The Impact of Mold and Mycotoxins on the Gut Microbiome
When should I suspect mold toxicity or mycotoxin illness?
While I feel most comfortable in my niche area of gut health and autoimmunity, I have found myself quite often recently working with clients who didn’t realize that underneath their gut health issues was mycotoxin illness. The way I usually discover this is that either the gut issues just aren’t getting better, or they can hardly tolerate any supplements that impact gut issues, or in our initial intake they mention a potential past or current mold exposure. So we do testing for mycotoxins and sure enough, they come out positive for some, or in some cases, nearly all tested mycotoxins.
I looked at these clients and I was trying to find common symptoms with all of them, and the one that I have noticed for all of them, anecdotally of course, is anxiety. While they might mention it on our first call, this manifests itself pretty clearly to me in frequent emails to ask numerous questions, worries about how they will follow my recommendations, clarifications of how to precisely follow instructions, and the general need for reassurance that they’re doing the right thing. Some had constipation, which in several cases was also caused by diagnosed methanogen overgrowths, almost all had food sensitivities, usually including histamine reactions, some worse than others.
And for the ones who I suspect had genetic susceptibilities affecting detoxification or immune regulation which would make them particularly vulnerable to mycotoxin illness, symptoms often appear across multiple body systems, from the skin, to headaches, brain fog, breathing issues, hair loss and autoimmune diseases. And many showed obvious signs of yeast, like a white coating on their tongue or recurrent yeast infections. But all that is just my anecdotal experience. Let’s delve into the official information on all of this.
What are mold and mycotoxins?
Mold grows on organic substances and decomposes them to absorb their nutrients. It grows optimally in moist environments with organic material to feed on, with humidity levels exceeding 70%.
Mold and fungi release mycotoxins as a defense mechanism against predators. These mycotoxins may help weaken host defenses in animals and plants, though their primary role is often competitive — inhibiting other microbes, which indirectly helps the mold in colonizing. Fluctuating environmental conditions (temperature, moisture, UV exposure and nutrient scarcity) can also trigger the release of mycotoxins. Finally, some mycotoxins are produced naturally as a result of environmental stress, namely oxidative stress caused by environmental factors, including fluctuating oxygen levels, nutrient scarcity or chemical exposures. As a result, harmful gases, such as superoxide radicals, hydrogen peroxide and hydroxyl radicals are formed within fungal cells under stress conditions. Highly fluctuating oxygenation levels, like rapidly moving from low to high oxygen levels (i.e a fungus being buried underground to sprouting out of the ground) can also cause the release of these harmful gases.
Where is mold commonly found?
Common sources of mold exposure include water-damaged buildings, especially those affected by flooding or leaks, as well as poorly-ventilated, moisture-prone areas like bathrooms, laundry rooms, attics and crawl spaces. Mold can also grow inside plumbing systems, air conditioning units, and older carpets and appliances, particularly when they trap moisture. In humid climates, mold is more likely to thrive both indoors and on stored foods such as grains, coffee, cocoa, dried beans, sesame seeds, cheese, yogurt, malt, beer, nuts, fruit, dried fruit, and spices, where improper storage can encourage contamination.
Is everyone affected by mold?
Mold spores are found ubiquitously in the air we breathe. However, most people do not experience adverse effects due to several mitigating factors. First, our immune system is capable of clearing low level mold exposure. Also, neutrophils in the lungs kill germinating mold spores asymptomatically. However, for people with compromised immune systems or lung function, they may be at a higher risk of developing adverse health effects after exposure to mold. Furthermore, only a few species of mold are harmful to humans. The overwhelming majority of mold species are not harmful to humans, which are called saprophytic molds, which feed on dead organic matter and typically do not infect humans, and many more don’t even produce mycotoxins.
Of those that do produce mycotoxins, only a handful are pathogenic. Finally, genetics play a large role in determining whether or not a person is highly susceptible to mold toxicity. Genes involved in immune regulation, detoxification pathways and inflammatory cytokine production can influence how someone responds to mold exposure. Specific genes like HLA-DR have been implicated in mold illness susceptibility, particularly in people with Chronic Inflammatory Response Syndrome (CIRS). People with certain cytokine gene variants may be more prone to chronic inflammation after mold exposure.
Do mycotoxins affect the gut microbiome?
Mycotoxins can significantly disrupt the gut microbiome, leading to dysbiosis, or microbial imbalance. Research shows that mycotoxins reduce beneficial bacteria such as Lactobacillus and Bifidobacterium, while promoting the overgrowth of inflammatory species, particularly from the Proteobacteria phylum. Mycotoxins have been shown to damage the epithelial lining of the gut, increasing gut permeability. Increased gut permeability allows undigested food particles, toxins and microbes to enter the bloodstream, putting stress on the immune system and, over time, can dysregulate immune responses. This microbial imbalance and leaky gut is at the root of food sensitivities and chronic inflammation, creating a cycle of ongoing gut damage and immune activation, which may manifest as brain fog, joint pain, skin issues and autoimmune flares.
Mycotoxins also impair the gut microbiome’s detoxification capacity, further weakening the body’s ability to clear toxins and maintain gut barrier integrity. These toxins can further alter the gut ecosystem, amplifying inflammation and weakening the gut lining. However, research suggests that prebiotics and probiotics may help restore microbial balance and enhance the gut’s ability to metabolize and neutralize mold-related toxins before they trigger further disruption. Supporting a diverse and resilient microbiome may be one of the most effective strategies for protecting gut health in the face of mold and mycotoxin exposure.
Can mycotoxins lead to SIFO or candida?
The modulation of the gut microbiota by mycotoxins can also lead to SIFO (Small Intestine Fungal Overgrowth) or Candida overgrowth. While candida is a normal resident of the gut, when it overgrows it can extend beyond the gut, through hyphae, which are branching filament-like structures that can penetrate gut tissue, contributing to intestinal permeability. Systemic candidiasis can manifest as bloating, sugar cravings, sinus congestion, skin rashes, brain fog or fatigue, and may also be evidenced by yeast infections, fungal nail infections or thrush, which can be seen as a white coating on the tongue.
How do mycotoxins affect your immune function?
The inflammation and immune dysregulation associated with mycotoxins may contribute to the reactivation of chronic infections like Epstein-Barr or Lyme, or gut pathogens like C. difficile, due to weakened immune surveillance, which allows latent infections to flare. Mycotoxins can impair immune defenses against pathogens and disrupt the gut’s natural detoxification processes. This can lead to a whole slew of health issues such as inflammatory bowel disease and irritable bowel syndrome, as well as extra-intestinal diseases, including heart disease, obesity, type 1 diabetes and celiac disease.
Mycotoxins have also been connected to mast cell activation syndrome (MCAS), and histamine intolerance. So when I see histamine issues, my first thoughts are either mycotoxins or hydrogen sulfide producing bacteria.
What are the symptoms of mold toxicity?
The symptoms of mold toxicity are highly variable between individuals and can mimic gut symptoms, including abdominal pain, nausea and diarrhea. Respiratory symptoms, such as rhinitis, coughing, wheezing, sinus congestion and tenderness, and respiratory infections such as bronchitis and pneumonia, are frequently reported. Skin irritation and mucosal irritation, such as dry eyes and pharyngeal cobblestoning, are also commonly reported. Some individuals may experience headaches and sensitivity to bright lights. Some studies have also reported symptoms like anxiety, depression, muscle aches and cramps, joint pain with morning stiffness, unusual pains around the body, excessive thirst, a metallic taste in the mouth, weakness and fatigue. As mold toxicity progresses, some individuals may experience deficits in their neurological functioning, including deficits in short-term memory, executive function/judgment, numbness and tingling, disequilibrium and dizziness, and poor concentration and hand/eye coordination.
Mold toxicity, in conjunction with other health issues, may exacerbate other symptoms not usually related to mold toxicity. So while you may have some slight gut issues, if you pile mold toxicity on top of that, it can seem much worse and become impossible to resolve your gut issues until the mycotoxin issue is addressed first.
It is important to note that the symptoms attributed to mold toxicity are still debated, as many symptoms overlap with other conditions, many of them mundane.
How do you test for mold in your home?
If you suspect a mold issue in your home, relying on visual inspection alone is often insufficient. Mold spores themselves are microscopic and invisible to the naked eye, and mold growth can occur inside walls, under flooring, or in HVAC systems, where it cannot be seen without specialized tools. Humidity meters do not detect mold spores directly, but they can identify excess moisture and humidity levels, which create ideal conditions for mold growth. For a more comprehensive evaluation, ERMI (Environmental Relative Moldiness Index) and HERTSMI-2 tests, which analyze dust samples for mold DNA, are useful screening tools — especially for assessing past or cumulative mold contamination in water-damaged buildings. EnviroBiomics is a company that offers these tests (I believe you order the plates and lay them out in the house then send them back for analysis) and I’ll link to that in the show notes. However, they are not diagnostic on their own, and results should be interpreted alongside a thorough home inspection. One company that does mold inspections is called Environmental Analytics, and I’ll link to them in the show notes.
Air and surface testing can also help detect mold, with active air sampling being a common method where a pump draws air through a filter, which is then analyzed for mold spores and other pollutants. While air sampling provides a snapshot of airborne mold levels, it can miss hidden mold or fluctuating spore counts, so it is best used in combination with moisture mapping, thermal imaging, and targeted surface sampling. If you suspect mold damage, it’s highly recommended to hire a professional mold inspector, preferably one who is independent from any remediation company to avoid conflicts of interest. In states with mold regulations, such as Texas and Florida, this separation between inspection and remediation is required by law, ensuring a more objective assessment.
How do you test for mycotoxins in your body?
When I suspect mycotoxins, I use either the Mycotoxin Panel from US Biotek/Real Time Laboratories (which recently merged), the Mosaic Diagnostics Mycotox or Vibrant Wellness’ Mycotoxin Panel. These are all urine tests. For someone with ongoing nasal/sinus issues, I may also suggest a MicroGen DX SinusKEY test, which uses qPCR technology to check for 57,000 potential bacterial and fungal pathogens in the sinuses. I sometimes am also clued in to potential mycotoxin issues when I see elevations on the Mosaic Organic Acids Test in markers 2, 4 and 5, which are indicative of aspergillus, a type of mold that can be environmental. Vibrant Wellness’ Organic Acids test also has these same markers: 5-Hydroxymethyl-furoic acid, Furan-2,5-dicarboxylic acid and Furancarbonylglycine – you’re looking for the words furan or furoic in these longer, more complicated names for potential environmental molds.
However, these can often be negative while mycotoxin tests are positive because there are many different types of mycotoxins and most of them are not measured on an Organic Acids Test. Generally, I recommend testing your body before your home, as the various mycotoxin tests currently run from $289-$400 each, whereas a home inspection I’ve heard can cost around $500. Not to mention that you may be exposed to mycotoxins at someone else’s home that you visit frequently or at your place of work.
How do I heal from mold toxicity?
If you determine that you have a mycotoxin issue, the first step is to either get out of the moldy environment or have it professionally remediated. And I’d recommend that if you are very impacted by this issue, that you remove yourself from the home or building during remediation. You should never take care of this problem yourself, but hire a professional mold remediation service.
If you can’t get out of the environment or remediate immediately, you can take binders specific to the mycotoxins detected on your test until you can get out. Until then, it’s not recommended that you take antifungals, as this may be too much for your system to handle while still in a moldy environment, and will be futile, because you’re still taking in mycotoxins. However, taking binders on an empty stomach with plenty of water can help bind up the mycotoxins and prevent damage in the meantime.
If you’re doing this without the benefit of an MD or naturopath who has prescribing rights, the binders you’ll likely have access to will be activated charcoal, which binds ochratoxins, aflatoxins and trichothecenes (tree-co-thee-scenes) and bentonite clay, which binds, gliotoxins and aflatoxins, and Saccharomyces boulardii* (a probiotic yeast) and NAC, which bind gliotoxins. Chlorella and bentonite clay may help bind certain mycotoxins, including trichothecenes.
I often recommend Quicksilver’s Ultra Binder* or Biocidin’s GI Detox* as all-around binders with several of those compounds in them. If you’re very sick and/or sensitive, you may need to start with less than an entire capsule of binders to start, even ¼ capsule mixed in water for example, just to check your initial reaction. You may experience a die-off or Herxheimer reaction that feels like getting the flu. If that’s the case, I suggest you titrate up very slowly, but eventually, you should get to 1 capsule 3 times a day of binders, always on an empty stomach with plenty of water, with at least an hour before eating and two hours after eating or taking supplements. If you’re constipated, you may need to take additional magnesium citrate (I personally like the Natural Vitality Calm* powder, which is magnesium carbonate that turns to citrate in water) to promote bowel movements as binders can be constipating. You should get up to the full dose of binders before adding in any antifungal agents.
For many mycotoxins, supportive nutrients like vitamins C and E, selenium, zinc and magnesium are good to have on board before going through detoxification protocols. In addition, using NAC, glutathione,* CoQ10, melatonin and polyphenols can positively impact your health, protect your body from oxidative stress and open up detoxification pathways.
When it comes to helping clients actually kill the molds, I educate clients on the protocol developed by Neil Nathan, MD, who leans on the Dr. Brewer protocol, and described in his book Toxic: Heal Your Body from Mold Toxicity, Lyme disease, and Multiple Chemical Sensitivities, and Chronic Environmental Illness*. His protocol involves the use of Argentyn 23 (hydrosol silver) nasal sprays to start, to test sensitivity and then work synergystically with antifungal nasal sprays. He recommends prescription nasal sprays made by compounding pharmacies, because many molds have come from the air and may have settled in your sinuses. When those aren’t available, the Xlear* nasal spray (xylitol-based) with added drops of Biocidin* (10 drops per 1 ounce of spray) is a reasonable alternative, because Biocidin is a strong, combination antifungal agent. All nasal sprays start at one spray a day then go up to as many as 3 sprays per day, if you can tolerate it. And again, you don’t move on to the next stage until you can tolerate both binders and nasal sprays.
Dr. Nathan then recommends using prescription itraconazole (brand name Sporanox), a systemic antifungal, starting at a dose of 100 mg every two weeks and slowly working up to 1-2 doses per day.
When prescription options aren’t available, Biocidin* drops are again a good option, starting with 1 drop a day and working up to 15 drops twice a day or 10 drops three times a day, 15 minutes before meals. Other natural antifungal agents include berberine, oregano oil, grapefruit seed extract and undecylenic acid (primarily targeting Candida). Most of these are very strong antibacterial agents as well, so it’s wise to protect your microbiome with supportive prebiotic foods while taking them, like pomegranate powder, cranberries or cranberry powder and matcha green tea powder.
I often suggest clients combine these into a gut healing smoothie with collagen, l-glutamine and any other powders people may be taking like AuRx*, a palatable butyrate powder which helps firm up stool for people with loose stool or diarrhea as well as helping seal the colon, and serum bovine immunoglobulins, which can help bind fungi and pathogenic bacteria and and support gut barrier function. This combo can help seal up a leaky gut and protect you from autoimmunity and inflammation. A diverse probiotic with well-researched strains may also help with gut health during a mold protocol. I like Seed Synbiotic* as a general lacto-bifido type probiotic.
Dr. Nathan also adds SFI Health Ther-Biotic Interfase Plus* to disrupt biofilms. I think it’s wise to wait until you’ve gotten to the point of tolerating daily doses of antifungals before starting this, as it may increase die-off. This is taken by itself with water on an empty stomach an hour prior to antifungals.
Other helpful modalities for supporting detoxification from mycotoxins include infrared saunas, coffee enemas and lymphatic drainage using self-massage or dry brushing, and any activity that will make you sweat, while bringing in adequate hydration and electrolytes of course. There are links for those things in the show notes.
There are lots more details about how Dr. Nathan treats mold, so if you are thinking of self-treating or trying to ask your conventional doctor for prescription antifungals, I’d recommend getting his book before launching into this project, although it’s much safer to work with a practitioner and have guidance as things often go differently than expected/planned when taking supplements and medicines.
I mainly wanted to take this time to alert you to the idea that your gut health issues could have their roots in mycotoxins, as sometimes I’m not even thinking about mycotoxins unless you suggest it may have been an issue, and only you will know about potential mold exposures in your past or present. So do be proactive with me or whoever your practitioner is if you’re experiencing symptoms like I described in this podcast, have recalcitrant gut issues or remember living in a moldy, mildewy place in the past.
If you’re dealing with gut health issues of any type (diarrhea, constipation, bloating, SIBO, IMO, H2S SIBO/ISO, IBS, IBD, gastritis, GERD, H pylori, diverticulitis, candida, etc.) or have an autoimmune disease and need some help, I see individual clients to help them resolve their digestive issues or reverse autoimmune disease naturally, You’re welcome to set up a free, 30-minute breakthrough session to see if you’d like to work with me. I also have my own two products, Tributyrin-Max, which is particularly helpful for loose stool and diarrhea as it slows your motility and firms up your stool, and SBI powder, which is an all around gut pathogen binder, which is super safe and won’t harm beneficial bacteria, and is usually the first line of treatment I educate my clients about in order to avoid stronger antimicrobial herbs.
*Product and dispensary links are affiliate links for which I’ll receive a commission. Thanks for your support of the podcast by using these links. As an Amazon Associate, I earn from qualifying purchases.
Adapted from episode 139 of The Perfect Stool podcast and edited for readabilitywith Alyssa Simpson, RD and Certified Gastrointestinal Nutritionistand Lindsey Parsons, EdD.
Lindsey:
So, we had a great conversation about autoimmunity on Alyssa’s podcast, The Gut Health Dialogues, last week, and I’m glad to have you here this week to talk about prebiotics and probiotics and fiber and stuff like that. So before we head into the meat of it, can I ask how you got into working with digestive issues?
Alyssa Simpson:
Yeah, you know, it’s actually kind of funny, because I didn’t really have digestive issues until I started working with people with digestive issues. I had been a dietitian for about 11 years, just doing general nutrition, lot of diabetes, I was a certified diabetes educator, and I had always wanted to be in private practice, so I left my job, quit my job, started a private practice. Around the same time, I was learning more about integrative and functional nutrition, which is a whole other learning curve, and there was so much stress between starting a new specialty, starting a new business, and I developed really, really severe acid reflux and constipation. It was just general chronic-stress related, I know that’s what triggered it, and then the whole landslide that came with that of food sensitivities and then learning how to really manage my stress as the root cause.
It’s been a journey, because I was initially waking up, you know, it was affecting everything, my sleep, because I couldn’t fall asleep because I was coughing from the reflux. And my throat was sore all the time, and I actually was downing Pepto Bismol in between clients. And I thought, I’m a gut health dietitian, what am I doing? So I did end up getting more interested – I was focusing on integrative and functional, but that made me really start to focus in on gut health. And it’s been a journey.
And even most recently, everything’s been under control and managed, but I’m still learning more. One of the things I learned about recently was vagal nerve stimulation, and so now I’m doing that, and that kind of has brought me to a whole new level of calming my nervous system. So that’s my story, and I am now focusing mostly on the gut. I think just as a result of having the connections I have, a lot of the people that find me, they just don’t know what’s wrong with them. They’ve seen a gastroenterologist. Maybe they have, maybe they haven’t. A lot of them have, just because I have a lot of gastroenterologists that refer to me, but they’re still having issues, and they don’t know why. So that’s kind of the person I help and you know, often those are functional issues, especially if there isn’t something that’s been structurally diagnosed. So we’re looking at IBS, SIBO, things like that.
Lindsey:
Yeah. So for people with SIBO or IMO, Intestinal Methanogen Overgrowth, first of all, do you recommend probiotics while treating SIBO or IMO? Or is that something you like to leave for after treatment? Or is it part of the treatment itself?
Alyssa Simpson:
You know, yeah, I don’t start off with them. I definitely know a lot of people that already come to me. They’ve already tried probiotics. A lot of times they tried it and it made things worse. And that’s because if you do have SIBO, and this might be true whether or not they know they have SIBO, but if you do have SIBO, sometimes a probiotic, depending on what strain it is, can actually add to the overgrowth you already have, and it can stimulate symptoms. So that would be especially lactobacillus strains, because those can tend to accumulate in the small intestine, versus other strains that tend to populate more in the large intestine.
So the answer to your question is, I actually am all for starting one early on in the SIBO process. So in a perfect world, I do, and usually it’s going to be a spore based. I was using Bifido blend for a while, and I’m still liking that, but I’ve switched to spore based for that purpose. But those are both ones that are less likely to aggravate SIBO while the overgrowth is active. But the reason there’s a little caveat there is I do notice that throughout the protocol, people have very sensitive systems. There’s a lot of supplements sometimes that we need to use, and so I tend to layer things in just for the ease of the patient, and not just load them up with a whole bunch of things. So sometimes I don’t add the probiotic until a little bit later for that reason, just pill burden and patient sensitivity.
Lindsey:
What about the whole consideration of, am I just killing off whatever probiotics I’m putting in there?
Alyssa Simpson:
Oh yeah, so even with the spore based, because, technically, the spore based should be protecting itself, but I’ll still have them take them a couple hours away from the anti-microbial just to decrease that.
Lindsey:
Right. And are there particular probiotics you like in a situation with diarrhea versus constipation or are the spore based good for all those?
Alyssa Simpson:
Actually, for diarrhea, Saccharomyces boulardii* is really good. So a lot of times, especially if somebody really has no idea what’s going on yet, so typically, with that person, I’d want to do a stool test and a SIBO test just right off the bat, unless they’ve had one already. But I’ll just start them off on the Saccharomyces boulardii sometimes, because that can be really helpful in calming down the diarrhea.
Lindsey:
I’m curious how you dose that, because I just heard Lucy Mailing talking about using it when you’re on antibiotics, two pills, two 250 milligram pills, three times a day, which was the highest dosing I’d ever heard about for S. boulardii.
Alyssa Simpson:
I do two and two.
Lindsey:
Two and two? Okay.
Alyssa Simpson:
Yeah.
Lindsey:
Of the 250 milligram ones?
Alyssa Simpson:
Yeah, 250, yeah, exactly.
Lindsey:
I was curious, okay,
Alyssa Simpson:
Quite a lot, but . . .
Lindsey:
Yeah, well, if you want to get that diarrhea under control, I know it has been studied in traveler’s diarrhea and such.
Alyssa Simpson:
Yeah, yeah, exactly.
Lindsey:
And what about with hydrogen sulfide SIBO, which I recently found out has now been renamed ISO, or Intestinal Sulfide Overproduction. Any probiotics?
Alyssa Simpson:
For that one, I would just do the same, yeah. I haven’t seen much on researching probiotics for hydrogen sulfide SIBO. So I would go with the general because it’s still a type of SIBO, so it’s an overgrowth in the small intestine, so I would still be cautious with Lactobacillus in that case.
Lindsey:
And what about constipation? Is there one you like for that? Or the spore-based?
Alyssa Simpson:
So for constipation, yeah, there’s actually some strains that are more beneficial in general. So the Lactobacillus reuteri would be the one that I most commonly like with that. And then usually, because, again, I’m adding this in a little bit later in the protocol, so I’ll probably try to include some other probiotics as well. But if there’s someone that constipation prone,
Protectis* or Gastrus, I guess both of them have that, it’s like, DSM something, something after that (DSM 17938).
