Deuterium Depleted Water and Hydrogen Sulfide SIBO: Exploring the Connection with Greg Nigh, ND

Deuterium Depleted Water and Hydrogen Sulfide SIBO: Exploring the Connection

Adapted from episode 153 of The Perfect Stool podcast and edited for readability with your host Lindsey Parsons, EdD and Dr. Greg Nigh, Naturopathic Doctor and author of the book The Devil in the Garlic: How Sulfur in Your Food Can Cause Anxiety, Hot Flashes, IBS, Brain Fog, Migraines, Skin Problems, and More, and a Program to Help You Feel Great Again.

Lindsey:    

So when I did an intro call with Dr Nigh, we ended up talking at length about deuterium depleted water and how important he thinks this topic is to gut health and human physiology, and he has articles out on the topic with Stephanie Seneff, a well-known glyphosate researcher. So I promise we’re going to get to sulfur and hydrogen sulfide SIBO-related topics. But I think if we don’t start here, you’ll take me there anyway. So can you start us off with what deuterium and deuterium depleted water are?

Dr. Greg Nigh:    

Gosh, so let’s start with what deuterium is, and I suspect a lot of your audience knows, but just to make sure it’s clear, deuterium is an isotope of hydrogen, which is to say it’s basically the same as hydrogen. But it’s got a neutron in the nucleus, which regular hydrogen doesn’t, and that makes deuterium heavy. So people might have heard of heavy water, and that just means water that uses deuterium isotopes as the H’s, so it just weighs more. So the thing is, deuterium is everywhere. It is ubiquitous in our environment. It’s in all the water we drink. It’s in the food that we’re eating. It is constantly coming into us, but that’s a problem because deuterium doesn’t behave like hydrogen when it’s in the body. And so our bodies have pretty amazing mechanisms in place to be sure that deuterium doesn’t gunk things up. And what I think is true is that a great deal of modern maladies, if you go to the root, have to do with deuterium getting in the way of normal cellular function. Did I answer the question?

Lindsey:    

Yeah. So does this have anything to do with oxidative stress, or is this unrelated?

Dr. Greg Nigh:    

It’s all kind of related. Certainly, you know, obviously normal cell physiology has all kinds of reactive oxygen species that are getting created, and now we know that those are signaling molecules. They’re not just bad. And then things could get tipped into an excess of oxidation, which then we call a stress. And so the processing of deuterium is in a balance with the oxidation state of the cell. So if deuterium gets dysregulated within the cell, so just to give you a quick example, we know that the mitochondria is the powerhouse of the cell, and hydrogen get funneled to the mitochondria, which ultimately pass through that ATPase pump, spins the pump, creates ATP. That fuels pretty much everything about physiology. So the thing is, those are hydrogens that go through that pump, it’s literally like a funnel, and every time one goes through, it spins the funnel. If a deuterium makes its way to the mitochondria and goes through that pump, it binds to a protein in that pump and causes the pump to sputter, and so it impedes the efficiency of the pump, and so the more deuterium that make its way to the mitochondria, the more it is clogging up those ATPase pumps- not only compromising the ability of the cell to generate energy, but in the process, generating extra free radicals. This enhances the level of oxidation that’s being generated within the mitochondria. And of course, that ricochets all over the place, creating problems.

Lindsey:    

Okay. Now, just for clarity’s sake, because there’s so many other types of water out there that people are talking about – does this have anything to do with hydrogen water or alkaline water, or what other types of water?

Dr. Greg Nigh:    

Structured water, and yeah, all of that, which all may very well have beneficial physiological effects, but they are not the same as deuterium depleted water. Depleting those isotopes out of water is a very intensive industrial process, which is why there are only a few companies in the world that are doing this for retail sales. So, yeah, if you look up, like probably on YouTube, there are some videos about how to make it in your kitchen. It ain’t real – it’s not a thing. Unfortunately, you have to buy deuterium depleted water. Now, what I will say about hydrogenated water and we’re going to end up talking about this when we come back to the gut, hydrogen gas is inherently depleted in deuterium. So when you bubble hydrogen gas and dissolve it into water, one of the consequences of doing that, and maybe one of the reasons it’s beneficial is that you are enhancing the number of hydrogen relative to deuterium within the water. So in drinking that water, you’re supplying hydrogens and less deuterium. It’s not taking deuterium out. It’s just making hydrogen more present.

Lindsey:    

Yeah and does that also work if you’re taking a tablet and putting it into your water, is that same thing? 

Dr. Greg Nigh:    

Yeah. 

Lindsey:    

Okay, interesting. So now let’s get into how deuterium depleted water relates to gut health or deuterium itself.

Dr. Greg Nigh:    

Okay, so, and keep in mind this was all discovered or uncovered in the past eight months. It’s very, very new. So this is something that Stephanie initially got me keyed into. She published a few papers on the topic, and then we recently published a paper together that’s right now going through peer review. So we have this fundamental truth, which is that the body needs to be very careful in what it does with the deuterium that is always coming in. And I am to a fault in many ways, and Stephanie and I are very much aligned in this way, in thinking that bodies are adaptive to almost an absurd extent; everything is to help us function normally. And what has become apparent as we get into the chemistry and physics of this stuff, which of course, Stephanie is way beyond me and all of that, is that the microbiome, human microbiome, the gut microbiome, is a sieve.

So all of the food and water that we’re taking in, which has deuterium in the water that we drink, deuterium is present at about 150 parts per million, and in food. So all of those carbohydrates have all those hydrogens attached, well, some portion of those hydrogens attached to carbohydrates are deuterium. They’re not hydrogen. Ditto for protein and fat. But in terms of deuterium content, carbohydrates have the highest deuterium content, protein is next, and fat is the lowest. Okay, so we’re drinking our water or whatever liquids we’re drinking, deuterium’s in all of that. We’re eating our food, deuterium’s in all of that. And if that deuterium makes its way into peripheral physiology (cells doing what they need to do,) it’s going to cause problems if it’s not taken care of. 

So the first line of filtration is these trillions of bacteria in the gut that have enzymes in place. It’s like they’re sniffing all the molecules coming through. And if they spot a deuterium, there are enzymes that play two roles. One is that when water or food comes in with all these hydrogens, those hydrogens get plucked off and utilized for all kinds of reactions throughout the body. But those enzymes are very careful. That is, they’re plucking off hydrogen. If they grab a deuterium, they let go. They won’t utilize the deuterium. They leave it there so that it never gets used down the road for something else physiologically. So that’s one way that it prevents deuterium from getting into reactions further in the body. What then happens, the deuterium-enriched stuff is left behind because you’re leaving it behind. Well, it just so happens that there are several kinds of bacteria that actually grow better with deuterium. They like an enriched deuterium environment, which is great, because they can sop up deuterium that’s present. What bacteria? E. coli, Clostridia, the kinds of things that we commonly see as dysbiotic bugs when we do the testing. They actually do better when deuterium is left behind. So if there’s more deuterium coming in, there’s more to leave behind, and you need bacteria there that can tolerate that. So that is one way that the bacteria are scrubbing the incoming molecules. 

A second way, and this is really the main focus of the paper that we just wrote, is that there are certain molecules that will trap deuterium. So an example would be collagen, or, more specifically, proline. So proline is out doing what it’s doing, but if it encounters a deuterium, it will put it in a pocket and hold on to it. And this is why, then proline goes on to build collagen. Collagen is actually enriched in deuterium, because it’s associated with all the proline, and there’s a whole hydration shell around collagen, which is a whole other story. But the point is that collagen and other organic molecules, essential fatty acids, are able to do this as well, if they are out there doing what they do. But if they encounter deuterium, it’s like a mouse trap. It will snap it into place, and then it will be excreted. 

There are also enzymes that will trap deuterium. And it’s like they have these other enzyme things that they’re doing. But if they encounter deuterium, they trap it, they shut down. They don’t do any more of their enzyme activity, and they get excreted. Carotenoids are another example. They will trap deuterium. And so there are these various molecules that are in our gut that are hanging out in our gut doing their molecule thing, proteins and various enzymes that are doing whatever it is they do. But if they encounter deuterium, their enzymatic activity stops. They trap the deuterium, and they get excreted. So it’s this way of making sure that whenever deuterium is encountered, it is gotten rid of.

So on the one hand, are the enzymes that are making sure not to use deuterium as they pluck hydrogens off, and on the other end are these other molecules that are constantly on the prowl for any deuterium that is left behind, they trap it and they get it out so that it can be excreted and thus not get into peripheral metabolic activity. So the gut is like this first line of defense in preventing an accumulation of deuterium. And what I believe to be true is that what we call dysbiosis, you know, to come out a different way- I don’t think bodies do anything to just piss us off; they’re doing what they’re doing in order to fix a problem.

Now, there are exceptions, I understand that. But for the most part, I think that bodies are trying to fix a problem, and I think that a good case can be made that what we are calling dysbiosis, ‘dys’, meaning it’s functioning wrong, is maybe not “dys”,  maybe it’s adjustments in the microbiome that allow it to do things more efficiently, things that need to be done. And so, there are with SIBO, the classic- the hydrogen and methane and hydrogen sulfide, all of those. All three gases are deuterium depleted gases, the enzymes that are creating those gases make sure that those gases are deuterium depleted and the hydrogens that are associated with those gases then go on to be used in various ways, like the bacteria are making hydrogen sulfide. Well, those H2 on the sulfur are not deuterium, they’re hydrogen. And that’s very important, because hydrogen sulfide is going to go on to be oxidized into sulfate, which is, of course, the body has to have access to sulfate all the time, and it needs that sulfate to be deuterium depleted, because otherwise it messes up the various things that it’s supposed to be doing in the body. 

Ditto for the hydrogen gas that is being created in the gut, which you know, is like, oh, how do we kill the bugs that are making all this hydrogen gas? Maybe the body needs more access to hydrogen, meaning that there’s too much deuterium around. You need more hydrogen to be involved because hydrogen gas just dissolves through the gut wall and gets in circulation. It delivers hydrogen throughout the body for all kinds of metabolic reasons. 

So I forget where I started on this. But the point is that what I think is true is that the gut is constantly working with us to manage a deuterium problem in generating not only those gases, but the gut is constantly generating the short chain fatty acids – butyrate, propionate, acetate, all three of those are deuterium depleted. The bacteria that are generating them have enzymes with a very high what’s called a KIE, kinetic isotope effect. And that means you’ve got to transfer hydrogens to stick them on to the molecule building butyrate, for example. If they grab a deuterium instead of a hydrogen, they won’t use it. They will only be using hydrogen. So all of these short chain fatty acids that our gut is making for us, bless their heart, those are deuterium depleted fatty acids that are then delivered around the body, supplying hydrogens for all kinds of metabolic needs. So that’s kind of the overview of what I think guts are up to. 

Lindsey:    

Okay cool. So does that make sense then, if you think about the fact that people often get overgrowths of things like E coli or C Diff or whatever, when they eat bad diets full of processed carbohydrates and sugar and such.

Dr. Greg Nigh:    

Yeah, absolutely. I mean something that has always mystified me as a practitioner – so people come to me and say they test positive for hydrogen SIBO, and they go through treatment, and they get rid of the bacteria that are generating this excess hydrogen, not down to zero, but they dramatically reduce that population. And then they take all the right probiotics, and they eat the right diet, and they meditate, and they do all the right things, and two weeks later, those bugs are back. They’re creating the same symptoms again. And ditto for people with methane or sulfur, doesn’t matter, kill the bacteria to get rid of that production, do all the right things and so commonly, people have their symptoms come back. It doesn’t make sense.

Why would the body bring those bacteria back in spite of everything we’re doing to prevent that from happening? It makes sense to me that they come back because they’re serving a purpose. They’re doing something that our body needs done. You know, our gut is not concerned that it’s making us feel bloated or whatever. That’s not the concern. The concern is to meet a metabolic need, and the microbiome is just an organ. I mean, it really is an organ in the body that is constantly adapting itself to meet the various needs – generating neurotransmitters and hormones and vitamins and short chain fatty acids and constantly generating things that we need. And it’s a factory that is always reshaping itself to do that.

Lindsey:    

So that makes sense to me in the case of someone who doesn’t have elevated vinculin antibodies. But I, for one, have post-infectious IBS with elevated vinculin antibodies. I can tell you that my stomach doesn’t gurgle hardly ever, like it’s a day for celebration when I hear my stomach gurgling, so I have no motility in my small intestine. So for me, it’s kind of obvious that the reason it keeps recurring is because the bacteria aren’t getting cleared out with the migrating motor complex. Do you not believe in that theory? Or do you think these are different questions?

Dr. Greg Nigh:    

I’m not saying that there’s no such thing as pathology associated with the gut. Certainly there are neurological issues that can slow the bowel and prevent normal kinds of motility, and all kinds of other things can happen. Certainly, it’s not a universal statement that everything happening in the gut is an adaptation. I don’t think that’s true. What I think is true is that there is a great deal of what we consider to be bad in various ways, different kinds of bacteria that are happening in the gut, and that our approach is to target the bacteria. And I think that at least in my experience in interacting with patients, is that it’s not a very successful strategy to be killing bacteria that we believe to be the underlying cause of the symptoms. That is temporary. Now, once in a while there’s a home run hit, but for the most part, and maybe they’re a biased sample, and maybe I’m just seeing the patients that it doesn’t work for, and so they come to me and say, great, what can you do? But my impression is that it’s not a winning strategy to focus on trying to manually adjust bacterial populations.

Lindsey:    

Okay, so last time we talked, you were starting some clients out on deuterium depleted water. And so I’m curious if anybody has noticed an impact yet.

Dr. Greg Nigh:    

Yes. I certainly feel like I’m still very early in this clinically, as I mentioned before. There is not a long history behind this. I have had three patients tell me that they feel like their gut is improved through this. And there are probably between somewhere around five to eight patients that have now actually implemented it, and one of the reasons not to implement it, which is an aside, is just the cost of it, which I can come back to. But in my experience, there is the modest improvement that I’ve seen with gut changes. And what I believe to be true is that it’s not a standalone fix for guts. I think that there’s other foundational kind of work that needs to be done to repair sulfur and sulfate metabolism, for example, or to adjust diets, there is a deuterium depleted diet that I think can be quite valuable for people to pursue the most dramatic change. 

I have emails with people saying, “I can’t believe how different I feel”, and that is just with general vitality, clarity and overall oomph to get through the day. I had just this last week, got an email from a patient telling me she’s 61 years old and she feels like she’s 45 years old. She hasn’t felt so much energy in a few decades. So there’s that, which I personally don’t think is just a perk. I think what that kind of change is indicating, obviously, is enhanced cellular energy production, right? I think that’s not a trivial change when you’re talking about enhancing someone’s overall health.

My hope is as more people adopt this and are reporting back to me how their guts are doing, that I’ll continue to accrue some positive feedback about that. And of course, if any other practitioners want to start implementing this, not just for gut health. I mean, personally, I think that I don’t know of any other singular therapy that has as much universal application as deuterium depleted water, because it is literally every single cell that has to deal with the deuterium problem. 

Lindsey:    

So speaking of that, I had just started because I was looking at the other article you sent me related to cancer and deuterium. And so I just Googled the question and it popped up with a systematic review of clinical and experimental trials and the second sentence is, “the clinical experiments indicated that deuterium depleted water monotherapy or in combination with chemotherapy, was beneficial in inhibiting cancer development.” So, I mean, it just seemed like a straight statement like, this is beneficial, no question. 

Dr. Greg Nigh:    

I mean it was one of those hit myself on the forehead when I realized how much information is out about deuterium as a cancer therapy. It really is shocking. There are very few therapies, and I mean, it’s silly to call it an alternative therapy, because its freaking water. I mean, that’s not all that alternative, you know, but there are so many clinical trials that are out about deuterium in cancer therapy. And it’s like, if there’s a chemotherapy that can get an additional, like, six months – one group gets this drug and the other gets the standard drug and oh my gosh, this other drug got six months longer overall survival on average. It’s like headlines. In these deuterium depleted water studies, where they have one group of cancer patients doing standard therapy and the other doing standard therapy AND drinking deuterium depleted water – it is freaking outrageous. Often the deuterium depleted water group has survival measured in years longer than the other, the group that didn’t get it. I mean, it really is quite dramatic. I think maybe even more important is with the context of people who had cancer, they do therapy, and then they get NAD where there’s no evidence of disease, and then their whole being is about preventing cancer. In that context, deuterium depleted water, there was a study that just came out. I wish I could quote the stats on it, but I’m pretty positive that in the group that was no evidence of disease, in that group that drank deuterium depleted water, there was no recurrence of cancer at all in the duration of the study, as opposed to several who had recurrence in the other arm of the study. I could get that citation to you. 

Lindsey:    

Wow, that’s great.

Dr. Greg Nigh:    

But it was very impressive when I read it.

Lindsey:    

Yeah. So big question then, how expensive is deuterium depleted water? And where do you get yours?

Dr. Greg Nigh:    

Yeah, so deuterium depleted water, I mean, I’m not advocating the different companies that make it, or anything. I happen to have established a relationship with Adrian, who’s a guy who owns a company called ExtraLightWater.com* . I actually think it’s called Hydro Health is the name of the company. But the website is extralightwater.com, so DDW is generally made, you buy it in the amount of deuterium in the water. He sells it at 50 parts per million*, 25 parts per million*, and 10 parts per million. And he tests every batch that he makes. And he just put out that his 25 part per million water was actually tested at 19 parts per million. So he’s always coming under. He won’t sell it if it goes over, but it often comes under. So for example, I just did, personally, a course of about 80 days total. I went through four cases of 25 parts per million water.

Lindsey:    

Only that, no other water?

Dr. Greg Nigh:    

Well, I drank a little bit of other water during the day, but for the most part, I mean so a case is 24 bottles through this company, and each bottle is half a liter. So I was definitely drinking some other water, but every day I had at least one, usually a little more than one bottle, so half a liter. Yeah, I would have a half a liter plus some. And if you buy it case by case, then through that company, 25 part per million is 190 bucks per case. So 24 bottles 190 bucks. You can do the math on what each bottle is. 

The way I did it, because if you do it as a subscription, you get, I think it’s 8% off. So I knew I was going to do a series of four, so I just had it automatically send me a case every three weeks, because I was drinking a little more than one bottle a day. So I would pretty much run out at the three-week mark, and that drops the price from 190 down to 172 you know, it’s still a decent amount of money. Adrian points out that if you calculate the price per bottle, there are a whole lot of people spending more than that on their Starbucks every day. So, you know, I think it works out to like a buck 80 a bottle [actually, $7.17] or something like that. I forget exactly, but it’s not cheap. It’s not something that everyone can do. 

Now, I, in my own clinical practice, have significantly reduced the number of other supplements that people are doing so that they can concentrate their spending in a more focused way with deuterium depleted water being part of that. You know, your question earlier about what I see happen with people’s guts? So I’m early in that experiment. I’ve been using it more extensively with cancer patients, because that’s where the evidence is. I mean, there’s a lot of evidence there, not only cancer, but anxiety, metabolic disease, diabetes, neurological disease. There are clinical trials with all of that. Cancer is just the situation where most of the research has been done. 

