics. I mean, probiotics have been around for decades. We’ve all used some form of Lactobacillus, Bifidobacterium, Streptococcus, even yeasts like Saccharomyces.

These mostly came from the food industry—cheese, dairy, other fermented foods. So we always embraced the idea that living microbes could be beneficial, not just in themselves, but also through the metabolites they produce.

As the microbiome field exploded—it’s probably one of the most actively researched areas globally—we went from a handful of publications a decade ago to around 20,000 a year. With all that interest, we started trying to understand keystone species better. How do we go from identifying them in stool or saliva or the urogenital tract to actually growing them in stable, viable conditions?

That was our focus from 2009 to around 2017–2018. It was exciting, but also painful. The tech needed to grow these is tough—most are strict anaerobes and extremely sensitive ot oxygen-sensitive, even more than water. So that technology took us a bit.

But along the way, we also asked: what feeds them? What keeps them alive? What makes them want to take up residence—not just pass through? That’s where we started experimenting with different prebiotics. We used a lot of plant compounds: flavonoids, polyphenolics. Then we discovered they also need basic nutrients—certain B vitamins, glutathione, even a little carbon. These are the small but critical details we learned over time.

So we realized we not only wanted to support keystone species—we needed to educate people on the full scope of what a prebiotic can be. The current definition is a fiber or a microbial-accessible carbohydrate, but it’s much broader. It includes polyflavonoids, alkaloids, cyanidins—you’ve probably heard of ellagitannins or ellagic acid converting into urolithin A. That’s a keystone-driven microbial reaction with real physiological benefits.

So along with our probiotic work, we took the prebiotic journey too, incorporating a range of compounds—some not traditionally thought of as prebiotics, including human-derived ones like mucin and glycosaminoglycans.

Lindsey:

Let’s get into some specifics on the keystone species in your probiotics.

Dr. Shayne Morris:

Yeah. So the way we’ve approached organizing these keystone species is by identifying the systems where they’re most impactful. For example, we have something called Terra Terrain. While not all of them are keystones per se, they’re part of a larger need for soil-based organisms. Many of those are spore-forming. There are about five common commercial ones, but there are many more.

Looking more deeply into Europe, Africa, and Asia, you’ll find other species with real probiotic benefits—ones we’ve largely ignored in the U.S. But if you sequence healthy people eating from their gardens or local farmers markets, you’ll see these show up. Just a few examples: Bacillus lichenformis, Bacillus amyloliquefaciens, Priesta megaterium, Paenibacillus mucilaginosus, Bacillus indicus, which is more commercially recognized, there’s Paenibacillus polymyxa. These are all unique SBOs that we now have.

We’ve also partnered with people using kefir grains and kombucha SCOBYs from various places. We use the live organisms from the SCOBY and the kefir grains to then round out these more transient organisms. That’s one way we’ve incorporated the fermented food world.

Then we get into the actual keystone species. I’m going to list some of these off for you, but they’re their names are crazy. I have to say that microbiologists are not the greatest at naming things. But we have things like Micrococcus luteus and Staphylococcus epidermidis. Luteus is a gut-based keystone species, but it seems to have a benefit to our skin. It produces certain carotenoid pigments that end up in the skin, creating a UV protection, not unlike recommending the carotenoids from beta carotene to gamma, alpha, delta. Or you may have heard of other types of blueberry compounds or blackberry compounds that are protective in the skin. Well, we have microorganisms that produce similar compounds.

And then you have things Staphylococcus epidermidis, which is a skin commensal. And it’s brilliant, because it out competes Staphylococcus aureus. Now aureus is the problem child, and its main enemy, believe it or not, is staph epi (epidermis) is what we call it, and the competition between those two is significant. Epidermidis creates what we call bacteriocins that only reduce the aureus population—it has no impact on other organisms, just aureus. So when you see people that are suffering from Staphylococcus aureus issues, they likely lack epidermis in their skin. And that’s a really, when . . .

Lindsey:

And those are all in the Derma µBiomic?

Dr. Shayne Morris:

Derma µBiomic and the Derma Serum. Epidermidis is in there.

Lindsey:

So you have a topical for that? Wow, that’s awesome.

Dr. Shayne Morris:

Yeah, it’s a plant-based oil where we’ve tried to mimic a lot of the oils we secrete from the sebum, and then we’ve lyophilized the epidermis and also included Staphylococcus xylosus, another commensal. These are found on the skin in various regions, and they are protective in the fact that your immune system needs to know they’re there. It educates them. But they’re also protective against invading.

Lindsey:

And what does a skin infection with Staph aureus look like?

Dr. Shayne Morris:

The most familiar one is atopic dermatitis, especially in children. There’s a brilliant scientist, I forget her name, out of UC Davis or maybe Stanford. She studies pediatric skin conditions like psoriasis and atopic dermatitis. And she’s published a number of amazing studies showing that most atopic dermatitis on children is essentially an overgrowth of Staphylococcus aureus. And one of the unique features that differentiates aureus is when you have a rash that fills and looks like atopic dermatitis and it itches, the itch is somewhat indicative of Staph aureus, because they actually that organism actually sends a signal to create itching into our skin. It’s kind of devious, right?

Lindsey: Cool that you have a serum that fights it.

Dr. Shayne Morris:

Yeah, and for really recalcitrant versions, we actually tell people to open up Derma and Immune capsules and make a paste  and lather it on top of the issue prone area to really try to get these colonies to push back against the non-desirable. . .

Lindsey:

I can already think of a client who needs this…

Dr. Shayne Morris:

It’s incredible that—I mean, for me, it’s always an incredible journey to not only keep up with the ever-increasing and ever-amazing world of the microbiome and these organisms, but also the clinical applications that really range from our metabolism to our neurological health to our lungs and our kidneys and liver, etc., right? Some of these are really amazing at destroying metabolites—I mean, helping us metabolize xenotoxins, for example. It’s going to be an area that is ever-growing and ever-improving. And this is where we’re at the tip of the iceberg, but we’re excited to be here because it’s taken us a while to get here.