Alyssa Simpson:
Yeah, unfortunately, we don’t have too many products to choose from with that. So that’s the one I use.
Lindsey:
I know I keep wondering whether that one’s like patented, or whether you can get a hold of it, yeah.
Alyssa Simpson:
I dont know. It’s like the research is there that you think they would jump on it.
Lindsey:
Yeah, indeed. So what about fermented foods? I have post-infectious IBS, and have sort of recurrent SIBO, hydrogen dominant, and I do okay with sauerkraut. But, I mean, I’m only eating all of a teaspoon and a half, I’d have to say, or two teaspoons, in the morning and I can eat some yogurt, but like, if I eat a whole thing of yogurt, even it’s only like four ounces, I start to feel sick. So I’m kind of curious about probiotic foods, and is it problematic, or is it just uncomfortable?
Alyssa Simpson:
Well, that’s a great question. I would say probiotic foods are such a slippery slope. And it’s so sad just how nuanced this gets, because I feel for people trying to figure this out. A lot of the things that you think are going to be good for you actually are the very things that aggravate you. So the fermented foods, the probiotic foods, fall in that category where- and for a few reasons, but they can do a little too good of a job. They can, like we were just talking about with the Lactobacillus probiotics, they can add to that bacterial overgrowth and trigger symptoms.
They also are high in histamine and a good percentage of people with SIBO also have histamine intolerance, because there’s histamine naturally occurring in many different foods, and we produce histamine in reaction to certain antigens, and so we have a histamine load in our body. And if you have SIBO, it can decrease your production of the enzyme that breaks down histamine in the intestines, and so you become sensitive to foods that are high in histamine. Fermented foods are in that category, so anything aged actually can build up in histamine. So that’s probably the most common reason people feel bad or get symptoms when they have a fermented food. Is that the type of reaction, is it a histamine-like reaction? Or do you feel like it’s bloating?
Lindsey:
No, it’s more like bloating. And I actually feel nauseous when I eat too much yogurt. And this happened too when I made my own Bifido yogurt out of the Evivo strain, the Bifido infantis.
Alyssa Simpson:
Okay. And you think the lactose was low, so that’s not-
Lindsey:
It was a coconut yogurt,
Alyssa Simpson:
okay, okay, yeah, even with a Bifido yogurt, okay, yeah.
Lindsey:
So I just think maybe I just have that gut ready to ferment things.
Alyssa Simpson:
Yeah it is a slippery slope, and I almost never start somebody out with fermented foods, but they are a wonderful thing for maintenance as you ease into that, you know, start low and go slow. So I’m a huge fan of them in general. Don’t use them very much because I’m working with people who are not well, we need to fix them first so that they can get back to those things. But I do think that fermented foods are just really a great way to populate and maintain good bacteria, maybe even more so than probiotics, because I think there’s, I don’t know why, they just seem to do better, and I’ve seen that in the research as well, as far as maintaining . . .
Lindsey:
What fermented foods do you like?
Alyssa Simpson:
Well, I like kombucha and sauerkraut. Those are my two favorites, and I like kimchi, but it’s a little less convenient. You have to make it, or you can buy it, but it’s even less convenient to buy, to find all the time. So how about you?
Lindsey:
Yeah, sauerkraut is my go to and I’ve been trying to make the Bifido yogurt. But by that, I mean I’ve made one successful batch and one not so successful batch. It took me about a month to get through it, and you’re supposed to eat it within three days, but if I ate that much Bifido yogurt in three days, I would be a balloon.
Alyssa Simpson:
Yeah, yeah. The practicality plays in for sure.
Lindsey:
I mean, it required a high level of sterilization, because it ferments for like 36 hours. So the very first batch was totally unsuccessful; it was a pile of mold. Then the second batch, I’m literally dipping every single thing that’s going anywhere near it in boiling water before I do it, including the plastic tops and all these things. I’m thinking, great, I’m going to be eating microplastics. But mostly they are just in glass jars, so it’s just over the top. But yeah, crazy effort went into this. So the more times I do it, I’m sure the easier it’ll get. But I don’t want to make the mistake of having a moldy batch again, because after 24 hours, I was very disheartened that I had lost-
Alyssa Simpson:
Oh gosh, yeah, absolutely, yeah . . .
Lindsey:
. . . a packet of my $85 probiotic.
Alyssa Simpson:
Yes, I know.
Lindsey:
So fiber and prebiotics are another area that can be tricky, especially in constipation, because my standard advice for people who are constipated is to get more fiber. Or I shouldn’t say my standard advice, the standard advice. But in my experience, people with IMO can’t really tolerate fiber. So what else do you use to help them poop?
Alyssa Simpson:
Yeah, again, it’s one of those things that you would think that going and eating more fiber would help. But absolutely, with IMO, it can make you worse, cause lots of bloating. Yeah, so first of all, we want to think about why are we not tolerating it? So you’re kind of presenting the question as you know you have IMO. We just want to make sure that we’re talking about ways to help you poop. But we also want to circle back around to the root cause. So maybe, you know you have IMO. If you don’t know why you’re so constipated, or if you don’t know why you’re not tolerating fiber, a lot of people will say, oh, I can’t handle fiber, I know it tips me over the edge. You do want to look deeper and evaluate why that is and ultimately address that. So that’s the sort of things we can help with.
But the next step, I would say, first of all, think about what is the fiber source. So it can seem like all fibers are a problem, because a lot of our high fiber foods are actually high in FODMAPs, fermentable carbohydrates that are the most gas-producing types of fibers. So it may be that following a low FODMAP version of a high-fiber diet would help calm symptoms. And I do see that with lots of my clients. They feel like they can’t tolerate fiber because maybe they’ve tried a fiber supplement, which are just notorious in general, for triggering bloating and symptoms in people with IBS or SIBO, or they’ve, you know, just the foods that are high in fiber, like bran and beans and all those foods aggravate you, so you think it’s the fiber. You may do better with a low FODMAP, high fiber diet, emphasizing foods that- what I like to use is chia seeds to really get people like up a lot closer to their fiber goal, because they’re low In FODMAPs. So they’re not going to contribute to a lot of gas production, but they are give you a lot of bang for your buck, and they’re pretty easy to incorporate into your day. You could stir them into anything, a smoothie, a cereal, anything like that. I have a really nice overnight oats recipe with different variations to help my IMO people move without triggering symptoms. So that would be the first thing as far as fiber.
It’s also so important to make sure that you’re hydrated. I have clients that’ll say, yeah, yeah, I know I don’t drink enough water, I need to work on that. And I mean, it’s kind of like they’re like, next, what else should I do about my constipation? It’s like, no, that’s foundational. You absolutely need enough water. Because, think about it, your stool is dry, and maybe you’ve added fiber, so it’s fibrous. I mean, where’s that water going to come from to soften the stool if the body’s not hydrated properly? So we absolutely have to have the water. I would also think about the electrolytes. So let’s say you are getting plenty of water, which I would say is at least half of your body weight in ounces. You are getting plenty of water, you know, is the water being used by the cells. Having enough electrolytes will help the intestinal muscles contract like they’re supposed to as well. And with this, I would make sure you’re not doing just some of those general – like Gatorade and stuff – it’s just a lot of sodium. You’re not really getting a full array of electrolytes. So you want a good, well-rounded electrolyte product that has many different minerals to help you – plenty of potassium, chloride. Should be pretty low in sodium, actually.
Lindsey:
Which one do you like?
Alyssa Simpson:
I like Ultima* or Hi-Lyte* is another good one. Yeah, has lots of different flavors. It doesn’t have any ingredients that I don’t like. Tastes good. So electrolytes are number two. If you just need that extra little push, not physically, but that extra little boost, I really like magnesium. I used that myself for so many years, till I recently found that with vagal nerve stimulation, I don’t need it anymore. So that’s awesome, that’s little side note there. Yeah, I would suggest, if you haven’t used magnesium, and I mean specifically magnesium oxide, or maybe magnesium citrate, the other forms of magnesium aren’t – well, they’re actually better absorbed, which means they’re not going to help stimulate a bowel movement as well. We start around 400, 500 milligrams, but one of the keys with magnesium is you might need more than that. So understand, I would still start there, because if you get too much. you’re not going to be happy with that result either.
Lindsey:
Flush of the system.
Alyssa Simpson:
I would start there, and after it, give it a few days to see how that’s going to affect you. And then you might need to go higher, like 600, 800 milligrams. And if you do need to go that high again, circle back to the root cause, because usually there’s something else that should be addressed. So in my situation, I had to use 400 milligrams of magnesium for years to stay regular, and then started doing the vagal nerve stimulation. With the vagal nerve, it’s just the nerve connecting your brain and your gut, and it’s that connection that allows the brain to tell the gut to do all the things that it’s supposed to do, including motility. And, wow, yeah, after just a few weeks of doing that, I haven’t needed to use the magnesium since then. So I think that that really helped. I think, initially, stress triggered a lot of my issues, and then I think that must have helped to retone the vagal nerve.
Yeah, yeah. It’s kind of like, you know like the TENS machines that will stimulate a muscle, but it’s not a TENS machine, but you put it on your neck right here, and, like, right where you take your pulse, that’s where you put it, and you can feel the stimulation. You can feel the tingling, and it goes for two minutes. You do it twice a day. The research actually had the test subjects build up, like, titrate up to six minutes twice a day. So you could choose to go by that. But the thing turns off after two minutes. So I just did that twice a day. Yeah, I’m just amazed. So I wanted to try it myself before I recommend it to clients, and now I’m starting to recommend it to clients and whoever else might benefit.
Lindsey:
I had somebody on the podcast ages ago talking about something that both could be used as a stimulator for the vagus nerve. I think it was a frequency specific, forgetting the third word, FSM, frequency specific microcurrent, but it was a device like that that could both stimulate the vagus nerve or be used on the abdomen, or that kind of thing. Okay, yeah, anyway.
Alyssa Simpson:
Yeah, we went on a side note, but yeah, that really helped me.
Lindsey:
Well, back to magnesium. So how much is too much magnesium? Like I get people are saying, well, I’m already taking 1200 milligrams. You know, is there a point at which, okay, this is no longer going to be useful.
Alyssa Simpson:
You know, I’ve heard experts say, don’t go over like 2,000 but I don’t go much over – like I wouldn’t go beyond 1,200. I just haven’t found it to be beneficial honestly, above maybe 1,000, I haven’t seen any added benefit. And so usually, then you need to look at other things. So, and sometimes we are in that boat. So Vitamin C is another thing. Magnesium oxide works well because it’s not absorbed well, so it stays in the intestine and draws fluid in. Vitamin C also has an osmotic effect, but because it’s absorbed well, you have to figure out what is your amount that’s going to exceed your tolerance level, so that it will have that osmotic effect. So it’s a milder effect, but it can work nicely in conjunction with the magnesium. So that might be something I might try next. If somebody’s already at 1200 milligrams, I would probably add vitamin C and see how that works.
Lindsey:
Yeah, and how will you dose the C then?
Alyssa Simpson:
Probably, I would start at 1000 and go up from there.
Lindsey:
And are these taken all at once, like before bed, or spaced throughout the day?
Alyssa Simpson:
Normally at bedtime, but I’m flexible on that, so sometimes it also depends when the patient can get it in. For me, personally, I was doing mine in the morning, and it always worked. So we don’t think it really matters. I’ve heard the recommendation to do it at bed, so that’s generally what I’ll recommend. But I haven’t seen much of a difference.
Lindsey:
Yeah, and did you notice any difference in the forms, like the powders that you mix in water, versus pills? For example, of the magnesium, whether one was preferable.
Alyssa Simpson:
I haven’t, have you?
Lindsey:
I mean, I kind of feel like the Natural Vitality Calm* one, that one’s always sort of my go-to because I have had people taking a lot of pills, and then I’ll say, we’ll just try this other one, and then it seems like they get more of an effect at a lower dose.
Alyssa Simpson:
What’s the form of that one?
Lindsey:
So it’s carbonate, but when you mix it in water, it becomes citrate.
Alyssa Simpson:
Oh cool, okay, yeah, okay, that’s a great tip for me. Maybe I’ll try using that one because I haven’t. But, yeah, people do get overloaded with pills, so.
Lindsey:
Right? I mean I guess that’s the other dilemma. If you have to take a bunch of pills, you probably have to drink a bunch of water with it. Of course, if you’re drinking powder, mix and water, that’s also water, and it’s all before bed. But of course, you can, you know, do it an hour before bed, not immediately before bed, right? Yeah, so people aren’t up peeing three times during the night.
Alyssa Simpson:
Yeah, exactly. I think that’s one reason I kind of tell people at bedtime, but if they’re concerned about it, I’ll usually flex because, yeah, I haven’t seen it to be essential. There are other things we can talk about as far as helping motility, but I’m happy to answer any other questions you have as well.
Lindsey:
Well, I had a couple questions about magnesium. So thinking about the fact that something like a magnesium citrate or oxide is not well absorbed, when you think about the dosing of a glycinate or a malate or another type of magnesium, versus the citrate and the oxide, how might those differ then knowing that you’re not actually absorbing that much of the magnesium, when we’re thinking about just a deficiency of magnesium, as opposed to exclusively using it for motility purposes.
Alyssa Simpson:
Okay, so you’re saying, if we wanted to use a citrate to actually help get into the body,
Lindsey:
Because that’s the form that people are already using for the purposes of motility, is there any kind of a comparison, like 800 citrate’s worth X amount of glycinate?
Alyssa Simpson:
You know, I’m not aware of one. But now I want to know.
Lindsey:
I just kind of asked that question to myself because I know that you get recommendations often from these tests like Metabolomix or a NutrEval that says, okay, they need 400 mg of magnesium. And I’m like, okay, well, if that’s magnesium citrate, they’re probably pooping out three quarters of it.
Alyssa Simpson:
Exactly, yeah, I tend to just not use it, or I’ll give them a magnesium blend where you can get a few different kinds in one.
Lindsey:
One thing I have noticed, though, with those blends is that they’ll often come to me already on magnesium, and I’ll say, oh, okay, which one and how much is it per pill? And they’ll be like, oh, it’s glycinate, and it’s like 400 per pill. And I’m like, yeah, that’s not possible. There’s no such thing as one pill of glycinate that’s 400 milligrams. And then they’ll look and they’ll go, oh, okay, it looks like there’s some oxide, and they’ve got like five different kinds. And I’m like, Okay. And my estimation is probably 350 oxide. You’ve got like, 50 milligrams with something else mixed in.
Alyssa Simpson:
I know, yeah, yeah. They don’t realize how many capsules they’re supposed to do, because they do try to advertise 400 on some of those products.
Lindsey:
Oh, right, that too, right, so you’ve got to look at the serving size.
Alyssa Simpson:
I also don’t prefer the blends, because I can’t titrate the one I want to titrate without affecting all the other ones. But I’m sure as more of a maintenance thing, it could be a decent option.
Lindsey:
I’m kind of suspicious that the whole – I think I was just listening to a podcast, and they’re like, you need all the five different types of magnesium in your body, and therefore you should buy our blends. I’m like, this just feels like marketing to me, like, I imagine our body can probably make most of those types from the raw materials that are in there. So, you had said you had some other things you wanted to talk about related to motility?
Alyssa Simpson:
Yeah, yeah. I have some other things that would be important as we’re talking about this. Another tip I have, I like using, and this is again, keeping in mind that we’re going to want to work on the root cause, but sometimes, if you just need relief, I do like whole-leaf or outer-leaf aloe vera juice. It has other benefits, aside from motility. It’s very soothing on the mucus layer. It helps to stimulate that mucus production that protects our stomach, esophagus and our intestines. I also like it because the whole-leaf has a chemical in it, aloin, that stimulates the bowel. So I would start with four ounces of aloe vera juice – make sure it’s the outer leaf. The inner leaf is not bad. It’s just not going to have that helpful chemical that helps with motility. Maybe start with four ounces. You can have more than that, but again, see how that’s going to affect you per day after a few days. So I like using that one sometimes, especially when we’re talking about people who can’t handle a lot of fiber. So maybe we’re working on building up the fiber, and that can kind of help as well.
Is this something they find it like a health food store? Or do you find that normal grocery stores?
Sprouts around here, is what we have, where I find it. I like the Lily of the Desert brand. Yeah, usually at a health food store, you probably have a better chance.
Lindsey:
Alyssa is my neighbor in Arizona. She’s up in Phoenix.
Alyssa Simpson:
Yep, yeah! So we have Sprouts. You guys have Sprouts down there, right? Yes, but it’s a health food store, and so any health food store would probably have aloe vera juice. Sometimes they try to do you the favor of flavoring it. Watch out for that, because they may add lemon juice, and if you have GERD, that might trigger you, be careful of that.
Lindsey:
Any other motility tips? Or was that the last one?
Alyssa Simpson:
The squatting position, or the squatty potty*. So when we’re sitting on the toilet, we’re actually not in the proper position, and so we actually have kind of a kink, like between the anus and the rectum, there’s a little bit of a kink. And so, that’s helpful when you’re trying to hold it in on your way in the bathroom, but when you want to actually have a bowel movement, having your feet up so that your knees are above your hips will actually basically open up that angle between the rectum and the anus to allow for a better bowel movement. So you can start out with a stool, if you just have any stool you can put your feet on, but the squatty potty, especially if this is a major issue for you, is not a major investment, and definitely something to consider.
Lindsey:
And I think that’s pretty important for people who are shorter, right? Because they can’t really get into that position.
Alyssa Simpson:
Yeah, right, yeah.
Lindsey:
Okay, so what about introducing fiber? And are there particular forms that are easier for people who are a little bit fiber intolerant?
Alyssa Simpson:
Yeah. So, well, I like SunFiber*, the partially hydrolyzed guar gum that is the most researched and the gentlest I find. I use it with my SIBO people, my IMO people, they could be bloated like crazy, and I’ll still use it maybe, maybe do some other things to calm their bloating first. But you just start low and go slow with it. So it could start at maybe a third of the dose, or if you’re super sensitive, a quarter of the dose, and maybe every week go up an increment if you’re super sensitive. But the reason you would want to take it is it does start to add a gentle fiber. So again, if you’ve tried a fiber supplement, any of those out there, like a lot of the common ones, you know, Metamucil, Citrucel, like all these things that are recommended to people with IBS, and it triggered you. Most people do pretty well with this PHGG, and I have a lot of my clients that they are just like, I’m never not going to use this. I love it so much. I’m like, you could maybe graduate to a different fiber in time, but that’s how well it’s tolerated. And then another one would be Acacia fiber that people do pretty well with, too, even the most sensitive people.
Lindsey:
Yeah. Are there any prebiotics that you particularly like, other than getting it from food?
Alyssa Simpson:
Yeah. So prebiotics is here in this whole conversation about that, like slippery slope, right? So everything I said earlier about fiber and FODMAPs, like the things that are supposed to help you, can actually aggravate you when there’s a bacterial overgrowth. And so prebiotics are in that category, because a lot of the times it’s FOS or GOS or inulin or prebiotic ingredients, and those can be the harshest and the most likely to bloat and cause symptoms. So for I’d say, starting with most sensitive, like you said, other than foods. But I would probably start with foods for the most sensitive people. Like, the green bananas, the cooked and cooled potatoes, even maybe a resistant starch, maybe even a cooled rice congee or something.
But as a fiber supplement when they’re ready for some prebiotics, I like PaleoFiber RS* because it is basically like starting them with foods – a little more potent, but the ingredients are green banana flour and potato starch, and there’s one other ingredient in it. So PaleoFiber RS is my favorite kind. I would either do that as a prebiotic, or you can lean on polyphenols, which are the components in brightly colored plants, fruits and vegetables, that give them their antioxidant benefits, but they also have a very gentle prebiotic effect, but it’s a non-fiber! So it’s a wonderful kind of little thing to start with, so that you could do it with foods or with a supplement. Sometimes I’ll just recommend Polyphenol Nutrients*, which is by Pure Encapsulations*, because if the person needs a multivitamin, that way, we’re getting some polyphenols in there. And then from foods, you can use things like green tea and cranberries and blueberries and olive oil for polyphenols.
Lindsey:
Yeah, I’ve been trying to do this gut shake that I stole from Mark Hyman. I maybe get it once a week myself, but it’s pomegranate powder, I use cranberries rather than the cranberry powder, just use frozen cranberries and matcha green tea powder, and then taking protein powder too. The original formula, I think, has collagen and glutamine and butyrate and all that other stuff. But I’m sort of selectively using the things that I need myself. So, yeah.
Alyssa Simpson:
Yeah, yeah. And then when the person’s ready, I mean, once you clear the overgrowth, you can gradually add in less gentle forms of fiber. So then I do think it’s a good idea. And one of my favorite tips is making a veggie mash, which, if you’re looking for another project, you know, it takes couple hours. It doesn’t take all day. So you basically take 10 to, I guess you could do, probably 10 to 15 will work the best, different vegetables, and you blend them up. I have a recipe that I can share with your audience, my gut rebuild veggie mash, because it has quite a few root vegetables, which I like for the resistant starch. So you steam those. You lightly steam some of the other vegetables. But really, the idea behind a veggie mash is you just grab 10 to 15 different vegetables, blend them up in a food processor, works best, and then you just put them in ice cube trays and just pop out a cube to blend up in your smoothie or to mix with your entree or to eat just with salt and pepper by itself. And that way you get a diversity of plant fibers.
So we’re talking about fiber right now, kind of in the context of fiber amount, like getting enough fiber, but diversity of fiber is so important too for feeding a diversity of good gut bacteria. So I really like the veggie mash, because even if you have Brussels sprouts in there, which are high FODMAP, and I think the low FODMAP portion is like one sprout or something, or a fragment of a sprout, you know, you will be able to tolerate a little bit in the veggie mash, because the whole recipe only has a handful of each thing, and then it’s making, like, weeks worth of quantities. I think it’s like 10 ice cube trays you get out of it.
Lindsey:
Yeah, I’ve heard that technique for reestablishing oral tolerance when you’ve had a lot of food allergies, like, just the little bit of a bunch of different things.
Alyssa Simpson:
Yeah, and I like this strategy, because it’s, again, the practicality, it’s hard to get a little bit of a lot of different things, especially when things are going to go bad in the fridge, if you don’t have anyone else to eat the rest.
Lindsey:
And winter squashes are not exactly easy to cook, unless you buy them pre-chopped or whatever.
Alyssa Simpson:
Right, exactly. So mine is pretty root vegetable heavy. It has butternut squash. It has purple potato. It’s colorful as well. It has a sweet potato in there. And yeah, I like that tip as well.
Lindsey:
I’ve started to use the MegaPRE* with people who don’t have any Akkermansia or any Faecalibacterium prausnitzii or very low levels that need to kick it up, because it’s got some ingredients in there that have been shown in studies to bring those up. Have you used that at all?
Alyssa Simpson:
Yeah, so if the person’s really sensitive, I’ll start with the Paleo Fiber RS, but I like to move to MegaPRE if I can, because I consider that ideal to use those ingredients, but I will start at low dose and gradually increase it once I see that they’re doing okay with it, because even after the issue’s cleared, there’s a period of healing, and the tolerance gradually gets better to food, so usually it’s easing back into fiber and prebiotics.
Lindsey:
And what do you think about colonics and enemas for people who’ve been chronically constipated?