So, yeah, it ain’t cheap. So body deuterium content, and there are tests for this – if you go to deuteriumtest.com they have a saliva test. There’s another company I forget their URL, or I would give it, that has a urine test. But if you look it up, salivary testing seems to be a little better supported. So deuteriumtests.com, I think it’s 199 bucks for a salivary test, you spit in a vial, and it’ll tell you what your body deuterium level is. So our normal body deuterium level runs at around, I think it’s about 145 and that’s because we’re always trying to lower our deuterium. So we’re taking in 150 parts per million. And then we’ve got to get some deuterium out. When you drink deuterium depleted water, you’re essentially, over time, replacing your body’s water with this lower deuterium water. The goal is to lower the overall deuterium level in the body, and once you get below a certain threshold. And nobody’s really sure exactly what that threshold is, some say it’s around 130, I saw another source saying 118 is the magic number where all the genes start being activated for all the anti-cancer effect. In my mind, I’m just trying to get it as low as I can get it in the period of time that I can get people to do this. 

So generally, usually, and not always, usually, what I’m doing is have people drink two cases of 25 part per million water, and then two cases of 10 part per million water, and that gets them through about 80 days, and then take a break. By the end of 80 days, body deuterium level has dropped dramatically, drinking just one bottle a day. So I just did a test on myself recently. I did four cases of 25 part per million and did the salivary test at the end of that trial, and I was at 119 parts per million of body water by that point, which I think is a pretty decent drop. Now, I didn’t do a pretest to find out what I was at prior. It’s possible, just because of what I eat and whatever that I was not at the normal 145. I don’t know, but it was good to know that, okay, four cases of 25 can drop it down, yeah, pretty significantly. And I think with a cancer patient, I would definitely have them do those last two cases at 10 permanently and just drop it down even more. 

Lindsey:    

And how do you feel? Different, to decidedly different? 

Dr. Greg Nigh:    

You know, I wasn’t necessarily a good test case, because I don’t really have significant anything that I could use as a gauge. I mostly wanted to see what the impact would be on body water overall. And so I got that info. I mean, had good energy and but I generally am fine on that anyway. So I didn’t really have a good barometer about how it was impacting other things.

Lindsey:    

So you mentioned foods and diet that are more deuterium depleted. What kind of diet does that look like?

Dr. Greg Nigh:    

Well, unsurprisingly, it’s basically a ketogenic diet. Fat is the lowest of the dietary deuterium that we can take in. Ghee, I think, is the lowest of the oils in deuterium. Butter is way down there as well. But generally oils are low in deuterium, then protein is the next lowest concentration. Highest is carbs, and the simpler, the higher the deuterium level. So it kind of matches what we generally think about as healthy eating.

Lindsey:    

Okay, that’s interesting because I was noting every once in a while, I’ll throw all my food into Cronometer and see how my macros are falling out and am I getting enough of every nutrient and I noted that my diet was like 55% fat, at least for the couple days I was tracking it. And I thought, I am not doing that on purpose, but I’m generous with the olive oil. I love to put some of that hot olive oil on my food. I’ve got the spicy stuff. I’ve got the basil olive oil.

Dr. Greg Nigh:    

I think it’s a great way. 

Lindsey:    

But the trick is getting enough protein and doing that, and getting enough fruits and vegetables, and doing that, it’s just like I’m absorbing so many calories into fat that, how do you get the rest of the stuff you really need? 

Dr. Greg Nigh:    

Oh yeah. I agree. I think it’s stuff we all know about, sourcing food and protein, like, if you’re eating grass-fed meats and all, that’s going to be inherently deuterium depleted, just because that’s what it is. So, yeah, I think combining deuterium depleted diet with deuterium depleted water. And, in fact, I think there are studies on this. I’m pretty sure Dom D’Agostino, you know, he’s the dude who has published a lot about hyperbaric oxygen therapy, and he’s published with Tom Seyfried on ketogenic diet and all of that. And they have both, I think D’Agostino even more than Seyfried, he’s published some really impressive articles on deuterium and deuterium depletion in the diet, and I think he has published about the combination of drinking DDW and eating a ketogenic diet, and how that is like the rock star way to eat.

Lindsey:    

I have to say, it seems to work better for men than women. I don’t know a lot of women that have been able to sustain that. I think something related to our hormones.

Dr. Greg Nigh:    

Yeah, yeah. 

Lindsey:    

I mean just to say that I love carbs way too much to give them up entirely, like it’s just a non-starter. But yeah, I can say that I did it once, for like, a month, and I felt fine, but I think the quantity of fat did not agree with my gallbladder.

Dr. Greg Nigh:    

You know, what I remember is, 10-11 years ago was when Thomas Seyfried came out with his book, Cancer as a Metabolic Disease*. And I read that book, and I was like, holy crap. The book is all about ketogenic diet and kind of the metabolic effects it has on cancer. But all of his research was on brain cancer, was on pretty much glioblastoma. That was his thing, and that just happened to be the cancer that he decided to study. And it was very serendipitous that he did, because it works really well that cancer. And then it wasn’t long after that book came out, and we ended up both being at the Oncology Association of Naturopathic Physicians’ conference. We’re both talking there, and I got to pick his brain over the course of the weekend. And what I really wanted to understand was, okay, this is working really well in glioblastoma. Is there any reason, like, what are the other cancers we should expect this to work in? And his opinion was, this should work in every cancer type. There’s no reason it should be unique to glioblastoma. 

So, you know, I have worked for years with Maria Zilka and nutrition therapists, and so we go back to the clinic, and I’m like, all right, every cancer patient, we’re going to implement a ketogenic diet, and we’re going to see what happens. So that’s what happened, and it was quite enlightening in that there are some people who implement a ketogenic diet, they feel fabulous, their brain clears up, and they have great energy, and they lose weight, but not too much. They just go to a healthy weight, and OMG, it’s like everything goes really well. 

And then there are those other people, it sounds like you’re in that group, where they just cannot do it. Their body won’t do it, and some people, one group, even following the diet as closely as they possibly could, they cannot get their ketones down to what is considered a therapeutic range, which is totally mysterious. Maybe they were cheating, I don’t think so. But something metabolically, their body would just generate glucose. And then there was another group who just felt miserable, just there was brain fog and energy was crap and mood was bad, and they never got past, you know. . . There’s ketosis, and then you’re supposed to get into that keto-adapted state, where you’re just burning ketones and feel fabulous. They never got to that. They just sort of stayed in what we think of as that fluey kind of ketosis state and were miserable. And so for those people, you’ve got to bring them out. You’ve got to bring carbs back into their life, and there was no test that you could do in advance to know which it was. And in my observation, it didn’t really divide down male female lines, because I had people in both categories, male and female both. So yeah, I don’t know. But clearly there are some metabolic types that just don’t get into that keto-adapted state, and they never feel well.

Lindsey:    

Yeah, no, I think I did. I mean, I got to the point where I was in ketosis, but I just couldn’t sustain it. I mean, I just love carbs too much, and to me, it just felt like another meal of you know, meat and broccoli, and I don’t eat dairy so that’s like, a significant source of fats for people who are on a ketogenic diet, because I’m lactose intolerant. So it was just like, what’s left?

Dr. Greg Nigh:    

So for you, I’m just curious, it was as much a psychological heaviness of staying on the diet as it was, like a physical bit.

Lindsey:    

Yeah, I mean, it’s like the joy of a piece of toast with your breakfast. I mean, literally, I have to force myself to eat everything else around the piece of carbs. I’m a foodie. I love food. So, you know, maybe some people are kind of indifferent to food, like they’re just like, yeah, it’s just fuel, whatever. Maybe for them, they’re just as happy eating. And I have clients just like that, yeah no problem. You tell them what to eat. They’re like, no problem. I can implement anything you tell me. Other people who are just like, so terrible, I can’t eat anything.

Dr. Greg Nigh:    

No, I have the same, yeah. I wanted to say one of the most shocking diets that I have been introduced to, which was by patients who told me about it. And of course, we all know it now, and that is the carnivore diet. And I have had multiple and by that, I mean probably half a dozen patients, whose gastrointestinal problems were completely “cured” (put little quotes there). But in their experience, all of their symptoms resolved upon adopting the carnivore diet, which is so counterintuitive to me.

Lindsey:    

But did all the symptoms come back upon going off of it?

Dr. Greg Nigh:    

Well, they didn’t, although, yeah, a few of those. I mean, these weren’t people that I was managing on that diet. They heard about it, and they implemented it on their own. And so I had a few of them actually just send me an email, hey, doctor, and I just want to let you know I’m cured, and I just did this diet. I have had people who came, and they told me that they implemented the carnivore diet. They did fabulous. And then over time, you know, for various reasons, it didn’t work so well, or they stopped doing it, and eventually their gut got bad again, and they tried it again, and it didn’t seem to work as well the second time, or whatever. You know, people are all weird, and we all respond to diets differently and all that, but it is one of those, one of the rare diets where people implement it and describe to me dramatic changes in how they feel. I mean, I have a lot of people implement the AIP diet, or, you know, there’s so many freaking diets out there now that people do and yeah, you know, people will describe, yeah, I felt a little better. I think I did better doing this and doing that, but there are only a few diets, in my experience, that people describe it in profound ways, like everything changed when they started that diet. 

Lindsey:    

Yeah. So I don’t doubt that people feel better, but sometimes I see stool tests on people who’ve been on these sorts of diets, be it ketogenic, be it carnivore, and then I look, and they’ve got elevated beta glucuronidase. And I’m like, I’m sorry, you need to go off all meat now and all fat, and you need to turn this around, because you might end up with colon cancer or breast cancer. And so, you know, it’s like, in theory, they might be fixing stuff, but they’re breaking other stuff, and you don’t know until you do the test. Anyway, that’s just my comment.

So I’m not a big fan of anything extreme, because for me, you’re losing out on the joy of eating if you’re just eating meat. And most of the people that I’ve spoken to doing carnivore are not doing it right, like they’re not even eating – they’re just eating steak every day or hamburger every day. They’re not eating organ meats. They’re not getting the full gamut of nutrients, and often, they’re not actually doing carnivore, like there’s a couple vegetables they eat, or a little bit of fruit they eat, or something, like there’s always something else, because they just can’t stand it, like, at the end of the day, it’s just meat. 

I do want to get to sulfur. So let’s get back to the original reason that I did reach out to you was your expertise in sulfur metabolism and how it relates to gut health. So why don’t we start first with an explanation of the different forms of sulfur and which forms are good for us, and which are bad for us, and what it’s doing in the body.

Dr. Greg Nigh:    

I mean, I don’t really know if I could categorize it in that way. I think the big picture on sulfur is that, of course, we have to have sulfur all the time, because we have to generate sulfate and these various other sulfur compounds. So these compounds that get generated, like sulfate, we’re not eating sulfate. I mean, sure, there’s maybe some trace amounts in some people’s well water, but for the most part, that’s not what we’re taking in dietarily. We take in various sulfur compounds, and we have to convert them to the biologically useful forms of sulfur. And the problem, which literally, I just stumbled upon is that some people, for various reasons, can’t efficiently get from the dietary sulfur to those converted forms of useful sulfur. 

And I think the most important of those is the sulfate, because sulfate, I mean, we are sulfating things all the time. It’s crazy how much sulfate has to be constantly available to the body in order to carry out all the sulfation reactions. So if that gets compromised for various reasons, then bodies, because they’re fairly intelligent, they figure out, or they already know, somehow, how to work around the problem. And the workaround, at least one of them, is to generate more hydrogen sulfide, because hydrogen sulfide gets directly oxidized to sulfur dioxide (SO2) which gets directly oxidized to sulfite (SO3), which gets enzymatically converted to sulfate (SO4). So it just steps up the oxidation scale to get it to sulfate, which we now know is deuterium depleted sulfate, which is gold for all those sulfation reactions in the body. 

So dietary sulfur is the raw material for doing that. Different sources of dietary sulfur, and this is just discovery over a decade of just doing this with people, some forms of dietary sulfur are just harder for many people to get converted into those other useful forms of sulfate than others are. So the highest source of dietary sulfur is meat. I mean, the cysteine and methionine hanging out in meat is by far and away the biggest bulk of sulfur that obviously, anyone but vegetarians, is taking in. My experience is that meat is rarely, not never, but rarely a problem. Most people tolerate eating meat. Garlic, if I’m going to pick one, I mean it’s not a coincidence I named my book “The Devil in the Garlic*” because garlic tends to be the most reactive of the sulfur compounds that people take in. And I think one possible reason for that is that, unlike sulfur compounds and other foods, the compounds in garlic, once they’re absorbed and they’re in circulation, they are taken up by red blood cells and can be directly converted into hydrogen sulfide. 

And so our entire system of red blood cells becomes a factory for generating this hydrogen sulfide gas, potentially, and I think likely for some people that gets upregulated for who knows, genetic reasons, or I don’t know. In order to detoxify that hydrogen sulfide so that it doesn’t then leak out of red blood cells and get into circulation, you have to have vitamin B 12, and you have to have glutathione. And so there are lots of people who are compromised in one or both of those, which would potentially add insult to injury. So, garlic, in doing this low sulfur protocol with people, you know, a diet where people significantly reduce the amount of dietary sulfur coming in for a couple of weeks, and then one by one, introduce it, has been, oh my gosh, to see how many people at the end of two weeks have significant or even complete resolution of some symptoms. 

Now I ain’t saying it is a cure for everybody, but there have been a really dramatic number of people over the years who had problems sometimes for decades. They had all sorts of colitis symptoms or irritable bowel and within four or five days of starting this diet, they have no symptoms at all. I mean, it’s crazy. And so we get people through two weeks, and then at the end of two weeks are the reintroductions. The first thing to reintroduce is garlic, and it is shocking how many people, their symptoms have been gone for a period of time, or at least significantly reduced for a period of time. They reintroduce garlic, bam, there’s a symptom again coming back, whether it’s brain fog or migraine or joint pain or gut – irritable bowel, rashes, whatever it is, there it is again, when they reintroduce garlic. 

So then we have people do their reintroductions one by one. Then after that, and they can’t reintroduce the next one until the symptom from that one cleared, of course. So you know, for some people, usually it’s only a couple days and the symptoms clear. Some people, it’s a week or two, but then onion and kale, and go through the list of the reintroductions, egg, broccoli, cauliflower, cabbage, and so you get a really good picture for this individual which sulfur compounds they don’t seem to tolerate well, and so usually you can hold those out for a period of time, bring the others back in, because, of course, we want people’s diets as diverse as possible to keep enough different varieties of gut bugs active in their gut. I don’t like people staying on restrictive diets for extended periods of time, and lots of people back themselves into a corner that way, which I understand they’re just trying to not have symptoms. But once you stay in that corner too long, you’re stuck in a corner, and it’s not easy to get out. 

So, you know, we kind of catalog which of the sulfur compounds seem to be the most reactive and then try to bring in various kinds of support, which is often trial and error. Yeah, there’s educated guessing about it, but you’re just trying to figure out which things work for which people. Usually we get somebody to a place where they can then reintroduce the foods that were reactive, like garlic. Now there are some people who cannot reintroduce garlic with all the support we can get, but most people get to a place where they can reintroduce it. Now I mean, a lot of them were taking, like, two garlic tablets a day and putting garlic everywhere on their food. They don’t get back to that, but they get back to – they can put a little bit of garlic powder on there as a seasoning or something. And actually, oddly enough, many of them form an aversion to garlic once they’ve been through that process, and kind of clean the garlic out of their system, and they reintroduce it, and it causes misery. Many of them are fine. They feel like they don’t even like the smell of garlic anymore. So yeah, that’s good. 

So it’s always a mystery which particular compounds somebody might react to, and not everybody reacts to any of them. And it’s not actually an individual reaction, it’s just a composite of total sulfur load that comes in over time, and eventually the bucket is full, and it spills and causes symptoms. And so for those people, it’s actually much easier than – they’re just certain things you can have people do throughout their day or week, at least, to lower or to, I guess, drain their bucket faster so that it doesn’t overflow. But I mentioned every time I do a podcast, I’m talking about things like Mo-Zyme Forte*, which is a particular form of molybdenum that I have just found that works really well. Epsom salt baths have been like another one of those holy crap. I can’t believe some people; it changes their life to just do Epsom salt baths.

Now, maybe it’s because they’re getting magnesium that way, but I think the people that I’m working with it’s because they’re getting sulfate that way. Because by doing Epsom salt baths, I have had a number of people who then can expand the amount of sulfur foods that they can eat. They’re less reactive to their sulfur foods. Why is that? I think it’s because they’re getting sulfate directly through the skin. So the body has a supply of sulfate. It doesn’t need to generate hydrogen sulfide in their gut to produce more sulfate. They’ve already got enough. So again, the bugs aren’t needed. They don’t show up. They will go away on their own.

Lindsey:    

Yeah. So you’re describing a group of people who have sulfur issues, but not all of them have what appears to be a hydrogen sulfide SIBO presentation, correct?

Dr. Greg Nigh:    

Yeah, for sure, absolutely. So I started getting interested in sulfur. It’s weird. I tried to trace this back, and I couldn’t figure out exactly, but early on, I had read a paper by Stephanie that had to do with sulfur, and that’s how I first got into communication with her. So I was working with Maria at the time, and I said, can you just put together a low sulfur diet? I just want to see what happens. And so she did some homework and put together a diet and it was like people with migraines or hot flashes or anxiety or eczema, or when I was trying, it was like unreal, how many different things were responding really well to low sulfur. 

I remember a patient coming in who told me she had been detoxing, and I asked her how long. She said about three years she’d been detoxing and just felt terrible, like brain fog and fatigued, you know, but she’s doing all this detox therapy, so I asked her what she was taking, and she’s taken a laundry list of sulfur supplements, right? Lipoic acid and garlic and methionine and NAC and glutathione, and, you know, all these detox supplements. I said, okay, I want you to stop all of that. Do the slow sulfur thing. It’s fine. She wasn’t detoxing. She couldn’t process the sulfur. She was taking in too much sulfur, so we just got rid of that. And she felt totally fine, fabulous after that. 

So I was working with lots of other conditions, and then this was back, we’re talking about in like 2010 or 2009. Then people started coming in with these SIBO tests. SIBO back then was not a thing, but people were coming in with these tests saying they had high hydrogen or high methane. They didn’t test hydrogen sulfide at that point, so they had these test results, and their guts were a wreck, and they’re like, can you help? And I didn’t know anything about SIBO, really, but I was like, well, what the hell?

Let’s just put them on a low sulfur diet and see what happens. And a large percentage of them got better, like they had significant improvement by doing a low sulfur diet, even though their tests, whatever these hydrogen or methane things, which kind of led me to this thinking that maybe sulfur issues are underlying those other types of SIBO, which I think can be true. I don’t think it’s always true, but I think there are situations where it seems to play out that way, because if you just do low sulfur with them, their symptoms seem to resolve. 

Now I will also say, as I’ve said before, I don’t test SIBO, I don’t do methane, sulfur or hydrogen sulfide testing. The test is the program. I have had many, many, many, many patients who show up telling me about how they tested high in some sort of SIBO, and then they went through a treatment protocol, and they tested again, and they were happy to report that they didn’t have any more of that kind of SIBO. And I always follow up to say, did you feel better? And they usually say, no, not really. It’s like symptoms seemed to me to be a fairly loose correlation with test results. So I don’t really do much testing. I am more focused on symptomatics, because ultimately, I think that’s where the pudding is.

Lindsey:    

Yeah, so in the SIBO community, and I mean, especially like the research that Mark Pimentel has done, you know, they’ve identified certain bacteria that they say are culprits, in hydrogen sulfide SIBO, or what they’re now calling intestinal sulfide over production, or ISO, and I believe, I think the three that they’ve targeted, or maybe even only two of these, are Desulfovibrio, Fusobacterium and Bilophila wadsworthia. But in your book, you list many more. And I’m also seeing in my experience, because I do stool testing, and sometimes I do metagenomic sequencing that more than anything else, there’s lots of cases where Klebsiella seems to be the dominant sulfur fixing bacteria that’s causing an issue. And I know there’s others. Can you list what those other sulfur reducing bacteria you put in your book?