But let’s jump to, let’s say, on the immune front. So we know that the microbiome is incredibly powerful when it comes to our immune education, our immune evolution, and just navigating new threats all the time. And, you know, our keystone species in that regard are some interesting names. Again, we have some Bacteroides species—one of them is ovatus. We have uniformis, also Bacteroides. We have Roseburia hominis, which is a pretty fun one.

Lindsey:

I was very impressed to see that in there because that’s another one that often is depleted in people’s microbiomes.

Dr. Shayne Morris:

Right. And then we have another one called Collinsella aerofaciens. Again, a very unique keystone that has this incredible ability to help educate not only the area of the gut, which, you know, can be inflamed—the gut is, of course, overwhelmed by things like invading organisms, invading food, invading toxins, etc.—so it helps manage a lot of that immune/epithelial tissue regulation to keep things as managed as possible and healthy. It lowers inflammation, for example.

And then from the hormone front, we were able to get Bacteroides uniformis. We have Lactobacillus crispatus—a version of that that’s ours. That one, I believe, is now commercially available, one strain. And then we have Lactobacillus vaginalis, which is also a really important urogenital organism. And I oftentimes get the question: okay, we call it hormone balance in the microbiome, so we call it Hormone µBiomic and Hormone Superfood. Although there are a number of organisms that benefit women, no doubt, men also benefit. And in women, oftentimes people don’t realize that the organisms that colonize the urogenital tract are also found—or can transit—from the gut into the urogenital tract, likely because of the close proximity.

And when you study the consumption of pre- and probiotics to help improve the urogenital tract in women, taking them orally works. You can also use these in a suppository way, which is completely normal and healthy and fine. But you can also just rely on oral ingestion, and they will colonize. When that is their place, the body has this beautiful innate ability to help traffic these organisms to where they need to be. It’s quite a unique process. When they’re available and you’re feeding them properly, the body will do the rest in many cases. But for people that are struggling, we oftentimes recommend oral as well as suppository urogenital support.

Lindsey:

And have you seen that using these species in the Hormone µBiomic has some impact on hormones?

Dr. Shayne Morris:

Yeah, right now we’re conducting some observational preclinical work. So everything I have on the hormone—especially in women in childbearing years, as opposed to perimenopausal or menopausal—is anecdotal. But we’re getting some really good anecdotal data, very positive, improving urogenital health in regards to recurrent UTIs, just overall health of the urogenital tract, as well as the gut simultaneously.

Now we’re moving into sequencing samples and trying to follow these more specifically. And of course, there is a lot of really good data just surrounding the crispatus and the vaginalis that help us follow the academic work. So we’re kind of on a parallel path with academia as well regarding these.

And you’ve probably heard that female urogenital tracts have been classified into about five different classifications. The first four are essentially Lactobacillus-dominant ecosystems, and the fifth one is pretty much lacking Lactobacilli. It’s not as common, especially in industrialized countries, but it is just every bit as healthy—it just has a whole separate ecosystem or community that we look at. So in that case, you would support the gut, and then that unique person would have to feed and really encourage the growth of these other unique keystone organisms outside of the Lactobacilli that we can actually provide directly.

Lindsey:

Yeah, and those are also in that Hormone µBiomic?

Dr. Shayne Morris:

Yeah.

Lindsey:

And what’s the predominant species in that fifth type?

Dr. Shayne Morris:

Oh, the fifth type—those we don’t have. Those are unique. And so far, the work that’s been done and the work that we’re following—they’re not organisms that we’ve been able to culture and, of course, run the safety studies, etc., and get them ready to bring to commercial. But by employing the probiotics that are keystone—and especially the prebiotic world, so a lot of these superfood prebiotics—you can actually encourage the reconstitution of that particular urogenital classification through what we call nutritional intervention.

It helps bring back all of the external factors that drive dysbiosis in the urogenital tract of women. You bring that back. You make sure you understand whether or not they’re using cleansing products, or if their partner is healthy at the moment—avoiding a lot of the disruptive things—as well as reintroducing these healthy pre- and probiotics that help the GI manage the UTI. Because there is a connection.

And of course, the piece I can’t speak to at length today—because it’s a whole different topic—but you also have to monitor hormones. Hormone variations can absolutely disrupt the female urogenital microbiome. They’re intimately connected. If a woman is highly estrogenic—carrying way too much estrogen—we want to look first at their GI microbiome. Because if they have the enzymes—you’ve probably heard of these, these glucuronidases and galactosidases—they will re-cycle estrogen that’s being excreted. That increases the estrogen load in their bloodstream, which does, in fact, impact the epithelial lining of the female urogenital tract and can disrupt the microbiome.

Now, conversely, if there’s not enough estrogen, it will also impact the urogenital microbiome. That’s an area that needs to be looked into when there’s a recurrent urogenital problem in women. You’ve also got to look at the hormones, for sure.

Lindsey:

and how about the Metabolic µBiomic?

Dr. Shayne Morris:

Yeah. So we have, of course, our two—the last two—and we’re coming out with more, by the way. So this won’t be the end of the story. We’re about 70% through. The Metabolic µBiomic and its Superfood: we tried to take what was known, as well as our own research, and say, okay, metabolically, there’s a number of impactful things. We know that the microbiome has the ability to metabolize our food, whether it’s processed food or whole food. There’s a certain metabolic function that our microbiome has, and if that’s disrupted—one, by diet, and two, by the population or the ecosystem—it’s extremely impactful and detrimental on our metabolic uptake, the way we store lipids, the way we metabolize and sense sugar, and other areas of hormone production. And these neuropod cells that communicate directly to the brain through the vagal nerve and maybe even through the central nervous system.