Alyssa Simpson:
Well, I think sometimes whatever you need to do to get it out, it’s fine. So I don’t have any concerns with that. Do you?
Lindsey:
No, but I don’t have an office that offers things like that. So it’s not something that I refer people to, but I know that people who have offices that do that often are more big fans of such things.
Alyssa Simpson:
Well, I’m probably in your boat, because I also, I’m 100% virtual. I’m a dietitian, so I’m not doing medical procedures anyway. Yeah, so I usually, if I get that question, someone’s wondering if I agree with it, if it’s okay, or maybe that will clear their SIBO, and unfortunately, it won’t clear bacterial overgrowth. But I’m all for it if somebody just needs to get cleaned out, doing something like that. And I have even recommended it when somebody just, for example, let’s say we find that you have SIBO, but you haven’t had a bowel movement in two weeks. Well, we can’t start. We can’t do much about it until we can get things flowing. So yeah, that could be a good use for it to just kind of get a jump start.
Lindsey:
Yeah, sometimes in that scenario, I’ve sent people to do a C cleanse, just to get everything washed out. And then I’m like, okay, then maybe. Because they’re kind of desperate at that point, if they haven’t had a bowel movement in days, or, goodness, I don’t think I’ve ever had anybody who said two weeks, but if it’s been a while, and they’re uncomfortable and they’re backed up and they’re bloated and they’re in pain, then you know, you just got to get that out of there.
Alyssa Simpson:
Yeah, because it’s unhealthy for you.
Lindsey:
Yeah. I mean, I think that that’s an important thing that people maybe don’t – like, they know it doesn’t feel good, but I don’t know that they realize the connection between cancer and constipation, like, there’s much higher rates of colon cancer and breast cancer. You don’t want to have stuff just sitting in there. These are toxins that are supposed to be getting out of your body, right?
Alyssa Simpson:
Or even if you have diverticulosis, you know, that could potentially fill up those pockets with stool. A lot of people have diverticulosis. So, yeah, absolutely. And so with SIBO, here we are. We’re about to kill off a bunch of bacteria, and your body has to detoxify that. And so the worst thing we could do, it would not be a good thing to start killing them off, only to be reabsorbed into the bloodstream and recirculated throughout the body. Yeah. So you would feel terrible as well, and it wouldn’t be healthy. Yeah, so I’m actually all for the anything you can do to get things going. And then sometimes people will ask, well, if I do that, will it get rid of all my good bacteria? Well, no, because they live in the layer of the intestine, so you’re not going to flush out all your good bacteria doing that or doing a colonoscopy prep, either.
Lindsey:
Yeah, I was a bit a little bit worried about that myself, and I hesitated to do the colonoscopy and put it off for a few years, which I did also because I just didn’t want to get a colonoscopy, but did the Cologuard, and then three years later, thought, okay, I’m just going to suck it up and do the colonoscopy. And it wasn’t bad, and I had a nice clean colon. I was happy to hear that; no polyps.
Alyssa Simpson:
Yeah, I mean, it would be nice if we could clear dysbiosis with just colon prep.
Lindsey:
It’s a funny thing that that’s not that helpful, given that the elemental diet is something that seems to work for it, which I guess, obviously it’s a little bit more extended than a colonoscopy prep in terms of time.
Alyssa Simpson:
Yeah, well, I think it’s just like you’re clearing out the stool. I mean, the stool is not where the bacteria live. They live in the mucus layer, so you’re not shedding the mucus layer. And the elemental diet is starving the bacteria in the small intestine and in the large intestine, but yeah, they’re resilient. So, yeah.
Lindsey:
Do you use elemental diets much?
Alyssa Simpson:
I used it twice. It’s very hard for people to do, so it’s a last resort.
Lindsey:
I kind of feel the same way, like I wouldn’t do it, so I’m not going to ask somebody else to do it. But sometimes it’s like, I agree. I’ve had people who no quantity of antimicrobials was getting rid of that bloating. And I’m like, okay, let’s try this. And for both people, it was the first thing that really broke it at all. I can’t say it was like, 100% they were done and, like, that was it, because I think there’s always other issues that play into it, like stress, maybe that whole vagus nerve question, but it was the first thing that made any dent.
Alyssa Simpson:
Okay, so that’s, yeah, it really does take – the person has to really be on board. I haven’t been in that situation too much, where we’ve run out of options to really make a dent, but usually it’s been the patient’s idea if I do it or I will put it out there as an option, and the patient has to be the one who’s like, yes, I want to do that.
Lindsey:
Yeah. I think sometimes they feel like it’s really expensive, but I’m like, well, keep in mind, you’re not going to be buying any food for those two weeks or three weeks, right?
Alyssa Simpson:
Yeah, exactly.
Lindsey:
And it just feels a bit different spending your budget on a package of powder you’re going to have to drink than it does to go to grocery store and buy a load of groceries.
Alyssa Simpson:
It does. And the die off is tremendous. I mean, the die off is a problem anyway, but it’s so tremendous with the elemental diet. That’s another thing, not only are you only consuming liquid for two to three weeks, but die off, meaning that kind of reaction that happens when you first start killing off the SIBO, and you have your flu-like symptoms, and all kinds of symptoms can pop up. And so I’ve seen that in both people be pretty bad. The other thing is, I have a lot of people who are underweight, and it’s just not a good idea. Now, actually, in reality, if they do drink all the formula and they have malabsorption from the SIBO, they’re probably getting better nourished with the elemental diet.
Lindsey:
Yeah, I’ve heard that for underweight people, they’ll gain weight. For overweight people, they’ll lose weight. It works itself out.
Alyssa Simpson:
Yeah, I’ll actually use elemental shakes often as a supplement for underweight people, so they can get the nutrients in, but not as the elemental diet is designed to work, even though I know it will probably nourish them better. There’s still all the issues, like the patient has to be on board with it, it’s very difficult to do, and it’s just concerning, because if the person is already super underweight, it just makes you hesitant to turn their diet on its head in any way, especially going on an all liquid diet.
Lindsey:
I have noticed, and just to send the word out there to people, that people get really kind of scared and desperate when they’re losing weight and they’re not trying to because of malabsorption related to SIBO. But I’ve never seen anybody that’s like, starved to death. They always gain the weight back eventually. Like, once you start to turn things around in the gut, the weight comes back on. They don’t just waste away to nothing . . .
Alyssa Simpson:
Yeah, yeah.
Lindsey:
So people really do that. It’s like there’s a certain level of desperation in a person who’s been losing weight and just keeps losing weight, like they really get scared.
Alyssa Simpson:
Yeah, yeah. I think it’s scary if you don’t know why it’s happening and you don’t know how to stop it, right?
Lindsey:
You mentioned about having gastritis and constipation. I’m curious why those two tend to come together.
Alyssa Simpson:
Gastritis and constipation, GERD and constipation?
Lindsey:
Yeah.
Alyssa Simpson:
Well, if you’re chronically stressed, it can cause a slowing of motility, versus if you’re acutely stressed, it can trigger diarrhea. These are very general statements, obviously, but in general, that’s how the gut, brain, the vagus nerve, works. So I believe that my chronic stress at the time caused everything to slow down. And I was not mindfully eating. I was scarfing down my lunch, trying to pack in as many patients as possible, often missing lunch, eating in my car on the way home. I mean, there is a lot of factors, and I still didn’t know very much yet about any of this. Yeah, so I think it was a perfect storm for me with the GERD. I probably had chronic stress and acute stress, and wasn’t being mindful of my eating, because that’s a big part, too. If you’re rushing and you’re multitasking and you’re not focusing on your food, then your brain isn’t focusing on the food. So it’s not telling the gut to produce enzymes and acid, and so food is sitting there longer, and then there’s pressure on the lower esophageal sphincter, and you know, you get the acid coming back up. So it was a whole messy storm.
Lindsey:
Yeah, I was thinking that there might be a connection through the question of stomach acid, right? Like, if you’re stressed, you’re probably not producing as much stomach acid, and then you’re-
Alyssa Simpson:
Yeah, I think that was a factor,
Lindsey:
Right? And then, of course, low stomach acid can cause GERD.
Alyssa Simpson:
I think that was part of it too. Yeah.
Lindsey:
So tell me about where people can find you and the stuff that you do.
Alyssa Simpson:
Yeah, I see people one on one over a virtual platform and help people walk through the process of figuring out what’s going on in their gut from a functional perspective. So, especially if you’ve had lots of the standard testing and whether or not they found anything, but if you’re still having issues despite the normal medical interventions, we can look deeper, and we’ll look at what’s out of balance in your gut, and we’ll walk through the different phases with a personalized approach. I learn about your eating habits. I learn about your schedule and your family. And what dinner is like with your family, and we just come up with a personalized approach that’s going to work for each person. We look at everything else that’s going on with your health so that everything is in line to support your goals, all of your goals, holistically. And through just the use of simple strategies, diet changes, elimination and reintroduction of some sort, usually, maybe sometimes we’re ramping up fiber or calories or whatever it might be. And strategic supplements that, like I say, I tend to layer through in phases, and we work on not only calming the symptoms down, restoring more normal gut function, but also putting a maintenance plan in place so it doesn’t just keep happening again and again to you. So that’s what I do, one on one.
People can find me at nutritionresolution.com so it’s like a New Year’s resolution, and I’ll also provide the link to that veggie mash so that you guys can download that, if that sounds interesting. That’s helpful for anybody who just doesn’t have enough vegetables in their diet to get that diversity to feed a healthy microbiome, but it’s especially helpful for sensitive individuals as well. And I’m at @nutritionresolution on Instagram.
Lindsey:
Okay, great. We’ll put those in the show notes, that way people can find you easily. Any final thoughts before we go?
Alyssa Simpson:
Everything we talked about today are the things that are – I feel like, logically, you’d say, okay, if I’m having gut issues, I should eat more fiber, I should eat prebiotic foods, I should take probiotics. And those can be sometimes the worst thing. So I just feel for anyone out there trying to do their best and it’s not working, or they’re getting worse, because it’s kind of hard out there sometimes to figure out the right thing to do. But in general, find a good practitioner to educate yourself as much as you can so you know what to ask, and also listen to your gut as far as who it feels right to work with, who kind of resonates with you and gets you excited about what’s actually possible for you. I just wish everyone the best in their health journey.
If you’re dealing with gut health issues of any type (diarrhea, constipation, bloating, SIBO, IMO, H2S SIBO/ISO, IBS, IBD, gastritis, GERD, H pylori, diverticulitis, candida, etc.) or have an autoimmune disease and need some help, I see individual clients to help them resolve their digestive issues or reverse autoimmune disease naturally, You’re welcome to set up a free, 30-minute breakthrough session to see if you’d like to work with me. I also have my own two products, Tributyrin-Max, which is particularly helpful for loose stool and diarrhea as it slows your motility and firms up your stool, and SBI powder, which is an all around gut pathogen binder, which is super safe and won’t harm beneficial bacteria, and is usually the first line of treatment I educate my clients about in order to avoid stronger antimicrobial herbs.
*Product and dispensary links are affiliate links for which I’ll receive a commission. Thanks for your support of the podcast by using these links. As an Amazon Associate, I earn from qualifying purchases.
Adapted from episode 138 of The Perfect Stool podcast with Lindsey Parsons, EdD, and edited for readability and Andrea Nakayama, Functional Medicine Nutritionist and educator, host of the 15-Minute Matrix Podcast and the founder of Functional Nutrition Alliance. She has led thousands of clients and now teaches even more coaches and clinicians around the world in a revolution reclaiming ownership of both their own and their clients’ health.
Lindsey:
So can you tell me about your history and what got you into the field of functional medicine?
Andrea Nakayama:
Yes, I’d be happy to! So, I was in a completely different career in my life. I worked in book publishing for over a decade, and in April of 2000, my late husband was diagnosed with a very aggressive brain tumor. It’s called a glioblastoma multiforme, and it’s a stage 4 cancer. He was given about six months to live. He was in his early 30s. I was just seven weeks pregnant at the time, and I was also a foodie. I was definitely experimenting with food for my own health, noticing little things, but that catapulted our reality into a whole different realm of care.
So first and foremost, we entered into the medical system, and I had never been in the medical system. Sure, I’d been to the doctor for a broken wrist or arm, for a sinus infection, but had never been in the system in this way, and that experience kind of woke me up to some of the gaps in our medical system, and the two gaps that I noticed at that time were that everybody is treated like their diagnosis, and everybody with the same diagnosis is treated the same. So if you have a glioblastoma, the 32-year-old man, my late husband, is treated the same as the 80-year-old man. It is a protocol for that condition. And so while we were in this reality, this grave new world that we were in, I was looking to see anything and everything we could do to shift the outcome in any way we could, so I was bringing him information about diet and lifestyle, how does sugar impact inflammation and tumor growth. And ultimately, it was his decision to make, but we made major dietary changes. He ultimately lived past his prognosis. He lived two and a half years. So he died when our son was 19 months old. This is back in 2002, and that really changed my perspective on health care, quote, unquote, food is medicine and what’s possible to help a person navigate through the system. And slowly but surely after his passing, I realized that this was my calling, and that led me forward to trainings and exposure to functional medicine, which really spoke to me, and on from there, which I can talk about as we have time.
Lindsey:
Yeah, well, first of all, I’m so sorry for your loss, and how tragic to be cut off so early.
Andrea Nakayama:
Yes, thank you.
Lindsey:
So you said in our pre-interview call that your practice’s sweet spot is the client or patient who has not had success anywhere else and maybe is hopping from practitioner to practitioner, and I know I’ve seen a few of those, and they maybe are having trouble taking most supplements or eating most foods. So can you explain your philosophy around helping those types of people and how you proceed with them?
Andrea Nakayama:
Yeah. So most of what I do now, I started my practice back in 2009. I started training other practitioners in 2012. So, at this point, most of what I do is train other practitioners, health coaches, dietitians, a lot of nurses around the world, who really want to understand the principles and philosophies of functional nutrition. And I’ve really established a systems-based approach that speaks into what you’re talking about. So the first thing I really want to understand is who it is that I’m talking to. I have the entire functional nutrition matrix, which is modeled after the Institute for Functional Medicine’s matrix, but it’s a little bit more easy to use and think through and talk a patient through, and that’s divided into categories that I would call “the story, the soup and the skill”. The “soup” is the system’s biology. It’s all the areas where the gut’s connected to the brain, all the things are happening inside the body, and we recognize that they’re connected. The “story” is what I really want to understand in relation to what you’re talking about. What are your, in functional medicine, we call them ATMs; your Antecedents, your Triggers, your Mediators. Tell me about where you came from, what’s happened throughout your life, and what you have noticed helps you feel better and makes you feel worse. And the “soup” is our systems biology. The “story” is our unique journey, and the “skills” are all the things: sleep and relaxation, exercise and movement, nutrition and hydration.
Oftentimes, what I see when somebody has been there and done that, they’ve tried everything, is that they’re doing all the practices, but they’re not really focused on the internal healing at a pace that’s appropriate for their body, so they’re chasing fixes, but the internal healing that allows their body to accept the foods, accept the supplements, work with that next intervention are impaired, and that’s the work that hasn’t happened. Oftentimes we have to slow it down to speed it up, and people are very fixated on going on a protocol or following the next principle or tracking or finding the quick fix, or the next supplement; or I can’t sleep should I take this herb or these hormones, or whatever it might be. And oftentimes, for a sensitive body, it’s too much, too fast, and the body doesn’t have the time to heal. So all that to say, I’m going to do a really, really thorough assessment of an individual to understand what’s actually happening. What have you tried? What have you learned? And then let’s get really systematic to allowing the body to heal and receive healing, as opposed to chasing the next thing.
Lindsey:
Can you give me an example of someone who maybe was in that situation and what the body needed to be able to start accepting the healing?
Andrea Nakayama:
Yeah, I mean, a lot of times – I’m not thinking of a case, I’ll be honest, I’m not personally working with that many cases right now so I have to dig back, and one might come to me, but what I often see is that the body’s in a sympathetic-dominant state, so that chasing, that questing; when we think about sympathetic dominance, that’s our fight-or-flight mechanism. And I’m often seeing people who are questing the next fix, the next solution. How do I do this? So what I will hear, if I think about my case study group where I was working for people for my book that have been there and done that, worked with all the top functional medicine doctors, done the tests, taken all the supplements, eaten the quote, unquote, perfect diet with the perfect timing, and they weren’t feeling better, and they feel angry, they feel jilted, because the things that are promised to us just don’t work. I think we think those protocols are very sexy, and they’re going to be the answer, and they get us further fixated and stuck in that “fight-or-flight, where’s the next thing, How do I fix my broken self” perspective?
Lindsey:
Yeah, I’ve definitely seen people who’ve been through the ringer with some of these top names, functional medicine, and they’ve said, “Oh, I spent $20,000, I spent $50,000” or whatever,
Andrea Nakayama:
Correct.
Lindsey:
And they just stuck them on a set protocol. They literally take everybody they see, and they go, “okay, this is just what you’re going to do.” Everybody does the same thing. And I’m shocked, honestly, that that’s the way they’re practicing. I just sort of assumed the top names of functional medicine would be a little more individualized.
Andrea Nakayama
Yeah, I mean, unfortunately, I think that the road that functional medicine has gone on has veered away from the three primary tenets of a truly functional practice, and those three primary tenets are a therapeutic partnership, meaning we are equal in this relationship and your understanding of yourself is as important as my expertise; looking for the root causes, which means we know how to ask, “Why is this happening, not just what do I do about it; and a systems-based approach, which embraces systems biology. Those are the three tenets of a functional practice as designated in the origins of the Institute for Functional Medicine. And unfortunately, it’s become very conventional-based in that it’s another pill for an ill. The pill might be different, or it might be a bucket load of pills. They think that diet is a handout. Dietary change is not a handout. There is a lot that goes into making change, understanding a person’s relationship to change and what their body can tolerate and not tolerate. So I think there’s a lot of mistakes happening in a lot of functional practices today that really are going too fast for the needs of the individual.
Lindsey:
So you talked about sympathetic dominance and I’m thinking about something I heard on a podcast recently, which was they had looked at children who had abuse, you know, ACEs (Adverse Childhood Experiences), that type of thing, and they would check their cortisol, and right before bed, all of their cortisol was elevated such that it was impacting their sleep.
Andrea Nakayama:
Yes.
Lindsey:
and that this is something that persists through adulthood.
Andrea Nakayama:
Yes.
Lindsey:
How do you undo that kind of stuff?
Andrea Nakayama:
Yeah, so I think that when we’re looking at adverse childhood experiences, when we’re looking at trauma, whether it’s childhood trauma or adult trauma, like I received with my late husband’s diagnosis and illness and death, that we have to recognize where and when it is our job to address that with a client or patient and where it is our job to hold space for it. So my job is making the connections visible for people. So that matrix: that story, the soup, the skill, helping people to understand that everything is connected. We are all unique, and all things matter.
In my practice, one of the things that I’m teaching others is what I call the three tiers to nutrition mastery. Tier one are the non-negotiables. Now non-negotiables are vast, but the non negotiable trifecta that is true for all of us, is sleep, poop and blood sugar balance. If those aren’t there, then it’s going to be hard to heal. So if I see somebody who has elevated cortisol or is having dysregulation around sleep, I’m going to really dive into that one thing. Not with “hey, go sleep, take some melatonin,”, or “hey, your cortisol is elevated, take these herbs.” I’m going to really look at how do we unpack that, bring to awareness to some of the triggers that might have us in that sympathetic dominant state, that fight-or-flight state. Look at all our practices around sleep. Start to recognize what makes us feel better, what makes us feel worse, which are our mediators, and really start to see if we can make a slow but steady difference in small practices that lead to more sustainable results.
And this is a very long-winded way of saying, when I give that person a supplement for their sleep, I’m bypassing the opportunity for that person to learn, in a long-form fashion, what actually helps them to be more empowered with the decisions they’re making, and I’m making them more reliant on me for their solution. That’s not what I want. I want to empower people to have that deeper awareness about what is happening with their own body. So a child who’s carrying that lack of safety into their nighttime routine, that awareness is something I’m going to ask them to bring to the fore, potentially with a therapist who can hold that space for them. And meanwhile, we’re going to work on, how do we make your bed and your bedroom and your sleep time ritual as safe as it can possibly be for you, and what kind of language do we need to use to bring you into that parasympathetic, that rest and digest, and sure, are there ways we can manage your blood sugar, help with your mineral support, like all the things that are going to help there, but it’s not a one and done that’s mine to fix, I guess is the thing. It’s mine to recognize the connections and help illuminate them, while bringing the foundations into place that really help to support that person in moving forward.
I just thought of a case, Lindsey. Somebody was asking me to look at their labs. I look at people’s labs. I’m a geek when it comes to serum labs, and I can make all sorts of connections. But just looking at – this is the husband of my cousin, who is also a functional nutrition counselor, and I was looking at his labs with him, and he was trying to control his sleep and his anxiety with herbs, and he was constantly getting to, what I would call, is a later-stage intervention. When I look at his labs, and he’s a teacher, I was like, are you hydrating? And he’s like, well, I drink like one Nalgene a day. And I’m like, How much do you weigh? So I could see in his labs that he’s dehydrated. Dehydration can lead to anxiety and fatigue because the blood isn’t pumping as fluidly as it needs to the heart and the brain, and so my ability to understand the simplicity on the other side of complexity is then what helps me make connections and help him to slow down. Let’s trial that for two weeks, and then let’s look how sleep is. Make sure your hydration is earlier in the day, so you’re not having to go to the bathroom, but just things that we often overlook in favor of the fancy, newfangled supplement or protocol when we’re not creating the foundations of health.
Lindsey:
So what markers were off on his bloods?
Andrea Nakayama:
All his red blood cell markers. So in his CBC with differential, all the red blood cell markers are your, you know, your RBC, your hemoglobin, or your hematocrit, your MCV or MCHC, like all of his red blood cell markers, were indicators to me to ask the question, are you hydrating?
Lindsey:
Were they high or low?
Andrea Nakayama:
They were high.
Lindsey:
Okay, interesting. So, given we’re on a gut health podcast, what are the factors that people might not be thinking about that could be affecting the health of their gut microbiome?
Andrea Nakayama:
Yeah, so when it comes to the gut microbiome, there are many factors that I like to think about that influence the entire digestive tract. So I like to think about it as one of the three roots. Any sign, symptom or diagnosis is a branch in my book, and the three roots are our genes, digestion and inflammation, and that’s like a Venn diagram for me. The digestive root, the circle of influence, or the “soil”, is the mechanical, the chemical, the structural and the microbial. So before I rush to microbial issues, I want to make sure we’re chewing, we’ve got the hydrochloric acid and the enzymes that we need, and I don’t mean supplementally, I just mean we are able to produce and break down the foods that we’re bringing in. We have structural integrity, which comes back to the microbiome, but really making sure that the inflammation is down and the gut structure is not hyperpermeable or leaky, and the microbiome is going to be key, but we forget that sleep feeds the microbiome, that exercise feeds the microbiome, that vitamin D feeds the microbiome. We often rush to what we’re going to take to feed the microbiome. Now, if we are feeding the microbiome with food, I’m going to think of three classes of foods, and those include our ferments, of course, our polyphenols and our resistant starches.