Dr. Greg Nigh:    

Yeah, off the top of my head, I can’t, I know I put it in my book. And there’s an article that actually lays it out really well, and kind of talks about the sulfur cycle.

Lindsey:    

I found the page, yeah, H pylori, Desulfovibrio, Campylobacter jejuni, E coli, Clostridium, Enterobacter, Bilophila wadsworthia, Staph aureus, Streptococcus anginosus and Klebsiella.

Dr. Greg Nigh:    

Yeah. And those are the kinds of things that we see all the time on the stool tests for people; they’ve got dysbiosis, and we see those bacteria showing up. Now, I ain’t saying that they’re only showing up to make hydrogen sulfide, but they are making hydrogen sulfide, and so maybe, maybe they’re doing that for a reason.

Lindsey:    

Yeah, okay, so the diet, let me just clarify the diet that you use. It’s essentially no cruciferous vegetables, onions, garlic, I assume. The other things like leeks and chives and everything else in that family also out, yeah, and alliums, I guess. And then no meat, also no fat?

Dr. Greg Nigh:    

No, I don’t say no fat. 

Lindsey:    

Oh okay, that’s because that’s the protocol I’ve learned.

Dr. Greg Nigh:    

But I just send people to Maria to get oriented to the diet. And I think maybe the first week is still vegetarian, just to do that break. But it is not part of the two-week elimination. Meat is not part of the two-week elimination anymore, because it was exceedingly rare that somebody had a meat reaction, and when they did, it was so crazy over the top, dramatic that it seemed like something else was going on. It was not a sulfur thin. Some what is that,  alpha gal? 

Lindsey:    

Yeah, alpha gal. 

Dr. Greg Nigh:    

And I usually have people taking Mo-Zyme*, I titrate the dose up on that to see what dose they feel the best. I might be doing butyrate. I am almost always doing autonomic regulation therapies along with them, because, we’re going to be out of time, I don’t have time to go into the autonomic piece of things, but I feel like I was late coming to the realization of how central that is. And the fact is, I think it is becoming a much more dominant picture overall, in all of the chronic diseases that we’re seeing, people are so much more complicated now than they were when I started to practice. And I think that is in large part due to a much more prevalent and dramatic autonomic dysregulation. We are talking about people who are overstressed, essentially, and that just aren’t managing it well, or it goes beyond that.

People have many reasons. I think it is, yes, it’s that, but I think that there are exposures that we have now that are dysregulating us in ways that can come back and manifest themselves as sort of an anxiety and feeling wired. But I don’t think to just call it out. I think things like EMF exposure, the density of the fields around us has increased probably 1000-fold, a million-fold, maybe in the past 15 years. When you think about the saturation of our environment with Wi Fi now, it’s raining down from the skies. I mean, we know that those things have an impact on our autonomic balance, and so it’s like the ocean we’re swimming in. So it’s hard to even tell what the effect is that it is having. But I have no doubt that it’s having one. These vaccinations – I wrote a chapter for Neil Nathan’s book about – actually two chapters. But one chapter in particular about these mRNA shots and the autonomic impact of those on the body, which is not trivial. There is a reality, not in my belief, just in my clinical experience and reading the experience of other doctors, that shedding is a real thing, that exosomes are coming off of people who have had vaccinations. So even people that have not had vaccination are exposed, and those exposures have an autonomic impact. And so these are, I mean, this is just some of the stuff. 

Of course, there’s all kinds of other chemicals and stuff in our environment that are contributing, but it’s all piling up on us and leading to significant, widely prevalent autonomic dysregulation that makes everything else harder to treat. It’s much harder to get the body to respond even to a good set of therapies if there’s that underlying autonomic imbalance in place. So I am a big proponent of having people do autonomic therapies. Maria is trained in the Safe and Sound Protocol, which I think is an extremely valuable addition to almost every therapy that I am setting people up with, and there are others. Lots of people know about autonomic therapies, but I think it is, in many ways, the elephant in the room when it comes to having people that aren’t responding to whatever program I’m putting them on.

Lindsey:    

Okay, so it sounds like you’re using primarily diet as a tool. So what about I assume, of course, that there are people who go through the diet, and they’re still bloated and they’re still miserable at the end of it. So then do you do move towards antimicrobials, or what other kinds of interventions do you then go to for someone with something that looks like a hydrogen sulfide SIBO presentation.

Dr. Greg Nigh:    

It’s like a sulfur problem is one of many possibilities of why somebody might feel bloated or funky in their gut. And so I usually start there, because it has the best, I think, the best potential, to get some symptomatic relief for the people that it fits. If it doesn’t, then it’s like, alright, check that box. We looked into it – it didn’t seem to be a thing. And then any number of – it’s like we all have our ways of trying to figure out why somebody feels the way they feel. I am doing testing, hormone testing, and all kinds of blood testing and trying different kinds of diets, elimination diets, or different diet work. I work with people with various homeopathic programs that for some people are a home run on getting their gut working the way it needs to. So it’s like, if that one gets ruled out, then you just do what any practitioner should do. And that is all right, well, what’s the next on the list of usual suspects? And kind of knocking down the list.

Lindsey:    

So I heard of this method of using MSM, which is methyl sulfonyl methane, which is a sulfur-based supplement, as an antimicrobial for someone with severe bloating. And the doctor who described it, I believe it was on Nirala Jacobi’s podcast, she said she didn’t discriminate between what kind of SIBO people were presenting with. And anyway, I started taking it myself and followed her protocol up to the max dose. And sure enough, it cleared out my SIBO for a time, like everything that kills bacteria does, and then it came back, as it always does. But anyway, she said it didn’t matter whether somebody had a hydrogen sulfide SIBO presentation or methane. It seemed to be very successful with the methane in particular. And I’m curious what you think? You know somebody who’s got a sulfur issue, would MSM be an issue for taking it? Would that make sense, that that would be too much sulfur for them? Or might that have the same effect as the Epsom salts?

Dr. Greg Nigh:    

Well, I will start by saying what I’ve often said, which is that people are weird, and so there are, I mean, I’ve had patients, I can think of one in particular, very sensitive to sulfur, like all kinds of dietary sulfur, the one way that she could keep herself symptom free is taking 25 grams of MSM a day. I mean, that’s a lot of sulfur, yeah. But for her, it worked. And I have had a few other patients since then who heard about that protocol, who did the protocol, oh my gosh, my gut is completely better. I have at least an equal number of patients who did the protocol and it wrecked them. It was not a good experience at all. Yeah, now I feel confident that I don’t know the doc who, or whoever the practitioner is, who put that protocol together. I have no question that she’s very competent and that if she were working individually with people, maybe she could have guided herself in a way that would not have led to that. But what I suspect is true is that it’s going to work for some people and it ain’t going to work for others, and probably you just got to do it and find out. Like, I doubt that there’s a test that says, oh yeah, that’s not going to work for me. 

Lindsey:    

Yeah. So you did in the book mentioned some of the genetics of sulfur, and I know that, like CBS and SUOX were some of the SNPs that are relevant. Can you talk about this a little bit?

Dr. Greg Nigh:    

Yeah, a little bit. I think in the book, I mentioned that I don’t give it too much weight, and I would say I give it even less weight now, you know. The one that gets the most attention probably is CBS. And I have seen people with CBS problems, you know, glitches on CBS, who have gut problems. And I’ve seen people with CBS glitches, with no gut problems. And so I go, you know, people are weird. I think I also mentioned in the book, I don’t remember, I haven’t read it in a while, but I think I mentioned that sulfite oxidase, the SUOX, that one, it seems pretty consistent to me that if somebody, I’ve not ever seen homozygous on that, I’ve only ever seen heterozygous, but if somebody has a heterozygous glitch on that, it is pretty much guaranteed they’ve got sulfur issues going on, which makes sense to me. There’s only one way for sulfite to get converted to sulfate, and that’s through that enzyme. And so if you slow it down, it makes sense that it’s going to cause problems.

Lindsey:    

And is that where molybdenum comes into play?

Dr. Greg Nigh:    

Or, yep, that’s exactly where it comes in. That is its role.

Lindsey:    

And what about hydroxocobalamin*? Where does that come into play?

Dr. Greg Nigh:    

Hydroxocobalamin oxidizes hydrogen sulfide in the periphery, and so it’s not converting it to sulfate, but it’s converting if you have excess hydrogen sulfide in the blood. Hydroxocobalamin will oxidize it up to sulfite, which will then get converted to sulfate by the SUOX enzyme.

Lindsey:    

Okay, so it helps if you’ve got excess- I know that’s one of the supplements you mentioned in the book. 

To move on to one other subject in our last five minutes, I noticed on your website that you were interested in peptides, and I’m curious if you recommend oral BPC-157 for gut issues, and if you think it’s effective and which forms you prefer?

Dr. Greg Nigh:    

I do. I think peptides are a really interesting new cat on the block. So I do with BPC-157* (use code PERFECTSTOOL for 20% off), I have people take it orally. I happen to just use a company called Integrated Peptides, which has a couple of good formulations. I’m blanking right now on the powder that they have for the gut, it only comes in a jar – Gut Powder. It has BPC-157* and some other good – it’s got Akkermansia in there. But that one I find to be very helpful. But I’ll also, for some people, just do BPC-157, just as a supplement. Yeah, there are some other peptides, Thymogen Alpha One, which is a really important immune modulator.

Lindsey:    

Is this injectable, or is this also oral?

Dr. Greg Nigh:    

That’s oral, yeah, yeah, these are all oral. So yeah, I do think peptides are a really important new kid on the block in terms of, I mean, not a standalone always with all the other kinds of additions that we’re doing. But yeah, I think it’s a valuable tool.

Lindsey:    

Yeah, I don’t know if they’re publicizing them better now, but I definitely have had more clients ask me about it, and it’s an expensive supplement, so I don’t just like, jump to that, but if they bring it up, I’m like, well, sure if you want to spend on it, I’m happy to have you take it. Yeah, no, I’ve looked at the InfiniWell ones that have the extended release and the quick release. And so I was thinking, which would be better for gut health, you know, if you’re wanting it in the small intestine, I’m thinking would be quick release and large intestine, extended release. 

Dr. Greg Nigh:    

Yeah, I think it’s generally how I would do it, yeah, or, I mean, for acute, acute things, I’m going to do a quick release. For more chronic, I’ll tend to do more extended release, yeah, but yeah, I think they’re good and they are expensive. You know, when I give it to patients, I always apply a discount. I drop ship it and discount it. So, yeah, yeah.

Lindsey:    

So, I had one client who I think had some success with gastritis, and that seems to be one thing where sometimes you just get a person who, for whatever reason, cannot seem to get rid of gastritis, like no matter what. Everything else fixes, but that one thing is just and that’s one place where I think it feels useful.

Dr. Greg Nigh:    

Yeah, I agree. Inflammatory stuff, I agree. You know, another therapy we got one minute left. How about that? Another thing that I am doing quite a bit is just infrared light applied to the abdomen, because there are actually studies on using it to treat gastritis and other inflammatory bowel stuff. Because with the powerful enough light, and especially with infrared, you get penetration into the gut, and it has all kinds of good shifting effects on the gut bugs and the microbiome and inflammatory state of the bowel.

Lindsey:    

So is this with a clinical grade infrared light or the kind of infrared light somebody could afford?

Dr. Greg Nigh:    

Yeah, no, I just Amazon, like you type in red light therapy. They’re all kinds of different ones that are available, and they have different levels of power to them, like over the gut. I probably wouldn’t do LED lights. There’s some that are quite a bit more, sort of more like a spotlight red light. 

Lindsey:    

Yeah. Interesting.

Dr. Greg Nigh:    

So, all right.

Lindsey:    

Yeah we have delved into all sorts of interesting things. And I’m not sure anybody could wind that up into a useful protocol, but it was certainly interesting, so I will definitely point people to you and your work and articles and stuff. 

Dr. Greg Nigh:    

Yeah, excellent. 

Lindsey:    

Okay, well, thank you so much for being with us. 

Dr. Greg Nigh:    

Thanks for having me. It was fun. 

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.

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The Silent Epidemic: Why We Need to Talk About C. Difficile with Christian John Lillis

The Silent Epidemic: Why We Need to Talk About C. Difficile with Christian John Lillis

Adapted from episode 152 of The Perfect Stool podcast and edited for readability with Christian John Lillis, co-founder and CEO of the Peggy Lillis Foundation, and Lindsey Parsons, EdD.

Lindsey:  

So why don’t we start with what C. diff is and how you got involved in advocating for C. diff awareness.

Christian John Lillis:

C. diff, or Clostridioides difficile, which is still difficult to say, so we generally call it C. diff, is a spore-forming bacteria that is found all throughout our environment. When a bacteria is spore forming, that means that when it’s under stress or outside of the body, it moves from its vegetative state to like a seed state, or like an acorn state, and when it’s in that state, it is really difficult to kill. Antibiotics may not kill it. In order to kill it on surfaces, you have to let it lay in bleach, and so one of the things I recommend for C. diff is not to use hand sanitizer, but to actually wash your hands with soap and water, not because the soap kills C. diff, but because the hand washing removes the spores from your hand, and they go down the drain. 

It’s also obviously a microorganism. You can’t see it. Most people get it through what they call the fecal-oral route, meaning it came out of somebody’s butt and you touched it and it ended up in your mouth and you swallowed it. So there’s a proportion of us, some say it’s 2%, some say it’s 10%, that have this bacteria in our body. I’m sure your listeners are very familiar with the gut microbiome, so it’s there alongside all of these other bacteria, viruses, all kinds of microorganisms. And as long as your gut is healthy, it’s kept in check. But what happens often is when we take antibiotics or take something else that disrupts our microbiome, the C. diff now has all this space to grow because the other bacteria have been washed away or killed off by the antibiotics, and as it reproduces, it gives off a toxin, and that toxin is harmful to humans. So in reproducing itself, it gives off a toxin that harms the cells of our colon. This results in what we call a C. diff infection. 

You have urgent and frequent diarrhea, fever, nausea, those are the main symptoms, and if it’s left untreated, C. diff can severely damage the colon, leading to a condition called toxic megacolon, which is frequently deadly. So patients who progress to toxic megacolon, or if they have multiple recurrences of C. diff, which I’m sure we’ll get into, they’re at a very high risk for sepsis and for death. 

A feature that distinguishes C. diff from a lot of other opportunistic infections is what we call recurrence, meaning you’ve been treated, it seems like you’re clear, but then it comes roaring back. And the reason that happens is because until the microbiome of your gut is healthy again, the C. diff does not waste an opportunity to regrow, right?

So, a recurrence is you have a first infection, typically treated with antibiotics, most people experience either a lessening or sensation of symptoms during their course of antibiotics. But then for 30 to 40% of people who have that first treatment, somewhere between two weeks to up to three months after they finish their course of antibiotics, the C. diff comes roaring back. So, now you’re in a recurrence. We have about again, 30 to 40% of people, so maybe 180,000 Americans every year, will get recurrent C. diff. And once you had a recurrence, if that gets treated, and you seem to be out of the woods, your likelihood of a second recurrence goes up to like 50 -60%. To get a third recurrence, it’s now at 80% and also, there was a study that came out last year, led by Dr. Paul Feuerstadt that showed that for every recurrence you have, your chances of sepsis and death increase significantly. So it’s something we really want to, pardon the pun, sort of nip in the bud and kind of catch it and treat it as early as possible.

In terms of why we got involved with this, you know, you mentioned the organization I run, the Peggy Lillis Foundation. So Peggy was my mother. She was a 56-year-old kindergarten teacher. She was a single mom for most of our lives, and in April of 2010 she went to the dentist to get a root canal. The dentist prophylactically gave her Clindamycin, and a few days later, she developed severe diarrhea, fever, nausea. Being a kindergarten teacher, she didn’t think anything of it. She was a pretty healthy person, but if you spend five days a week around 20- five-year-olds, your chances of getting, like, at least one, you know, she’d get a bad bronchitis or a bad head cold, but again, like just once or twice a year, and she would joke and say, the kids slimed me. So she just thought she got something from the kids. It was only when it persisted into the fourth or fifth day that we became concerned. And I was mostly concerned about dehydration, because I’m sure people who listen, who have, maybe even IBS, like if you’re constantly having diarrhea, it’s really hard to stay hydrated.

So we were initially going to take her to a GI appointment, but when I got there, she seemed so fatigued, and, you know, her color was off and she was very listless that I said, I think we just need to go to the ER and get you hydrated and then they can test you there. You know, I’d worked in healthcare in other ways before this. And so I kind of knew, if you show up and they can’t help you in the office, they’re just going to send you to the ER.

Anyway, we get to the ER, my mother’s white blood cell count is over 40,000 and normal is around 10,000 so four times normal. This is a the indication you have a severe infection, and about within an hour of getting there the attending ER visit and the attending infectious disease specialist asked to speak to me and my aunt, who had met me at the hospital. And they basically tell us that my mom has a life-threatening infection. They believe she has toxic megacolon, and that it’s caused by this thing called C. diff. I had never heard of C. diff before.

My aunt, who was an oncology nurse, said, how can my sister have C. diff? She hasn’t even been hospitalized in like 30 years, and she’s 56. So she was already going into septic shock. Her kidneys weren’t functioning. And, you know, I guess from watching TV or whatever, I thought that if people were in septic shock, that they were, like, in a coma, like I didn’t know you could be up and talking and arguing with me that you want Diet Pepsi and not more ice chips and be in septic shock, right? So they told us at that point that she was the sickest patient in the hospital. And these doctors really did everything they could. I mean, this was a small hospital in Brooklyn. It was not a Mount Sinai or NYU, like it was a small hospital in Brooklyn, because we just thought she needed fluids. But they really did everything. They contacted colleagues at the leading institutions and leading academic medical centers. We talked about moving her, but they were afraid she wouldn’t survive the trip.

So to sort of shorten the story, that evening, they came to us and said we would perform a colectomy, but we don’t know that your mother would survive it right now. So what we want to do is keep her overnight, try to arrest the sepsis, try to reverse the sepsis, and then in the morning, if that hasn’t worked, we will do a colectomy in an attempt to save her life. If it has worked, hopefully she’ll regain consciousness. But either way, we can decide what the next steps are. 

So we go home, we go to bed, we don’t sleep very much, as you can imagine. 6 a.m. the phone rings. It’s the surgeon. He says she has not improved overnight, and we have to meet him because we have to consent to surgery, because I’m her next of kin, and this is despite overnight, they gave her broad-spectrum antibiotics through a central line: they were giving her vancomycin enemas, IV immunoglobulin. And so around 10 a.m. they perform the surgery, she does much better than anyone expected her to, in terms of her vital signs, and they move her back to ICU. And my mom had eight siblings, most of whom still lived in the New York area, so the waiting room by ICU is like 50 people. It’s a complete clown show. 

And you know, we go in two by two to sit with her, to talk to her, and I remember telling her, you’re so strong, like, if anyone can beat this, it’s you, like you got through a divorce. You raised me and my brother, who are not easy kids, like you’re tough as nails. But then around four o’clock, they asked to speak to us, and they said that despite everything that they were doing, her brain wasn’t getting enough oxygen. And my mother would have taken a colostomy bag and she would’ve been fine, but brain damage, you know, these are things she wouldn’t want. So they said they were going to do their best. People continue to go in and sort of talk to her and try to encourage her.