This is a very, very enormous part of the microbiome’s job—and perhaps one of the more significant after the immune system—where, when you have a dysbiotic gut, you find that everything else, the number of hormones that you’re signaling, the number of neurotransmitters you’re making, the number of systems that are connecting through the vagal nerve and managing all of our endocrine system, our neuroendocrine system, as well as our detox systems—these are all starting to fail us. And this is why we have the chronic epidemics that we do. It’s one of the main features.

So as we were developing this, we decided to pivot. We knew the keystone organisms we wanted—and of course, foremost has been the Akkermansia. We have two different strains of Akkermansia, and they both—you know, we won’t get into strains too deeply—but they both impact. They have separate… when you think of you and I’s genetic potential, there’s going to be different things that you and I do genetically. Even though we might be 99.9% identical genetically, we have these little nuances—these things that you and I can do differently or better or worse—and each species of organism has the same potential. So you might have Akkermansia muciniphila, two of them, but they both maybe perform something a little bit differently. That’s the ongoing knowledge that we’re getting from these strains.

So we have two Akkermansia muciniphila. We have a Butyricoccus pullicaecorum, and that’s a really complicated name, again, and just from the name you can tell that it’s very much involved in maintaining small chain fatty acids from a number of food sources. So it’s Butyricoccus because it produces butyrate—and it produces butyrate that we really need to manage a lot of our epithelial metabolism in the gut. And then, of course, that becomes a systemic benefit as well. And in maintaining that, it creates an integrity in our gut lining that, of course, not only impacts the inflammatory process, but it helps us then manage our metabolic switches—whether we’re letting a lot of glucose in or we’re keeping it out, we’re triggering the L cells to produce more GLP-1 along with the Akkermansia, or do we want to produce PYY or CCK. And these are all what we call satiety hormones. These help us manage our metabolic uptake and the way we store it, and it’s critical.

And of course, now that’s blown up with this new generation of GLP-1 agonists, we can now have that conversation more, I guess, candidly, because the candor around GLP-1 is—it’s out there. And there are more than just GLP-1. Like I say, there’s a number of—you know—the ghrelin, the leptin, the PYY and the CCK. These are all hormones that our body has used, intimately related to our microbiota and our diet, to manage a healthy metabolic process. And we’ve disrupted all of those. So bringing it back to some of these organisms that help us do that is critical. And it’s been phenomenal science. So—excited about that.

Lindsey:

Curious, because I had only previously been familiar with the Pendulum products that had Akkermansia in them. And I know from their original experiments that after supplementing—I think their study maybe was two or three months—after supplementing it didn’t implant. And so I know they have a protocol that’s a bit longer now. So I’m curious, have you looked at implantation of Akkermansia and how long it takes and what you need to do to make that actually happen?

Dr. Shayne Morris:

Yeah, we have. In fact, we’re in the process of doing that right now as we speak. We’ve done it a few times. The work we’ve done so far has shown that pretty much every one of these has implanted and lasted over 60 days. Now beyond that, we didn’t run those further out, which we are doing now. We’ve only done it against one of the Akkermansia strains, so we only have data on one of the strains. The other strain, we have not looked at its—not only implantation—but what we call it taking up residency.

Lindsey:

And how long did they supplement for before you ran the 60 days?

Dr. Shayne Morris:

We ran stool at—so supplemented for 30 days—and then we ran it again at 60, and then at 90, and then we followed that washout period for another 60 days. We were seeing the organisms. After 30 days, we were seeing them regularly.

Lindsey:

Implant at the dose that’s in your product? At the recommended dosage?

Dr. Shayne Morris:

Yeah. Okay, yeah, exactly. And what we found just as fascinating in that—because that’s something we were looking for, right? That’s an experiment where you’re looking for something, you’re doing it. One of the surprising outcomes with these—and keep in mind, we were also giving them the prebiotic, the superfood at the same time. That was a requirement. We didn’t just do probiotic. We did a pre and a pro together. And my hypothesis is that’s an important feature we underappreciated. That if you just supplement a probiotic and then follow it—if you’re not giving it the nutrients that it requires—it will not really engraft and become a resident, because there’s no priority for it to. If it’s not getting its food, it’s going to leave—it’s going to bail.

So we’ve always run our studies with the pre and pro together. And what we found is not only were we seeing really healthy outcomes with the keystones, we started seeing the emergence of a lot of other keystone species that we don’t have, that no one has—but they were growing as a consequence of the pre and the pro journey. And we don’t know if they were just caught in there and they were just surviving at some low level, or if they were being introduced through contact with humans and food. We don’t know. We just know that in our dataset, we not only saw the organisms we were looking for, but we started seeing a lot of new organisms show up that were beneficial organisms. And we saw the reduction of the non-beneficial organisms—or essentially the pathobionts or pathogens—would decrease. And that’s because the whole ecosystem was becoming more competitive, and we weren’t feeding those, right? We were not feeding organisms that don’t belong there—we were feeding the ones that do. It was quite exciting.

And so we’re repeating some of those just to see how far we can take this. And when we did that, we only had probably about a dozen of the Keystones, and we now have more. So as we do this in the future, we can start adding more of these to see how we’re doing. And more of the pre and probiotics, like the superfood for the Metabolic, not only has plant-based compounds, it has a number of what we call human oligosaccharides or human polysaccharides that our body produces to maintain our own microbiome. And, you know, that’s important. It’s an important feature of our uniqueness—not just from a diet perspective, but from your own body’s ability to regulate the microbiome through the production of food for these guys.

Lindsey:

And I think we still have one left—the Neuro, is it?

Dr. Shayne Morris:

Yeah, the Neuro. The Neuro one is a really exciting one. This one was—in fact, a version of this was launched first. So back in 2018, we did a beta of the Neuro. Now, we’ve added since then, but key players in that were, of course, the Faecalibacterium and we had Parabacteroides—but we’ve added to this one since. In the early launch, we had the Neuro and the first version of the Neuro superfood. We called it Neurobiome. But both those together, again, we got really great anecdotal feedback. We got some good stool feedback.