So those are the ways that, first and foremost, I’m going to make sure that we’re feeding the microbiome in a daily way, in addition to supporting that with probiotics and prebiotics that we might take in in different ways. I am not a fan of specialty testing for the microbiome unless I find I need to. That’s usually later on down the line, if at all. I’d prefer an Organic Acids Test over a GI Map or anything like that, but I rarely would have us in our clinic do those because we can assume that the people who are coming to us likely have gut dysfunction, even if they are not experiencing gut issues. So again, one of the three roots, if you have chronic sign symptoms or diagnoses that aren’t getting better, digestion has to be focused on, and the microbiome is going to be a part of that.
Lindsey:
Okay, so you mentioned sufficient hydrochloric acid to break down your proteins, of course, and I have read that one sign of insufficient hydrochloric acid, stomach acid, is nails that are cracking and breaking. This has been my 20-year quest to fix this problem, and I have autoimmune IBS. I have elevated vinculin antibodies and recurrent SIBO that I have to keep under wraps.
Andrea Nakayama:
Yes.
Lindsey:
Am I missing something? I mean, I’ve tested the zinc; I am deficient and taking it. But the but the nails are getting worse!
Andrea Nakayama:
Yeah, and I think this is where we can get stuck on thinking x leads to y. So deficient hydrochloric acid could lead to a number of symptoms, but so could different nutrient deficiencies that might be excluded from a specialty diet. So I always like to put the “but” in the column of the specialty diets, because when we reduce our food intake, sometimes we’re missing certain nutrients. A common one for those of us with autoimmunity are our B vitamins, which are tricky to take for a lot of different reasons, but when we reduce certain foods from our diets, particularly grains, we might actually be missing some of the B vitamins that also help with our hair, skin and nails. So it’s hard to say that it’s just because of one thing. So if you have worked on your hydrochloric acid, and you’ve supported that and you’re not seeing results, give it a checkbox and know that you still don’t know the “why” of that thing, right?
Lindsey:
I’m on the multi, on the B complex, on zinc.
Andrea Nakayama:
Yes, exactly. So there’s different reasons that may not be evident yet. And with all you know Lindsey and all you’ve looked at, it’s one of those things that’s like, “Okay, I don’t know the answer to this.” How much is it bothering me? Is it bothering me because it hurts, or it’s painful, or is it bothering me because I should know the answer, and I don’t.
Lindsey:
Entirely cosmetic.
Andrea Nakayama:
Exactly, exactly, and that’s where I think, like coming into that parasympathetic, like, I’m doing all the things I need to do and all the things I know to do. I’m still having this issue, so I’m just going to hold space for that.
Lindsey:
Perhaps that’s the one I one idea that hadn’t occurred to me, just accepting.
Andrea Nakayama:
Just accept that for now; something will reveal itself.
Lindsey:
Yeah. What bothers me about it, though, is that I feel like it’s telling me that there’s something not working right, and that it’s somewhere else. There’s something more serious going on that I’m not seeing.
Andrea Nakayama:
And I think if you’re looking at everything, if you’ve looked under the hood, I think this is where we can get hyperfixated on some notion of right or healthy. And this is where we then start questing, when, in fact, like, you’re thriving, your brain’s working, your body’s working, you’ve done all the looking, and you’re taking really good care of yourself. How can we just celebrate that and put down the thing that we feel like is trying to tell us something, but you know, maybe it’s not to be heard right now.
Lindsey:
Okay, I will accept my bad nails.
Andrea Nakayama:
They’re not bad, they’re just what they are.
Lindsey:
My slightly imperfect nails.
Andrea Nakayama:
For now.
Lindsey:
So, you mentioned your “three roots, many branches” philosophy, can you apply that to autoimmunity?
Andrea Nakayama:
Yeah, yeah, that’s exactly what I created it for. So if we think of any autoimmune condition, it is a branch and all the associated signs and symptoms with that autoimmune condition. So if we can envision a tree with leaves or branches that don’t look as healthy as we want them to, like your nails, then we can think that’s a symptom, that’s a branch. And if we focus on the branch, let’s say we go up to a tree in a forest and we want to help this tree thrive, but its branches are turning brown and the bark is falling off. Do we want to pick off those branches? Do we want to saw them off? No, we want to think, how do I get deeper to the trunk? How do I get deeper still to the roots, and how do I nourish the soil that those roots live in?
So autoimmunity is a branch. It is a result of many things, multifactorial aspects that are happening internally. There is not one root. And I just want to say this is another mistake I see a lot of practitioners putting out there; that there is one root, that histamine intolerance or mold or SIBO is the root. There is never one root. There are always three roots. The genes, digestion and inflammation give us a broader perspective, and then each of those has soil, or what I call the circle of influence, that allows us to think, “Where do I need to focus my attention there?” So genes, just as an example, we can’t change our genes, but we can change the expression of our genes. That’s epigenetics, and the factors there are food, movement, environment and mindset. And so we’ve been talking inadvertently about this notion of mindset. You know, how does mindset around sleep and safety, around what the signs are that our body is telling us, how does that put us into that questing state? And can we actually heal in a questing state? I’m not sure we can. The inflammation, the circle of influence is clear, calm, enhance and modulate. We may need to clear a microbial infection. We may need to clear a food that isn’t serving us. We may need to clear an environmental factor that our body can’t process. But we may also need to clear negative thoughts that are keeping us from being in our thriving selves.
Yeah, I have started recommending to some people, in particular, these tough cases where it seems like you try literally everything on them and just nothing is working, referring them to other programs like the Gupta program.
Yes.
Lindsey:
Or hypnotherapy, or, you know, something that’s going to intervene on the mental side. Because as a gut health coach, I don’t quite have the time to work on those types of things. If they were doing once a week, health coaching, 12-week program, maybe. But I don’t see a lot of clients in that type of setting anymore.
Andrea Nakayama:
Yeah, exactly. Everything matters, it’s all connected. And so that’s a brilliant move, where you recognize somebody, I think you said it really beautifully, needs an intervention between that mindset piece that’s keeping them in that questing, frightened, sympathetic dominant, lack of parasympathetic dominant state that the body cannot heal in, and we have to learn to catch ourselves in those states. I have a really stressful work situation because of how large the organization is at this point, and I have to have a number of practices that buffer my day to be able to cope with the stress in the middle of my day.
Lindsey:
Yeah, I have this RingAIRE*, and it tells me about my stress. And I find it interesting because they’ll say, like, what are the different categories – well, one says sympathetic activation, one says stressed, and the one is just, I can’t remember, it’s like a mid level, just activated or something.
Andrea Nakayama:
Yeah, and that slight tune-in. So if I think about my stress levels, and I think about I’m somebody who can tolerate drinking coffee, but if I drink it on the weekend, I’m fine. If I drink it during the week when I’m already in a stressful situation and I’m already in go, go, go, I can notice what it does to my heart rate, whereas if I’m in my “let things go weekend mode”, that’s all balanced and so that ability to tune in and give myself some allowances. To me, that’s what health is, where we don’t have to be so straight and narrow, where it isn’t so restricted, but we’re kind of navigating life and living with all that we know.
Lindsey:
Yeah, I just had a client who said before she even started working with me, she had stopped drinking nightly and drinking coffee, and she’s like, I already feel so much better that, you know, she still is bloated every day, but you know, she was like, I feel so much better just from those two changes that I can’t even believe how far I’ve come just from that. And I’ve never been a coffee drinker or a daily alcohol drinker so I’ve never noticed anything huge in modifying those. But I thought that was a good testimony to the basics.
Andrea Nakayama:
Absolutely, absolutely. Making those changes, we often bypass them while looking for all these other things. And you know, drinking alcohol at night can be a huge detriment to sleep in a number of factors and to mindset and our mood. And I don’t think we realize those things when we’re in it just living our daily life. We also have to recognize that healing may look different than idealing, right? So when we’re living in an ideal state that has a little bit more wiggle room, that is where we get to live into it like I’m talking about. When we’re on a healing journey, we might need to get a little bit more strict with the recognition that it is so that the wounds can heal, and that’s when we then move forward. I think my biggest concern, going back to one of the earlier questions you asked, is that a lot of people are making the dietary and supplemental changes, but they’re not allowing or supporting the body to do its healing. So the wound is still there, while the restrictions get more and more and more narrow, and then that leads to frustration.
Lindsey:
Yeah, so back to the whole question of the rings. So I see, and it’s shocking, honestly, because the thing is that you don’t sense that you’re stressed out.
Andrea Nakayama:
Totally.
Lindsey:
That’s the thing that’s shocking. When I look at it, I’m like, oh, okay, at that moment where I had to make this transition and I was getting up and going and making breakfast, or where I was then interacting with this person, or like, each of those transition points seems to send me into stress mode. And I don’t have a sense that I’m stressed out. I think it was a pretty relaxed day, and then I look and I’m like, “Oh!” Or when I’m working, like, yesterday, I had a super quiet day, sitting at work just sitting on my computer, didn’t talk to another human being. That would be, for me, a really low-stress thing, because the more you interact with other people, the more you know it requires a different level of activation, shall we say. And I was sympathetically activated all through the morning just getting on my computer and answering emails and following up with clients.
Andrea Nakayama:
Yeah, I think it’s that feedback loop, where we’re getting it from, internally or externally, is really interesting. So if you don’t feel it internally, is there some aspect that is a natural level of when your cortisol is naturally raised, which should happen in the morning, which is then being interpreted as stress? Like again, where do we outsource our feedback loops to the data on the scale, on the test, on the ring, to the nails, like, where are we outsourcing what we actually feel? And is there a way to trust what you’re actually feeling? So I use my Ouro Ring to kind of track my activity through the day or at the end of the day, and to look at my sleep as a reflection, like, what little things can I do to shift some of these markers with my sleep so that I’m getting better sleep, and does that impact my heart rate variability, which is ultimately helping with my resilience to the stress in my life. But I don’t use it as a directional. I use it as a clue to kind of give me some feedback to support how I’m feeling, or what I could be doing. And I think again, there’s a tendency, not on your part, but culturally, there’s a tendency to biohack, to outsource to all these different tests and data measures when our body actually is telling us something. And I’d be curious, like, are you stressed or are you jazzed about what you’re doing, like, what’s actually happening there that would help you interpret that data from a different lens?
Lindsey:
Yeah, I think I need to know more about how they designate the levels, and that’s the part I haven’t learned, so then maybe I’d have a better understanding. But yeah, I do recognize that you have the cortisol waking pattern that is falling during the day. So I’m not quite sure how – I assume they’re measuring it on the basis of things like heartbeat and temperature. I don’t know what else they gather, so.
Andrea Nakayama:
Exactly.
Lindsey:
On the drinking question. So I have noticed something though about drinking and sleep, which is, if I drink the next night or the night of drinking, I get more deep sleep. And I’ve been thinking, this isn’t because drinking is a good thing for me and it’s giving me more deep sleep. It’s because my body needs more time to detoxify the alcohol.
Andrea Nakayama:
It could very well be! So not the night you sleep, but the night after?
Lindsey:
No, no, the night I sleep.
Andrea Nakayama:
Okay, the night you drink. I mean, it’s a depressant too. So you know, you’re coming down. I think some people are going to have more blood sugar swings because of the alcohol. So they’re not going to have that deeper sleep. They’re going to wake up more often to go to the bathroom depending on blood sugar levels. You’re probably, you know, somebody who tends to your blood sugar. So that’s not an issue, but it is a depressant. And so ultimately, your body’s coming down. And yes, nighttime is our- sleep is our number one form of detoxification, so your liver is going to work for you.
Lindsey:
So I’m not sure if you mentioned them already, because you seem to have a lot of different, sort of, groupings of ideas. But did you already talk about the three tiers to nutrition mastery?
Andrea Nakayama:
I mentioned them. So just to put it into context, there are three systems that I’m thinking through all the time. System one is the matrix. That’s how I map a person. You know, the story, the soup, the skill. Everything is connected. We’re all unique. All things matter. Then I mentioned three roots, many branches. So those three roots being the genes, digestion and inflammation, with the branches, if you’re listening and you can list a sign, a symptom or a diagnosis that has been chronic, that is a branch. And if you’re focusing there, then we have to take our attention down deeper. So that leads us to the three tiers, and I mentioned the non-negotiables and the non-negotiable trifecta. So let me just say the three tiers. Tier number one is the non-negotiables. Tier two is deficiency to sufficiency. On the other side of that is toxicity. And tier three is dismantling the dysfunction.
So dismantling the dysfunction is like going for the branches. It’s that top level. It’s what medicine does. This is wrong, let’s fix it. In functional nutrition, what we should be doing is taking a different way into the same problem. It’s that root and soil approach, and that’s what leads me to the tier one and the tier two. So tier one, non-negotiables, like I said, I have the non-negotiable trifecta: sleep, poop, blood sugar balance. Those all have to be in place and worked with, otherwise it’s hard to move forward. So I want to make sure we’re really diving in and understanding that. But then each individual has their own non-negotiables. So Lindsey, if I asked you, what makes you feel better and what makes you feel worse, you have a list of those things, as do I. Some people don’t and that becomes what we really start to unravel with them, because in functional medicine, those are our mediators. When I go to sleep by 10 o’clock, I feel better. If I stay up past 10 o’clock, it’s going to mess with my sleep pattern. That then messes with my blood sugar the next day. There, I know that a 10 o’clock bedtime is a non-negotiable for me. Not eating certain foods, I don’t drink, I don’t eat refined sugar, I personally don’t eat cow dairy or gluten. Those are my non-negotiables, mine. I’m not saying they’re true for everybody.
So sleep, poop and blood sugar balance is the “we all need to” but then for each of us listening, get into learning about your non-negotiables. What do you know makes you feel better? What makes you feel worse? And then you’re in a risk-reward situation with yourself every single day. When I drink coffee during the week, I notice my heart rate’s a little bit more elevated. I’m a little more aggressive at work, I get to make that decision. Do I want to be that person or do I want to have my green tea that day? Like, which person do I want to be? My decision, so that I’m not following a protocol. I’m in a state of awareness. Deficiency to sufficiency, that tier two, sure that can be a deficiency in zinc or vitamin D or B vitamins. There are many nutrient deficiencies. Could be a deficiency in enzymes or hydrochloric acid. It could also be a deficiency in love or joy or play or laughter or sleep or sex. You know, there’s so many things that when we think more broadly, we have a much bigger toolbox for healing.
Lindsey:
Right, so just so that people can take some very actionable nuggets out of this, one of your non-negotiables is pooping. For a person who is not pooping regularly, what would you recommend?
Andrea Nakayama:
Yeah. So first of all, I want to see what that means, right? So before I say take some magnesium or do x, y, z, I want to see what does not pooping regularly mean? So does that mean you’re going once a day? Does that mean you’re going once a week? I want to also micro-timeline that. When did this start? Have you always had an issue? Is there any oscillation between the elimination? Does anything you’ve tried in the past make it better for you or make it worse for you? I want the whole story. And then I’m going to start with my three principles in terms of diet before I bring in different changes. So there are three principles, I’m going to go to principle number two, which is “eat the rainbow”. Do we have enough fiber in the diet? And can your body tolerate fiber? So a lot of people, as I’m sure you know being a gut health coach, can’t tolerate fiber, and so I’m looking at that. I’m trialing different things. I might have to do some more internal gut remediation so that we can bring in more fiber. But that’s my first opportunity, versus forcing elimination to occur, it’s a sign that there’s some more I need to work on.
So the “eat the rainbow” also leads back to principle number one with food, which is “fat, fiber and protein”. So I’m going to document with somebody, through a food, mood, poop journal; mood being any sign or symptom, including constipation, bloating, any of it. So it’s not mental mood, it’s any mood the body’s having. But I’m going to look at what’s true for you before I make any recommendations regarding what to do. But I’m starting, first and foremost, after the inquiry and the assessment, my first recommendation is going to be, what can we do dietarily, to kind of 2.0 what it is that you’re currently doing.
Lindsey:
So it sounds like this method that you’ve developed is very intensive, like, it seems like it would be very time-consuming. So I’m curious, when somebody signs up with somebody who’s trained under you, how many appointments do they typically have to sign up for? Or, how does that work?
Andrea Nakayama:
Yeah, I mean, different people work it differently. I’m going to talk about how we work it in our clinic. So the people who trained under me, who actually work at the Functional Nutrition Alliance, we have a initial session that really is deep in its assessment. So that initial session is actually three parts. It’s a strategy session, and then it’s a premier case review that has two parts. The first part is after the intake, where we’re going to do motivational interviewing and learn a lot more and create a functional nutrition timeline. So we want to see who you are, when did this start. Like I said, with the micro-timelining around the constipation, I want to know when did you first know? And people will say, I’ve always been constipated. When was the first time you actually noticed you were constipated or recognized it was constipation? Are there times where it’s gotten better ore worse? I want to understand who you are. That’s the assessment.
Then the second part of our premier case review is where we will do nutrition counseling. We’ll have the functional nutrition matrix completed from the prior sessions and be able to make some initial recommendations. In our practice, we then have three and six month packages. Some people might go beyond that and continue to work with us for years, or come back at intermittent times, maybe when they’re more independent, but want us to look at their labs twice a year, or whatever it might be. It’s very dependent on the individual; what they’re working with, as is our cadence of visits. So with some people, we may meet with them for a half-hour once a week, whereas with other people, we might meet with them for an hour once a month. It really depends on where they are, what they need, how acute their chronic issues are, so like, what’s the intensity they’re dealing with at this moment to get through some of the pain that they’re experiencing. In my prior years of practicing, I worked with people for years, but the intensity of our work went from very intense, to more spread out, check in, and learn new things as you need them.
Lindsey:
Yeah. So that initial intake, it sounds like that it could last multiple hours.
Andrea Nakayama:
The initial intake is going to take time for the practitioner as well as for the practitioner and the patient. So the patient is doing some pieces, like filling out a lengthy intake. And then there’s the motivational interviewing, where we’re creating a timeline. There’s work for the practitioner before the timeline, there’s work for the practitioner after the timeline, right? So it is a process. I call it the art of the practice. Assess, recommend, track, repeat. And so we are constantly in an inquiry and assessment phase without making recommendations just based on a sign, symptom or diagnosis.
Lindsey:
Got it. So I’m curious, did you develop this whole system after starting out within the traditional functional medicine world, and then seeing the flaws, and then you were like, something needs to change. So you kind of developed a system. How did it come about?
Andrea Nakayama:
Yeah, so there were ways that I was working, not coming from a healthcare background, that were kind of more of a story arc, and I didn’t realize I was doing something that was different than any other health coach or nutritionist, like I had no clue. And then when I started to show up in health coach spaces, I was recognizing that I was having a lot more success in practice, and people were asking me to teach them what I was doing. So I kind of had to unpack the way my brain worked in order to teach it to others, which is where these systems-thinking come about, because we have a way to talk about it. I then found my way to functional medicine. I was like, holy moly, this is what I do in the realm of nutrition. So that’s functional medicine. I’m actually thinking similarly, but it’s in the realm of nutrition. So I started to develop the sister ways of thinking about what I was doing to what was happening in functional medicine, and with their approval at the Institute for Functional Medicine, I adapted some of the principles and practices for a different scope of practice. So I’m trained as a functional medicine nutritionist, but what I’m teaching is functional nutrition and functional nutrition counseling, and what we’re offering is functional nutrition. So it is not medical. It is not meant to be medical. We don’t diagnose, we don’t prescribe. I think this is a mistake a lot of people make. We don’t treat, we assess, we recommend, we track. It’s a different process, but it’s very adjacent to functional medicine. So it kind of happened in an organic way over time.
Lindsey:
Interesting.
Andrea Nakayama:
Yeah.
Lindsey:
Well, this has been a really interesting perspective, sort of at a higher level, maybe, than often I dig down into the details, being a detail-oriented person. And I think you have good big-picture thinking, which helps to pull out and look a little bigger sometimes.
Andrea Nakayama:
Yes.
Lindsey:
So thank you for bringing that perspective.
Andrea Nakayama:
Yes, my pleasure, and it’s something I’m often doing with our students. I had one of our power hours today. It’s a two-hour Q&A, and it’s a often reminder to get out of the weeds and think like, what are we missing? What happens when we bring our weedy bias to our own care or the care of others? Sometimes there are things we might be overlooking. So when we broaden our perspective, there’s a lot that might live there.
Lindsey:
Yeah. So tell me where people can find you.
Andrea Nakayama:
Yeah. So lots of places. Andrea Nakayama in all the places. So andreanakayama.com. On all the socials, LinkedIn, it’s Andrea Nakayama, and then at the website, andreanakayama.com, it’ll lead you back to the Functional Nutrition Alliance, where I train practitioners. So there’s different information, the more patient-focused information, and not me as a practitioner, but me speaking more generally, like I’ll be doing in my book, is over at andreanakayama.com and the practitioner stuff is at Functional Nutrition Alliance,
Lindsey:
Okay, and then the practice that you are associated with is located where?
Well, thank you so much for sharing your knowledge with us today!
Andrea Nakayama:
Yeah, thanks for having me. It was really 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.
*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.
Let me start by briefly describing what a healthy digestive system looks like and how that interacts with the food you eat. While there has been a lot of focus on the importance of diversity in the gut microbiome in health, primarily because that means that if you lose one species or strain that performs a certain function in your microbiome, then another one can take over that function, there is no set number of bacteria that has been agreed upon that constitutes an acceptable number. Having interpreted many stool tests, and more and more using metagenomic sequencing tests, I think a more relevant question is whether there are large overgrowths of pathogenic bacteria than how many species or strains you have in total. It has been proposed that a microbiome that is 85% commensal or healthy bacteria with 15% or fewer pathogenic bacteria is a healthy microbiome.
But beyond the microbiome, there is also the functioning of the digestive organs. In a healthy digestive system, you will have adequate amounts of salivary amylase starting to break down food in your mouth, the lining of the cells of the stomach will be intact and not inflamed, so that your stomach will be sufficiently acidic to break proteins into amino acids and to keep your lower esophageal sphincter from opening up and letting acid into your esophagus. Your stomach acid will also be sufficient to kill off the majority of incoming pathogens that may be slipping in with your food. And you will have the release of intrinsic factor from the parietal cells lining your stomach so that you can absorb vitamin B12 from your food. Sufficient stomach acid will also help with the absorption of calcium, magnesium and possibly zinc.
Then as the food passes out of your stomach, you will have sufficient bile released into the duodenum, the first part of the small intestine, to both help in digestion and to raise the pH or alkalinize the chyme, or mashed up food mixed with stomach acid, that’s exiting the stomach. The bile is produced by the liver and stored in the gallbladder and released by the gallbladder when it senses fat in your food, and it emulsifies fats like dishwashing detergent does on grease so that they can be broken down further and absorbed. In a healthy digestive system, the bile is of sufficient fluidity not to get stuck in the bile ducts and clog them up or form stones. So if that’s all going well, you should be absorbing fatty acids properly from your food, provided you’re not deficient in l-carnitine, an amino acid found primarily in animal products or produced by your body from l- lysine, or in vitamin B2, which are necessary for bringing fats into the Krebs cycle to produce energy. Bile also is taken in and transformed by your gut microbiome through various enzymatic processes resulting in secondary bile acids, which perform distinct biological activities of their own, which science is only beginning to unravel.