Lindsey:  

She was awake?

Christian John Lillis:

No, no, no. She was unconscious. No, she wasn’t awake. She was never awake again after the surgery. So they asked us to ask everyone to step out of the ICU so they could do something for her. And around three minutes later, the ER attending came and told us that our mother had passed, that they had tried three times to resuscitate her, and that she was gone. We were very, very close to our mother. My mother had 13 God children. She was a very beloved person in our community and in our neighborhood, and so the grief was overwhelming and inescapable and really hard to believe. You know, like so quickly, so quickly and again, like someone who, I mean, she was tough as nails, you know, even when she became a teacher, she still waitressed on the weekends. The woman worked six days a week and went to school almost the entire time, from the time I was, like, 10 years old until the day she died, you know, so it was crazy.

So what happened to her is the inspiration, but the secondary inspiration is for us raising C. diff awareness is that I was a college-educated person who had already, at that time, been a fundraiser for NYU Langone. I wasn’t working there anymore, but I was a savvy person, and for me not to have heard of C. diff, and then to go home and start doing research and find out that it was killing at that point, they estimated 15,000 people a year. It’s now been revised to 30,000 people a year. And for context, you know only about 17,000 people die of AIDS every year now. Less than 10,000 die of drunk driving. So when you think about all of the attention, deserved attention, to those public health crises, for us to have a disease that’s killing twice as many people and really nothing was being done about it was unacceptable to us.

Lindsey:  

Yeah, wow. That is horrible. So now, with what you know, what should someone do if they have some kind of severe diarrhea like that? How quickly should they see a doctor?

Christian John Lillis:

So, C. diff diarrhea, it is urgent, and it was very frequent, like, you or I might eat something bad. And so maybe the next day we wake up, or we’re going all the night, and we have to go, you know, like, within six hours, we might feel crappy, but it’s gone, it’s out of us. 

Lindsey:  

Right? Maybe throw up too. 

Christian John Lillis:

Yeah, like you might feel it might be loose for another day or two, but yeah, and with norovirus, it might be two or three days, but it’s not that you’re not going 20 times a day with norovirus, you know, right? So if you have this urgent 10-20 times within 24 hours, if you have a fever, and especially if you if you’re somebody who’s being treated for cancer or any immune-suppressant drugs or have recently taken antibiotics, those are all risk factors for C. diff. So in that case, get to the hospital, get to a doctor as soon as possible, ask to be tested for C. diff. If you’re younger, if you’re under 60, most doctors will not think of you having C. diff, so you have to be proactive. 

Lindsey:  

Okay and better to go to the doctor or straight to the ER?

Christian John Lillis:

I mean, unfortunately in this country, you know, we have this crazy system where people go to the wrong ER, and they get a bill for $20,000, so I think you kind of have to, like, I think if you go to urgent care or an ER or if you can get an appointment the next day, but I think, I wouldn’t wait. 

Lindsey:  

Yeah, because I’m just wondering how quickly the test results come back if you see a doctor?

Christian John Lillis:

Like, I would go to the ER if I thought I had C. diff, yeah. I’ve been doing it for 15 years. So I have a list of doctors of who I would start with, and . . .

Lindsey:  

You’ve got your preferred doctors. 

Christian John Lillis:

Yeah

Lindsey:  

Okay.

Christian John Lillis:

I would just show up on one of our board members’ doors and be like, Dan, we’re going to your hospital ER.

Lindsey:  

So how prevalent is C. diff in the US and worldwide?

Christian John Lillis:

So the most recent estimates, which are now about four or five years old, there probably would be more recent estimates, but Covid, the CDC does the estimate, and Covid kind of threw everything out of whack. So back in 2019, around that time, they estimated around half a million infections every year, and about a third of those people get recurrences, around 180,000 people that experience recurrence, and about 30,000 deaths. 15,000 of those deaths are directly attributable to C. diff, they’re septic, and then the other half are someone has cancer, someone’s had surgery, they get C. diff, and C. diff is kind of what pushes them over the edge on something that they might have otherwise survived. So it might be considered like a contributing cause of death, as opposed to the primary one. So we say about 30,000 were C. difficile, the direct cause or the indirect cause.

Worldwide, unfortunately, it’s pretty unclear. Many countries do not publicly report their healthcare associated infections. There have been efforts in the EU and in Canada, but there aren’t even back 20. Probably in the last maybe 5- 10 years ago, pre-Covid, the EU estimated data of about 80,000 cases throughout the EU every year. I don’t, in my head, know the number. How many people that is? But it’s equivalent, but once you get outside of the West, it’s pretty difficult. The other thing that I would say is this brings us in that we talk about a lot as patient advocates, is like in preparing for this, I knew you wanted to talk about this, I did research on worldwide estimates, right? And the ones that I could find, they didn’t talk about how many people. They talked about the percentage of 10,000 patient days.

Lindsey:  

Oh, okay. And so, like, how many, how many hospital days are taken up?

Christian John Lillis:

Or, yeah, like how many. Like, as an advocate, right, as somebody who’s trying to raise awareness, you as a podcast host, that is useless information to us, because it doesn’t tell us anything. It’s like an insurance measurement, right? 

Lindsey:  

Yeah.

Christian John Lillis:

And it also doesn’t help us, as people who are trying to raise awareness of a disease, articulate what that data means to the public, because the public doesn’t care how many days you were in the hospital. The public wants to know how likely am I to get C. diff, or my loved one or my friend who’s in the hospital, right? So 600 out of 10,000 patient days mean, you know, patient hospital days means nothing to us. So I could find some of that for other countries, but I couldn’t tell you how many people. 

Lindsey:  

Okay, no worries. So I actually just recently heard a podcast and I should get the name, because it was really interesting about the fact that many people think that they are allergic to penicillin, when in fact they are not. And because of that, these heavier-duty antibiotics like clindamycin, vancomycin, etc., are used for infections unnecessarily, and that something like 97% of the people who think they’re allergic to penicillin, it was from something that might have happened. Maybe you had a viral infection that was attributed to . . . well, it was coming from a virus, you took an antibiotic, and you had a rash, therefore they said you were allergic to it. And it’s some sort of thing your mom told you when you were young. And therefore, anyway, so that people can get cleared of their allergies to penicillin by going and seeing a doctor, getting a skin test, and then doing a test, a secondary test . . .

Christian John Lillis:

If they react to the skin test, so they don’t react to the skin test, they’re fine.

Lindsey:  

Right and so I wonder, are there particular antibiotics that are associated with C. diff?

Christian John Lillis:

So this whole penicillin allergy thing is very important, and it’s something that people should be aware of. Because, as you said, many people, especially as kids, I’m a Gen Xer, but like millennials and Gen alpha, whatever they’re called, people younger than me, Dr. Martin Blaser is a brilliant person in this field. He did a study, probably 10-15 years ago, in nature that estimated that millennials and the generations after them, by the time that they had reached the age of 18, they’d had 20 courses of broad-spectrum antibiotics. And this is unprecedented in human history to have our to have to have our bodies shot through with antibiotics so much and often for no reason, for colds.

Lindsey:  

I just don’t get that because, like my kids, have literally never had antibiotics other than my son, before I adopted him, they gave him a couple courses. But after that, neither of them, other than no, I think my older son, when he had his wisdom teeth out, I think it was two days’ worth.

Christian John Lillis:

I mean, I had scarlet fever when I was six, so I was given tetracycline. And, you know, before antibiotics, scarlet fever killed half the kids that got it. So having these things is really incredible, but they’re really being overused. Then what happens in a case like with penicillin is somebody was given antibiotics and they were a kid, they got a rash, they got some reaction. The doctor said, your kid’s allergic to penicillin. The parent tells the kid you’re allergic to penicillin, that kid then for the rest of their life, or that adult, then tells everybody they’re allergic to penicillin. 

Lindsey:  

Yeah.

Christian John Lillis:

. . . which is a whole branch of antibiotics. 

Lindsey:  

That’s amoxicillin. 

Christian John Lillis:

It’s yeah. So then what happens? And I’ve talked to dentists who believe, like, right now, if you go to the dentist and they either think of an infection or want to ward off an infection, they’re likely to give you clindamycin, which is what my mother had. A much more powerful drug than penicillin.

Lindsey:  

Yeah, or if you have a heart murmur, they’ll want to prophylactically give you that before you have treatment. But I think now that maybe the rules have changed.

Christian John Lillis:

They have moved back from that. And so people should again, my brother has a mitral valve prolapse, and for years he had to be premedicated for a cleaning. And so again, this is how we end up with people having 20 courses for no reason. So I do think, yeah, if you’ve been told you have an allergy to penicillin, you should investigate that as an adult, because if you don’t have it, there is a lot less risk.

Lindsey:  

Yeah, but in terms of C. diff, are the broad-spectrum antibiotics like Cipro or vancomycin, clindamycin, are these more dangerous?

Christian John Lillis:

Fluoroquinolones are correlated, in the UK, the NHS, they did an antibiotic stewardship program where they restricted fluoroquinolones only for certain very severe infections, and they saw their C. Diff rates drop 80% throughout the system.

Lindsey:  

Which ones are the fluoroquinolones? Is it Cipro?

Christian John Lillis:

Cipro is a fluoroquinolone. So moxifloxacin, basically anything that ends in oxacin, 

Lindsey:  

Okay. 

Christian John Lillis:

Like Cipro is ciprofloxacin? Yeah. So all the -floxacins are fluoroquinolones. 

Lindsey:  

Okay.

Christian John Lillis:

Those are the ones to avoid. But, I mean, I think it’s just generally, if you don’t need an antibiotic, don’t take an antibiotic, right? Of course, yeah, if you do really need it, but there is just such overuse, particularly in this country.

Lindsey:  

Yeah, and one of my mentors and people I follow in the gut health world, Lucy Mailing, she put out a recent article, and she said, if you’re going on antibiotics, my recommendation is taking butyrate daily, usually in the form of either like Probutyrate* (low dose for constipation) or Tributyrin ( high dose for loose stools). I can’t remember the dosage, but for me it would depend on whether you had loose stool or if you were constipated to begin with, I would probably suggest different dosages. But then to take Saccharomyces boulardii* two pills, which is 500 milligrams, three times a day, as preventatives, and that those can help you to avoid these kind of opportunistic infections while you’re on antibiotics.

Christian John Lillis:

Yeah, I don’t know.

Lindsey:  

Do you have any suggestions in those areas based on your work?

Christian John Lillis:

So the challenge with supplements is that it’s very hard to know the quality of them, and so we kind of steer away from suggesting things. What we actually tend to suggest is that people try to get more probiotics through food. So like drinking kefir without sugar, low or no sugar yogurts, fermented foods, like you could be adding sauerkraut. So things that are going to give your body the building blocks and the good probiotics. Of course, you can always supplement them. But actually, one of our most popular articles on our website is how do you choose a good probiotic? 

Lindsey:  

Okay.

Christian John Lillis:

And I think that’s like, a very American thing where we want like, well, give me a pill that will solve my little, fix my stomach. And it’s actually, the best thing you can do is eat whole foods and things and we do have a lifestyle and nutrition guide. People that that have had C. diff have C. diff., as you can imagine, it’s difficult to eat when you’re that sick, but it’s really more about once you’re past the acute stage, how do you make yourself less likely to get it again?

Lindsey:  

Yeah, so one of the one of the cycles that happens, you know, like when you have a gram-negative bacteria, which C. diff is [Lindsey: correction – C. diff is a gram-positive bacteria, I misspoke, but I checked in Consensus and it said that “Yes, butyrate shows protective effects in C. difficile infections, mainly by reducing inflammation and supporting gut barrier function, but it may also increase C. difficile sporulation and toxin release.”], is that you start to pull oxygen into the colon, and then it promotes the growth of these facultative anaerobes that can live in the presence of oxygen. And then you get more and more of them. So the butyrate turns that process around by feeding the cells lining the colon, therefore creating a hypoxic or oxygen-free environment in which those bacteria don’t thrive. So that’s one of the reasons that butyrate is protective in that scenario. I incidentally, have a butyrate product called Tributryin-Max.

Christian John Lillis:

I’m like, this sounds good. I want some. I’ve never heard of it before.

Lindsey:  

Yeah, on a daily basis, it’s good for loose stool, or people who tend towards, you know, if you have, IBS-D, that kind of thing. So, so that was one of the things that anybody who has . . . 

Christian John Lillis:

Where you when I was in college, Lindsey? I could have used the all the butyrate I could get when I was in college. I knew where every bathroom was between my house and the college and every one near my classrooms. 

Lindsey:  

Well, yeah, so because I gave it to everybody, I ended up making a product called Tributryin-Max. And it is a reasonably high-dose butyrate, so you don’t have to take so many pills. So anyway, you mentioned that people wouldn’t suspect that C. Diff was in a younger person. So is it primarily in older people then, like, who are hospitalized? Or what’s the typical . . .

Christian John Lillis:

So, historically, that’s true. Historically, C. diff was almost – what they used to call a nuisance disease, meaning that it wasn’t terribly fatal. But you know, you’re in the hospital, you’ve had surgery, now you have diarrhea all the time, like it just made life difficult and it did primarily affect elderly people and people with immune-compromised systems. However, that changed in the early aughts. It was first detected in Canada. So it’s called the North American pulse one strain, or the NAP1 strain, and that started showing up in Canadian hospitals in 2004 -2005 and it was far more virulent, meaning that it was much more toxic. It caused many more deaths, especially among the elderly, but it was also then increasingly seen in younger and younger people. So it’s thought now that the NAP1 strain is the primary strain that we see in the west. So that’s why you see so many more people getting it and getting sick. Over the past 10 or 15 years, we have also seen, and it’s hard to know, is this the disease, or is this changing medical practice?

But I think as more and more people are having outpatient surgeries, we are seeing much more C. diff that is community onset, where, like women who give birth and they’re released within 36 hours, and then two weeks later, because they had a C section, they were shot through with antibiotics, they now have C. diff. I hear that story a lot, so it really doesn’t discriminate. Like they’ve even done studies looking at Black Americans versus white Americans, and white Americans have a slightly higher rate of C. diff, and then black Americans have a slightly higher rate of poor outcomes. And I think in both ways, that’s sort of institutionalized racial capitalism, you know, which is like black people don’t get health care as often as white people do, so we’re going to have slightly more chance of a health-care associated infection once we get it, they get then get a poor outcome, because, again, they don’t have access the way that we do.

So it’s nothing to do with our race. It’s everything to do with society, right? But one of the things that has been concerning is that we are seeing it more and more in the community, and we’re seeing it among younger people, even children, and they haven’t necessarily taken an antibiotic or been in the hospital recently. And in my brain, there’s this big question of like, what is this change? Why are we seeing this? Has the bug changed? Is it that those people that had 10 to 20 courses of antibiotics as kids are now adults, young adults? You know what I’m saying. So, being older is a risk factor. Taking antibiotics is a risk factor; but it can happen to anybody.

Lindsey:  

Yeah, yeah. And I’m sure that the compromised microbiome that is coming from, because I do see so many people with their comprehensive stool tests, and I see, you know, they have no Faecalibacterium prausnitzii which is one of your primary butyrate producers that sits in the colon. They don’t have any Akkermansia muciniphila, which eats that mucin layer and helps regenerate it and keep it healthy. So those two are working together. They’re in the colon, and they don’t have any of those. So obviously getting rid of the bad stuff, but then eventually you’ve got to rebuild the good stuff with prebiotics, things like, well, they love all the polyphenols, pomegranate and cranberry and matcha and things like that. So getting people on gut shakes and getting them eating beans and lentils so that they can build up those bacteria again. And now, of course, you can even get Akkermansia probiotics. So I see that a lot with people who’ve been through a lot of antibiotics.

Christian John Lillis:

Yeah, and I think, you know, we also have a ton of processed food that is impacting our guts, and, yeah, it’s calorically dense and nutrient light and so I think when you and I were growing up, a lot of our meals were cooked at home and using more or less whole ingredients. I mean, I know that that’s the way I cook, but I’m very lucky and privileged in that way, because I work from home.

Lindsey:  

Right. No, the biggest problem, I think. I mean, obviously there are bad things in processed food and just sort of poor-quality food, but it’s just that there’s not nutrients. That’s the thing is, they’re not, right? If you look at, say, the typical school cafeteria, the vast majority of the calories are coming from gluten and dairy. They’re not getting a lot of vegetables and fruits or if they’re offering them, they’re poor quality, and students don’t eat them. So at the end of the day, these processed food diets are just simply lacking in the things that make you healthy.

Christian John Lillis:

Yeah, the kids are also shot full of sugar, and then they’re like, sit still for eight hours. Good luck.

Lindsey:  

So what is the standard of care currently for C. diff? 

Christian John Lillis:

So in reverse of this question, I was like, well, the standard of care is bad. But what I mean by that is, based on the clinical guidelines, most doctors will prescribe either Vancomycin, which, as we talked about earlier, has a 30 to 40% failure rate, meaning people get a recurrence, or Fidaxomicin, which has a lower failure rate, but it’s not as widely used. Vancomycin is completely generic now; it’s not on patent. Fidaxomicin is still branded, and it costs a lot more money, but it has the lower rate of failure, of having, like, maybe 10% of people have a recurrence. To me, it’s worth it.

Lindsey:  

Yeah.

Christian John Lillis:

As a patient, it’ll also be worth it in terms of our healthcare system, because if we have fewer people’s recurrences, fewer people are spreading C. diff, etc., but insurance doesn’t want to pay for it. And then, besides that, you know, because I knew we were going to talk about FMT, but like, there’s a lot of doctors out there who, and it’s not just doctors, I don’t want to drag doctors – my father-in-law is a doctor. People get used to how they practice something. And so, you know, even before the FMT craze, like a lot of doctors are like, oh, you got recurrent C. diff, I’m going to give you 10 days of vancomycin. I’m going to give you 14 days of vancomycin. Oh, that didn’t work. I’m going to give you 30 days. And then a 60-day taper, where you take vancomycin every day every other day for 60 days.

And you know, there are doctors out there, that’s what they do. And the thing of it is, the whole time that’s happening, the person is suffering, you know, the person is worried about the C. diff coming back, or the C. diff is back, or, you know, they took their last vancomycin pill last night, and they know in the next three or four days, it’s going to come right back again. And you know, by the time you get diagnosed, particularly if you’re a younger person, like you might have been sick for weeks, you know, and now you’re going to spend the next three months being put on and off of antibiotics. And you know, if you think you’re going to have diarrhea, it’s like you don’t want to leave the house because you want to be near a toilet.

And obviously there are many people whose job involves them having to be outdoors, having to work someplace. I talked to a young man a few months ago who lives in Wisconsin, and he is an engineer who works on cell phone towers. Now imagine being worried you’re going to poop your pants, and you have to be outside in the cold, there’s no bathroom. So it’s a very torturous disease in that sense, and the guidelines don’t even suggest any sort of microbiome restoration until at least the second recurrence. So we’ve had people ask me, like, well, why don’t we just give everybody an FMT that’s ever had C. diff? And there are reasons why we don’t do that either.

So I think it’s a combination of what the insurance doesn’t want to pay for, and then plus doctor’s sort of clinical, habitual clinical practice. So this thing where people have to really advocate for themselves, because generally, you’re going to be given 10 days of vancomycin or fidaxomicin, and for 60% of people, that’s going to resolve it. It’s the other 30 to 40% of people who that’s going to be the beginning of a journey.