And because we knew it was early on, we went through the beta, collected all the data—I think I had somewhere around 4,000 data points from practitioners using it in their clinics during the beta test. And then we went and reset it. We actually reformulated it in 2021 to get a better result than we got the first time. But we’d also learned more from academia. I mean, there are these two researchers in Ireland—Dinan and Cryan*—who are phenomenal. They coined the term “psychobiotics,” so we follow their work, and it helped guide us in this new direction.

But in that product, of course, we now have Parabacteroides distasonis, Agathobaculum butyriciproducens—again, that’s a butyrate producer but it’s a unique keystone. You probably haven’t heard that name. It’s a unique name—Agathobaculum. That’s pretty cool. We have M. Vaccae, and of course we have an L. farciminus. So there’s a number of unique ones there as well—and more to come.

And really, what we’re looking for there—we have a GABA producer in there. It is a Lactobacillus, but it produces GABA. We know that from looking at the studies, and that’s actually from work with a supplier—a group that creates probiotics. And then a number of these organisms are known to produce what we call neurotransmitters or neurochemicals. They don’t all cross the blood-brain barrier, but they still do what they need to do systemically—your serotonin producers, your dopamine producers, the L-DOPA process, as well as the GABA and glutamine and glutamate.

So there are some pretty amazing organisms that we’ve now utilized in this approach to their neurological microbiome with the Neurobiome—or the psychobiome.

Lindsey:

There’s a lot of exciting stuff there. And I’m honestly quite excited to know about these products and to think about who I’m already working with who could probably use some of these. So I’m curious about the specific foods—because we did talk about polyphenols and cyano… whatever they’re called, cyano-something or others, yeah—but when people are actually eating food, what kind of foods are going to most help nourish and support these keystone strains?

Dr. Shayne Morris:

Yeah, that’s a great question. And to be honest with you, I love whole foods. But you’re right—it’s going to depend on where people are starting from. So if you take a relatively healthy 20- or 30-something who’s already been on a wellness journey, they’re going to be able to start with some pretty nutrient-dense, fiber-rich foods—these microbial accessible carbohydrates. That can be from the brassicas. They can start incorporating, at a minimum—we all need to get to the point where we’re utilizing at least 30 to 60 different vegetables and fruits per week, at a minimum. That’s quite an ask, right, when you think about it.

This can include a decent dose of what we call non-staple foods. So we can all increase the amount of broccoli, beets, asparagus, radishes, various squashes—the gourds, the pumpkins. We can all increase the leafy greens, the strawberries, the blueberries, the blackberries. We all have access to those—and hopefully to good, clean versions of them.

But on top of that, there are these unique ingredients we get from other plants—plants we wouldn’t normally include in our diet. Herbs and spices—we might think of them as medicinal, like turmeric, ginger, ginseng, resveratrol from chicory root. These are compounds we’ve thought about medicinally, but I want people thinking about them from a microbiome perspective.

A lot of these—especially tubers—are important when it comes to microbiota. The resistant starches, you’ve probably heard that term. We really encourage including resistant starch-based foods. A purple potato or sweet potato or yam—if you cook them twice or cook and freeze them, that process creates what we call resistant starch. So you drop the glucose impact on the body and increase the microbiome benefit.

And then we use other plants that bring in things like glucomannan, galactooligosaccharides, xylooligosaccharides, polymethoxylated flavones. We use dragon fruit, larch extract with arabinogalactans, baobab pulp, Indian kino, turmeric, Poria (a mushroom)—all high in medicinal value and amazing for the microbiome. Things we don’t normally think of, but that exist in mushrooms and other plants—especially tubers—are all involved in what we call our prebiotic presentation.

Even things like pectins, cassava, butterfly pea flower, cranberry—certainly important for women—these are all what we call plant-based carbohydrates. But it’s not just the carbohydrate we care about—it’s the phyto constituents, the phytochemicals like polyphenolics, polyglucosinolates, and others.

Across our prebiotics, for me personally—and this was a personal journey—it was really hard to get my 50 to 60 veggies and fruits per week. So I wanted to incorporate all of those into our prebiotics. Doesn’t mean you can’t do it with whole foods. Someone really dedicated can source many of these organically—especially if they live where you can grow food year-round, without harsh winters. But we dry and include them in our prebiotics.

If I take two or three of my prebiotics a week, I’m hitting 30+ plants and fruits and vegetables, and I feel much better about it. I encourage people to eat whole foods and also use pre- and probiotics. It’s tough to jump right into this. Depending on where someone is starting, if they’ve been really neglectful of diet, then they need to introduce prebiotics slowly—even if they’re food-based. Ginseng, fruit, saccharide-containing foods, onions, garlic, broccoli, etc.—introduce them slowly so the microbiome can catch up.

If not, you might get a rebound effect—microbes aren’t happy, convert things into gases, you might get bloating, cramping, gas, changes in bowel movements. So you’ve got to go slow to let the microbiome adapt. The most I’ve seen someone need is about two weeks—by then they’re feeling great, no more pushback, and they can begin rotating in more.

I rotate monthly—different versions, different diets. I always tell people: eat for the season, eat for your ancestry. There’s a genetic component to this. So eat your ancestry, eat your seasonal—both help guide where you’re headed.

Lindsey:

Does that mean—because I’ve got Italian in me—I can eat a lot of pasta?

Dr. Shayne Morris:

You can eat good pasta. And really, if you’re getting pasta from Italy, those grains are absolutely healthy. I mean, there are a number of studies that have shown how the ancient grains—especially heirloom grains grown in areas that are still healthy, without glyphosates and other high-production food treatments—are phenomenal for the microbiome, and especially supportive of both your ancestry and your microbiome. And then you can just infuse that with Italian plants, and you’ll feel amazing from that.

Lindsey:

So what should consumers know when they’re using probiotic supplements? Because there’s such a variety—some are refrigerated, some not. There are different types. How do you sort it all out?