Then a healthy and intact pancreas will release sufficient pancreatic enzymes to help digest your food. These include amylase, which breaks down carbohydrates, lipase, which breaks down fats, protease and elastase, which break down proteins and trypsin and chymotrypsin, which digest proteins. Then the cells lining the small intestine will also release what are called brush border enzymes, which further help to break down your food. Some key ones include maltase, which breaks down maltose into glucose, sucrase, which breaks down sucrose (table sugar) into glucose and fructose, lactase, which breaks down lactose (milk sugar) into glucose and galactose, and peptidases, which break down peptides (or small protein fragments) into amino acids. So most of the nutrient absorption is happening in the small intestine.
Now along with food, you will bring in things that are not food with your food – and that’s where the role of the gut immune system comes into play. Seventy percent of our immune system resides in the gut, because that’s one of the primary places where the outside world comes into contact with the inside world. There’s a wide variety and complexity of immune cells in the gut, most of which I don’t fully understand, but I will say that one that we measure on stool tests, secretory IgA, is produced by B cells and plasma cells in the gut, and serves to bind to pathogens and toxins and prevent them from attaching to the gut lining. It also neutralizes viruses, bacteria and toxins before they can invade tissues. Secretory IgA, along with other gut immune cells, are your second line of defense after the stomach acid, and prevent you from getting sick from the pathogenic bacteria that inevitably come in with your food.
Secretory IgA also selectively culls the microbiome, binding to pathogenic microbes and promoting the growth of beneficial ones, and it does its work without triggering inflammatory responses, which protects the gut from excessive immune activation. It also helps train the immune system to tolerate beneficial microbes and dietary components.
Then your gut microbiome is your third line of defense. If you have a healthy gut microbiome, each group of microbes will occupy a certain niche in the gut. As a result, pathogenic bacteria entering the gut will not have any place to settle and make a home. This is why you often see gut health issues appearing following antibiotics – as bacteria are killed off, niches open up in the gut into which pathogenic bacteria can enter or opportunistic or otherwise not harmful bacteria can overgrow and become problematic. And certain bacteria, in particularly the spore-forming bacteria from the genus Bacillus found in spore-based or soil-based probiotics like Just Thrive*, Megasporebiotic*, Proflora 4R*, CoreBiotic* or ProBioSpore* also can secrete antibiotics that kill off other bacteria. In fact, they have a quorum-sensing capacity of finding overgrown bacteria then getting next to them and secreting these natural antibiotics. Based on the name, you can probably tell that they naturally come from soil, so traces of soil may bring them in naturally, or they may come from the tissues of plants, via air or water or from fermented foods.
Now back to the major organs, although it could be argued the microbiome is an organ, once most of the nutrients are absorbed in the small intestine, the food hits the large intestine, whose primary role is to absorb water and electrolytes from partially-digested food. This is where the majority of the microbes live. These microbes actually produce B vitamins and vitamin K, which are absorbed into the blood, and ferment the leftover undigested fiber into short-chain fatty acids. These short-chain fatty acids serve as a primary source of energy for the colonocytes or colon cells, help to maintain the integrity of the gut barrier, modulate inflammatory responses, and promote immune tolerance and impact insulin sensitivity, glucose uptake and fat storage. There are four of them: acetate, which plays a role in regulating appetite and energy expenditure, propionate, which may contribute to cholesterol metabolism and blood sugar control, valerate, which supports energy production, reduces inflammation, helps maintain the gut barrier and modulates microbiota balance, and butyrate, considered the most important short-chain fatty acid, which maintains gut barrier function and has anti-inflammatory properties.
So everything I just described assumes that you’re getting all the nutrients necessary from your diet to keep everything functioning well. And that you’re not getting too many anti-nutrients or toxins that would impair gut function. So now let’s move on to some of the types of foods that can cause damage to the gut.
How can food damage the gut?
Let’s start with fast food. Of course, I understand why people sometimes feel the need to eat fast food out of convenience: it’s cheap, fast and if your taste buds haven’t been trained to appreciate good food, tastes good. You don’t have to deal with prepping ingredients or doing the dishes after. Instead, all you have to do is drive 5 minutes to your local fast food restaurant and have a meal ready in the same time it would take you to chop an onion. However, fast food only solves short-term problems at the cost of long-term consequences. Most fast food is made up of Ultra Processed Foods, or UPF’s. These aren’t foods that are grown in a garden or on a farm, but instead created in factories by combining chemical compounds, inorganic ingredients and other synthetic additives, including artificial flavors, colors, emulsifiers and preservatives. These foods are designed to be hyper-palatable and addictive but often lack nutrition, especially fiber, which is integral to proper gut functioning, if you recall, that production of short-chain fatty acids that leads to healthy colonocytes and reduced immune activation. Ultra processed foods supply your body with empty calories and foreign substances that are difficult to digest, potentially causing a huge variety of health problems, both in the short term and long term. Some common adverse health effects associated with consuming UPFs include obesity, cancer, type-2 diabetes, cardiovascular disease, irritable bowel syndrome, depression and even all-cause mortality. Some common ingredients you might see on nutrition labels for UPFs include high-fructose corn syrup, hydrogenated or interesterified oils and hydrolyzed proteins. If you see these ingredients in the foods you are buying, you are eating UPFs.
High fructose corn syrup is especially ubiquitous in the American diet and it has been shown to be closely related to the increased prevalence and severity of multiple diseases, including inflammatory bowel disease, gut-liver axis dysfunction, and more. High fructose corn syrup has been shown to exacerbate intestinal inflammation and deteriorate intestinal barrier integrity, worsening existing gut conditions and increasing the risk of developing new ones. Trans fatty acids, another common ingredient in ultra-processed food but not shown on the nutrition facts label because if there’s less than 0.5 grams, they aren’t required to list it, also contribute to gut inflammation and increase the risk of developing metabolic syndrome, diabetes and coronary artery disease. They’re so unhealthy that the FDA actually banned any amount exceeding 0.5 grams/serving of them in our food. But if you see any oil called “hyrogenated” on the label, they’re in there.
And then there’s the thickeners and emulsifiers like carrageenan, xanthan gum, guar gum, locus bean gum, polysorbates and propylene glycol that have been implicated in helping cause and exacerbate inflammatory bowel diseases (that is, Crohn’s and colitis).
Eating fast food can cause changes in the gut very quickly. In as short as a few days after eating a high volume of UPFs, your gut microbiome’s ability to optimally digest food is impaired. UPF’s kill fiber-fermenting bacteria in your gut, decreasing your body’s ability to digest food, excrete toxins and absorb nutrients. Eating UPFs also increases intestinal permeability, allowing harmful substances to enter the bloodstream, sending inflammation beyond the gut.
And you may think that eating some UPFs, like some chips, desserts or other snack food isn’t a big deal, but they contain anti-nutrients like phytates or phytic acid, which is found in grains and binds to minerals like zinc, iron and calcium, reducing their absorption. And the sugar requires extra zinc to process it, as zinc is used in insulin production and carbohydrate metabolism. So imagine you’re always eating grains and sugar alongside foods high in zinc like meat and seeds. You may end up deficient in zinc, as one example.
Zinc has numerous roles in the digestive system, including serving as a cofactor for over 300 enzymes involved in digestion and metabolism, strengthening the tight junctions between intestinal cells, preventing toxins and pathogens from entering the bloodstream, supporting immune cell activity in the gut-associated lymphoid tissue, reducing inflammation and promoting balanced immune responses, contributing to the production of stomach acid, which is vital for breaking down food, killing harmful bacteria and activating digestive enzymes like pepsin, which is essential for protein digestion. It’s also essential in healing and repairing tissues, making it important for healing ulcers or damage to the gut lining caused by conditions like gastritis. Zinc helps with the absorption and transport of other nutrients like vitamin A, which is also important for gut health. Vitamin A, in the form of its active metabolite retinoic acid, helps immature immune cells differentiate into specialized cells that enhance mucosal immunity and drive the production of IgA-producing plasma cells in mucosal tissues. So you can see how eating processed foods, which contain few nutrients and some antinutrients can start a zinc deficiency which can then cascade into other deficiencies like protein and vitamin A, which will further break down the digestive system and its immune system.
That being said, for those of you panicking that you’ve ruined your gut by eating McDonald’s once last week, don’t worry! The effects of eating fast food can be reversed by regularly eating organic, nutrient-rich, whole foods, and focusing on high-fiber foods like beans and lentils, aka legumes.
Speaking of organic, with the official organic designation, you can know that the foods you’re eating aren’t genetically modified, are grown without the use of harmful chemical fertilizers and are grown with sustainable practices. Not genetically modified means that your body will recognize them, and that they won’t be doused in the herbicides that genetically modified foods were designed to resist. Organic fruits, vegetables and grains often contain higher levels of polyphenols — compounds known to nourish beneficial gut bacteria and promote the production of short-chain fatty acids. Organic farming methods can also result in foods with slightly higher levels of certain micronutrients, which may indirectly support gut microbiota health, and are more easily digestible than conventional and synthetically-supplemented foods. For example, if you’re eating conventional bread, it will likely have added B vitamins, as in the US white flour is usually enriched, because when you remove the bran and the germ from a wheat kernel, you remove the B vitamins. So they will add them back, but in the form of the cheapest, least absorbable forms of B vitamins – so folic acid rather than methylated folate, which people with MTHFR mutations do not absorb well, and B12 in the form of cyanocobalamin, rather than methylcobalamin, which is also much less usable by people with mutations in the MTHFR, MTR and MTRR genes, which are incredibly common. Of course, you can avoid this problem by eating whole wheat bread, but when you add on the organic component, you are also eliminating the pesticides, which is the most important aspect of eating organic.
Why is glyphoste of particular concern?
I’ll mention one pesticide in particular today, glyphosate, because it’s become omnipresent and has particular concerns for the gut microbiome. Dr. Stephanie Seneff, glyphosate researcher and author of Toxic Legacy: How the Weedkiller Glyphosate Is Destroying Our Health and the Environment*, has proposed several hypotheses about how glyphosate may impact the gut microbiome. Glyphosate preferentially harms beneficial bacteria from the genera Lactobacillus and Bifidobacterium while allowing opportunistic pathogens like Clostridium difficile to thrive. It also impacts the shikimate pathway present in many gut bacteria, which is critical for the synthesis of aromatic amino acids (e.g., tryptophan, tyrosine and phenylalanine). Disruption of this pathway could limit these essential nutrients and affect gut health. It also may promote the formation of protective biofilms by some harmful bacteria, which can make them harder to eliminate.
Glyphosate is also a chelating agent, meaning it binds to metals, in particular, manganese and molybdenum. This can reduce the bioavailability of molybdenum, a trace element necessary for enzymes involved in detoxification (e.g., sulfite oxidase and xanthine oxidase). Molybdenum-dependent enzymes help break down sulfur compounds and purines. A deficiency might impair these processes, potentially contributing to issues like sulfite sensitivity and uric acid buildup. This is believed to be one of the issues in hydrogen sulfide SIBO, now known as intestinal sulfur overgrowth or ISO. Dr. Seneff has also postulated and found some evidence to support the fact that glyphosate, which differs only slightly from the amino acid glycine, may be substituted for glycine in the formation of proteins in plants, and then incorporated into the human body this way. Glycine is particularly important in collagen formation and is one of the three amino acids that make up glutathione, our master antioxidant and the second most abundant molecule in the body after water. And I’ve seen over and over on my clients’ organic acids tests an elevation in benzoic acid and much lower hippuric acid, which is indicative of an absence of glycine, which is used to convert benzoic to hippuric in the liver. Not to mention low glycine on amino acid tests and markers of low glutathione status. So I believe I’m seeing concrete evidence of the harm of glyphosate from non-organic food in clients.
Chronic glyphosate exposure has also been linked to anxiety, depression, Alzheimer’s, Parkinson’s, and other neurodegenerative diseases, though these links aren’t fully proven. Some studies suggest glyphosate may impact brain function and increase the risk of neurological conditions due to its potential interference with neurotransmitter function and mitochondrial health. It has also been connected to osteoporosis due to the depletion of minerals and nutrients like manganese, calcium and magnesium, and could potentially contribute to bone density loss. Finally, there is emerging evidence suggesting that glyphosate may have endocrine-disrupting effects, which could influence fertility in both men and women.
So if you’re trying to avoid glyphosate, you should know that genetically modified crops were created to resist being killed by this herbicide to allow for Round-Up, the brand name of glyphosate, to be sprayed liberally on crop fields to kill off weeds. Soybeans, corn, cotton, canola and sugar beets are crops specifically genetically modified to resist glyphosate, so if you’re eating or using those conventional products, you will be taking in glyphosate. Unfortunately, glyphosate is also used for pre-harvest desiccation (drying crops for uniform harvesting) on non-GMO crops, particularly wheat, oats, barley and sadly, lentils and pulses too like chickpeas and peas. Glyphosate is also applied in orchards and vineyards to control weeds around trees and vines. The only way to protect yourself from this exposure is to eat organic. And not just organic vegetables, but bread, grains, pastas, legumes, corn products, etc. As for vegetables, if for budget reasons you need to prioritize, choose organic from the EWG’s Dirty Dozen list and you can eat conventionally raised crops from their Clean 15 list. But be sure to check for the new lists each year.
What is superior about pasture-raised or grassfed meat and dairy?
When it comes to meat and dairy, I often think that it’s even more important to focus on the highest quality foods (than say organic vegetables) because these animal foods represent the top of the food chain, which means that all the pesticides and toxins these animals take in accumulate in their fat, which makes up part of the meat and of course the fat in dairy products. Studies have also shown that pasture-raised meat and milk contain higher concentrations of anti-inflammatory omega-3 fatty acids and CLA (conjugated linoleic acid), which is also anti-inflammatory, promotes lean muscle mass and insulin sensitivity.
Pasture-raised products are also higher in carotenoids, and antioxidants like vitamin E and have lower levels of toxic trans fats compared to grain-fed animals. And in this case, often the organic designation is a less important question, especially if you’re dealing with a small farm or a local producer who can’t afford to get organically certified, but the term to look for is pasture-raised (not to be confused with pasteurized). You may also see the term grass-fed for beef and lamb, which can be problematic because many producers will mark ground beef as grass-fed, if the animal was fed grass at any point in its life, when in fact, the cows were corn-finished, eliminating the benefits of grass feeding earlier in the animals’ lives. Corn is not a natural part of a cow’s diet, which should be primarily grass. High starch, low fiber corn leads to excessive acid production in the cows, which causes bloating, ulcers, liver abscesses and discomfort, a negative shift in the microbiome and increased methane emissions from cows. Methane is 80-85 times more effective at trapping heat in the atmosphere compared to CO₂ over a 20 year time span, so a way more potent contributor to climate change, not to mention when you have massive feedlots of cows together, they generate massive amounts of manure, which is not used to fertilize crops but rather stored in lagoons, which emit methane and can leak into water sources.
So “grass-finished” is a better term than “grass-fed”, if you have the option. Often the best way to find such products is to look online and find a local farm that delivers in your area. This usually involves having to plan ahead and get a meat delivery weekly or monthly, and recognizing that most of the cuts of meat from a grass-fed animal are not steaks, and those will be much more expensive. So plan on using a variety of cuts in your cooking. Pork can also be pasture-raised, but not grass-fed, as pigs don’t eat grass. Pasture-raised pigs are able to eat a diverse diet of plants, insects and nuts, in addition to being fed silage and grain. And they are raised more humanely, of course, exposed to sunshine and are able to forage, run, jump and root in the soil. Pasture-raised pork is higher in nutrients like vitamin D, selenium and omega-3 fatty acids, and lower in saturated fat.
And of course, chicken can be pasture-raised as well, which is especially important when buying eggs, because terms like free-range are essentially meaningless, as chickens raised indoors in giant henhouses and overstuffed with food to produce giant breasts can hardly walk, and the one-door in the entire, giant place rarely produces much of an exodus. Eggs from pasture-raised chickens contain significantly more omega-3 fats, and have higher levels of vitamins A, D and E. You can tell a truly pasture-raised egg from the color of the yolk alone, which is a much deeper orange from beta carotene, much like the darker yellow you can see in pasture-raised butter. So for your gut health, pasture-raised meat, dairy and eggs add up to better gut health and reduced inflammation, not to mention a much more humane way to raise animals.
Why is a plant-forward diet important for the gut microbiome?
Some people would argue against eating animal products at all, but I do believe that most people benefit from them nutritionally. But of course, we could all benefit from eating more plant-based proteins in the form of beans, peas, lentils, nuts, seeds, quinoa and oats, which also offer the benefit of an increased amount of fiber, which is essential for producing short chain fatty acids and having optimal colon health. I recommend ¼ to ½ cups of legumes a day for optimal gut health. Plant-based proteins are also less associated with pro-inflammatory pathways compared to diets high in processed foods and animal-derived foods. Finally, plant-based proteins are linked to a lower risk of chronic diseases, such as type 2 diabetes, obesity and certain cancers, due to their lower saturated fat content and higher fiber content. Despite all of this, be sure to check the ingredients in your plant-based proteins to ensure they don’t contain UPFs or other harmful additives that may counteract their beneficial effects. Many meat substitutes are just processed soy products raised with heavy pesticides and filled with unhealthy additives.
Eating plant-based and animal-based proteins, if you’re able to, is a great way to optimize your gut’s functionality and your protein and nutrition intake. Combining plant and animal proteins is a great way to get a more complete mix of amino acids. Plant proteins often miss some essential amino acids that animal proteins have in abundance, so pairing them together helps fill in the gaps.
Are all processed foods bad for you?
It’s important to note that most foods are processed in some way. Most foods are put through machinery to be sorted and packaged. However, not all processed foods are bad for you. One such example is fermented foods. Fermentation is technically a form of processing food, but these foods, such as yogurt, kimchi and sauerkraut, can bolster your gut’s microbiome. Just check the additives, as many yogurts contain additives such as gums and thickeners, lots of added sugar and more and more, harmful artificial sweeteners. But overall, consuming fermented foods produces bioactive peptides, biogenic amines, and other metabolites like short-chain fatty acids, which are associated with improved digestion and reduced inflammation.
Since all packaged foods are processed in some ways, sometimes it is difficult to discern between Ultra Processed Foods and less processed foods as there is no clear indication on most product packaging. Instead, you can look at the ingredient list for some of the chemical compounds that I’ve mentioned today, unfamiliar chemical names [but be careful you aren’t confusing nutrient names like ascorbic acid (vitamin C), retinol (vitamin A), tocopherol (vitamin E), calciferol (vitamin D) or thiamine hydrochloride (vitamin B1) for chemicals. You can also look foods up in the Environmental Working Group database of food scores. But in general, less processed foods don’t include chemical additives or inorganic compounds; they are much easier to digest and absorb nutrients from, compared to UPFs and fast food. Eating fast food every once in a while when you’re in a bind and need a quick bite will not destroy your gut microbiome. However, eating it regularly will impact your gut’s functionality in the long term.
Some people find that meal prepping on the weekends makes it easier to eat healthy during the week. And I’ve gotten into the habit of soaking beans overnight even if I have no specific plans for them, then popping them into my instapot with some chicken bouillon and spices and sometimes vegetables and making a quick soup or beans to throw on salads or for a small fiber and protein-rich main or side dish. An adequate intake of fiber for men is 30-38 grams a day and for women is 21-25 grams, and that’s hard to reach without including legumes in your diet.
Well, my goal in this podcast was to convince you that it’s worth it to switch to organic, pasture-raised and minimally-processed foods. I hope I achieved that goal by giving you some specific details about the impacts of these foods on your digestive system and body. If cooking is a big challenge for you, you might try looking into some of the organic meal services that offer pre-made cooking kits.
If you’re dealing with gut health issues of any type and need some help, I see individual clients to help them resolve their digestive issues and you’re welcome to set up a free, 30-minute breakthrough session to see if you’d like to work with me. I also have my own two products, Tributyrin-Max, which is particularly helpful for loose stool and diarrhea as it slows your motility and firms up your stool, and SBI powder, which is an all around gut pathogen binder, which is super safe and won’t harm beneficial bacteria, and is usually the first line of treatment I educate my clients about in order to avoid stronger antimicrobial herbs.
*Product and dispensary links are affiliate links for which I’ll receive a commission. Thanks for your support of the podcast by using these links. As an Amazon Associate, I earn from qualifying purchases.
Adapted from episode 136 of The Perfect Stool podcast with Vincent Pedre, MD, Board-Certified Internist in private practice in New York City, Medical Director of Pedre Integrative Health and President of Dr. Pedre Wellness, and Lindsey Parsons, EdD, and edited for readability.
Lindsey:
So today we’re going to be focusing on difficult cases of reflux and gastritis. So can we start by just getting definitions of what those two conditions are and what symptoms you might have if you have either or both?
Dr. Vincent Pedre:
Yeah, a lot of times they can overlap in terms of symptoms, but someone who has acid reflux, technically, is having some acid from the stomach coming up through the lower esophageal sphincter, which is the little muscle that closes the esophagus when you swallow, to make sure that acid doesn’t come up. And the acid is somehow making its way up into the esophagus, and that usually causes that sensation that people get of heartburn, usually here in the chest, but sometimes they’ll feel it in the throat too. They may wake up in the middle of the morning or the next day and feel like they’ve got some acid in their throat, or they might actually have a little bit of a hoarse voice from acid refluxing back and getting onto their vocal cords. Or they might actually wake up with some mucus in the morning, and all these could be signs of acid reflux.
Obviously, sometimes, you know, in the body, there are symptoms that tend to converge together. So having throat symptoms could also be post-nasal drip. You always have to be thinking that things could be coming from different directions, and gastritis is basically an inflammation of the lining of the stomach, which can come from a variety of reasons. A lot of times it can be, actually, deficiency of certain micronutrients, like zinc and l-carnosine that are necessary for the health of the stomach lining, not enough mucus production, and unfortunately, a lot of times, I think we’ll get into this, these issues are treated with acid lowering medications like PPIs. Now, the difference with gastritis is that you won’t get the heartburn symptoms, but you may get some feelings of upset stomach, sour stomach, maybe food doesn’t sit well in the stomach. A lot of people will have chronic gastritis and probably not know that they have it, and it’s usually an incidental finding on an endoscopy or an imaging study where they look down through your esophagus with a camera and a tube and take pictures of the stomach. So a lot of times it will be found, but the person isn’t necessarily aware that they have gastritis.
Lindsey:
I’ve also had clients, though, who have real, burning sensations in their stomach.
Dr. Vincent Pedre:
Yeah, which could be an ulcer, or could also be a symptom of gastritis, as well.
Lindsey:
Yeah. And obviously an ulcer is pretty serious. So what would alert someone that they have maybe an ulcer and they should be getting some immediate medical attention?
Dr. Vincent Pedre:
Sometimes it’s just the degree of the symptom, the severity of the symptom, the time course of how the symptom changes over time. Usually, an ulcer, if you’re not doing anything to make it better, it’s going to continue to get worse and worse. It’s going to get more and more intense over time, whereas usually gastritis kind of lingers in the background. It doesn’t necessarily get really, really sharp in the way that an ulcer can get. And then you also want to look at other behaviors, like, did the person recently hurt their ankle, or something like that, and they’re taking over the counter ibuprofen, and they thought that it was safe, and it was okay to take without a prescription. And then two weeks in, they start getting stomach pains, and they’re not sure, well, why am I having stomach pains now?