Lindsey:  

Yeah. So, if people can do anything for themselves, the first thing would be advocating to get the Fidaxomicin?

Christian John Lillis:

Dificid is the brand name in the US.

Lindsey:  

Okay, so advocating for that as your first line treatment because it has a lower recurrence rate, and then if it comes back, what do you think is the best thing from your research compared to what might be the standard of care of going back onto another antibiotic?

Christian John Lillis:

So when it’s an acute infection, right? So like when you’re having the chronic diarrhea, what you want is that antibiotic, and then what is going to follow that, that’s going to help restore your microbiome, right? So over the past 15 years or so, there’s been a growth in the use of fecal microbiota transplant. This is essentially taking highly tested for pathogens, for transmissible diseases, but minimally processed stool, like literally put in a blender with saline and then via colonoscopy or enema or, God forbid, nasal gastric tube, putting it back into your colon. And this is not a new idea. As far back as fourth century China, they were using some form of fecal microbiota transplant. It’s also used widely in veterinary medicine.

So basically, we’re giving you the stool of a healthy person to sort of kick start your own gut microbiome. So, but it was also hard to get because it’s considered experimental, for a whole host of reasons. Thankfully, in the past couple of years, we’ve had two FDA-approved, they’re called live bio therapeutics, LBP, Live biotherapeutic products, and one of them is basically a more refined version of the typical FMT. So they’re getting donor stool, they’re testing it highly, they’re processing it, making sure that it doesn’t have anything transmissible, and they’re sort of standardizing the dosing and stuff, so we know what we’re getting. That’s one option.

Lindsey:  

Is it delivered by enema, or is this now a pill?

Christian John Lillis:

The first one that I’m talking about is delivered by enema. They are some doctors who are doing it via colonoscopy. Technically, it’s off label, but there are some that are; they’re studying it. There’s a paper out there that shows it’s actually even more effective when it’s done by colonoscopy, just because it gets where it needs to go, better than enema.

Lindsey:  

And what’s that one called?

Christian John Lillis:

So the technical name is almost unpronounceable. So the brand name is Rebyota.

Lindsey:  

Okay, yeah, I’d heard of that one.

Christian John Lillis:

We try to stick to technical names or not promoting products, but oh, the name, the names are bizarre. Like, it’s not like fidaxomicin versus Dificid. It’s like, LG, s, dash, j, i s, m, yeah, it’s a terrible name. Sounds like you’re speaking a different language, like I’m an alien. And then, as you’re starting to say, after Rebyota was approved, they approved another drug called Vowst. And Vowst is a pill form, and Vowst is also, where Rebyota is sort of the whole, you know, again, more processed, more tested version of a standard FMT, Vowst is actually selected like they’re using specific Firmicutes. And so when you take it orally, it’s designed to store that, by the time it gets to your colon, and the capsules release, it then sort of seeds your gut and helps your gut to restore itself. Neither I nor Peggy Lillis Foundation have any opinion on which of those is better for you, or if you need a standard FMT, which for people with severe and fulminant disease, they may need a standard FMT. Because if you’re that sick, you can’t wait for the pill. You take the pills like over three or four days, you need something more immediate.

So, but what we do think, what we are happy about, is that there are now options, but right, like any new drug, they are more expensive. You are going to have to fight with your insurer to get it covered. We are advocating for greater access to the extent that we can, but it’s the kind of thing where, you’re going to have to go in there and – but if I had C. diff, and if I had a recurrence, I would go to my doctor, I’d say, okay, so I want fidaxomicin, and then I want either Rebyota or Vowst, you know, depending on what we think is best, because I don’t want a third recurrence.

Lindsey:  

Okay, so what was the success rate with FMT prior to these other options?

Christian John Lillis:

So NIH did a prospective study in 2021 of 229 patients who are part of the national fecal transplant registry, which is run by the American Gastro Association, and they found that about 86% of people had a sustained cure of between one to six months. Some of them missed the one-month visit. So the data is just a little skewed there. I do think I hesitate to directly compare antibiotic treatments versus FMT because when we’re getting down to people getting FMTs, and some of these were in pill form, some of them were enemas, and most of them are colonoscopies. You know, we don’t really know the exact mechanism of why an FMT works, right? Like, I mean, we know that it’s that we’re replacing bacteria, but not exactly which bacteria you know.

Lindsey:  

It needs to be different because it’s coming from a different donor.

Christian John Lillis:

Yeah and what we do know is that, and something that you know you’ve been talking about from your own perspective, is a healthy microbiome is a diverse one, right? You know that has a lot of different ones, and oftentimes, when you see people who are very susceptible to C. diff, they have low species variation, you know they’re missing something. So then, of course, if you look at different cultures in Asia, their microbiomes look different than Western microbiomes, but they’re both healthy microbiomes. I’m talking about a healthy microbiome, not one that’s degraded, right? So we’re not giving FMT to two thirds of patients who’ve responded to the antibiotics to begin with, so the 86% rate, it’s great for people that have recurrence, but it’s just hard to directly compare the two, and especially because you’re going to get antibiotics before you get either of them, right?

Lindsey:  

So the standard of care is –  how many courses of antibiotics do you have to try before you can access FMT or one of these other pills or other treatments?

Christian John Lillis:

And so typically, your second recurrence.

Lindsey:  

So you have to have two courses of antibiotics before you can get a hold of these other treatments?

Christian John Lillis:

Well, three, because before they give you one of these, they give you antibiotics to reduce the acute infection, and then . . .

Lindsey:  

. . . they give you that, okay, but you’ve failed antibiotics.

Christian John Lillis:

Yeah, the FDA actually lists them as preventatives, not treatments.

Lindsey:  

Okay, so in theory, you could get them sooner.

Christian John Lillis:

No, no, okay, it’s the prevention of recurrence. It’s like, do prevention of recurrence, right? Yeah, it’s just, it’s a weird thing.

Lindsey:  

Okay, and what about the success rate with with Rebyota and Vowst, do they have any data yet?

Christian John Lillis:

They both do. I don’t work for either company, so I tend to stay away from those things. They both do have good efficacy, and they both have very minimal side effects. 

Lindsey:  

And are they pretty accessible, like, whereas it used to be. I mean, you’ve got to find somebody who does fecal transplants and all that. Like people have trouble sometimes finding that. Does every hospital do that at this point?

Christian John Lillis:

Yes and no. So they are so in my world, in the way that I always saw this from the time that we started really hearing about FMT in 2011 and 2012, sadly, too late for my mom, but I always imagined it as like an interim step, right? Like there was a period. And there are places now where, you’ll just get a whole blood transfusion, right? But there are also things where, like, you need platelets, you need volume. So I kind of imagined, eventually they would figure out, and they would have different options for whatever was going wrong with you. Like, not just for C. Diff, but then, what are the other applications? Right? So both Rebyota and Vowst are out there. They can be prescribed. They’re easy to order.

Typically, a gastroenterologist would perform, especially if it’s enema, or if you can get them to do in a colonoscopy, when it’s with Rebyota and then with Vowst, because it is pills, it’s even easier, because you just take them while you’re home. You know, right? In terms of the patient, the difficulty is getting them covered, right? 

Lindsey:  

Yeah. And if they’re not covered, how expensive is something like Vowst?

Christian John Lillis:

So the list price for Vowst is $17,500. 

Lindsey:  

Oh, my Lord. 

Christian John Lillis:

And for Rebyota, it’s just under $10,000. That said, both companies have really good patient assistance programs, and we’ve worked with a lot of people where, if you’re uninsured, they’ve given it for free, they’ve waived the copay. So they’ve really been trying to work with people, because they also understand that a lot of times, if you’ve had recurrent C. diff, like you might not have been able to work, like people lose their jobs with this disease, you know? And then I think some of it is like you have to fight with your insurance company a little bit, like you have to be willing, and if you’re not well enough, then have somebody who can do that for you. 

Lindsey:  

Yeah. Time is of the essence. So a lot of times, insurance companies sit on these decisions for a while. So it’s like, you get it and then you fight, or what?

Christian John Lillis:

Sometimes that happens. Yeah, sometimes that happens. And then, you know, you might get a bill, or threaten and you have to fight because it should be covered. I mean, this is, again, something that we’re also working on as an organization in terms of advocating, because, like I said to you $17,500 and you’re like, whoa, right, that sounds like a lot of money. In terms of our healthcare system, which is like $3 trillion a year, it’s actually not a lot of money. 

Lindsey:  

A day in the hospital is what, at least 10,000 I would think, right?

Christian John Lillis:

But if you end up hospitalized with C. diff, the average hospital stay for C. diff is going to be $70,000.

Lindsey:  

Okay, exactly so it’s in their interest, to some extent, to make sure you get better.

Christian John Lillis:

And my mother, who died, like the cost of her being hospitalized, having surgery and those treatments for 36 hours was over $70,000 and she died. So this may be for a separate conversation, but one of the things that I feel like in this country, in particular, but in the west more generally, is that we think we’ve conquered infectious disease, and we think that everything related to it should be cheap. I think HIV might be the exception, right? But, like, we want a free flu shot. We wanted this, you know, like, ever since they stopped giving away the Covid vaccines for free, uptake has dropped precipitously, right? And my feeling is like, if this was cancer, if it was heart disease, if it was a joint replacement, nobody would – five figures, nobody would even blink their eyes. But an acute infectious disease, people are like, well, $10,000? It’s like you’re saving somebody’s life, like it is literally a life-saving treatment. Do you know much money I would have paid to have my mother live?

Lindsey:  

Of course. So I know that in the early days, people were just getting fecal transplants from a family member, but they were doing it in the hospital. Are they still doing that?

Christian John Lillis:

That is still an option. There are still some doctors who offer that. That is probably going to be an option for people who have severe inflammation disease. Also, perhaps it will be an option for kids, because, unfortunately, neither of these products is approved for pediatrics, and so that’s something that we have been and we’re continuing to advocate at FDA to figure out, like, can we carve out an exception where FMT could be used more broadly in kids, because these drugs are not approved for them.

But, you know, it, it’s a sticky widget because the FDA, yes, they take public commentary, yes, they use this, but like, they’re kind of oblique in terms of why they’ve decided, what they’ve decided, right? And I don’t think that they take into account the sort of public health impacts and population health impacts of their decisions. Like, if you even mentioned the cost to them, they won’t talk to you about it anymore. But it’s like, we live in a for profit healthcare system; cost is going to matter.

Lindsey:  

Yeah. So yeah, I guess that that leads me to the final question, which was, what are the current obstacles in the world of C. diff advocacy, and how could my listeners be of help?

Christian John Lillis:

So I would say we have two primary obstacles. The first is low public awareness. You know I talked to you earlier. I said HIV. There have been studies. 85% of Americans know what HIV is, only 30% have heard of C. diff. Oddly, 95% have heard of Ebola because there was a movie about it with Dustin Hoffman in the 90s, right? Everyone’s seen that movie. So being that there are many other things that people are much more aware of, including Zika, which, yes, I don’t want to malformed baby, but like, it’s not killing people. You know what I’m saying? A lot of it has to do with the press. And I think because this was historically a disease of old people, we’re not great to elderly people in this country. Like, we should just be really clear about that.

So I think if you’ve had C. diff, or a loved one has had C. diff, getting them to talk about it, being open about it, sort of forgive the language, but like coming out about it. And I think because the primary symptom is diarrhea, people are embarrassed. But it’s like, if you needed blood transfusions, would you be embarrassed? You know, you’re just sick. Like us having a poop thing is, like, that’s just us being weird. You know, you said you have kids. I’m the oldest of 19 first cousins. I have a six-year-old nephew. I’ve changed many, many diapers in my day. Like, there are lots worse things than poop happening in the world, so awareness!

And then the secondary thing is that I think this is applicable to a lot of infectious diseases, is that people get treated for it, and then they forget about it, and they don’t think about all the other people who weren’t as lucky as they were. And so what we noticed is that people who have had recurrences that have lasted for months or years, they’re the ones who join us, become volunteers, stay in the fight.

But if more people, people listening to you, who have had C. diff maybe, maybe it was cured in a couple of weeks, like if they signed up for our mailing list, wrote their congressperson, shared stuff on social media. Though I’m not crazy about social media lately, but if they were just more open about it and talked about it, that would be very helpful, because, and I understand, like who wants to think about the last time they were sick? But this is a disease that we’re increasingly building the tools for and getting more tools for it, but no one knows the tools, because they don’t know the disease exists.

Lindsey:  

Is there a C. Diff Awareness Day? 

Christian John Lillis:

November is C. Diff Awareness Month? 

Lindsey:  

Okay.

Christian John Lillis:

C. diff campaign the entire month of November. 

Lindsey:  

Okay in November I can relink to the episode.

Christian John Lillis:

Yeah, those are the two biggest ones. And then there are things that are downstream from that, you know, like, there’s not adequate public health funding anywhere in this country. So any communicable disease we struggle with, I think asking your hospital or the place that you get healthcare, like, what their infection rates are, just to keep them thinking about it. Because I work in this world, and I’m sure you have something corollary, but like, there was just pre-Covid, like in 2018 and 2019, they were finding people were getting  CRE [Carbapenem-Resistant Enterobacterales], which is a very antibiotic-resistant, dangerous infection, and they were getting it from colonoscopy and endoscopy scopes that weren’t properly cleaned.

And so I had to have a colonoscopy/endoscopy. I called the doctor’s office like three times, and I was like, and how are they cleaned? And who cleans them, and how are they packaged, and who opens the package? And, I mean, I went, but the point is, more people have to question, do I need this antibiotic? What is it for? You know, have you isolated the infection? What do you think I have? You know what I’m saying? And worst of all, if you’re sneezing and you’re coughing or whatever, and it’s cold and flu season, do not go and ask for an antibiotic.

Lindsey:  

Yeah, that’s viral. It’s not bacterial. Will not help.

Christian John Lillis:

I mean, you know, if it persists for more then we can go to the doctor and say, like, test, you know you can, they can test you, but have them test you. Yeah, you know exactly right? Don’t assume it’s strep throat, because you woke up with a sore throat one morning. Maybe the heat was on too high the night before; you slept with your mouth open, I don’t know.

Lindsey:  

Postnasal drip and it made your throat sore. You have acid reflux or a lot of other reasons, right? Okay, so where can people find Peggy Lillis Foundation?

Christian John Lillis:

So we make it really easy for you. You can obviously Google Peggy Lillis Foundation. We’re pretty easy to find. It’s very uncommon last name, but you can find us at C. diff.org.

Lindsey:  

Oh, okay, great. 

Christian John Lillis:

And then on most social media, if you look up Peggy Fund or just look up Peggy Lillis, we’ll come right up.

Lindsey:  

Okay, great. Well, we will link to those in the show notes. Thank you so much for sharing about this. This is a topic that’s long overdue for this podcast. 

Christian John Lillis:

I know it’s interesting that you guys hadn’t tackled it yet, but, but you’ve been tackling a lot of stuff that other people are not talking about. So good for you. And I’ve been listening, and I’m going to go back and listen more, because obviously we both care a lot about gut health. 

Lindsey:  

Well, thanks. 

Christian John Lillis:

Thank you for having me, Lindsey

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.

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SIBO Secrets: What My Gut Test Uncovered with Lindsey Parsons, EdD

SIBO Secrets: What My Gut Test Uncovered with Lindsey Parsons, EdD

Adapted from episode 151 of The Perfect Stool podcast and edited for readability with Lindsey Parsons, EdD.

If you’ve been reading my newsletter, you would know that I recently did a Gut Zoomer stool test. Today I’m going to be interpreting that test for you. So you’ll want to go to the Show Notes Web page for this episode, where you’ll find a link to the test results, if you want to follow along. And I also wanted to let you all know, for people who are new to hearing about my gut health, that I have a condition called post-infectious IBS/which is like autoimmune SIBO. It’s an autoimmune form of IBS that comes from an episode of food poisoning. Mine happened more than 30 years ago. There is currently no cure for this condition, although I heard recently in a webinar with Mark Pimentel from Cedars-Sinai in Los Angeles that there will be clinical trials in humans for a drug for this in 8 to 12 months. So that’s pretty exciting. But in the meantime, I’m doing the only thing that holds out hope as an actual cure with no negative side effects, fasting. I’m actually on day 1 today of the 5-day ProLon Fasting Mimicking Diet*, which makes your body believe you’re fasting while eating something and preserving lean muscle mass. And so far, I got to eat a fasting bar with nuts and 2 capsules of algal oil and spearmint tea for breakfast, so I’m not starving at all. But this is day 1 – you get like 1100 calories on day 1 – it will get harder as we go on. My husband is doing this adventure with me. So today we’ll head to Mexico to an empty house with no food to not have see food and be tempted as we fast. 

But I wanted to make sure everyone had that background as you may be wondering why I’m not in perfect gut health as a gut health coach. So when you have this condition, because of slow motility in the small intestine, you have a stagnating pond in your intestines, so it can be a game of whack-a-mole with different gut pathogens popping up each time you test. So for example, on my last stool tests, I had some C difficile in there. Gone now, but a new pathogen has surfaced this time. When you have this condition, you’re much more susceptible to food poisoning, which I keep trying to tell my husband when he does things like take cooked meat off the grill and put it back in the raw meat marinade. So you have to be super careful about not getting food poisoning again, which I tend to be not very good at because I have a pathological need to not waste leftovers. 

But anyway, on to the interpretation. So I’m going to skip to p. 3 (and I’m going to be referring to PDF page numbers, not the numbers on the page) and just FYI some of the graphics got a little weird when I copied the file and eliminated personal information. So you can see I’m right at the beginning of the green section for the Shannon’s and Simpson’s indices, which have to do with gut diversity. The Shannon’s index is about richness, i.e., number of different species and evenness. So a higher level is a higher diversity with attention to evenness. The Simpson’s index is more about dominance, so it’s more about whether certain species are dominating the community, so a higher value means less dominance of a small number of species and more balance. So I’m right at the bottom of the good reference range on both of those, so average looking overall.

Next we have the pie chart of my phyla. So in general the biggest phyla are supposed to be Firmicutes and Bacteroidetes. I tend to think of Firmicutes as related to a higher fat/meat diet, and Bacteroidetes more elevated in plant-based type diets. You can see that I’m a little dominating in Firmicutes at 49.8% (and only 36.4% Bacteroidetes) and they tag that as at higher risk for obesity, metabolic disorders and inflammation. I don’t have the first two, may have the third, but the research on this division being important for metabolic syndrome, etc. has been discredited to some extent. But I hadn’t been eating as many beans and lentils as I’d like before I did this test as I’d just come back from 5 weeks in Italy a few weeks before. 

Then you’ll see the next two biggest pieces of the pie are the Proteobacteria and Actinobacteria. Ideally Proteobacteria would be 2.5-3% or lower and mine are 4.9%. This is higher than my last test which was like 2.6% but much lower than some of my first stool tests before I learned about how to use butyrate to modulate the colon microbiome. My first stool test back in 2019 was 31.9% and my second in 2020 was 50.1%! It’s very typical to see this Proteobacteria number higher in people with SIBO and dysbiosis. Antibiotics kill obligate anaerobes who produce butyrate in the colon and that leads to the colon pulling in oxygen, leading to an overgrowth of facultative anaerobes, which are the Proteobacteria. Most of the major pathogens fall into this phylum, like Camphylobacter, Salmonella and E coli. I tend to run low on butyrate and need it if I’m not eating lots of beans and lentils, so when I see these results, I know I need to get back on the legumes, as well as taking supplemental butyrate like my Tributyrin-Max, as long as I’m not constipated. Ironically, I was going through a short and rare bout of constipation when I got these results, so I didn’t end up taking any butyrate, although I have since been able to take some. 