Dr. Shayne Morris:

Yeah, it’s a lot. I’m glad you asked because it can be so frustrating. With this microbiome revolution, everyone’s trying to understand probiotics, prebiotics, postbiotics, synbiotics… it keeps expanding.

My take is—work through clinicians. Clinicians can stay on top of the education and understanding, and that helps patients get better input and outcomes. When you’re looking at probiotics and prebiotics in the mass market, it takes work to sort them out. The growing field has created a marketing machine. So even if you don’t want to work with a clinician long-term, at least consult one. Don’t just rely on marketing. The marketing is one thing—but the data is another.

A lot of probiotics out there are still old-school, transient types. They come from the dairy industry—cheese, milk, yogurt. And while those aren’t bad, they don’t necessarily generate the outcome you might want. When you take a probiotic, it could offer general benefits. But probiotics can also be used as a precision tool. If you’re taking a general probiotic from a fermented food source that’s not human-based, it might have a general, transient benefit. It can help shift nutrients and encourage growth of existing organisms. Things like kefir, kombucha, kimchi, sauerkraut—all of those can do that.

But when you need precision, you have to understand what’s in the product. Do they contain keystone organisms? Are they human-based, clinically studied organisms like Lactobacillus and Bifidobacterium? The ones we use in Alimentum, if they’re Lactobacillus or Bifido, they’re still human-origin—not dairy-origin. That allows you to be more precise, especially for things like IBS, IBD, gut-liver axis, gut-brain axis, etc.

So you really need to dig into the label, talk to your clinician, and understand the formulation to get that benefit. Otherwise, you see people saying, “I took a probiotic for a few weeks and didn’t feel better, so I gave up,” or “I took a prebiotic and felt worse, so I stopped.” That’s not what we want. We know the benefit is there—we just have to use them appropriately.

Lindsey:

Right. There are so many different types. And like you said, the strains are different. So it’s crazy to think, “Oh, I got this one from CVS,” versus the ones you’ve got. It’s like the difference between eating an apple and eating a bag of chips. There’s no comparison.

Dr. Shayne Morris:

Exactly. It’s very different. And that’s the future of this—we need people to know the benefit is there. But they need to know how to use it. I’d love to make it simple—but it isn’t. It’s powerful, and we have to understand it. Because if it’s misused or used out of context, you don’t get the result. And then people lose faith—and that’s not what we want. We want them to get the benefit, but we have to start with appropriate use.

Lindsey:

Brief segue into another topic. I saw on your website you have a product called Pseudo Vyrome—and I noticed it’s a bacteriophage that specifically targets Pseudomonas aeruginosa, which I know can be a lung pathogen. I had a client with a chronic lung infection with this bacterium. Could you briefly explain what bacteriophages are and talk about Pseudomonas aeruginosa?

Dr. Shayne Morris:

Yeah, it’s such a unique part of our microbiota. So, what are bacteriophages? They’re probably the most dominant micro—I’m going to call it a microorganism—even though it’s not technically alive. It’s in the virus world. A phage is a virus that only targets bacteria.

In us and on us, we have bacteria, bacteriophage, eukaryotic fungi, some parasites, and mammalian viruses. But the vast majority are bacteria and phages. Phages are viruses that target specific bacteria. They live in us and move through us. You’re exposed to trillions of them in the ocean, lakes, soil—just pulling a carrot out of the ground, for example.

Phages help manage bacterial populations. If a bacterium grows out of control, phages grow alongside them to bring the numbers down. Without that control, bacteria could overwhelm us or any animal or plant. Phages attack and destroy bacteria. And they’re super specific—there’s a phage for E. coli, Salmonella, Pseudomonas, Bacteroides, Lactobacillus, Bifidobacterium—pretty much every bacterium we’ve looked for.

We use phages nutritionally as a kind of prebiotic—to help maintain a healthy ecosystem. They help promote eubiosis and reduce dysbiosis. Research is still limited, especially here in the U.S., but there’s a long history of phage use in Eastern Europe. Now the science is growing again in the U.S. and Europe.

So we’re using phages to help maintain balance in the gut, skin, and maybe other areas, though we still know very little about their role in organs like the lungs, liver, or kidneys.

Lindsey:

I suggested it to my client—so I’ll let you know if he has any positive effects!

Dr. Shayne Morris:

Please do, yeah. It’s amazing.

Lindsey:

Where can listeners learn more about your work, your research, and the products?

Dr. Shayne Morris:

We’ve got social media—my Instagram is @drshaynemorris. Also Alimentum and Systemic have social platforms. And there’s a website: alimentumlabs.com* (use Doctor Referral Code: AZPA11 to access products). Also systemicformulas.com. We’ve got another one called NBResults—that’s more on the DNA side and will be the future for microbiome testing.

We’re creating more all the time. We’re just getting to the point where we can really get out and tell the story. We’ve been in the lab for 12 years, and now we’re emerging from it so we can start sharing all of this.

Lindsey:

Everybody should check the show notes for all the specific links and such. Thank you so much for sharing all this information with us!

Dr. Shayne Morris:

Yeah—thank you for having me on. It was such a pleasure.

Lindsey:

If you’re interested in accessing these probiotics with unique keystone species, there’s a link* and referral code (AZPA11) to register for an account on Systemic Formulas.

But I highly recommend setting up a consultation with me first—and doing a stool test—to figure out which species you most need to replenish and whether you need to address any pathogens first.

If you’re dealing with gut health issues of any type (diarrhea, constipation, bloating, SIBO, IMO, H2S SIBO/ISO, IBS, IBD, gastritis, GERD, H pylori, diverticulitis, candida, etc.) or have an autoimmune disease and need some help, I see individual clients to help them resolve their digestive issues or reverse autoimmune disease naturally, You’re welcome to set up a free, 30-minute breakthrough session to see if you’d like to work with me. I also have my own two products, Tributyrin-Max, which is particularly helpful for loose stool and diarrhea as it slows your motility and firms up your stool, and SBI powder, which is an all around gut pathogen binder, which is super safe and won’t harm beneficial bacteria, and is usually the first line of treatment I educate my clients about in order to avoid stronger antimicrobial herbs.