Lindsey:
Yeah, I had that happen. I had terrible sciatica, and really, there was nothing that would manage it except ibuprofen. And it got to the point where I was like, I’m giving myself an ulcer; that has to stop. I’m going to have to figure out what else to do.
Dr. Vincent Pedre:
Yeah, people have to be really careful with that. And you have to also be really careful because you might be taking ibuprofen. And then, because all of these medications are available over the counter, you start feeling some stomach pain. So now you go and get an over the counter anti-acid medication, whether it’s Pepcid or some sort of PPI that are now available over the counter, and you’re self-treating, but without really knowing what’s going on underneath, and you’ve got to make sure that you’re stopping what is causing the underlying problem, which in that case is, could be Naprosyn, could be ibuprofen, could be any of the NSAIDs.
Lindsey:
Right. Yeah. So for me, you know, as a gut health coach and someone who deals with gut health issues, there are some obvious reasons for reflux and gastritis, like SIBO, which would normally be accompanied by bloating or loose stool, diarrhea, constipation; and then H. pylori, which is easy enough to test for and correct. But I also have a number of clients who either have relatively low levels of H. pylori, so like on a PCR test, it shows below reference ranges by a good degree. You know, it’s something to the second power versus to the third power, which is the reference range (one to the third).
Dr. Vincent Pedre:
I’m even skeptical about those reference ranges when-
Lindsey:
oh, okay
Dr. Vincent Pedre:
-it comes to H. pylori, I think that we have to be really careful with the H. pylori test in some of these PCR tests, and-
Lindsey:
you think like over killing it? or under-killing it?
Dr. Vincent Pedre:
I think we’re over diagnosing, and we may be over treating H. pylori. H. Pylori is very controversial, because it does exist in certain individuals without causing any symptoms.
Lindsey:
Right, right.
Dr. Vincent Pedre:
It doesn’t cause gastritis; it doesn’t lead to ulcers. And the question is, in a patient that might show up with H. pylori, do you still treat them for H. pylori, meaning, you’re putting them under a regimen that’s going to take time, effort, it’s going to affect quality of life, it’s going to add some extra stress, or do you just leave it be? And I think I’m very careful with some of these PCR tests saying that “you’re out of range” with H. pylori, I always want to go back to the patient first. What symptoms are they having? Does it correlate with H. pylori? And I like to do a test to determine whether they do actually have active H. pylori infection with either the stool antigen or a breath test.
Lindsey:
Mhm.
Dr. Vincent Pedre:
So I think it’s important when it comes to H. pylori, I think the decision tree has to be a bit more careful than just using a tool like the GI map, for example.
Lindsey:
Right, right. What I was getting at, though, was that you might have somebody who doesn’t seem to show, what I would believe, is a problematic H. pylori, because the reference range is low, there’s no virulence factors, or their H. pylori isn’t even existent, but they still have that burning and the gastritis in the stomach. So what reasons, beyond SIBO and H. pylori, might there be for that? I guess we’ve talked through ibuprofen use or NSAID use. What other possible reasons are there for the reflux or gastritis?
Dr. Vincent Pedre:
Yeah, we have to think, first of all, of hypochlorhydria, so inadequate production of stomach acid, which could be in conjunction with gastritis or just loss of the mucus barrier, not enough production of the mucus as well as hydrogen, which is dependent on zinc. So that’s why zinc l-carnosine becomes a very important nutrient in treating these patients, because a lot of them are actually zinc deficient, and that’s partly why they’re having these symptoms. When you have low stomach acid, it can do the opposite of what you would think. So you’re wondering, well, if someone has low stomach acid, why are they going to get reflux or heartburn? That doesn’t make a lot of sense. The issue is that when you have less acid production in the stomach, food isn’t going to break down so easily, and as your body detects that, it’s trying to break that food down by producing more gastric juice, but that gastric juice maybe is at a higher pH, it doesn’t have both the strength and also the proper pH for the proteases to work at their best, most efficient. And as your stomach fills up, it’s very likely that some of that gastric juice is going to spill up into the esophagus and give that heartburn sensation.
It also can be dependent on when the person is eating. It’s so, so important to ask our patients, what time are you eating dinner? Especially, how long after dinner do you lie down? So it’s not good to lie down – regardless of what’s going on in the stomach – within a few minutes of eating or eat dinner and then an hour later go to bed because digestion isn’t finished, there’s still food in the stomach. It’s very likely that, even if you don’t have low stomach acid, you don’t have a propensity to reflux, just by the pressure of the food and lying back with gravity, you’re going to get some reflux symptoms.
Lindsey:
And what would cause the loss of the mucous barrier? Is that zinc deficiency, or are there other reasons for that?
Dr. Vincent Pedre:
It partly can be zinc. We see it also with H. pylori infection; the barrier starts to break down, and then it becomes easy for the lining to become inflamed or even eroded and lead to an ulcer. More rarely, this would be a very rare case, where you’re getting bile reflux into the stomach, and that could also cause these heartburn-like symptoms, you know, where people feel like they might have an ulcer, they have gastritis, but it’s actually bile moving in the wrong direction.
Lindsey:
Yeah, so we’ve talked a little bit about causes for reflux that were not, sort of, the obvious couple things. What about causes for gastritis that beyond the obvious?
Dr. Vincent Pedre:
I think going back to nutrient deficiencies, you have to think about, basically, doing a very comprehensive look at the person’s micronutrient profile as well as their ability to heal. So things like vitamin C, other nutrients that are very important for healing, like I said, zinc, even thyroid function, like, if a person is slow healing, thinking about do they have hypothyroidism? And also, let’s say, a less obvious one is going to be vagal nerve dysfunction, which really comes from stress. So people are walking around stressed and in fight or flight, which shuts down the vagus nerve. The vagus nerve is also needed, very important, to signal and trigger gastric acid production, as well as protection of the lining with mucus, as well as the production of digestive enzymes. So if we lose vagal tone, that also increases the risk for these things, as well as dysbiosis, although it’s not as important in the stomach, the stomach is not a very microbiome-rich environment like the large intestine and the small bowel, with the large intestine being the biggest reservoir for the microbiome.
Lindsey:
Yeah, and so what can people do to restore their vagus nerve function?
Dr. Vincent Pedre:
Oh, I love this! One of my favorite, favorite things to talk about. I mean, first of all, it’s about really making space for mindfulness and for relaxation. Just breath work, bringing up the diaphragm, doing deep diaphragmatic breathing, is super important. Most people, when I ask them to take a deep breath, they’re breathing up here, you know, so, and I’m sure if you see your clients, you ask them to take a deep breath, they probably go like this. They’re breathing all up here, but they’re not really breathing down here with the diaphragm. And that’s a huge problem for a lot of people, and people don’t realize that stress actually causes them to constrict their belly, even just the rib cage gets constricted. And sometimes you have to go in and massage the edges of the diaphragm to kind of loosen up some of the fascia so that you can then get an easier, deeper breath, even just by massaging here and up and down the rib cage and even around here, because the neck gets so tight from people clenching their jaw at night. So many of my patients, I see that they’re clenchers; you can see the bottom incisors are worn away. They have neck pain, but it’s coming from the fact that they’re clenching their jaw. So, even just loosening the jaw, loosening some of the neck muscles, opening this up, just massaging along the edge of the diaphragm, so you can take a really deep breath, because then those stretch receptors in the lungs are going to then stimulate activation of the ventral vagus nerve.
We can do it other ways too, because the vagus comes here down on either side of the vocal cords, so things like singing, gargling, humming, all of these things are really good for activating that vagus nerve and calming the body. But we also know that having a balanced gut microbiome also helps to activate the vagus nerve and that interface, because the vagus enervates the entire intestine, and part of the way that the vagus is sending signals back to the brain is through serotonin receptors. And if you have a disordered gut microbiome, you’re not going to get as much serotonin production. If your gut lining is disturbed, then the enteroendocrine cells, which are sparsely, they’re almost like stars in the night sky; they’re interspersed all over the intestine, and they’re also producing serotonin and helping to stimulate the vagus nerve. But if this is the disorder, then that’s also going to affect vagal tone, and then that has a downstream effect on the entire gut. I think it’s one of the most important issues that we need to never forget to address in our patients, because we can get so lost on the mechanics, and supplements, diet and forget the critical importance of the vagus nerve.
Lindsey:
Yeah, yeah, I’ve been doing breathwork every night for the last, I don’t know, three or four months with my husband and he mentioned that since we’ve been doing it, he’s taking much deeper breaths; that before he was breathing very shallowly. I’m sure that all upper chest kind of breathing, and I was excited to hear about that.
Dr. Vincent Pedre:
Yeah, it keeps you more in that fight or flight response. It’s almost like people are wearing an armor, like if you’re stressed, you don’t even realize it. It’s subconscious. But you put on this armor, and the armor is in the form of you bringing your chest wall in, and you take shallower breaths. I always think of it, like I tell a patient, imagine walking out into a field, a big green field in the countryside, where the views are all the way to the horizon, and imagine what it is to take a breath there. You know, you feel this expansiveness. It’s easier to take a deep breath, because you feel more space and you don’t feel attacked by being in a city, or even just by the stress that you carry with you at all times.
So what about Crohn’s disease? Could that manifest in the stomach or the esophagus?
Crohn’s is a systemic disease that is not limited only to the intestines. It’s actually an autoimmune disease that can even be manifest in the eyes, for example.
Lindsey:
So people who are having extreme pain in their stomach or esophagus and don’t seem to have all these other things could, it could be Crohn’s.
Dr. Vincent Pedre:
I mean, it would be rare, because you’re always going to have Crohn’s also in the intestines, in the small intestine and possibly the large intestine. So it would be, it would have to be a really extreme case where it’s spread that far. But most of the time it’s more- you’ll find it more in the small intestine or large intestine. And again, it’s one of those things, you know, we give it a name, but the name doesn’t really say what the true underlying cause is.
Lindsey:
Right, right. Okay, so I have a couple of clients whose gastritis is so bad that they came to me already having been on very extreme low acid diets, and/or they’ve already been on PPIs long term. So, I’m wondering if there’s ever the case for those kind of diets, or is it more about finding out the root cause of the issue and then correcting it?
Dr. Vincent Pedre:
Well, I’m always going to say it’s about finding the root cause. And yeah, I mean, if your house is on fire, you don’t want to throw more wood into the house. So if things are really on fire in your in your stomach, you have to be really careful about eating the the big triggers like chocolate, mint, fried foods, acidic juices, tomato sauces, wine, all those things are going to be big triggers. But what I found is that, in contrast to the Western medical model, where we would take that person and we would just say, Well, you have these symptoms, here, take this medication, and now you can drink your wine, now you can eat these foods, they won’t bother you anymore, but the minute they stop the medication, those foods are going to bother them. And what I found is that, when you work on the root cause, the things that we’ve been talking about, like improving gastric acid production, improving the mucus layer, using different things like leaky gut formulas, formulas that have zinc carnosine, slippery elm bark, marshmallow root extract, all these things that help to heal and seal the gut lining, and change the behavior, make sure they’re eating meals properly at the right time of day, not eating too late at night.
As you heal the root cause, the person then can start eating more “normally”, and can actually enjoy things that they were not able to enjoy, because now you’ve healed the gut. So maybe if they want to have that glass of wine once a week out with their friends, they can do it, and now they’re not going to pay the price in the same way. So I think it takes a little bit more work to unravel the root cause, and it takes a bit of introspection, looking at self, looking at behaviors, looking at how the person is holding stress, and even today, looking at dietary patterns. So today, I had a patient who suffers from intermittent reflux, and she was having dinner, but then having a big bowl of fruit right after she had just finished eating dinner. And having fruit right after having a big meal with protein, the fruit is going to sit there and it’s going to start fermenting and it’s going to produce gas, and very likely, it’s going to cause some burping and reflux. So sometimes you have to tease out the little behaviors that just require repositioning, like, okay, let’s not eat fruit right after finishing dinner, especially fruits that tend to ferment, like watermelon, not a good idea.
Lindsey:
Yeah. So with a lot of clients, when I’m doing their initial intake, they seem hesitant to admit they drink coffee like they think I’m immediately going to say, you need to give up that coffee. And I’m kind of agnostic on coffee, honestly.
Dr. Vincent Pedre:
People hold on to their coffee.
Oh yeah, exactly. But I mean, I’m agnostic about it, because I know it’s got some health benefits, and I know it’s a good bitter which promotes bile flow. But I’m not, personally, a coffee drinker, because I just don’t like the taste, although I love the smell. So is coffee a healthy food, and is it a possible contributing factor to reflex or gastritis?
It can be both. I’m going to say for someone who’s whose house is on fire, coffee can add a bit of fire to that house, especially if the coffee is more bitter, if it’s more acidic, if it’s got a high level of caffeine, all of that can be a trigger for more potential reflux. And also it’s depending on how the person has the coffee and whether it’s being drunk on an empty stomach, if they already have some food in the stomach. So there’s always mitigating factors that make things a bit confusing for people, because they think, well, one time I drink it, I’m fine, another time I drink it, I’m not fine. And, really, it has to do with the individual circumstances that surround every behavior and how you do things. So I’m always getting very granular on, what did you do in that moment? You know? Was it on an empty stomach? Had you eaten something else? I think it’s very important.
But the thing to know is that a good coffee that’s free of toxins, free of pesticides, free of mycotoxins, that has polyphenols or antioxidants like chlorogenic acid, coffee has a lot of potential health benefits, not just for the gut microbiome, but also for the gut-brain access and for brain function. So there’s a lot of really great benefits for coffee. And I think the truth is the majority of the world drinks coffee every day. I think it’s like a billion cups of coffee are served every single day, and at least 130 million American adults drink a cup of coffee every single day. So it’s a habit that’s not going away. It’s just the habit that we need to look at. Well, what are the other things that surround it that could also make it more unhealthy or healthier?
Lindsey:
Yeah, yeah. I know there was the big craze around keto coffee with MCT oil and all that stuff for a while. I don’t know if people are still doing that. My sister got into this pouring heavy cream into her coffee. And you know, we have family hypercholesteremia, like, listen, you were doing a keto diet, and the heavy cream might have been okay, but you’re now eating carbs. You can’t keep pouring like half a cup of heavy cream into your coffee and be eating all the carbs, like it’s one or the other.
Dr. Vincent Pedre:
Yeah, no, because then the carbs are going to turn on the inflammation, you know, and then it can make your cholesterol inflammatory. It’s really the carbs and the sugar and all that. Yeah, that was a big craze for a while. I’m trying to think of, like, how to, you know, there was the Bulletproof Coffee craze, right? Like, how to come up with another version of that. I mean, I know I have my Happy Gut Coffee (10% off with code perfectstool10), but calling it Happy Gut Coffee and having some other recipe or something that makes it gut friendly,
Lindsey:
Yeah. What do you like to do? Do you drink your coffee black, or you like something in it?
Dr. Vincent Pedre:
It depends on what coffee. I can definitely drink my Happy Gut Coffee black and, because it’s a dark roast and it’s very low acid and it has no bitterness, I actually like to add for my gut health, I tend to put in my coffee SBIs, Serum-Derived Bovine Immunoglobulins. So I put SBI powder, and then I also add some collagen peptides into the coffee, and then I may or may not add some almond milk as well. Always dairy-free.
Lindsey:
Okay, so how did you get the bitterness out of your coffee? I’m wondering.
Dr. Vincent Pedre:
It’s just what happens with the roasting process. You want to make sure that-
Lindsey:
The lighter roast? You said, No, it’s a dark roast.
Dr. Vincent Pedre:
When the beans are roasted, you have to make sure that they don’t get burnt. They have to be roasted exactly to perfection. That lowers the bitterness, lowers the acidity. It actually makes it a little bit lower caffeine as well. So for someone like me, who is actually a slow caffeine metabolizer, so I can’t drink a cup of coffee in the afternoon and have a good rest that night. It’s going to affect my sleep. But for someone like me, that’s a slow metabolizer, and usually I avoid drinking coffee, my Happy Gut Coffee does not cause that jitteriness that I get with some other coffees. And I think probably it’s a combination of things. It’s free of the toxins, no mycotoxins, no pesticides. And I think just being a much cleaner bean has a different effect.
Lindsey:
Okay, well, new, unrelated topic, but one I know that you have some expertise on. There’s been a lot of info in the news lately about not just microplastics, but now nanoplastics. That makes me feel like they’re impossible to avoid unless I grow all my own food and live in a cave. So how do these micro and nano plastics affect the gut, do we really know, and how can we avoid them?
Dr. Vincent Pedre:
This is a scary thing, right? Because when you go to the supermarket, a huge majority of the foods are stored with plastic, right? They’re in plastic containers. They have plastic wrap over them, and we’ve been doing this for ages. Well, maybe not for ages, because I feel like this has become more prominent since the late 70s into the 80s, having food convenience. And the thing is that these microplastics get everywhere, and we’re starting to find that they can actually accumulate in the gut, and not that this is a cause and effect, but there was a study that showed that people who had inflammatory bowel disease had higher concentrations of microplastics in their gut.
Now, association is not necessarily saying that one thing caused the other, but it does start to beg the question, is there some relationship between inflammatory bowel disease, when there’s no other obvious cause, and exposure to microplastics, from plastic water bottles, from plastic food storage, from, I mean, people who used to heat up easy meals in the microwave that come in plastic containers, not thinking about how the micro plastics get into the food. And we know that studies, for example, there was a study done on zebrafish that showed that microplastics cause changes in their gut microbiome, and the change was towards more harmful bacteria, bacteria that cause inflammation and actually also reduced mucus secretion, which is part of what protects the lining of the entire intestine is the mucus layer. It’s very, very thin, but it’s super important to keep the bacteria and other harmful substances away from the lining of the stomach. So we also know from another study in mice that microplastics were connected with increased body weight and changes in their lipid profile, and also cause elevation in liver enzymes.
So microplastics are doing something. And, I think if we try to think that they’re not, and just think, like, this is just way out there. Like, I mean, when I went to medical school, we weren’t talking about plastics. We didn’t talk about how plastics could have a connection with autoimmunity, like dysregulation of the immune system, Bisphenol A, no one was talking about that. And now here, suddenly we have to think about nanoplastics, like all these microplastics that are getting everywhere, and all the plastic in the ocean, the plastic that’s getting into fish. And it can get a little bit overwhelming, right? Like, yeah, what do we do?
And then the other place that’s worrisome, and partly why I’m trying to get people to almost step back in time and make coffee in a more traditional way, whether it’s a French press or doing a pour over with a filter, instead of those easy pods where you wake up and you can just flip the switch, and then your coffee is done in a few seconds, but that hot water is going through the pod that’s lined with plastic, and now you’re getting micro plastics in your coffee and drinking that, or when you go and you pick up your coffee to go from any place, they’re giving you, not a Styrofoam cup, but a cardboard cup, but the inside is often lined with plastic. So when it touches that hot water, you’re getting microplastics into your body. And I think the research now, what it’s showing us, is that we can’t ignore this. As if we needed another problem to pay attention to; another mitigator of disease for humanity. Because this one actually, when I wrote this article on my blog post on Happy Gut Life, I was really depressed by the end of it, because I thought, okay, but what do we do?
Lindsey:
Yeah.
Dr. Vincent Pedre:
Like, is humanity doomed at this point? Are we too far into plastics that there is no way back? And I know there are things – look, you can’t easily change what’s happening at the macro level, but you can make choices on how you choose to live at your level, like even just making sure that you’re drinking from a glass container, not from a plastic water bottle, or not using the convenience of plastic water bottles at the office instead of drinking filtered water that you bring from home. A lot of people do that. Or, just going to the farmers market with your own big fabric tote bag, and you put all the vegetables in there without using any plastic, so that you’re avoiding that contact with plastic. You know there, are choices that we can make every day as individuals that could help us avoid some of these exposure to plastics, and even just like thinking about the type of clothes that you buy because there’s polyamide and clothes that’s also plastic that’s used in textiles, or even filtering the air to make sure that microplastics that might be found floating in the air that you breathe are getting filtered out, making sure you’re drinking clean water. This is the-
Lindsey:
Let me stop you there, because the water is like the one that I’m sort of like, ah, what to do about this? Because I’ve got, like, the best water filter you can have in the fridge, right? Like, I’ve got this Zero Water, and it filters almost everything out, but it’s a plastic bottle that it’s sitting in! Now, I know it’s not the worst kind of plastic bottle. I assume it’s the better kind of plastic bottle, but it’s still in the plastic bottle. So it’s like, did I screw up? Do I need to go out and get a glass one? I don’t even know if they sell such things!
Dr. Vincent Pedre:
Or acrylic. That might be safer. Um, yeah, no, I agree.
Lindsey:
I don’t actually know what the substance is.
Dr. Vincent Pedre:
I agree that it’s overwhelming. You know what we do. The thing to note, though, is that it’s extremes of temperature that’s going to extract the plastics more or any sort of mechanical effect. So technically, the plastics going to, more likely, leach microplastics from big temperature changes or from being exposed to heat. So even just not exposing it to heat. That’s what’s so scary to me about plastic water bottles, because you don’t know how many temperature changes they’ve gone through as they’ve been transported from the source to where they’re finally sitting at the store. They’ve probably been in the hot truck somewhere at some point, and that heat makes them leach plastic into the water.
Lindsey:
Yeah, yeah, I stopped using those. The only one that I was using was I was getting Fiji water, because I know that that chelates aluminum, and so I was using that. And I’m just like, forget it. I’m not doing that anymore, unless I find some aluminum in my urine or blood or, you know, I’m not goofing around anymore because I had no aluminum. I was good. And I stopped. I guess the other thing I’ve done is I went out and I bought tons of those glass containers because it kept being, like, there was still some plastic in the cupboard, and we’d still end up using it because we just didn’t quite have enough of the glass ones. I just bought, like, reams of glass containers.
Dr. Vincent Pedre:
Meaning, that’s for food storage, right? Like making sure to store your food in glass containers. Because, I mean, the the scary thing about the study is that the plastic, the microplastics, accumulate in the gut, and then they don’t really have a place to go, you know? So you wonder if it’s another underlying root cause that we’re not paying attention to when it comes to inflammatory bowel diseases like Crohn’s and Ulcerative Colitis. Obviously, there’s- in things like that- there’s always multiple root causes, and you have to look at the additive sum of different things and control the factors that you can control and otherwise do your best.
Lindsey:
Yeah, yeah. The other thing I stopped doing is, like, even the plastic bags. I always tried to be good for the planet and wash out my plastic bags and reuse them. And now I’m just, like, not so much, like, one or two uses, and then it’s going to go in the garbage. Like, I’m not going to keep beating these things to death because, inevitably, you have to store some things in plastic bags. Like, you can’t fit a leftover loaf of bread in a glass container. So, you know, there’s some inevitable uses of plastic, I think. Any nuggets of wisdom for people who don’t have terrible gut health, meaning no huge issues, maybe occasionally they have a loose stool, occasionally they’re constipated, occasional indigestion if they’ve eaten the wrong thing, but normally they’re pretty good. Like, what’s a good gut health plan for the average person?