The next section of the pie is Actinobacteria!! This is pretty exciting to me because I’ve never had even as much as 2% Actinobacteria and ideally they are supposed to be evenly matched with Proteobacteria around 3%. And I have 4.7%! So I was excited to see that. Bifidobacteria are in the phylum Actinobacteria and I’ve historically been low but have been trying to bring them up, so I was happy about that. 

Then interestingly, the next biggest chunk is Verrucomicrobia at 2.1%. The best-known member of this phylum is Akkermansia, so this is promising and I’ll give you a preview that later in the test I have normal levels of Akkermansia. This is one of the most exciting and encouraging results for me, because I had low Akkermansia in prior tests and I’ve had lots of antibiotics and antimicrobials over the years. So I took Pendulum Akkermansia muciniphila* for a while about 6-9 months ago to try reimplant good levels, and then started my gut shake more recently to feed Akkermansia and it looks like it’s working! This, by the way, is one of the most common microbes to be wiped out by antibiotics and antimicrobials and its absence is connected with metabolic syndrome and an unhealthy mucin layer in the gut. So very happy about this. 

And then I’ve got 1.4% Fusobacteria. This I didn’t like to see, as there really aren’t any good Fusobacteria. I tend to want to wipe those out when I see them in clients’ tests. I’m particularly concerned about Fusobacterium nucleatum, which is associated with periodontal disease, colorectal cancer and inflammatory bowel disease. It’s an oral pathogen and I’ve found it before, but then eliminated it in my last Tiny Health Pro, which is a metagenomic sequencing, but they don’t list individual members of this phylum on this test, which is not a full sequencing, so I don’t know which Fusobacteria I have. I reached out to my Vibrant rep and she said they may add F. nucleatum at the next update of the Gut Zoomer, so hopefully that will come to pass. In the meantime, I got right back on DentalCidin rinse*, a great oral rinse for clearing out pathogens. And I put my husband on it too at the same time so we’re not passing it back and forth. And I think I’m going to take some panax ginseng* when I do my next supplement order. 

Then I’ve got 0.7% Euryarachaeota, which is nice because in my last test I had 0% Methanobrevibacter smithii, the major occupant of this phylum, so I was glad to see that I have some of that commensal, which may be helpful in balancing out my microbiome that tends to be dominated by E. coli, one of the two hydrogen producing bacteria common in SIBO. And the hydrogen bacteria tend to lead to loose stool, while M. smithii leads to constipation. If you’re someone who has loose stool, you can probably appreciate how novel and pleasant constipation feels, although if you’re the opposite you probably feel the same way about loose stool. 

But overall, I was really pleased with this pie chart, because for the first time ever in a stool test, I had something in every slice of the pie, so my microbiome was nicely diverse, which I think is a good testament to the power of the gut shake I’ve been having a few times a week. I have frozen bananas, cherries and cranberries as a base, then add almond or hemp milk, a tsp. of pomegranate powder and ½ tsp. of matcha green tea powder, and then some protein powders. 

Then there’s a ratio of Prevotella/Bacteroides of .55, with a reference range of ≥.48. So I’m on the good side of that range. Higher Prevotella is associated with plant-based, high-fiber diets so better fiber fermentation and short chain fatty acid production, whereas higher Bacteroides is linked to animal-protein and fat-heavy diets. However, too high Prevotella can also correlate with inflammation, insulin resistance and even rheumatoid arthritis in some studies, although this reference range doesn’t show a negative upper level on it. 

So after that they summarize all the potential correlations between your markers and various conditions. So I’m in the yellow for intestinal permeability, intestinal gas, ironically in the green for SIBO, but in the yellow for IBS, IBD or inflammatory bowel disease (which I don’t have to my knowledge), autoimmune health (now on p. 4 of the PDF file), metabolic health, liver health, nutrition, neurological health, probiotic health and keystone health. And I’m in the green for hormones and cardiovascular health. No reds. These are just correlations, not definitive. 

Now moving onto p. 5 of the PDF, we see the big issue (which was likely the cause of some diarrhea I had been having prior to doing this test): Enterotoxicgenic E. coli. This is the kind of bacterial pathogen that causes food poisoning and diarrhea, so I likely picked that up while traveling. After taking the test, I finally started taking some of my SBI Powder so I imagine I’ve already eliminated this pathogen. Someone with normal gut health would probably clear this in a few days, but for people like me who have post-infectious IBS, we may need more help in eliminating pathogens, as we have fermenting pits in our non-mobile small intestines encouraging their growth. The next page, 6, shows some elevated markers of inflammation in a model of the gut lining, which are described on p. 7. I had elevated beta defensin 2, which is an antimicrobial peptide produced by the epithelial cells in the mucous lining of the gut. It’s particularly responsive to gram negative bacteria like E. coli and other Proteobacteria. I also have elevated S100A12, which is released by activated neutrophils in response to pathogens. It usually correlates with active inflammation and is associated with IBD, but I have noticed that it’s pretty common to see elevated inflammatory markers like this when you have a major bacterial pathogen. I also have elevated fecal lactoferrin, also a specific and sensitive measure of inflammatory bowel disease, but there is a form of IBD that’s transitory in response to a pathogen, and I assume that’s what I’m seeing here. But I’ll definitely want to retest at minimum fecal lactoferrin to make sure that has gone down, although I’m not terribly concerned about IBD as I have no symptoms of it like mucous or blood in my stool or pain in my intestines, except when eating low quality gluten foods. And I had a clean colonoscopy last year and have no IBD in my family. 

The next marker listed is fecal zonulin, which is significantly elevated. This is a marker of leaky gut, but more specifically, a protein that is released by the cells lining the intestines and liver cells in response to gluten and gut microorganisms. Again, this is likely at least partially an artifact of this temporary pathogen, as any gut infection can cause a leaky gut, but I suspect that because I usually have a rotation of pathogens coming through, this is something I need to be more attentive to. Also, I have been eating gluten pretty regularly for the last couple years, so I may need to rethink that. I did once do a food sensitivity panel (IgG markers) and virtually everything I ate was on the list of intolerances, which is also a pretty good sign of a leaky gut. Anyway, so based on this, I think I’m going to start using ½ scoop of my SBI powder in my gut shake more regularly even when I don’t feel any pathogens coming through as a safeguard, as it binds to pathogens and helps seal up a leaky gut. Other things that I can do to address the leaky gut are L-glutamine* for the small intestine, and mucilagenous herbs like DGL, aloe, marshmallow root or slippery elm, as well as zinc carnosine. There are mixtures of those ingredients like GI Benefits powder* that I’ve used in the past or pills called DGL Plus*. 

The next marker, deaminated gliadin peptide, is a marker of an immune response to gliadin, which is a component of gluten. This is actually the first stool test I’ve done with a definitive marker for gluten sensitivity. This is a sad result for me, although I’m only slightly in the yellow at 11.8 (with ≤10 as normal), so I think I’m going to go back to not eating gluten at home and saving it for special occasions. I also happened to take another look at a DNA test I did a while back and I have genetics for non-celiac gluten sensitivity. 

I’m not that familiar with the next elevated marker, actin antibody. I don’t think I’ve ever seen this elevated before – it’s possible it’s new to the test, but apparently this identifies auto-antibodies to F-actin, or filamentous actin, a cytoskeletal protein found in the cells lining the intestines and in the liver. From the description, I’m seeing that this most commonly associated with autoimmune hepatitis as well as severe celiac disease, which I know I’m negative for. In a gastrointestinal context apparently elevated actin antibodies suggest advanced mucosal injury and immune dysregulation. I guess that given I have an autoimmune gut issue this makes sense, but I don’t know what else to make of this marker. I’m hoping that this is also related to the Enterotoxicgenic E. coli. Recommended supplements for this are listed as curcumin, omega 3 fatty acids, which I already take, and green tea extract, which I’m taking in the context of my matcha green tea powder and I also drink green tea, but I could ramp it up with some more EGCg,* which is an extract of green tea. 

Then on p. 9 of the PDF file, I had one marker of malabsorption, vegetable fiber found in my stool. I’m sure inadequate chewing is part of the issue, as I tend to swallow my food. Bad habit from childhood. But I’ve also often had less than optimal pancreatic elastase in past tests, which is ideally above 500, and this test is not different in that respect, but we’ll get to that later. Since I got these results, I ordered a powdered enzyme supplement specific to the FODMAP foods called FODZYME*, so I’ve been sprinkling that on my food. 

The next page is a diagram of the gut to show primary bile acids and secondary bile acids, which are what you get when gut bacteria convert primary bile acids. And then on the right we have the short chain fatty acids. Propionate is highlighted in red because my levels are elevated and butyrate is highlighted in red because it’s low. Apparently elevated propionate can lead to constipation, which I don’t think was an issue at the time I took this test. Low butyrate, as I mentioned before, is pretty common for me and when you have excess Proteobacteria, and I’ll address that by getting more fiber through my diet and when I have loose stool, taking my Tributyrin-Max. And my overall short chain fatty acids are low, which again is usually addressed with some form of butyrate. I generally recommend Tributyrin-Max for people who have loose stool or diarrhea, as it’s the highest dose butyrate on the market, and lower dose options if someone is low in butyrate but constipated and/or experiencing incomplete elimination or sticky stool. I usually pick Probutyrate*, which is 300 mg/pill or Tributyrin 350 Active*, for people in that situation, recommending only 1 pill every 3 days and increasing to once/day as tolerated without creating more constipation. 

The next three pages, 12-14, have some prebiotic and probiotic recommendations, as well as other supplements and foods. By page 15, we have a complete list of pathogens where you can see my elevated E. coli again, then nothing shows up on p. 15 of fungi, viruses, helminths, antibiotic resistance and virulence factors of H. pylori, which tells me whether the H. pylori I have is a concerning one that could cause stomach cancer or ulcers. None are positive and there’s no antibiotic resistance and my levels are low/normal. Then on p. 17, I test negative to more helminths and then you can see all the inflammatory markers in context. So you see how I don’t have an elevated marker for calprotectin, which is another marker for IBD, so yet one more reason why I’m not that concerned that IBD could be an issue, despite the elevated lactoferrin. 

Then the next section, on digestion and immune imbalance shows my pancreatic elastase, one of our primary pancreatic digestive enzymes, just inside the green at 201.6 (on a range of ≥200), although most practitioners consider >500 optimal. So that points to the need for digestive support, which is never a bad idea when you have post-infectious IBS, as it leaves less food for bacteria to ferment and create bloating. Thankfully, all the other markers were in range, including secretory IgA, which is your primary gut immune marker. Since I found out that I have poor genetics for converting beta carotene into the usable form of Vitamin A, retinol, I’ve been taking retinyl palmitate* (and note that you can get toxic doses of vitamin A, so don’t just hear that I’m taking it and decide that’s a good idea for you) but that may be helping with my gut immune system, which has tested lower in the past. 

Below that is a new marker, lipopolysaccride or LPS antibody. Mine was normal, but presumably this marks an immune response to LPS, which is an endotoxin on the cell walls of and released by gram negative bacteria, which Proteobacteria are. 

Then on p. 18, you can see some more gut antibodies in context. Some of these are new markers to the Gut Zoomer, including the anti-Saccaromyces cervisiae antibody. If you had this positive, the probiotic S. Boulardii, which is actually S. cervisiae subspecies boulardii, would be contraindicated for you. You can also see that there are 2 more markers for gluten sensitivity, and two of them are normal, so a good reminder that just because you get the green light on one gluten sensitivity marker, don’t assume you’re not sensitive. And most gut tests only have 1 marker. 

Below that is the section on malabsorption in full context, and fecal fats, and mine are all in the normal, but on the higher end of the scale. I tend to have a relatively high fat diet, mostly in the form of olive oil, avocadoes, olives, etc., usually something around 40-60% of my calories, so these results make sense. 

Then below are the bile acid metabolites, and all those look good, so no issues with my gallbladder apparently. I’m glad to see that because I was a little worried about my fat digestion a few months ago and did a 2-month protocol to gently remove any gallstones and thin the bile, and everything looks good. 

Then on p. 19, you see the short chain fatty acids in context, followed by a marker called beta glucuronidase. This was one of the primary reasons I did this test, because it was elevated on my Tiny Health PRO test* I took a year before. When elevated, it indicates a type of dysbiosis, that leads to the toxins attached to bile, which include estrogens, being detagged from the bile and sent back into circulation. This can lead to breast cancer, colorectal cancer and estrogen dominance, which I struggled with my whole life, I now know in retrospect, but not so much now that I’m in menopause. So you definitely don’t want to just sit on a result like that. A year ago following that high beta glucuronidase, I drastically changed my diet for a time, eliminating almost all meat and all fatty cuts of meat, moving to vegan protein sources and eliminating all dairy fat. I also started taking Seed Synbiotic* in order to bring in more Lactobacilli and Bifidobacteria to push out beta glucuronidase producing bacteria. So I was very relieved to see that my beta glucuronidase has normalized. 

The next section, from pages 20-23, is the gut commensals, or the normal gut occupants of a healthy gut. But of course even normal occupants can be overgrown. So I have to say that this is my least favorite part of the Gut Zoomer, mainly because of the scales, which all go from 1-20 or 1-10, which is a funny way to create scales of bacteria, when for some it might be normal for them to occupy 10% of your microbiome, and others less than 1%, so this results in the nature of the dysbiosis not being as clear as with other tests, like the US Biotek GI-Advanced Profile*, which always shows super clearly which bacteria are the issue. 

But anyway, there were only two elevated ones here: Actinomyces and Fusobacterium (the latter are hydrogen sulfide bacteria incidentally, although that’s never been an issue for me). I had more that were low, including the whole genuses Bifidobacterium, Blautia, Clostridium, and Prevotella, as well as the species Blautia hydrogenotorophica. Given those low levels and the high levels of E coli, I’ve started adding some prebiotic fibers to my gut shake, including acacia fiber,* Fibermend from Thorne*, which has partially hydrogenated guar gum or PHGG, apple pectin and larch arabinogalactin. I also got a probiotic from Life Extension called FLORASSIST GI with Phage Technology*, as the 4 bacteriophages in it, which are viruses that attack bacteria, target E. coli. So I’m going to take a bottle of that. 

Then on the second half of p. 23, there’s a list of probiotics. I had good levels of all of these, most likely because I didn’t pause my probiotics at all before taking this test, because I pretty much plan to continue with this plan so I figured no harm seeing how they’re showing up. I had low levels of Bifidobacterium bifidum but the rest are in great shape. So I picked out that probiotic I mentioned because it also contained B. bifidum as well as the phages. And that’s pretty much the end of the test. 

So overall, I was pretty happy with these results. Didn’t love seeing a major pathogen or inflammatory markers in there, but it was a good wakeup call about protecting my microbiome and not eating such old leftovers! And also didn’t love that I’m going to have to go off gluten again, but honestly, there is some great gluten-free bread available in Tucson – at Gourmet Girls if anyone is in the area – love their ciabatta rolls, so it makes life livable being gluten-free. I also tried attempt one at baking gluten-free focaccia, which wasn’t so great, but I’m hopeful that attempt 2 will go better. 

So if you’re thinking of doing a stool test and working with me or someone else, I’d encourage you to do a breakthrough session first, which I offer free to all comers, because each test has pros and cons and certain markers, and certain symptoms lead me to choose one test over another, so it’s good to consult about that before buying. Plus you can only get the Vibrant tests through a practitioner. 

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.

Schedule a breakthrough session now

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Bloated and Stressed Out: Cortisol, Insulin Resistance and Healing with Shana Hussin, RDN

Bloated and Stressed Out: Cortisol, Insulin Resistance and Healing with Shana Hussin, RDN

Adapted from episode 150 of The Perfect Stool podcast and edited for readability with Shana Hussin, RDN and Lindsey Parsons, EdD.

Lindsey:  

We talked a bit about what we were going to talk about, and one of the things that you like to focus on is insulin resistance and cortisol dysregulation, and that’s something that you’ve gone through yourself. So can you tell me about that?

Shana Hussin:

Yes, I know your story is similar and you’ve gone through the ringer with the gut stuff. When you’ve lived it yourself, I think it just becomes in your face and it’s easier to point people in the right direction. I’m a registered dietitian. I’ve been in the nutrition field for over 25 years, I taught the standard recommendations for a long time, and I was classically trained. Then, I discovered I had insulin resistance by following the standard nutrition guidelines and thinking I was doing everything that I should to remain as healthy as possible and feeding my family in the same way. Honestly, I didn’t know what insulin resistance was until about seven or eight years ago. Of course, I knew all about type two diabetes and pre-diabetes.  there is very, very strong genetic diabetes, polycystic ovarian syndrome, heart disease, in my family, so I’ve always been really mindful about that and careful with my lifestyle. I noticed I was having a lot of cravings and food noise in my head. I would eat a meal, and I’d already be thinking about what I was going to be eating for the next meal, and even though my weight has never been a huge issue for me, I was doing a lot to maintain my weight.  I was exercising a ton, I had three little kids, I’m like, “life just shouldn’t be this hard.”

And then, it’s kind of a long story, but my son got really sick, and I went into the deep thralls of alternative therapies, because the conventional system was not helpful for him and his healing. So, I went a lot of alternative routes, and I started to really dive deep into whole, natural nutrition and going away from the standard guidelines and was blown away by what I learned. Of course, intermittent fasting came on the scene, some therapeutic carb restriction therapies that I tried on myself, and I was blown away by the results that I saw. I actually wrote a book on fasting, and did that for a long time, and I mostly healed my insulin resistance, and again, I didn’t even know what that was. And what’s interesting about my story is that I always had normal blood sugars and normal cholesterol levels; my lipid panel looked great. Everything looked good on paper. I was in a healthy weight range, but once I learned about insulin resistance and how to test for it, I discovered that my fasting insulin was out of range on the high side, and at that time that I had my fasting insulin checked. I was already two years into this lifestyle of time restricted eating and therapeutic carb restriction, so I have no idea what my fasting insulin actually was when I was feeling all of the symptoms.  I was able to reverse that, and I teach people how to reverse their insulin resistance. 

But then, the second thing that you mentioned was that I also teach mostly women, because women are who really struggle with a lot of cortisol issues. Funny enough, when I was doing all of the things that I teach, and intermittent fasting in a way that I was I also kind of exacerbating my cortisol issues that were already there. For the longest time, I thought cortisol was all about managing your nutrition and managing your stress, which play a strong role. But that wasn’t the biggest piece of the puzzle. Again, I went down this deep dive into how to actually fix cortisol issues, because I just see it rampant in the people that I work with, women my age, who are in perimenopause and menopause. But even that, I had cortisol issues since college, I would say they started, and I just didn’t know how to fix them. So, long story short, I discovered how to fix my cortisol issues. Once I did that, once I brought my cortisol levels back into balance, I fully recovered from insulin resistance, because I still had a little bit of insulin resistance hanging on until I balanced that hormone. So that’s how I got into specializing in those types of issues.

Lindsey:  

Got it.  So you were mentioning your fasting insulin being elevated, and I assume you meant according to standard reference ranges. But, I have heard that for fasting insulin, below six is an optimal reference range. Is that something you use as well?