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

Adapted from episode 140 of The Perfect Stool podcast and edited for readability with Lindsey Parsons, EdD.

When should I suspect mold toxicity or mycotoxin illness? 

While I feel most comfortable in my niche area of gut health and autoimmunity, I have found myself quite often recently working with clients who didn’t realize that underneath their gut health issues was mycotoxin illness. The way I usually discover this is that either the gut issues just aren’t getting better, or they can hardly tolerate any supplements that impact gut issues, or in our initial intake they mention a potential past or current mold exposure. So we do testing for mycotoxins and sure enough, they come out positive for some, or in some cases, nearly all tested mycotoxins.

I looked at these clients and I was trying to find common symptoms with all of them, and the one that I have noticed for all of them, anecdotally of course, is anxiety. While they might mention it on our first call, this manifests itself pretty clearly to me in frequent emails to ask numerous questions, worries about how they will follow my recommendations, clarifications of how to precisely follow instructions, and the general need for reassurance that they’re doing the right thing. Some had constipation, which in several cases was also caused by diagnosed methanogen overgrowths, almost all had food sensitivities, usually including histamine reactions, some worse than others.

And for the ones who I suspect had genetic susceptibilities affecting detoxification or immune regulation which would make them particularly vulnerable to mycotoxin illness, symptoms often appear across multiple body systems, from the skin, to headaches, brain fog, breathing issues, hair loss and autoimmune diseases. And many showed obvious signs of yeast, like a white coating on their tongue or recurrent yeast infections. But all that is just my anecdotal experience. Let’s delve into the official information on all of this. 

What are mold and mycotoxins? 

Mold grows on organic substances and decomposes them to absorb their nutrients. It grows optimally in moist environments with organic material to feed on, with humidity levels exceeding 70%.

Mold and fungi release mycotoxins as a defense mechanism against predators. These mycotoxins may help weaken host defenses in animals and plants, though their primary role is often competitive — inhibiting other microbes, which indirectly helps the mold in colonizing. Fluctuating environmental conditions (temperature, moisture, UV exposure and nutrient scarcity) can also trigger the release of mycotoxins. Finally, some mycotoxins are produced naturally as a result of environmental stress, namely oxidative stress caused by environmental factors, including fluctuating oxygen levels, nutrient scarcity or chemical exposures. As a result, harmful gases, such as superoxide radicals, hydrogen peroxide and hydroxyl radicals are formed within fungal cells under stress conditions. Highly fluctuating oxygenation levels, like rapidly moving from low to high oxygen levels (i.e a fungus being buried underground to sprouting out of the ground) can also cause the release of these harmful gases.

Where is mold commonly found? 

Common sources of mold exposure include water-damaged buildings, especially those affected by flooding or leaks, as well as poorly-ventilated, moisture-prone areas like bathrooms, laundry rooms, attics and crawl spaces. Mold can also grow inside plumbing systems, air conditioning units, and older carpets and appliances, particularly when they trap moisture. In humid climates, mold is more likely to thrive both indoors and on stored foods such as grains, coffee, cocoa, dried beans, sesame seeds, cheese, yogurt, malt, beer, nuts, fruit, dried fruit, and spices, where improper storage can encourage contamination.

Is everyone affected by mold? 

Mold spores are found ubiquitously in the air we breathe. However, most people do not experience adverse effects due to several mitigating factors. First, our immune system is capable of clearing low level mold exposure. Also, neutrophils in the lungs kill germinating mold spores asymptomatically. However, for people with compromised immune systems or lung function, they may be at a higher risk of developing adverse health effects after exposure to mold. Furthermore, only a few species of mold are harmful to humans. The overwhelming majority of mold species are not harmful to humans, which are called saprophytic molds, which feed on dead organic matter and typically do not infect humans, and many more don’t even produce mycotoxins.

Of those that do produce mycotoxins, only a handful are pathogenic. Finally, genetics play a large role in determining whether or not a person is highly susceptible to mold toxicity. Genes involved in immune regulation, detoxification pathways and inflammatory cytokine production can influence how someone responds to mold exposure. Specific genes like HLA-DR have been implicated in mold illness susceptibility, particularly in people with Chronic Inflammatory Response Syndrome (CIRS). People with certain cytokine gene variants may be more prone to chronic inflammation after mold exposure.

Do mycotoxins affect the gut microbiome?

Mycotoxins can significantly disrupt the gut microbiome, leading to dysbiosis, or microbial imbalance. Research shows that mycotoxins reduce beneficial bacteria such as Lactobacillus and Bifidobacterium, while promoting the overgrowth of inflammatory species, particularly from the Proteobacteria phylum. Mycotoxins have been shown to damage the epithelial lining of the gut, increasing gut permeability. Increased gut permeability allows undigested food particles, toxins and microbes to enter the bloodstream, putting stress on the immune system and, over time, can dysregulate immune responses. This microbial imbalance and leaky gut is at the root of food sensitivities and chronic inflammation, creating a cycle of ongoing gut damage and immune activation, which may manifest as brain fog, joint pain, skin issues and autoimmune flares. 

Mycotoxins also impair the gut microbiome’s detoxification capacity, further weakening the body’s ability to clear toxins and maintain gut barrier integrity. These toxins can further alter the gut ecosystem, amplifying inflammation and weakening the gut lining. However, research suggests that prebiotics and probiotics may help restore microbial balance and enhance the gut’s ability to metabolize and neutralize mold-related toxins before they trigger further disruption. Supporting a diverse and resilient microbiome may be one of the most effective strategies for protecting gut health in the face of mold and mycotoxin exposure.

Can mycotoxins lead to SIFO or candida? 