Dr. Vincent Pedre:
Let’s start with the – I mean, this is even just for general health purposes – everyone can always avoid processed foods. Try to avoid excess exposure to seed oils, inflammatory oils, which are not good for the gut. Try to avoid exposure to genetically modified foods, those can be problematic for the gut. Try to avoid excessive exposure to foods that have high levels of pesticides. You can look at the Environmental Working Group website, and I actually included the chart in my last book, the Gut Smart Protocol*. So look at the Dirty Dozen and the Clean 15. Those are the lists of foods that have the highest amount of pesticides and the ones that have the least amount of pesticides. So if you’re like everybody nowadays, you know; food costs have gone up; you want to be on a budget with your food, but you also want to be healthy; buy organic any of the foods that are in the Dirty Dozen, and you can be a little more lenient with not having to be strictly organic with the foods that are in the Clean 15; that at least allows you to spread your food dollars wisely, and then, of course-
Lindsey:
-You’ve got check that each year, because they change, like sometimes like, bottom goes to the top, or vice versa.
Dr. Vincent Pedre:
Yeah, exactly. Every year you have to go to the website and see what their updated list is, and then sugar. Sugar is a big one. We know that sugar is one of the leading causes of disease, chronic disease, not just of the gut, but metabolic insulin resistance, diabetes, heart disease, all of that is connected to excessive exposure to sugar. So lowering your sugar intake in whatever ways you can. Not just obvious sugar, like cane sugar, like desserts, but also hidden sugars in drinks, or, like, putting syrups and things, like if you go get a fancy coffee. Or, also, eating too many refined carbohydrates. So even just starting at that level and eating more whole foods in general, that can be very helpful. I have varying opinions on whether people with, well, I guess we can talk about people with more severe gut issues. So that would be a different question.
Lindsey:
Okay, well that seems like a good plan for pretty much everybody. And what’s a good gut plan for people who feel like they may be inflamed or have markers of inflammation, maybe not that they have gut symptoms, but they have like, elevated hsCRP, or maybe appear to be at the beginning of autoimmunity, but no obvious gut health issues.
Dr. Vincent Pedre:
Yeah, and these people – I would still, in a person like that, take them and do stool PCR testing and look for inflammatory markers, because even if the person doesn’t have gut symptoms, if they’re already showing up with some signs of autoimmunity, it’s very possible that they’re already brewing some imbalances, dysbiosis, maybe some harmful back gut bacteria. They might have parasites, they might have Blastocystis, they might have yeast overgrowth. I’ve seen that in people that actually report no symptoms whatsoever in their gut. So I think that’s a very important myth to dispel, is that in order to have a gut issue, you have to have gut symptoms. You could be walking around feeling like everything is fine here, and yet actually have some pretty big imbalances in there that, maybe because you’re not so aware of it.
It could be that you’re distracted by symptoms in other parts of your body that you don’t realize what’s going on there, and then, depending on what’s happening in the gut, my diet plans could range from the extreme of actually putting someone on a very close to carnivore-like diet to be able to lower inflammation, heal the gut. Especially if they’ve got a lot of issues with digestion or low digestive function, not enough enzymes, it’s going to be very hard to break down a lot of vegetable proteins. Or having them, if they want to have vegetables, but no raw just cooked. Thinking like this is an intermediate diet for someone whose gut is not quite ready to have raw foods yet, when they eat a salad, they feel horrible, they feel really sick. That shows that there’s a lot of gut dysfunction happening. So for someone like that, making sure that their Omega three levels are optimized, whether it’s through supplementation, through eating Omega-3 rich foods. For me, the preference would be wild salmon or sardines. Like those types of Omega-3s are just much more bioavailable, much more readily used by the body than plant sources. And the plant sources can be harsh on the gut for some people. It’s always a hard conversation with people who are more plant-focused to get them to see that sometimes too many plants could actually be harmful to the gut.
Lindsey:
Yeah, no. It’s funny because I was more of, like, philosophically, more of a kind of paleo person. I can’t say that’s how I eat, because I don’t have the self-control to not eat other grains, and I don’t seem to have the need to be that strict for my health. But I see people who have high beta glucuronidase, and I’m like, I’m sorry, you’re going to have to eat like, a vegetarian diet for a while, or they have, like, hydrogen sulfide SIBO and I’m like, yeah, you need to go off meat completely. And then I have other people who are, you know, already vegetarians or vegans, and they’ve got methane, high methane, you know, and IMO, and I’m like, I’m sorry, you’re going to have to start, like, eating some meat, because I don’t know how you’re going to get protein without constipating yourself. So, I mean, now I’m just completely agnostic about diet. I’m like, it depends on what’s going on in their gut completely.
Dr. Vincent Pedre:
Yeah, I totally agree with that. And then, obviously, matching it with, and sort of meeting somewhere in the middle with the person’s food preferences, right?
Lindsey:
Of course, and inevitably that comes to bear.
Dr. Vincent Pedre:
Yeah, because you might think that for a vegan, the best diet would actually be a meat-eating diet, but they’re not ready to make that jump and it would be, like, the worst thing for them, psychologically, mentally, it might create a lot of stress, but I try to meet people like that halfway and see like, Okay, well, if we’re not going to get to meat, could we compromise with fish? Or is there one meat that you would be okay with eating, because oftentimes it does make the gut better.
Lindsey:
Yeah.
Dr. Vincent Pedre:
Yeah, and I actually had a patient like that last week who was eating a lot of substitute vegetable proteins-
Lindsey:
Oh yeah.
Dr. Vincent Pedre:
-to be able to, you know, to be able to get enough protein in her diet, but she was using one, one was like a mushroom protein, like chicken substitute, but it did have wheat and gluten in it. And then the other one that she was eating a lot of was seitan. She was having incredible gut pain, bloating, distension, constipation, and I just think, like when you’re making- if you’ve ever seen somebody make bread and you stretch it, that gluten is what makes the bread so sticky and gives bread that consistency. But now you’re eating that concentrated in a vegetable protein substitute, and all of that stuff forms this big sticky mass in your intestines. It’s very hard for it to move, for you to poop it out. Your body doesn’t have the enzyme strength to break it down, so it can cause a lot of gut disruption for people, but it’s hard convincing someone who is either was raised vegetarian or philosophically vegetarian that, look, eating some meat is actually going to make your gut better.
Lindsey:
Yeah, yeah, yeah. And sometimes you have to get in there and do that amino acid profile and show them they’re protein deficient and that they really have to figure that out. And maybe it’s a lot of protein powders at the end of the day, if that’s what they’re willing to do, but-
Dr. Vincent Pedre:
Even that can be problematic. I’ve had people have reactions to pea protein as well, which is one of the biggest ones used in these vegan protein powders. So, I will say it’s rare, but I’ve seen it enough to note that, okay, we can’t say that one protein powder is perfect for everyone, even pea protein, which is supposed to be hypoallergenic, some people may react to it. Now, if you’re listening to this and you react to a protein powder, you also have to think you’ve got some work to do on your gut. If you’re reacting to protein, that means maybe your stomach acid is low, you’re not breaking down protein enough. Maybe you have pancreatic insufficiency. You’ve got leaky gut. So there’s other work that needs to be done.
Lindsey:
Yeah, and I will tell you, because I just got some pea protein powder myself, that it tastes like peas. It’s not great in a smoothie. Like, I’ve discovered that. I’m sure there’s more combined ones that are better, which is probably- But the added artificial sweeteners are so repulsive, like the added monk fruit, I’m just like, blech I can’t take it.
Dr. Vincent Pedre:
That’s the other issue with them. I did find, when I was working with a company and we were developing a protein powder, and we wanted a vegan protein powder, but we were looking for flavor, texture, consistency. We were experimenting with chickpea protein. But the thing is, with chickpea protein, if you ever made a chickpea pasta-
Lindsey:
I have.
Dr. Vincent Pedre:
So when you make the chickpea pasta, after it sits for a while, it starts to stick together. It’s very, very sticky. Same thing happens with the chickpea protein in a smoothie. It starts to all congeal together. So we had actually figured out a combination of pea and chickpea protein, where, with the right ratio, the chickpea gave the smoothie a creamy texture, while not using only chickpea protein allowed it to have a smooth consistency and not congeal and get really sticky or almost like pudding.
Lindsey:
And did you have a protein powder in your Happy Gut line?
Dr. Vincent Pedre:
We do have ones that have pea protein. It is a micronized pea protein, so it’s broken down. It’s much easier to digest. But we don’t have one that mixes in the chickpea protein, just because of, still, the complications with figuring out the right ratio of the chickpea protein, and still, look, the pea protein, by and large, is tolerated by the majority of people. I think there’s like 2 to 5% of people that come back and they say that they have some sort of reaction to the pea protein.
Lindsey:
Yeah. Okay. Well, anyway, that was all interesting stuff. So, where can people find you and your coffee and your other happy gut products? And I know there’s also a discount code for my listeners.
Dr. Vincent Pedre:
Yes, they can go to happygutcoffee.com and that’ll take them to the website. They can check out the clean, Dark Roast that’s toxin free, low acid, and I like to say never bitter, because it is quite smooth. And everybody’s going to have a discount code for 10% off the store by using the code perfectstool10.
Lindsey:
Okay, awesome! Appreciate that. Any parting words before we sign off?
Dr. Vincent Pedre:
I feel like we gave a lot of really great tidbits of information for people who are listening and suffering from these types of issues. I think this was a really practical episode that people are probably going to want to go back and listen to it again and take notes and maybe go and speak to their health practitioner and say, hey, you know, maybe we should think about this this way. So I hope that anyone who listens to this is inspired to always dig deeper and not be conformed to just taking a medication to treat a symptom, to look for what is the underlying root causes, and is there a way to treat that in a way that will create long, lasting relief.
So if you’re dealing with low stomach acid or gut health issues of any type and need some help, I see individual clients to help them resolve their digestive issues and you’re welcome to set up a free, 30-minute breakthrough session to see if you’d like to work with me. I also have my own two products, Tributyrin-Max, which is particularly helpful for loose stool and diarrhea as it slows your motility and firms up your stool, and SBI powder, which is an all around gut pathogen binder, which is super safe and won’t harm beneficial bacteria, and is usually the first line of treatment I educate my clients about in order to avoid stronger antimicrobial herbs.
*Product and dispensary links are affiliate links for which I’ll receive a commission. Thanks for your support of the podcast by using these links. As an Amazon Associate, I earn from qualifying purchases.
Adapted from episode 135 of The Perfect Stool podcast with Dr. Nayan Patel, a pharmacist and wellness expert, who developed a novel technology to deliver glutathione topically, and Lindsey Parsons, EdD, and edited for readability.
Lindsey:
Since you’re clearly a glutathione expert, why don’t we start with what glutathione is and what it does in the body, and why it’s important.
Dr. Nayan Patel:
Okay, glutathione is a peptide that is produced by humans. It’s the most abundant peptide or molecule produced in the human body, and it’s important to me personally, because the body does not produce something so abundantly unless there’s a lot of functions attached to it. And so that’s why my research has always been around how do I improve glutathione levels? How do I increase those levels if they’re low? What can I do to increase levels if your body cannot conjugate and make its own glutathione and so on and so forth. That’s why I’ve been studying this a lot. And the reason we’re talking today is because, after 20 years of research on my side, on what I’ve seen, I think your listeners want to listen to me. I think it’s going to be profound impact on how we live the rest of our lives now, and it’s made a huge difference in my family and my patients lives and the people that I deal with. So, I think it’s about time we get the rest of the world to know this thing.
Lindsey:
Awesome. Well, I’ve often referred to glutathione as the master antioxidant. Is that an accurate description?
Dr. Nayan Patel:
Well, that’s one of the functions. We don’t know what it is, because most people don’t care what glutathione is, what they do want to know is what it can do for you. And so yes, antioxidants is one of the benefits that we experience because of glutathione. It is not the only benefit, but that’s one of the majority functions, and it’s called the master, or the mother of all antioxidants, because it has a regenerating capacity, so your body does not lose the capacity of over and over being an antioxidant. And so for that reason, it’s lot more beneficial over and over again.
Lindsey:
Okay, so I check glutathione levels on almost every client via the marker for Pyroglutamic acid, on an organic acids test or on a Metabolomix. I’m wondering, is that a reliable marker of glutathione status? And if not, what better way is there to assess glutathione status?
Dr. Nayan Patel:
So what you’re measuring is a urine test, for the whole thing. It’s one of the metabolites of glutathione, which is okay, it’s not the best test. There’s no best test for glutathione as of right now. So we do testing in the laboratory, in the research center, where we can draw the blood, put the bloodstream in the machine and measure the levels out right away. Anything besides that is not an accurate test, because what you’re really measuring is, for example, if you do a blood draw, by the time the test tube is filled with the blood and it sits there for like 10-15, minutes, the whole glutathione is completely oxidized. So you have no idea how much is reduced, how much is oxidized.
So in reality, most of the people, if they are otherwise healthy, with no other diseases, your body should have, 50/50, 50% oxidized, 50% reduced, and it stays at sort of an equilibrium. Patients with diabetes, autoimmune conditions, cancers, diseases, any metabolic diseases, you have a lot more oxidized glutathione and a lot less reduced form of glutathione. This ratio needs to completely be reversed. And so the tests are at the best telling your total glutathione load you have in the body, which, if that is low to begin with, oh boy, we are in trouble to start off with, right? And so most people are already low to begin with in the complete glutathione status, and then what we do not know is how much is reduced out of that. The urine test does not give you the whole picture either.
Lindsey:
Right, and reduced is the usable glutathione?
Dr. Nayan Patel:
The reduced is the one that is the active form of glutathione. The oxidized form has to be reactivated, which is okay. So if you have a lot of oxidized glutathione, you can actually activate this glutathione by taking supplements like vitamin C or vitamin E, and that’s what it does. It regenerates all your glutathione again.
Lindsey:
So why might someone be deficient in glutathione?
Dr. Nayan Patel:
Why might somebody be deficient? Life? So let me do a little bit broader than that. So glutathione is affecting not just the oxidative stress in your body, but it also helps with conjugation or detoxification of your liver. And so that process is a one-way process. That means the glutathione that has been used for conjugation and detoxification, you get rid of the glutathione out of the body, and the body has to reproduce it again. And so what happens is that when you’re young, under the age of 30, you’re kind of invincible. You think the world’s never going to end, nothing bad is ever going to happen to you, your body completely regenerates on its own, and you just feel fine. You can drink like a fish, and the next morning you’re back to work, “What happened?”, “Oh nothing, we had a good time last night.” Same behavior at age of 50, “Oh boy, two days ago I had a drink, and I’m like, still having a headache right now.” And so the body is not able to detoxify, recuperate, regenerate and recalibrate itself at a faster pace.
So what’s happening at that end is, at right about the age of 30, what your body’s actual need for glutathione is and what your body can actually produce, there’s a discrepancy. You’re not producing enough to meet all your body’s demands. For example, if you live in United States, and let’s say your expenses for the month are 5000 bucks, but you only make $4,000. Every month. You’re short 1000 bucks. It won’t take you more than 2, 3, 4 months. By the fourth month, I’ll say, “You’re dead under water.” Right? Because you have no reserves. And so that’s the thing that’s happening with glutathione. It’s like not quite similar to the money portion, but your needs are there. You can’t produce enough. And if you cannot produce enough, there’s a discrepancy. The discrepancy over time, take 10 years over time, now there’s an onset of diseases, and that’s why everybody should be listening to that is because this is not something magic that happens because I turned 40, so I should be going through this issue. My mom had this disease when she was 40. I’m 50. I should be okay. I still don’t have it. No, it’s how much your body is able to recuperate, and if it cannot do that over periods of time, now we have something to deal with.
And so when it comes to life, there are a few things that I want to talk about. To start off with, the first thing is environmental factors, like air pollution, sunlight, direct exposure to sun for long periods of time, chemical exposures, gas exposures, all those things the body has to somehow neutralize them, detoxify them, and get rid of it. Second thing is, we eat food. Now we’re supposed to eat food for our body as a fuel, but we eat food because our tongue likes it, and that’s a big difference, right? You do what your tongue wants, not what your body needs, and what your body needs is real foods, amino acids and proteins and things like that, or maybe carbs, complex carbs that the body can use up as fuel. We end up eating sugars and some empty calories that now the body has to somehow figure out, “Well, what am I supposed to do with this? I need to make glutathione. I need three amino acids, glycine, glutamine and cysteine. Instead, I have this junk that I don’t know what to do with it!” And so your body’s always deprived. The needs it has is to produce peptides like glutathione, and if it doesn’t have the amino acids, it cannot do that work. So that’s why I say, “When life happens, the glutathione levels drop.”
Lindsey:
Right, yeah. So you mentioned the three amino acids that go into glutathione, and I have found that, particularly in my parents and in other clients that I see, there’s a glycine deficiency. And I’m wondering why people end up deficient in glycine, or in cysteine, for that matter, because those seem to be the two that are most recommended for supplementation when people are deficient in glutathione.
Dr. Nayan Patel:
That is right. So there’s three things: glutamine, glycine and cysteine. So you’re right. Glutamine, we have an abundance of glutamine inside our body. I think there’s a new theory right now. They’re suspecting that an excessive amount of glutamine in the brain can be early onset of dementia, or early onset Parkinsons or ALS or MS, or any of those diseases that they were dealing with. And so they’re trying to figure out how to get rid of glutamine outside your brain. And the one way to do that is give them glycine and cysteine, and hopefully they’ll conjugate to produce glutathione. And hey, you get a twofer, you get glutathione the brain, oxidative stress, and reduce the glutamic acid in the brain. Anyways, that’s just a theory, right? We don’t have any idea how to do that part yet.
But the second part you asked me the question is, you supplemented glycine, or you’re seeing glycine deficiency. Now, glycine deficiency is not very common. There’s plenty of foods that are out there that have plenty of glycine in there. And so to replenish glycine, you just have to find glycine-rich foods and just consume that part. Glycine is very easily absorbed. There should not be any difficulty in replacing glycine from the foods that you absorb. And glycine is not something that I see commonly as a suspect that they have in terms of absorption. What I do see is a diet low in cysteine. And so cysteine, by far, to me, is the most important thing that you have to do to replace in order for you to improve glutathione status in your body. And so I always tell my patients that, first of all, if you’re ever in doubt, look at glycine-rich foods. In the search engine, put it in there, “Glycine-rich foods,” or put in your AI robot. I said, “Hey, find me glycine-rich foods, and I’m vegan.” And it gives you options. “I’m vegetarian.” It gives you options. “I’m a meat eater.” That gives you options. Everything has cysteine in there, and there are people that are out there that make a product which is both a combination of glycine and cysteine, and that’s also okay. I’m okay with either one of them. What I’m not okay is taking too much glutamine. Now, a lot of people have gut issues, and they take glutamine all the time, which is okay. I’m okay with taking glutamine all the time. You just know your status is going to be important. If you don’t have a problem, then don’t take it. If you have a gut issue and if you take it temporarily, go for it.
Lindsey:
Okay, but not too much glutamine otherwise.
Dr. Nayan Patel:
Not too much glutamine otherwise, no.
Lindsey:
Okay, and so what symptoms might tell you that you are deficient in glutathione?
Dr. Nayan Patel:
So glutathione, I always look at the job, this job is to reduce oxidative stress. Now, oxidative stress is linked to almost every disease that’s out there. I mean, I’d say 80% of all diseases in the world are linked to oxidative stress. Probably pretty much everything is linked to oxidative stress. As soon as we are born, we are breathing oxygen, we have oxidative stress. There is no way around it. What the body does is it keeps on neutralizing it every single day, so that you are becoming strong and resilient as the day goes by. But it’s not killing you.
Eventually when the oxidative stress gets higher, that’s when the issues are going to be. So if you look for particular symptoms, there are none, for glutathione deficiency, but you can tell the signs and symptoms of something that can lead to a disease or condition and that can be linked to oxidative stress. For example, if you see sun damage spots, age spots on your face, all of a sudden you turn 45 or 50 years old and say, you know, “I got some spots over here. What is that?” Right? And does the glutathione help get rid of it? Well, most of the time it’s sun damage. So oxidative stress causing the sun damage comes from getting oxidized into your skin. But glutathione once you reduce oxidative stress down and once you get rid of that, it’s gone. It’s not like a bleaching cream where you don’t see it, so it’s gone. No, no, it’s gone forever, right? If you go back in the sun again, it’ll come back again, maybe someplace else, maybe same spot again. But that’s okay.
So that’s visible signs and symptoms. If you’re looking for non-visible signs and symptoms, starting at the age of 30-35ish, first thing you start noticing is that, “Hey, I’m not as sharp as I used to be before.” Right? Oh, maybe I had two kids now I got the Mom Brain now. My kids are taking too much of my time, and I don’t have time to think about things like that. The creeping forgetfulness kicks in. For women, it’s subtle, right? They notice really fast. But the guys, it’s a gradual process. They have no idea what’s coming down the pike, so they’re just oblivious of every single thing. And so they say, “What’s the difference? This is how I am usually, normally anyways.” But the creeping forgetfulness is the first sign of oxidative stress in your brain. So please remember our brain is only 2% of the total body weight, but yet it consumes 20% of all the oxygen we breathe in. The highest amount of oxidative stress you have in your body is in your brain. So reducing oxidative stress in your brain is by far the most important thing we can do to have a fighting chance so the brain does not get clogged up or doesn’t have too much oxidation going on. And eventually, plaque gets built up inside your brain. We have all kinds of diseases that kick in. And trust me, we don’t want to treat any of those diseases because there’s no cure for it. So creeping forgetfulness.
The other thing is that to produce glutathione, we need two molecules of ATP, which is energy source, one molecule of energy, which is an electron transfer, and three amino acids and two enzymes. And so if the body is constantly producing glutathione because it needs so much of it, because either you’re drinking alcohol or exposing yourself to sunlight or chemical exposures or toxin exposures or the foods we eat are not adequate enough, the body is constantly producing glutathione. It is constantly requiring more and more of ATP energy, which is the mitochondrial energy. If your body cannot produce enough, that’s when the fatigue kicks in. Lethargy kicks in. Tiredness kicks in. By itself, completely benign. They said, “Oh, everybody feels tired when they’re old.” I say, “No, you should not be.” Right? And so supplement glutathione, you should expect to see a rise in energy in about two to three weeks when someone gets stabilized.
And so again, they’re not sudden symptoms of glutathione deficiency per se, but you can see that there’s a progression of oxidative stress increasing in your body. You can measure your cholesterol, your oxidized cholesterol, ApoB levels. You can measure MDA levels, which is Malondialdehyde levels. And if this starts rising, you know, “Okay, now the oxidative stress is rising.” If your insulin resistance is rising, that means the oxidative stress is rising, and so on and so forth. So if we start looking at every single thing, there’s a range. This is the low end. This is the high end, right? If you’re in the middle, well you’re still normal, yeah, but I was on the low end, and now I’m in the middle! It’s slowly getting there. Do we want to wait until it’s really bad before we treat them? Or can we do something today?
Lindsey:
So you mentioned the age spots on the skin, and I’ve got this one here that’s always driving me crazy, and I’ve heard of people using glutathione for their skin. Is this a topical? Are they taking it internally?