Shana Hussin:

I do. So when I first tested mine, and I was two years into this lifestyle, mine was 10.7, so if I had gotten that result in the conventional system, they would say fabulous, “that looks great.” I knew that it was at least slightly elevated. Again, I’m willing to bet it was probably in the 20s prior to that, when I first started working on reversing it. In the conventional system, most lab standards are up to 24.9 as being normal, which really high. So yeah, as you mentioned, I like to see that number between 2 and 6. When I first had mine tested, it was 10.7 and then I had it tested two years later, and it was 7.5 and I was still like, “what the heck? This is like four or five years later!” Not that it was extremely elevated by any means, but it was still outside that normal range. Once I balanced my cortisol and brought that last piece of the puzzle in, which was working on my nervous system and my lighting environment, then my level went to 2.2 and that was just this past summer, so just a couple of months ago, so I was really happy to see that.

Lindsey:  

Awesome. So I’m curious, because I have a client in this situation. So what does it mean if you have somebody who’s not diabetic, but they have a lower than 2 fasting insulin?

Shana Hussin:

Yeah, that can happen. You don’t want to have no insulin response whatsoever, but so you do want to have some. Under 2, in my experience, and this isn’t always true, but sometimes they can have higher than normal blood sugars because they’re just not secreting enough insulin to draw the blood sugar into the cell. Sometimes, as with type one diabetics, they don’t produce any insulin.

Lindsey:  

Right. It’s gone so far into insulin resistance, they don’t have the insulin coming.

Shana Hussin:

Exactly. Yeah, that’s an interesting scenario. Either their pancreas is needing some help, or I’d be willing to bet their blood sugars are probably a little bit higher.

Lindsey:  

Yeah. So I came into the functional medicine field when the term “adrenal fatigue” was coming under criticism, and I know most practitioners now call it an HPA Axis dysfunction, but the same type of diagnoses and treatments are administered, whether it was called adrenal fatigue or HPA Axis dysfunction. So, if someone has low DHEA and lower high cortisol, no matter what it’s called, the people I trained under, they’re giving pregnenalone, they’re giving DHEA. So I’m curious what your take is on all this and the terminology and how you deal with it. 

Shana Hussin:

Yeah, and HPA axis dysfunction is definitely more accurate than adrenal fatigue, and in the conventional system, adrenal fatigue, adrenal dysfunction, adrenal exhaustion, all of those terms are pretty much dismissed by conventional doctors most of the time, unless there’s actually something wrong with the adrenal gland, in which case, their only solution is typically medication. But as you mentioned, we know now, hopefully more and more people will be starting to know that it’s more of an HPA axis dysfunction. Cortisol is produced by the adrenal gland, but it’s produced in response to the signaling that it’s getting through the eyes and the light environment. So the light that’s coming into the eyes – eyes are basically an extension of our brain that is signaling to the hypothalamus what to do and what time of day it is, and basically telling the body what to do, when to secrete hormones, when to make neurotransmitters, when the organs should be doing what they’re doing. The hypothalamus then tells the pituitary glands to tell the adrenal glands to then make cortisol.

And so we blame the adrenal gland and say it’s adrenal fatigue – the adrenal gland is just tired, which you know in some circumstances might be true on some level, but it’s mainly just the communication that has been broken. The body is so confused by all of these different signals that it’s getting that we were not meant to take in through our eyes. That signaling is broken. And so the adrenal glands just don’t know what to do. They don’t know when to secrete cortisol. They’re secreting it at times of the day that it’s not normally secreted, or they’re not secreting it at certain times of the day when it should be secreting it. And so that’s where we do go back to that HPA axis dysfunction and being much more accurate. And in functional medicine, they’re definitely starting to come around. But I know with functional medicine too, a lot of times people would go in with cortisol dysregulation or imbalance. And the response was, “well, let’s give you adaptogens, or let’s give you ashwagandha.” And those things can certainly help. I’m not disregarding those, but it’s still not fixing the messaging along the HPA axis. 

Lindsey:  

It sounds like you’re using light. So is this about following a circadian rhythm, getting light in the morning, low lights at night, kind of thing?

Shana Hussin:

Yeah, that’s the main therapy, and the main thing that I have my students work on when they come to me. First, we’re looking at cortisol testing and looking at what their pattern is during the day, and we can talk a little bit more about that, but what their pattern is showing is how we’re going to set up their therapy, but it is primarily light focused. So I know for me, I got to the point of adrenal exhaustion. So the testing that I like my students to do is called a four-point cortisol saliva test. And maybe you’ve mentioned this on the podcast before, and the one that I have sent, I have a home kit sent to them that also includes the hormone DHEA, because usually that’s really low when the adrenal glands are not working correctly. It’s a salivary test; you spit into test tubes at four times throughout the day.

But why that’s helpful is that we should have a natural cortisol spike in the morning, when we’re getting up, it’s our system saying, hey, let’s get up and go. And then it should kind of peak midday and then start to fall, and it should be low by late afternoon to evening. A lot of times I see either a flattened cortisol pattern like I had, where it’s just kind of low levels of cortisol all day long, and that’s usually when this has been going on for a really long time. Things are just very chaotic and dysregulated by that time, the signals have been off for a really long time, or a lot of times, I’m seeing an inverse pattern where people are having high cortisol levels at night, and that sets us up for very disturbed sleep and not healing and feeling like absolute crap all the time, because you’re not getting restorative sleep.  It can lead to weight gain, and so you have these levels of cortisol going high at night, in the afternoon and in the evening, when they’re supposed to be falling, and that prevents us from going to sleep and staying asleep. People who are feeling wired but tired at night because they just can’t seem to fall asleep, they’re wiped but they can’t fall asleep. What happens is the cortisol goes high at night when it’s supposed to go low, and the inverse hormone is melatonin, and melatonin is our fall asleep, stay asleep, repair hormone, and that should peak at night, but instead, cortisol is high, and so we can’t fall asleep, stay asleep. We have very dysregulated sleeping.

And then come morning, when our cortisol levels are supposed to be going high again, they’re very low, because this whole inverse relationship is off with melatonin and cortisol. So that is where a lot of these issues are coming from. But like I said, I like to test my students first to see what their pattern is. My therapies or the suggestions that I make are very, very similar, but knowing what we’re starting from and where we’re starting from with cortisol patterns is really helpful. So then you’re just doing that saliva test at four times throughout the day to see what your pattern is, if that cortisol level is rising falling as it should be. It’s a really easy test to do, and we can track that over time.  I know I struggled with this for decades, and like I said, I got to the point of adrenal exhaustion. Once I learned how to properly incorporate and change my lighting environment and work on my nervous system, I was able to recover my pattern within a couple of months. So you know what’s causing it and how to correct it. You can do so pretty quickly. You can kind of go by symptoms, but I like to test and then test every three months or so to make sure that that cortisol is still well in balance.

Lindsey:  

Yeah. And so how can you correct that dysfunction? Or how did you do it for yourself?

Shana Hussin:

Yeah. So as I mentioned, mine was just low all day long. It’s weird, because a lot of times when people are to the adrenal exhaustion stage that I was at, they’re so tired, not wanting to get out of bed. And a lot of times they’re misdiagnosed with depression with really low levels of cortisol, or they’re diagnosed with anxiety when cortisol is spiking at the wrong time. It’s really kind of sad because had I gone to a conventional medicine practitioner, I probably would have been offered an antidepressant, or if I had high cortisol night, an anti-anxiety medication.

But what I did is I learned how sunlight and our lighting environment really are the triggers for cortisol, the main triggers. There are other things, I’m not going to say it’s just light, but that’s the primary one.  When sunrise comes into our environment in the morning, at daybreak (daybreak and sunrise are different) – daybreak is when the light is starting to come into the environment. Sunrise is when the sun is actually coming onto the horizon. At daybreak, there’s a lot of red light. And if you go outside, it’s like that warm glow. It’s kind of reddish looking. So a lot of red light there. Sunrise is where blue light comes into the environment, and it’s in the same amounts as red light. When blue light comes under the horizon, and our eyes can take that in, it’s the blue light that is picked up by the eyes that tells our body to produce cortisol. What happens is, people aren’t going outside much, right? The average American spends seven minutes a day outside, which is astounding. We did not live like this a couple hundred years ago. Our environment has changed so drastically, and our genetics have not had time, they really haven’t changed at all. They haven’t had time to catch up with all of this lighting change.

And so, going back to sunrise, if you can go and watch the sunrise, you will tell your body to produce cortisol. Mine was really low, so all I did was go outside every single morning at sunrise. I miss some in the summer because I live in Wisconsin, and sometimes the sun is coming up at like five o’clock in the morning, but as much as I could, I went outside to see the sunrise, and that triggered cortisol production. And the cool thing about the sunrise and the natural light in the morning is that it’s going to act as if your levels are too high, it’s going to bring them down lower. If they’re too low, like mine are, it’s going to stimulate that cortisol to be higher. So that was a huge part, just getting outside, going out to the sunrise. I’m not saying you have to sit out there for an hour. I set a timer for three minutes. If I can sit out there for longer than that I do; otherwise, I go out for three minutes just to get that signaling into my eyes. 

As we go throughout the day, our lighting is always changing outside, the spectrum is always changing. At midday, we have very high levels of blue light, not as much red light. And then we get into sunset, and there’s a lot more red light than blue light. And then after nightfall, there’s no blue light in our environment, and that’s important to take into consideration, because remember, blue light stimulates cortisol after nightfall. As humans, we’re not supposed to be getting those signals of blue light into our eyes anymore. We’re supposed to be winding down and going to sleep. But what has happened in our environment is then we stare at TVs, we stare at phones, movies, Netflix, computers, we have to do homework, iPads, whatever it is, and all those things are very, very high in blue light. So this is where that inverse pattern is coming into play as people who after nightfall, after dinner, after it gets dark, they’re watching TV all night, or they’re working all night.

Sometimes we have to work  – night workers, hospital workers, who are under these awful, awful fluorescent lights throwing all this blue light your body is perceiving that at all times. And so it gets really confused. It’s nine o’clock at night, and your body’s like, “Wait, I thought the sun went down, but all this blue light’s coming in. It must be midday. Oh, I better push my cortisol up. I better give Shanna some more cortisol, because it’s midday. She needs more energy.” Cortisol levels rise, and it makes it so hard to go to sleep. And the thing about cortisol, too, and why I wasn’t fully recovering from insulin resistance, is it also increases blood sugar, it increases insulin. It’s interesting. There are so many studies, even if you are not eating or you’re not hungry, you start to watch TV, you put a phone in your face, and the cortisol is stimulated. All of a sudden, you’re having cravings. You’re having “I want some ice cream,” whatever it is, the cortisol goes up, the blood sugar goes up, insulin goes up, and it’s really tough to reverse that insulin resistance fully. That’s the main thing I did to fix mine, just go out at sunrise, and I’d go out for light breaks throughout the day, and I don’t wear contacts or glasses, but you want to do this with naked eyes, if at all possible. 

Lindsey:  

Right. And not through windows, right?

Shana Hussin:

Not through windows. You can open the window and look through screen. That’s fine. If you’re driving, you can crack a window, but almost all UV light, and most red light is filtered by windows. Unfortunately, yeah, looking through the windows isn’t the same, no contacts, no glasses. I did a lot of light breaks. I did a lot of other things for my nervous system, like grounding and being in nature. Another thing that I did that I had no idea was exacerbating my cortisol issues was I stopped wearing sunglasses. And I know that that sounds really wonky for a lot of people. I live in Wisconsin, if it’s snowy, if I’m driving and there’s glare off the snow, or if I’m boating and there’s glare off the water, then of course, I wear sunglasses. But for the most part, I stopped wearing sunglasses because that’s confusing to the body too, because it’s filtering all the light signals.

Lindsey:  

Yeah, and what color are your eyes? I’ve got to ask. 

Shana Hussin:

They’re green.

Lindsey:  

Mine are too, and mine are so sensitive to light I cannot stand to be outside without a hat and sunglasses. I live in Arizona, so.

Shana Hussin:

Mine used to be that way, Lindsey. It’s interesting because I had very high light sensitivity, and that’s another sign of adrenal fatigue and adrenal dysfunction. And I was a lifeguard and growing up, and I’m like, “How am I going to stop wearing sunglasses? This is crazy.” But I just did it little by little, I started with a hat, and now I can go out. It’s really crazy. I don’t have to wear sunglasses anymore. 

Lindsey:  

You aren’t squinting the whole time?

Shana Hussin:

Nope. In the summer, at high noon, I’ll put a hat on, or I like to work outside, and if I’m able to, I’ll sit in the shade. But that light sensitivity goes away with time, and it’s just because you’re so accustomed to being indoors and to having sunglasses on. All of those things, within a couple of months, I tested my cortisol pattern again, and it was normal. And I’ve never been a night hawk, so nighttime wasn’t a huge factor for me. But the other thing that’s so important is blocking the blue light after the sun goes down.

Lindsey:  

Right. I also just heard, I was listening to the Huberman Lab podcast, and he was saying that there was a study that they were questioning the whole blue light hypothesis, and that maybe it’s not even the blue light, but maybe it’s actually the devices themselves and the amount of stimulation that they’re giving you that’s raising your cortisol, not the light coming off of them. I’m sure the jury’s still out on that question. It’s probably just one study.

Shana Hussin:

I would say both for sure. 

Lindsey:  

Without question, the stimulation of scrolling through social media and things like that.

Shana Hussin:

Oh, for sure. I’ve been wearing blue light blocking glasses for like a year. And I will say if I’m watching a stimulating show, even with my blue light blocking glasses on, I have an Ouro ring that tracks my stress response. My husband and I have been watching Yellowstone, and when I watched that right before bed, I watched my stress response climb. I’m like, “Okay, I’ve got to do my glasses and I’ve got to do my wind down routine.”

Lindsey:  

I know, I don’t like watching scary things and that sort of thing. My son got us watching this “Killing Eve”. And I’m like, “This is brutal. I don’t like this. I don’t want to watch this kind of stuff.” Anyway, I’m wondering why cortisol seems to get imbalanced, in particular with women in perimenopause/menopause. Why is that a thing? 

Shana Hussin:

I don’t have the exact answer, but I draw my conclusions. I just turned 49 so I’m in perimenopause, and I work with a lot of ladies in perimenopause, but you get more insulin resistant when you go through perimenopause just because of all of the hormonal changes.  So we can’t do the same things as we used to do. We can’t eat the same way, our stress response….

Lindsey:  

Or drink the same way. Can’t do anything the same way after you lose that estrogen.

Shana Hussin:

Yeah, your skin changes, your hair changes. You’re not as resilient. So I don’t know what comes first, the chicken or the egg with cortisol or insulin resistance. I honestly think it’s a combination of all of the above. You know, you’re probably the same type of person I am: type A. I raise three kids; I run a business. I want my kids to eat well. We just have busy woman syndrome. And I think by the time we’re in our 40s, 50s, our hormones are declining. We’re not as resilient as we were before. We’re more apt to store body fat because of the estrogen levels falling. We don’t sleep as well. We’re not as like, “Oh, get up and go and conquer the world.” Everything comes to a head, and we’re just at the time in our lives where my kids are older, two are in college, and one is in high school, but I lost both my parents last year. We’re just sandwiched into raising our kids and taking care of our parents and going through all these hormonal changes that is just a really hard time for women, and that mom transition too, where I was so busy with my kids for so long,. . . 

Lindsey:  

I just have one at home. And he drives too!

Shana Hussin:

And now, what am I going to do all the time? 

Lindsey:  

Have fun? 

Shana Hussin:

Like I said, women want to eat and drink and do the same lifestyles they did in their 20s, but now we have all of those changes coming at us, and we start to show some symptoms as a result.

Lindsey:  

It’s shocking how your health plummets when you start to lose that estrogen.  I’m on hormone replacement therapy, and even still, my cholesterol has gone up, blood sugar’s gone up. Admittedly, my last blood tests were after my honeymoon, because I got remarried, and I had been drinking every day because I was in France, and that’s what you do. 

Shana Hussin:

Well, their alcohol is probably completely different. You know, everything’s different there. 

Lindsey:  

I mean, whatever the quality of the alcohol, my liver enzymes were certainly above optimal by the end of that. I’ve been waiting to correct this all and retest and hopefully get better numbers, but still, just going into menopause shot everything for me, really, and I’ve been reading about that and what the alternatives are to even just your basic HRT. But looks like the alternatives are not great. If you really want to replace your hormones back to pre-menopause levels, which is what the authors of book I’m reading are proposing, you actually have to have a period, potentially even get injections of estrogen. I’m using a patch and progesterone pills. So it’s not crazy.

Shana Hussin:

That’s the one benefit of going through menopause, right? 

Lindsey:  

Exactly. I’m like, “I don’t know it’s a tough trade off, but I still get the hot flashes even when on HRT.”

Shana Hussin:

Right, it’s like, “I want my hormones, but I don’t want that anymore, exactly.”

Lindsey:  

So when somebody does have that spike right before bed in cortisol, other than keeping out the blue light and dimming lights, is there anything else that can be done about that?

Shana Hussin:

Yeah, so the blue light is the main thing. And when I start to work with people with cortisol dysregulation and insulin resistance too, the first thing that we work on is our nighttime routine, because it’s hard to fix the morning routine when you’re not sleeping well. So getting that under wraps, starting with the blue light blocking, and I will say there are more and more blue light blocking glasses coming out. And you can get them on Amazon; you can get them wherever.

Lindsey:  

Or if you wear prescriptions, you can get them built in, like I’ve got. 

Shana Hussin:

Yeah, but unless you’re wearing the orange toned at night, the clear ones aren’t going to block the blue light. They’re going to help with eye strain with your computer if they’re clear, but you want the orange tone or the red tone. I don’t wear red tone. I don’t need those. But the orange tone, I’ve switched out my light bulbs in my living room and my bedroom so that there’s almost no blue light. They’re 99% no blue light.

Lindsey:  

Okay, so what kind of light bulbs does one get? 

Shana Hussin:

They’re called Hooga, H, O, O, G, A, is the company that I order from, Incandescent lights will also have virtually no blue light. They were almost banned for a long time, but there’s now an executive order signed that incandescent lights can be sold again, and I could always get them in Wisconsin, but there were certain states, I know California for sure, you couldn’t get incandescent light. So the LED lights, the really bright, fluorescent lights, are the ones that are problematic. And then, of course, just having some kind of wind down routine. I try not to look at my phone or screens at least an hour before I want to sleep. I’m reading or I’m journaling, I know that’s not for everybody, but that really, really helps. 

Some other things that can help if you absolutely are having trouble sleeping, magnesium. We mentioned progesterone. You might need to look into that, but people are amazed at what blocking the blue light does with sleep quality. So we start there and work on the nighttime routine, and then the daytime and morning routine become a lot less challenging because you’re getting that melatonin peaking at the correct times. I tell my clients I work with, if you can be asleep by 10 o’clock, that is where I want you eventually, because all of these repair systems and the melatonin production peaking, melatonin peaks about four hours after darkness and after you’re sleeping. If you’re falling asleep around 10 o’clock, it’s peaking around 2 a.m., which is when it should be peaking, and then it’s starting to fall by the time you want to wake up.