The modulation of the gut microbiota by mycotoxins can also lead to SIFO (Small Intestine Fungal Overgrowth) or Candida overgrowth. While candida is a normal resident of the gut, when it overgrows it can extend beyond the gut, through hyphae, which are branching filament-like structures that can penetrate gut tissue, contributing to intestinal permeability. Systemic candidiasis can manifest as bloating, sugar cravings, sinus congestion, skin rashes, brain fog or fatigue, and may also be evidenced by yeast infections, fungal nail infections or thrush, which can be seen as a white coating on the tongue. 

How do mycotoxins affect your immune function? 

The inflammation and immune dysregulation associated with mycotoxins may contribute to the reactivation of chronic infections like Epstein-Barr or Lyme, or gut pathogens like C. difficile, due to weakened immune surveillance, which allows latent infections to flare. Mycotoxins can impair immune defenses against pathogens and disrupt the gut’s natural detoxification processes. This can lead to a whole slew of health issues such as inflammatory bowel disease and irritable bowel syndrome, as well as extra-intestinal diseases, including heart disease, obesity, type 1 diabetes and celiac disease.

Mycotoxins have also been connected to mast cell activation syndrome (MCAS), and histamine intolerance. So when I see histamine issues, my first thoughts are either mycotoxins or hydrogen sulfide producing bacteria. 

What are the symptoms of mold toxicity? 

The symptoms of mold toxicity are highly variable between individuals and can mimic gut symptoms, including abdominal pain, nausea and diarrhea. Respiratory symptoms, such as rhinitis, coughing, wheezing, sinus congestion and tenderness, and respiratory infections such as bronchitis and pneumonia, are frequently reported. Skin irritation and mucosal irritation, such as dry eyes and pharyngeal cobblestoning, are also commonly reported. Some individuals may experience headaches and sensitivity to bright lights. Some studies have also reported symptoms like anxiety, depression, muscle aches and cramps, joint pain with morning stiffness, unusual pains around the body, excessive thirst, a metallic taste in the mouth, weakness and fatigue. As mold toxicity progresses, some individuals may experience deficits in their neurological functioning, including deficits in short-term memory, executive function/judgment, numbness and tingling, disequilibrium and dizziness, and poor concentration and hand/eye coordination.

Mold toxicity, in conjunction with other health issues, may exacerbate other symptoms not usually related to mold toxicity. So while you may have some slight gut issues, if you pile mold toxicity on top of that, it can seem much worse and become impossible to resolve your gut issues until the mycotoxin issue is addressed first. 

It is important to note that the symptoms attributed to mold toxicity are still debated, as many symptoms overlap with other conditions, many of them mundane. 

How do you test for mold in your home? 

If you suspect a mold issue in your home, relying on visual inspection alone is often insufficient. Mold spores themselves are microscopic and invisible to the naked eye, and mold growth can occur inside walls, under flooring, or in HVAC systems, where it cannot be seen without specialized tools. Humidity meters do not detect mold spores directly, but they can identify excess moisture and humidity levels, which create ideal conditions for mold growth. For a more comprehensive evaluation, ERMI (Environmental Relative Moldiness Index) and HERTSMI-2 tests, which analyze dust samples for mold DNA, are useful screening tools — especially for assessing past or cumulative mold contamination in water-damaged buildings. EnviroBiomics is a company that offers these tests (I believe you order the plates and lay them out in the house then send them back for analysis) and I’ll link to that in the show notes. However, they are not diagnostic on their own, and results should be interpreted alongside a thorough home inspection. One company that does mold inspections is called Environmental Analytics, and I’ll link to them in the show notes. 

Air and surface testing can also help detect mold, with active air sampling being a common method where a pump draws air through a filter, which is then analyzed for mold spores and other pollutants. While air sampling provides a snapshot of airborne mold levels, it can miss hidden mold or fluctuating spore counts, so it is best used in combination with moisture mapping, thermal imaging, and targeted surface sampling. If you suspect mold damage, it’s highly recommended to hire a professional mold inspector, preferably one who is independent from any remediation company to avoid conflicts of interest. In states with mold regulations, such as Texas and Florida, this separation between inspection and remediation is required by law, ensuring a more objective assessment.

How do you test for mycotoxins in your body? 

When I suspect mycotoxins, I use either the Mycotoxin Panel from US Biotek/Real Time Laboratories (which recently merged), the Mosaic Diagnostics Mycotox or Vibrant Wellness’ Mycotoxin Panel. These are all urine tests. For someone with ongoing nasal/sinus issues, I may also suggest a MicroGen DX SinusKEY test, which uses qPCR technology to check for 57,000 potential bacterial and fungal pathogens in the sinuses. I sometimes am also clued in to potential mycotoxin issues when I see elevations on the Mosaic Organic Acids Test in markers 2, 4 and 5, which are indicative of aspergillus, a type of mold that can be environmental. Vibrant Wellness’ Organic Acids test also has these same markers: 5-Hydroxymethyl-furoic acid, Furan-2,5-dicarboxylic acid and Furancarbonylglycine – you’re looking for the words furan or furoic in these longer, more complicated names for potential environmental molds.

However, these can often be negative while mycotoxin tests are positive because there are many different types of mycotoxins and most of them are not measured on an Organic Acids Test. Generally, I recommend testing your body before your home, as the various mycotoxin tests currently run from $289-$400 each, whereas a home inspection I’ve heard can cost around $500. Not to mention that you may be exposed to mycotoxins at someone else’s home that you visit frequently or at your place of work. 

How do I heal from mold toxicity? 

If you determine that you have a mycotoxin issue, the first step is to either get out of the moldy environment or have it professionally remediated. And I’d recommend that if you are very impacted by this issue, that you remove yourself from the home or building during remediation. You should never take care of this problem yourself, but hire a professional mold remediation service. 

If you can’t get out of the environment or remediate immediately, you can take binders specific to the mycotoxins detected on your test until you can get out. Until then, it’s not recommended that you take antifungals, as this may be too much for your system to handle while still in a moldy environment, and will be futile, because you’re still taking in mycotoxins. However, taking binders on an empty stomach with plenty of water can help bind up the mycotoxins and prevent damage in the meantime. 

If you’re doing this without the benefit of an MD or naturopath who has prescribing rights, the binders you’ll likely have access to will be activated charcoal, which binds ochratoxins, aflatoxins and trichothecenes (tree-co-thee-scenes) and bentonite clay, which binds, gliotoxins and aflatoxins, and Saccharomyces boulardii* (a probiotic yeast) and NAC, which bind gliotoxins. Chlorella and bentonite clay may help bind certain mycotoxins, including trichothecenes.

I often recommend Quicksilver’s Ultra Binder* or Biocidin’s GI Detox* as all-around binders with several of those compounds in them. If you’re very sick and/or sensitive, you may need to start with less than an entire capsule of binders to start, even ¼ capsule mixed in water for example, just to check your initial reaction. You may experience a die-off or Herxheimer reaction that feels like getting the flu. If that’s the case, I suggest you titrate up very slowly, but eventually, you should get to 1 capsule 3 times a day of binders, always on an empty stomach with plenty of water, with at least an hour before eating and two hours after eating or taking supplements. If you’re constipated, you may need to take additional magnesium citrate (I personally like the Natural Vitality Calm* powder, which is magnesium carbonate that turns to citrate in water) to promote bowel movements as binders can be constipating. You should get up to the full dose of binders before adding in any antifungal agents. 

For many mycotoxins, supportive nutrients like vitamins C and E, selenium, zinc and magnesium are good to have on board before going through detoxification protocols. In addition, using NAC, glutathione,* CoQ10, melatonin and polyphenols can positively impact your health, protect your body from oxidative stress and open up detoxification pathways. 

When it comes to helping clients actually kill the molds, I educate clients on the protocol developed by Neil Nathan, MD, who leans on the Dr. Brewer protocol, and described in his book Toxic: Heal Your Body from Mold Toxicity, Lyme disease, and Multiple Chemical Sensitivities, and Chronic Environmental Illness*. His protocol involves the use of Argentyn 23 (hydrosol silver) nasal sprays to start, to test sensitivity and then work synergystically with antifungal nasal sprays. He recommends prescription nasal sprays made by compounding pharmacies, because many molds have come from the air and may have settled in your sinuses. When those aren’t available, the Xlear* nasal spray (xylitol-based) with added drops of Biocidin* (10 drops per 1 ounce of spray) is a reasonable alternative, because Biocidin is a strong, combination antifungal agent. All nasal sprays start at one spray a day then go up to as many as 3 sprays per day, if you can tolerate it. And again, you don’t move on to the next stage until you can tolerate both binders and nasal sprays. 

Dr. Nathan then recommends using prescription itraconazole (brand name Sporanox), a systemic antifungal, starting at a dose of 100 mg every two weeks and slowly working up to 1-2 doses per day. 

When prescription options aren’t available, Biocidin* drops are again a good option, starting with 1 drop a day and working up to 15 drops twice a day or 10 drops three times a day, 15 minutes before meals. Other natural antifungal agents include berberine, oregano oil, grapefruit seed extract and undecylenic acid (primarily targeting Candida). Most of these are very strong antibacterial agents as well, so it’s wise to protect your microbiome with supportive prebiotic foods while taking them, like pomegranate powder, cranberries or cranberry powder and matcha green tea powder.

I often suggest clients combine these into a gut healing smoothie with collagen, l-glutamine and any other powders people may be taking like AuRx*, a palatable butyrate powder which helps firm up stool for people with loose stool or diarrhea as well as helping seal the colon, and serum bovine immunoglobulins, which can help bind fungi and pathogenic bacteria and and support gut barrier function. This combo can help seal up a leaky gut and protect you from autoimmunity and inflammation. A diverse probiotic with well-researched strains may also help with gut health during a mold protocol. I like Seed Synbiotic* as a general lacto-bifido type probiotic. 

Dr. Nathan also adds SFI Health Ther-Biotic Interfase Plus* to disrupt biofilms. I think it’s wise to wait until you’ve gotten to the point of tolerating daily doses of antifungals before starting this, as it may increase die-off. This is taken by itself with water on an empty stomach an hour prior to antifungals. 

Other helpful modalities for supporting detoxification from mycotoxins include infrared saunas, coffee enemas and lymphatic drainage using self-massage or dry brushing, and any activity that will make you sweat, while bringing in adequate hydration and electrolytes of course. There are links for those things in the show notes. 

There are lots more details about how Dr. Nathan treats mold, so if you are thinking of self-treating or trying to ask your conventional doctor for prescription antifungals, I’d recommend getting his book before launching into this project, although it’s much safer to work with a practitioner and have guidance as things often go differently than expected/planned when taking supplements and medicines. 

I mainly wanted to take this time to alert you to the idea that your gut health issues could have their roots in mycotoxins, as sometimes I’m not even thinking about mycotoxins unless you suggest it may have been an issue, and only you will know about potential mold exposures in your past or present. So do be proactive with me or whoever your practitioner is if you’re experiencing symptoms like I described in this podcast, have recalcitrant gut issues or remember living in a moldy, mildewy place in the past.  

---

If you’re dealing with gut health issues of any type (diarrhea, constipation, bloating, SIBO, IMO, H2S SIBO/ISO, IBS, IBD, gastritis, GERD, H pylori, diverticulitis, candida, etc.) or have an autoimmune disease and need some help, I see individual clients to help them resolve their digestive issues or reverse autoimmune disease naturally, You’re welcome to set up a free, 30-minute breakthrough session to see if you’d like to work with me. I also have my own two products, Tributyrin-Max, which is particularly helpful for loose stool and diarrhea as it slows your motility and firms up your stool, and SBI powder, which is an all around gut pathogen binder, which is super safe and won’t harm beneficial bacteria, and is usually the first line of treatment I educate my clients about in order to avoid stronger antimicrobial herbs.

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