People who don’t go to sleep until midnight, or they have this blue light in their eyes, they’re not letting melatonin take over until 12, one o’clock in the morning, while it’s peaking, then at 4 or 5 a.m. That’s why you don’t want to get up, because your melatonin is high, your cortisol is low. And there’s people who are like, “I’m a night person, I’m a morning person,” and there’s definitely something to that, but a lot of times it’s just this dysregulated light environment, and then the morning routine becomes a lot easier. You’re able to get up and watch the sunrise and take in light breaks throughout the day, and that’s kind of where we start. But the melatonin production is just as important as the cortisol, because if you’re not healing and repairing and getting restorative sleep, it’s going to be very hard to recover from any disease. 

Lindsey:  

What about other patterns I’ll often see, like on the Adrenocortex or the ZRT four-spit cortisol test/adrenal test is that someone’s cortisol is particularly higher in that sort of 5 to 7 p.m. range.  I think that’s probably a natural rhythm of life. Just because that’s when we’re doing all the stuff. We’re finishing work, we’re picking up kids, we’re making dinner, we’re running errands. Those are naturally high cortisol things. So is that something that needs addressing, or is that sort of a natural period of higher stress?

Shana Hussin:

Yeah, I mean, it should be a little bit higher, that kind of mid to late afternoon, but it should be falling. I’ve seen that pattern for sure, where it’s out of range at that third time that they’re doing the spit test. But what we work on then is getting wound. I think that this is probably me, like, 10 years ago, where I’m taking my kids everywhere and you know, your workday kind of ends, but then it’s just beginning of the whole nighttime routine. So yeah, I do see that pattern, and a lot of times it has a bit to do with the blue light stimulation again. But it’s important to note, if you are working on getting cortisol back into balance, like I said, I primarily did all the lighting things, but I also had to work on my nervous system, like I was just in this perpetual fight or flight all the time. And some of that was everything that happened with my parents, but it was just that, like I mentioned, that busy woman syndrome too.

Or I just tell myself, you’ve got to slow down, you don’t have to be achieve, achieve, achieve all the time. And so I started things like journaling, Bible reading, just quiet time that I had never incorporated in my day before. And there’s a couple of other things that I teach in my course to really work on the nervous system. It sounds kind of crazy, but doing a couple of cold face plunges in the morning just takes you out of that fight or flight. You can feel it immediately. So there might be people who have that pattern as well, and as long as you can get it lowered by the time you go to bed, it’s not going to be as disruptive as a real high cortisol at bedtime.

Lindsey:  

So what is leptin, and what does it have to do with blood sugar and cortisol? 

Shana Hussin:

Leptin is another hormone. It was only discovered in 1994- I mean, it’s always been there, obviously, but we didn’t really discover it until 1994 and not a lot of people know about leptin or what it does, but it’s actually produced in the fat cells, and its primary job is to tell the body what’s the energy status on my body. This becomes very, very important, because leptin, telling the brain what the energy status is of the body will give it signals for hunger, satiety, how much to eat the next day. We can back off. We’re not as hungry the next day. But leptin, like I said, is produced in the fat cells, and it can become dysregulated. I see it mostly become dysregulated in women who have tried their entire life to lose weight, and they’ve kind of been in this caloric deficit, gain the weight back. Caloric deficit, gain the weight back. The perpetual dieter almost always has dysregulated leptin.

And the other thing that really screws up leptin is snacking and eating, and this perpetual I’m just going to eat and graze like the grazers. And so what leptin does is it docks to the brain, the hypothalamus, usually around midnight or so, and it downloads. It gives the body a download, like, “Shana has this many extra calories stored as body fat,” or “Shana really has no energy stored.” And what that does is it tells the body how much to eat the next day.  So if there’s leptin resistance where your leptin is too high, this happens usually when we have too much body fat, when we’re in that perpetual snacking, grazing mentality, the fat cells are just producing too much leptin. 

This is a problem because it’s just a miscommunication to the brain and then the perpetual dieters, restrictors. Those who’ve been doing a lot of fasting or a lot of caloric restriction, they can’t seem to lose weight a lot of times, they have really low levels of leptin, and that can become problematic too, because then you might have extra body fat. Your brain is being told you don’t have energy stores and to eat a lot the next day. When we’re leptin resistant, we’re almost always insulin resistant too. The thing that people should know about leptin is that it’s docking to the hypothalamus around midnight, but the receptor, the leptin receptor, competes with insulin, and so if you have higher than normal levels of insulin, it’s really hard for leptin to dock at the hypothalamus where it should, and your body’s not getting that communication either. So if you’re insulin resistant, a lot of times, we’re also leptin resistant, and we’re just kind of a hormonal mess.

And the other thing that’s really important to note about leptin is it primarily docks overnight, and so what I’m getting at is you don’t want to be eating at night, and you don’t want to be insulin resistant. You’re eating at night, and you have high blood sugar, high insulin, your leptin is not going to dock correctly. So that’s really important. So that’s a whole another thing that I work on with my insulin resistance folks is to stop snacking and stop eating at night, so your insulin can come down and your leptin can start to dock to your brain. Leptin will also download during the day about every four hours, and that’s why when we’re eating correctly and we’re managing our blood sugar and our blood sugar levels are healthy, we should be able to go 4, 5, even 6 hours without eating if our leptin is signaling correctly, and you won’t get a leptin download until about four hours after you’ve last eaten. So if you’re just in this perpetual snacking mode, your leptin is probably very dysregulated, and you’re going to have a really tough time losing weight, and just metabolically, you’ll struggle.

Lindsey:  

So are you measuring leptin on your clients? And if so, what’s an optimal level? 

Shana Hussin:

Yeah, I wish. You can. You can ask your doctor for leptin, but chances are they might…. 

Lindsey:  

Chances are they’ll say no. 

Shana Hussin:

If they’re more progressive, they might. I also work with ZRT. You mentioned ZRT earlier. This is the lab that I order all my own kits from too, they don’t have leptin right now. I’m hoping that in the near future they will. You can order it on Own Your Labs. Some of those lab websites where you can order up what you want and go to, usually it’s Quest or Lab Corp that will test it. I like to see a level like 2 to 9 somewhere in there, but unless you get it checked, you don’t really know. But it is important to look at your levels. Way over 9, it’s going to be a little bit different approach than if you have really low levels. And usually, like I said, my low leptin people that I’m seeing are those who are type A, over restricting in a caloric deficit. Maybe been over fasting for a long time, important to have that in balance too.

Lindsey:  

Yeah. And so the solution to that is just eating normally, not restricting your calories?

Shana Hussin:

Yeah, yeah. So how I go about fixing that, I used to do a lot of intermittent fasting throughout the morning. So we fix insulin resistance at the same time. The very first thing I have my people stop doing if they’re insulin resistant is snacking, and we just go to eating three square meals a day to begin with, protein centered, having some natural fat, having strategic produce in there, getting that under wraps first, along with working with the whole lighting thing at night so that you’re not hungry and wanting to snack, and cortisol going crazy. It’s a lot. It’s a lot. People are like, “Oh my gosh, there’s so much to do.” But really, once you understand your hormones and  the environment that is giving your hormone signals, you can start to fix it. The main thing is three square meals, allowing eventually to go at least four hours in between meals so you can get that leptin signaling in between meals, stopping the night eating for sure. And then we do go therapeutic carb restriction, at least for a while. And I’m not saying everybody’s got to go ketogenic or anything, but that does help to bring insulin levels down.

Lindsey:  

When you say carb restriction, how much? Obviously keto, you’re eating maybe 20 grams of carbs a day or something.

Shana Hussin:

Yeah. I actually have a carb quiz on my website to help people with this. Everybody’s different. It’s why I like to work with people individually. But generally I’m recommending 25 to 100 grams of carbohydrate a day, less restrictive around the 100 grams, and then somebody who’s really insulin resistant, like they’re requiring insulin, they’re on all kinds of diabetes medications, that would be more of the let’s eventually get you to around 25 grams of carbs, 50 maybe, until your body is utilizing carbohydrates a little bit better. Because usually you know you’re at that point, you’re very insulin resistant. You’re not utilizing carbohydrates well at all. That’s not forever, but for a time, bring it down. I have people carb flex in there and bring carbohydrates up, maybe one day a week, a couple times a month. I don’t like the perpetual, “let’s eat low carb, 25 grams of carbohydrate every single day for the rest of our lives.”  I don’t think that’s healthy.

Lindsey:  

Yeah. And so they’re not replacing those calories necessarily with fat, right? Or is it adding more protein, typically, that you’re looking at?

Shana Hussin:

Yeah, I have people build their meals around protein because it’s very satiating. It’s what we primarily build our body with. So, in general, I’m having women eat around 100 grams of protein throughout the day. When you meet that, you start to have those hunger and satiety mechanisms come back. I definitely have seen in my practice, people overdo fat and go way too high on fat, and then they’re struggling to lose weight, because even though they’re burning ketones and they’re burning fat for fuel, they’re burning fat that they’re eating, they’re not burning fat from their body. And so that’s where the time restricted eating comes into play, and the whole leptin resistance thing, because if your leptin signaling is healthy, your body will say, “oh gosh, I have 50 pounds of extra body fat here. I don’t need to eat a whole lot today,” and it will downregulate your appetite and all of it. It’s just all interplays so beautifully when it all works correctly.

Lindsey:  

Before we run out of time. I want to bring it back to the topic of my podcast, which is gut health. So how does all this relate to your gut health?

Shana Hussin:

Yeah, it’s fascinating. With cortisol, what I found was really interesting, and what I was struggling with my own gut health was a lot of bloating and a lot of food that wasn’t being digested well, and this is because I was in overdrive. I was in that fight or flight, and my body was so stressed out that instead of taking all the energy for proper food digestion, it just couldn’t digest. 

Lindsey:  

You were not in rest and digest. 

Shana Hussin:

Exactly. I was not in rest and digest. I was in fight or flight, and so almost every meal I would be bloated. I had more food sensitivities than I do now. That’s just one little thing. What really helped me, and this is in my adrenal recovery course, is I took betaine HCl and digestive enzymes for a time with every meal, and I still do that on a lot of days with bigger meals, and that helped to start to digest my food properly and stop that bloating. And another thing with digestion, with insulin resistance and eating too often, is we’re just not giving our digestive systems a break ever. And so that’s why, again, going to two or three meals, and I think it’s perfectly fine for some people to eat just one meal a day. Some of the time when they have a lot of weight to lose, but giving your body some rest and digest and rest and repair is so helpful for the digestive system. And if people do want to intermittent fast and inside my courses, we do have a more of a circadian approach, where we’re fasting late afternoon into evening, to really support the autophagy process during sleep and give that digestive system a nice, long break. 

Lindsey:  

As opposed to the skipping breakfast model, right? 

Shana Hussin:

Yeah.

Lindsey:  

The problem is nobody wants to skip dinner. Everybody likes dinner, and they want to eat it with their friends or family or whatever. And so it’s got to be challenging but makes way more sense metabolically.

Shana Hussin:

It is more socially challenging for sure. It has a lot more benefits. People are doing the habitual, and I did that for like, 5 or 6 years, and that just dysregulated my cortisol even worse . . . 

Lindsey:  

Yeah, I’ve heard it’s not good for women, the whole skipping breakfast thing, and maybe not good for anybody. I’ve interviewed the ProLon Fasting Mimicking Diet* folks, Joseph Antoun, he was saying that, in fact, if anything, skipping lunch, if you don’t want to skip dinner, skipping lunch would be a better choice than skipping breakfast. 

Shana Hussin:

Yeah, if you can be done eating by 3, 4, even 5 o’clock, that gives you a nice long break.  I skipped breakfast way too many years, and it took a toll on me, and I started to have high blood sugars throughout the morning because my cortisol was out of balance. 

Lindsey:  

Yeah. There’s no way I could skip dinner, though, I have to say, because I’m just somebody who’s got a super-fast metabolism. If I skipped dinner, I wouldn’t sleep a wink, because I’d be sitting there with hunger pangs all night.  So one last question, which is how cortisol, melatonin and leptin interact.

Shana Hussin:

Yeah, I like to call these three hormones the master circadian hormones, for all of the reasons that we already discussed. So if cortisol levels are off and melatonin levels are off, your body’s just in chaos and not signaling correctly. But those three hormones are above a lot of the downstream hormones. So if your cortisol and melatonin are off, there’s a hierarchy of hormones, and if you’re filtering all your energy into that cortisol, you’re not going to filter the energy into making sex hormones. It’s just so intricate, and once one hormone gets off, especially if it’s cortisol, melatonin or leptin, all of the downstream hormones, I don’t want to call them more important, but reproductive hormones can be out of balance and not affect us as much. They’re not life or death, right? It’s just “okay well, our fertility is going to not function correctly, but if we don’t have cortisol, we’re in big trouble. If we don’t have some of the other master hormones, we’re in big trouble.” When melatonin, cortisol, leptin are off, people have a lot of weight issues, a lot of chronic illness.

And the nice thing is that fixing them, we do it all in the same way. We get a strong circadian rhythm, we dial in our nutrition, we fix our lighting environment, all the foundational things. And really, when you think about it, just going back to being human, how humans are meant, like we’re not meant to be – my whole business is online, so we sit inside, under artificial light, staring at computers. That’s so much different. And then we eat by our desk, and we don’t socialize. I’m not saying everybody does this, but when you think about humans, even 200 years ago, as to now, things have evolved and changed so quickly that we just haven’t caught up. A lot of our bodies are internally in chaos, and we can’t understand what’s going on. But when we stop and think about how different our lifestyle is, it’s no wonder that we’re all sick and struggling.

Lindsey:  

Yeah, no, I think you really have hit on it too as it relates to gut health, how you start with these dysregulated patterns and then it has all these bad downstream effects. A lot of people that I see have gut health issues that ultimately seem to have stemmed from stress, and often a particularly stressful period in their life where, clearly, their cortisol starts to get dysregulated, their blood sugar gets dysregulated, then they lose their immune resilience. Really, I mean, their immune system gets weakened, and I can see it in their Secretory IgA levels on the stool tests that their immune systems are no longer functioning, but stomach acid levels have gone down. So there’s no protection. So then all of a sudden, these pathogenic bugs start to take over, and then you start getting all these gut symptoms, and it just snowballs from there. So yeah, it really does start with these patterns that come under stress and cortisol. 

Shana Hussin:

I like to tell people we need to fix the terrain. There is a reason why you are having all these imbalances, and the terrain is off, a lot of it has to do with not getting out into the sunlight, not getting proper messaging, eating crap that doesn’t belong in your body, and not sleeping. 

Lindsey:  

Yeah. So tell me where people can find you. And you do courses, yes?

Shana Hussin:

Yes. If you go to ShanaHussinwellness.com, all my courses are housed there. I have lots of freebies. I have a free eBook on cortisol dysregulation. I have a cortisol minicourse as well, if you want to learn the basics of how it gets dysregulated and how to start to fix it. And then I have a podcast called Optimal Metabolism.

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.

Schedule a breakthrough session now

*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.

The Role of Yoga in Stress Management

The Role of Yoga in Stress Management

In the journey toward optimal health, the connection between the mind and body is undeniable. One of the most intricate relationships exists between stress and gut health. Chronic stress not only affects mental well-being but can also disrupt the delicate balance of the gut microbiome, leading to digestive issues, inflammation, and a weakened immune system. Understanding how to manage stress effectively is crucial for anyone looking to restore and maintain gut health. Among various holistic approaches, yoga stands out as a powerful tool for stress management and overall wellness.

Stress triggers the release of hormones such as cortisol and adrenaline, which, when persistently elevated, can impair digestion, reduce beneficial gut bacteria, and increase intestinal permeability—often referred to as “leaky gut.” This cascade of effects highlights why periods of high stress often precede or exacerbate gut health problems. Therefore, addressing chronic stress is not just beneficial but essential in the recovery process from gut-related ailments.

Yoga, with its combination of physical postures, breath control, and meditation, offers a multifaceted approach to reducing stress and promoting gut health. Its practice encourages the activation of the parasympathetic nervous system, often called the “rest and digest” system, which helps lower cortisol levels and enhances digestive function. Beyond the physical benefits, yoga fosters mindfulness and emotional balance, equipping practitioners with tools to manage stress responses more effectively.

For those interested in integrating yoga into their wellness routine, you could find a local yoga studio, or if you happen to be located in Singapore, Yogabar.sg is a premier yoga studio based in Singapore that offers a diverse range of yoga classes tailored to address chronic stress and support gut health. Their expertise lies in creating accessible and flexible yoga packages that allow individuals to explore various styles and intensities of yoga depending on their needs and experience levels.

Yogabar.sg provides several types of yoga classes designed to alleviate stress and promote holistic well-being. Gentle and restorative yoga classes focus on slow, mindful movements and deep relaxation techniques that calm the nervous system and encourage healing. These classes are particularly beneficial for individuals experiencing high stress or digestive discomfort. For those seeking more dynamic physical engagement, Vinyasa and Hatha yoga classes combine breath with movement to build strength and improve circulation, fostering a sense of vitality and mental clarity.

Furthermore, Yogabar.sg’s emphasis on mindfulness practices, including guided breathing exercises and meditation sessions, helps students cultivate a deeper awareness of their body-mind connection. This increased awareness can lead to better stress management habits beyond the yoga mat and contribute to improved gut health by reducing stress-induced digestive disturbances.

What sets Yogabar.sg apart is their commitment to flexibility and community. Their unlimited yoga packages are shareable and designed to fit into busy lifestyles, encouraging consistent practice—which is key to reaping the long-term benefits of yoga for stress reduction and gut health. This approach resonates well with those who understand that healing and wellness are ongoing journeys rather than quick fixes.

Incorporating yoga into a health regimen focused on gut healing aligns with natural, integrative strategies that prioritize the root causes of illness. By managing stress through yoga, individuals can create a supportive internal environment that allows the gut microbiome to flourish and the immune system to function optimally.

For readers seeking to improve their gut health and reduce chronic stress, exploring the offerings at Yogabar.sg or a local yoga studio could be a valuable step. Their comprehensive approach to yoga, combined with a supportive community and flexible class packages, provides an accessible way to incorporate stress management into daily life, ultimately promoting better digestive health and overall well-being.

In conclusion, recognizing the profound impact of stress on gut health underscores the importance of effective stress management techniques. Yoga serves as a holistic and accessible modality to achieve this balance. Studios like Yogabar.sg exemplify how personalized yoga practices can empower individuals to take control of their health, reduce chronic stress, and support the healing of the gut. Embracing such integrative approaches allows for a more harmonious connection between mind, body, and gut, paving the way for sustained health and vitality.

Unpacking Mold Illness: Symptoms, Testing and Recovery Protocols with Terri Fox, MD

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.

Schedule a breakthrough session now

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How Food Poisoning Can Rewire Your Gut: Understanding Post-Infectious IBS

How Food Poisoning Can Rewire Your Gut: Understanding Post-Infectious IBS

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.

Schedule a breakthrough session now

*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.

The Cutting Edge of Healing: High-Tech Solutions for Gut Health and Autoimmunity with Dr. Har Hari Khalsa

The Cutting Edge of Healing: High-Tech Solutions for Gut Health and Autoimmunity with Dr. Har Hari Khalsa

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.

Schedule a breakthrough session now

*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.

From Pre-Alcohol to Fiber: Genetically Engineered Probiotics with Zack Abbott, PhD

From Pre-Alcohol to Fiber: Genetically Engineered Probiotics with Zack Abbott, PhD

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.

Schedule a breakthrough session now

*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.

Taming Gut Inflammation: Fiber, Prebiotics and Crohn’s Solutions with Will Bulsiewicz, MD

Taming Gut Inflammation: Fiber, Prebiotics and Crohn’s Solutions with Will Bulsiewicz, MD

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.

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