Dr. Nayan Patel:
So 140 years, we have known about glutathione, and FDA, or any countries in the world, has only approved N-Acetylcysteine, called NAC, as a way to improve glutathione levels. So your body does not have the receptor to accept glutathione from outside sources. So if you take glutathione from outside sources, the body will chop it up, break it down, absorb the amino acids and use the amino acids to produce glutathione. Well, save your money and just take the amino acids by themselves and let the body makes its own glutathione. But again, the issue is, can the body produce enough based on the body’s needs? And as we get older, it cannot keep up with the demands. So there’s always been a way to improve the glutathione levels. So then we say, “Okay, you know what? I’m just going to inject, infuse into the veins. There’s no country in the world that has approved IV glutathione, except for compassionate use only, for people taking a chemotherapy drug that includes platinum, right? Cisplatin is a platinum drug. If you’re taking Cisplatin as a drug for chemotherapy, they approved glutathione infusion to temporarily reduce the platinum overload inside your body. Other than that, glutathione is not approved for any other indication or purpose in the whole world.
Lindsey:
How come I hear about my clients getting infusions of glutathione then?
Dr. Nayan Patel:
Exactly! So they’re getting it from a compounding pharmacy. It’s not FDA approved as a drug, but they get it from a compounding pharmacy, but when they infuse the glutathione, there was a study done in 1991 that when they were given two grams of IV infusion, guess what? 100% of the glutathione was seen in the plasma and nothing went in the red blood cells. Well, that’s okay, right? People will think that part, but what they do not know is that plasma gets filtered by the kidneys, and in 5 to 15 minutes, all the glutathione is in the urine. Nothing is getting absorbed. It still works, and the reason it still works is because the body, even though it’s in the urine, is slowly breaking down and is reabsorbing the cysteine out of it. So about a couple of hours later, the researchers did see a spike in the blood levels of cysteine by itself. And so they’re scratching their heads saying, “Whoa, what happened here? We gave glutathione, and we didn’t see a rise in glutathione, but we saw rise in cysteine, and that’s when they figured out, okay, the body was breaking down this glutathione, reusing the cysteine, cysteine is then being used to produce glutathione again.
So fast forward, 20 years later, 30 years later, 2011 they did a similar study. Back in the late 90s, early 2000s, a technology called liposome technology emerged in the nutraceutical world. I was involved with making pharmaceuticals using liposomes. And the doctor who holds a patent on liposomes technology came to me and asked me, “Hey, can you make some liposome nutraceuticals like CoQ10 and vitamin C and glutathione and PQQ and all those things?” I said, “Okay, I know how to make it, so I’ll give it a shot at it.” And so we did. 1999 we made the first liposomal glutathione technology product, and the doctor was happy, and he sold off the technology to a bunch of companies and made some money. But one thing that did not work was the glutathione. It did not work for my patients, so I was always looking for something better.
So 2011 comes around, 26 kids, autism spectrum disorder, given liposomal form of glutathione, because it bypasses the gut, so it’s supposed to absorb better. What they found out was, guess what, zero glutathione levels in the blood. What they saw was a rise of all the amino acids, cysteine, glutamine, glycine, they all went up. So the conclusion was from the researcher, again, that glutathione does not get absorbed. It is broken down. The body absorbs amino acids, and the amino acids are later used to produce glutathione. Folks, save your money. Just buy the amino acids. It’s cheap, right? So that’s where my technology lies. We’ve been researching since 2001 and in 2007 we discovered a way to basically stabilize glutathione outside the human body in a petri dish in a completely intact manner. The second goal was we tasted it. It tastes awful, so nobody’s gonna put it in their mouth. We squirted it in the nose. It was very painful. So I said, “Okay, not going to go through your nose, either.” Nobody wants suppositories. I said, “Okay, well, the only route left is a skin route.” So I said, “Okay, skin route is even harder, because skin is such a big barrier. Nothing goes through your skin. This is a water-based product. I said, “Okay, what if I reduce the particle size even further small?” And so that’s what we did. So we reduced the particle size by 80 fold.
We took a dextrin molecule, put a cover over it. And the reason we had to use dextrin molecules is because your body has a receptor to accept dextrins. And so what happened was the body saw this as a dextrin molecule coming through your skin. The body goes, “Okay, I can take that one, I can use it up.” And inside, what stuck was glutathione like a Trojan horse. And so all of a sudden, within 5 to 15 minutes, we saw a spike in the glutathione levels in the blood cells. And that’s when I said, “Aha, we just figured it out.” Right away we applied for patents in 2007, but we quickly found out there was no research being done using this technology on any other product in the world. So I said, “Oh my God. Now what I do?”
So 13 years later, we did all the studies of ourselves, how much to give, how often to give, when to give, what kind of results are we going to see? It took us 13 more years. In 2020, we came to the conclusion that it’s time to launch the product. Wrote my book. Finished writing the book. The book got published. We knew that it was going to be launched in 2020. God was not happy, because in 2020 we wanted to launch the company in the first week of January and in the middle of February we were shut down because of coronavirus. The whole world was shut down. I said, “Oh my goodness.” So here we are talking today about this thing. Our goal is to get this out to the world and have them experience this. Because now we have a technology to deliver a peptide. Yes, it’s glutathione, but we deliver a peptide through your skin for the very first time.
Lindsey:
So it could be applicable to multiple peptides, not just glutathione?
Dr. Nayan Patel:
Oh yes. And so right now we have a blanket patent over the majority of the antioxidants, and now we are applying for another blanket patent for anything less than five amino acid chain peptides. And so that’s what we are working on right now. So we’re doing a lot more research. Everything that I make right now is going back into the research, because nobody’s funding me, so it’s all 100% self-funded, and I take time to educate people, and whatever time I have left over, I go back in the lab.
Lindsey:
So the product you developed is through the skin then?
Dr. Nayan Patel:
It’s through the skin.
Lindsey:
Is it a lotion? What form is it?
Dr. Nayan Patel:
It’s a solution. It’s a topical solution. It’s like a water-based system. If you look at it, it’s just water, but smells like glutathione, it has an odor of cysteine. Cysteine smells like rotten eggs or has a sulfur smell to it, right?
Lindsey:
Right.
Dr. Nayan Patel:
So it has a slight odor to it. Well, I shouldn’t say slight. Everybody’s different, right? To me it’s slight, for somebody else it’s, “Oh my God, this is awful.” It has an odor to it, and we use dextrin molecules. And dextrin is a little sticky to your skin. But the thing is, if you rub it on for about 30 seconds to a minute, the stickiness goes away, the smell goes away, and it becomes completely smooth, and all the glutathione is already inside your skin. And then all it does is, within the 15 minutes or so, you can literally do a blood draw on your patients and see the levels rise.
Lindsey:
And how long will that rise sustain?
Dr. Nayan Patel:
So we only did a single application study, like we applied one time and did the study. This is when I had no money. I could only afford, like, 100 bucks a test. We just got published last year. We did a human trial for 30 patients, and what we found out was that the peak was at 45 minutes. So once you apply it at 15 minutes, the level starts rising already, by 45 minutes, there was a peak. And the area under the curve, which is how long it stays in the body, was about four to six hours. Now, young patients, it was actually lasting longer. Older patients, it was lasting shorter. It made me realize that our needs as we get older, if you have never had glutathione for such a long time, they’re just using it up as we give it to them, right? Versus young folks? Well, the young folks were all med students, right? At the university. So young people, their levels were lasting longer. Six hours! Older folks, all the professors at the University, it was only lasting four hours, maybe less. Maybe less in some cases.
So when I do my calculations, because again, we can only do calculations at this point, is that 50% of the glutathione gets oxidized and recycled, 30% gets conjugated and used up. So if I give the same dose, which is, I think it’s going to be the right dose for the patients to increase levels to high levels, and 50% is used up every single day. Then hopefully, if they’re otherwise normal, within three to four months, each application should last them eight to 12 hours. But twice a day application should be giving a good 16-20, 24-hour coverage, which is ideal for me, which is not bad at all. But in reality, to achieve that, it takes a lot longer, because when people get healthier, they pick up bad behaviors.
Lindsey:
Yeah.
Dr. Nayan Patel:
And so it’s very, very difficult.
Lindsey:
Yeah.
Dr. Nayan Patel:
When you’re in trouble, you’ll do whatever it takes to get healthier. As soon as you get healthy, you forgot that you were in trouble.
Lindsey:
And you’re like, “I can afford those two drinks.”
Dr. Nayan Patel:
There you go! And that’s a problem. That is the concern that I have. I mean, over the years, before the launch of the company or the product, we were only working through physicians offices, and so we had over 100,000 patients that we have served before we launched the product to the open public. And so over the years, I’ve seen doctors themselves get healthier, and then they pick up bad behaviors, right? And so if the doctors are not willing to put the self control on themselves, how can you expect the patients to do the same thing? So that’s the difficult portion for me.
Lindsey:
Sure, well, you can only do so much. You can lead a horse to water, but you can’t make them drink. So you could buy the supplements, but you can’t force them to change the lifestyle, right?
Dr. Nayan Patel:
No, we cannot, but we can educate them.
Lindsey:
Of course.
Dr. Nayan Patel:
And that’s why I’m here. I’ve already seen what happens. I had one guy, he was an alcoholic, he was going to die because his liver failed, and so he said that he’s done. His family moved out. His wife moved out, the kids left him, and he was rotting his life away. He couldn’t stop drinking. And he was my brother’s best friend. My brother kind of had a heart for him and I said, “Use this glutathione. Don’t sweat it, just use it every single day.” And literally, a year goes by, he didn’t die. He got healthier, and he got to a point that his wife moved back in, his kids moved back in, and three or four years later, he was a completely changed person, right? Guess what happened again?
Lindsey:
He started drinking again.
Dr. Nayan Patel:
Drinking again. So my hope is, hopefully he listens to this message, that we are just human beings over here, but if we create better habits for ourselves, a better lifestyle for ourselves and keep the poisons out of our body, I think we have a fighting chance to live forever.
Lindsey:
Forever may be a hair ambitious, but you know, longer and healthier I’ll take!
Dr. Nayan Patel:
Yes!
Lindsey:
So in terms of genetics, I did one of these fancy DNA tests with somebody else who came on the podcast, and they said my genetics were such that I don’t have great glutathionization. What does that actually mean for me and my glutathione needs?
Dr. Nayan Patel:
So if you cannot produce glutathione, you need supplementation for rest of your life. The unfortunate part is that most of the supplements that you are taking over-the-counter don’t get absorbed in your system. Actually all of them, right? So you’re always going to be struggling to produce enough glutathione for your needs, versus the other gene SNPs, where your need for glutathione is much, much higher. The body can produce it, but your needs are much higher, and so for that, you require a lot of essential amino acids to keep on refreshing this glutathione. So I’m not sure which genes you have, but if you have the genes where your conjugated path is somewhat distorted, that means you cannot produce enough glutathione in the first place, you can take all the amino acids in the world, and you are at best, going to get half of the normal. You’re never going to reach the high normals ever. Versus if your body can produce glutathione and your needs are much higher, by taking supplements, amino acids, you can somewhat boost up a little bit. But keep in mind that as you age it’s going to keep on declining, decline, decline, anyways. In fact, I’m also doing a presentation at the World Anti-Aging Conference this year on genomics and glutathione supplementation.
Lindsey:
Wow!
Dr. Nayan Patel:
So this year, December, we’ll be presenting a whole day workshop to physicians on how to help doctors identify those genomic markers, and how do I help those people? Because we have cases that we have done that help people with heavy metal toxicities and dementia, patients with other ALS-type diseases, or Huntington’s Disease, things like that. And how the genes that are there were not diagnosed correctly, and they get the disease, you treat the disease, but the problem is something else! You’re also dealing with stress diseases, and you’re dealing with the disease itself, but the stresses were what caused the problem, but you’re not addressing the stress at all. And so by putting this in the limelight, I think we have a fighting chance that the doctors of tomorrow are going to be able to look at the gene markers and try to help you identify. They’ll say, “Hey, you’re this kind of person. So I would suggest you stay away from all these products, or you can do this one to improve your health.” Or whatever that is, right? 15 years ago, gene testing was so expensive that nobody could afford it. Today, most people can afford it, 400-500 bucks. Most of them can, right? To get a basic gene test. So it’s becoming like an average test that everybody can do now, and more and more people are doing it right now. The problem is the education behind the gene testing is still catching up.
Lindsey:
Yeah, and how many SNPs are involved in this? Are there heaps of them, or is it just a few you could look at?
Dr. Nayan Patel:
Well, right now, we are only going to teach them about three or four today to other doctors, but they have lots more than that. And this is just the surface right now. We just created a surface at this point. We have no idea how fascinating the human body system is. We assume that, “Hey, if I eat one avocado, I’m going to be all healthy.” Oh my God, you’re so far away from the truth, right? And so we are only mapping our human genome right now. But keep in mind, half of the body belongs to the bugs. The bacteria!
Lindsey:
Exactly.
Dr. Nayan Patel:
And who’s mapping their genome? Because if the bacteria is a problem, guess who’s suffering?
Lindsey:
Us!
Dr. Nayan Patel:
Us, because it’s inside our body. And we call them healthy bacteria, right? The gut microbiome, whatever they call them. And if they;ve got a problem, then we are going to suffer with that too. And so we have a lot more to learn, and I can only lead them to the next step if I can master the first step. And so I want to help this doctor master the first step, and I’m working with a doctor up in Beverly Hills, who’s the doctor to the stars when it comes to gene mutation testing. And so I recruited him to come speak at the event, and he said yes. So we’ll be launching this educational course for the physicians, and hopefully it’ll become available to every doctor that’s out there.
Lindsey:
Awesome. So you mentioned that over time, a twice a day administration of the glutathione would be sufficient. I’m just curious, because I know that this often happens. I’ll be interviewing somebody and they have a product and there’s dosing on the bottle, but the dosing might say one or two capsules, okay, or whatever amount that you put on your hand. But the reality is, the dosing is, in fact, a lot more than that. It’s one or two capsules three times a day. So what is the actual dosing that a regular person who is maybe already in their 40s or 50s or 60s or 70s, should start with and then what is the regular dosing for somebody who already is showing signs of oxidative stress, say they have high cholesterol or they have prediabetes or something like that.
Dr. Nayan Patel:
So we have two products. One is Glutaryl and that is about 200 milligrams per ml. The other one is Glutaryl+ which is stronger version of the same product. Exact same product, just a stronger concentration, 1.75 times stronger than the other one, which is about 350 milligrams per ml. The actual dose is on the regular product, four sprays twice a day, which gives about 100 milligrams, twice a day, approximately. And that’s a full dose. Even at that dose, a lot of people cannot tolerate the dose, because what happens then is, initially, if it’s releasing all the toxins, and the body’s not well equipped to handle all those toxins’ excretion, then you get reactions.
Lindsey:
Like if they are constipated?
Dr. Nayan Patel:
Well, oh no, it could be constipated, but could be even worse, could be causing diarrhea sometimes.
Lindsey:
Oh right, no. But I mean, if somebody’s constipated and they’re not getting rid of toxins fast, they’re getting . . .
Dr. Nayan Patel:
Well the thing is that’s a physical obstruction. But most of the toxins that we are dealing with are in the liver. And so when it gets dumped in the liver, sometimes people have headaches, sometimes have diarrhea, sometimes they have rashes all over the body. It’s not an allergic reaction, it’s a detox type reaction. That means that we say, “Hey, slow down. The body is not able to handle that part. There’s a lot more issues than just the glutathione by itself, but we can only deal with one problem at a time.” So I’ll reduce it down to maybe two sprays, or even one spray twice a day, if they can tolerate that part. And then slowly, slowly go to two sprays, three sprays, eventually the dose is going to be four sprays twice a day.
Now, that’s a typical dose for everybody, and that dose, again, you’re dealing with a pharmacist. I’m looking for outcomes. I’m not here to give you the safest dose possible so nobody will complain to me. And if you don’t get the results, it’s okay, but at least I won’t hear any complaints. No, I want results. I don’t care, right? If there’s a problem, I’ll work with you. I’ll work with your doctor. I’ll work with your physicians, everybody, and make sure that it works for you. Now, people that have high amount of oxidative stress that led to autoimmune diseases, people with type one diabetes or uncontrolled type two diabetes, or cancer patients taking high dose chemotherapies, their need for glutathione is extremely high. That’s the plus version that we have. We strongly recommend that if you use the plus version, that you try the regular version first. Make sure that you have no problems, and then go to the plus version the next month, for three months, six months, one year, depending on what the conditions are. If you have a chronic condition for years, it may take you over a year to be on the plus version, and then eventually you’ll come back down to the regular version anyways. The way you know this thing is, if you use the plus version, there’s something called too much glutathione. And when that happens, you’ll feel it on the other end as well. You’ll get the rash, itching. When that happens a year later, or six months later, your glutathione reserves have been tapped in, completely done. Switch to the regular version. Go to the lower concentration one. You’ll be fine. You’ll never have to change the dose again after that.
Lindsey:
Okay, got it. Can you explain about methylation and how glutathione relates to methylation, and whether an MTHFR mutation, which is incredibly common, can lead to suboptimal glutathione levels?
Dr. Nayan Patel:
So that was one of the gene mutations, COMT-MTHFR, where your body can produce enough glutathione, there’s no doubt about it. But with methylation defects, your body’s not able to detoxify a lot of products, right? Your body is craving the methyl groups from cruciferous vegetables and things like that, to, hey, I need this to detox my body. If it’s not there, the secondary product that’s used to detoxify the body is glutathione. So the glutathione is getting used up. Even if the body can produce enough, it’s getting used up. And so when you give glutathione to someone with an MTHFR gene mutation, the first 30 days, they are going to feel the difference. Immediately, they’re going to feel better, right? They’ll say, “Oh my God, this is how I’m supposed to feel.” It’s not solving any problems yet, because all he did was just replace what your body was missing. But what the body was really missing is methyl donors. And so eat enough cruciferous vegetables, get methyl groups, methyl B12s, methylated vitamins. Anything that’s methylated will be really good for you, because then the load of glutathione reduces and you can do some other things. But they’re going to feel fantastic.
Lindsey:
Okay, so you mentioned the liposomal glutathione and NAC and glycine and such. What about S-Acetyl glutathione? Is that useful at all?
Dr. Nayan Patel:
S-Acetyl glutathione that I’ve seen, I usually see them in commercial skincare lines, and lately, now they’re coming more towards vitamin supplementation as well. So when you acetylate a glutathione molecule, what it’s doing is it becomes water soluble. Well, let me put it this way, glutathione is already water soluble. To make it another product like this thing is not going to make it more water soluble, right? So that defeats the purpose. The other reason people do a similar form of glutathione is because glutathione is very reactive and it doesn’t stay stable in room temperature. And that’s why they’ve put an acetyl group to it, so it kind of protects it from getting oxidized. But what they do not know is that just because it is stable outside the room temperature or outside the body, that doesn’t mean the body’s going to accept it as is. As I said earlier, you have zero receptors for glutathione inside your body. The glutathione is never going to get absorbed by itself. It has to be broken down into amino acids, and amino acids have to be absorbed, and that’s how you get it inside your body. And so I have not seen any studies yet. I would bet everything I have that it is probably not going to be anywhere close to even other technologies. So there should be no benefits over some of the other products that are already out in the market today.
Lindsey:
Right, right. So other than your product, which is clearly quite different from these other things, the next best thing is just to supplement with the amino acids, because it’s going to be cheaper.
Dr. Nayan Patel:
That’s it, yeah!
Lindsey:
Okay.
Dr. Nayan Patel:
And just to let you know, 80% of people have no problems. They can take amino acids and make their own glutathione. It’s when they get older. If you wait for the diseases to come in, then God bless you, because you need all the help you can. But if you try and do it early on, if you have 20 year old listeners over here, please listen. Listen to your mom and dad. Eat the right fruits and vegetables. Doritos are not your friend. There are no amino acids in Doritos, right?
Lindsey:
Yes, eat foods with protein.
Dr. Nayan Patel:
Eat foods with proteins. That’s it. That’s what you need.
Lindsey:
And your fruits and veggies, especially your cruciferous veggies, for your methyl donors.
Dr. Nayan Patel:
Methyl groups. That’s if you have a problem. Some people don’t have a problem, then it’s okay. But eat real food, eat what your body needs and not what your tongue wants.
Lindsey:
Mm, and have you done any studies, or at least observed in patients the impact of getting these glutathione levels up to optimal in chronic diseases and aging?
Dr. Nayan Patel:
Oh yeah, we only published one study as a clinical trial. The other study was not published as a trial, because in 2020 when we first launched the company, we had started a study on COVID, but since there was no IRB approval, we could not publish as a human trial. We could only publish as a fact finding expedition, so to speak. We had no approval from the authorities to do our human trials, but we still gave it to them anyways. So we have done things a couple times, and both of them are published, by the way, so you can just Google glutathione dextrins that we have, and what is COVID and what is mycobacterium. We have two trials. And so what we did was we wanted to see what happens if I can improve the glutathione levels. What effect does it have on infections? We know glutathione is not an anti-infectant. It’s not antibiotic, it’s not antiviral. It has nothing to do with killing any bugs, but what it does is that glutathione can immediately improve your immune system to the point that it can kill the bugs on its own. And so that’s what we did. We did a three-day trial. In three days, what can you expect in three days? Right? Not a whole lot. Twice the application, four sprays in the morning, four sprays in the evening, for three days in a row, and that was it. And what we found out was, within four hours, they saw reduction of the MDA levels, which is a malondialdehyde, an oxidative stress marker, its levels just dropped, within four hours. They saw a rise of the glutathiones in the red blood cells right away.
The third thing that they did was they couldn’t infect the body, all the professors and the med students, with mycobacterium infection, because there is no cure for it, they’ll all die. And so we treat the blood with a test tube and then infected the blood with the mycobacterium. So 15 patients had applied the glutathione. 50% didn’t apply the glutathione on them at all. They applied the placebo. The people that applied the glutathione, they saw a rise in that test tube of all the immune markers, IL-2, IL-12, all the T cells went up, natural killer cells went up. Macrophages, with the immune system that kills all the bugs, went up to the point that within four hours, there was a resolution of the mycobacterium infection in a test tube. Imagine we do that every single day of your life. This is only a three-day trial that we did, we see such a profound impact. What that tells me is that there’s no drug in the world that has such a profound impact. What we need is our own body’s medicine. Our body has all the drugs we need inside our body. We just identify a couple of them so far, and the more we identify what chemicals do in your body, our job is done. I’ll be out of business as a pharmacist.
Lindsey:
So you mentioned other vitamins. I mean, I know when I think of oxidative stress, I think of vitamin C, I think of vitamins E and A. So do we still need those ones for people who are not getting enough from their diet?
Dr. Nayan Patel:
So, if you look at oxidative stress, there’s three things we can do. One is exogenous, or outside the body, sources of chemicals like vitamin C, vitamin E and things like that, to bring oxidative stress down. Second thing we can do is improve our endogenous products like CoQ10, glutathione, they’ll bring oxidative stress down, right? Direct impact. The third thing, we don’t talk about it, is enzymatic support, like superoxide dismutase, SOD, or glutathione peroxidase. These enzymes affect multiple pathways to help reduce oxidative stress. Which was the most powerful one, of course? Enzymes, because glutathione peroxidase enzymes will produce glutathione, which will do all the work. So that’s more powerful than the product itself, which is glutathione. The least is vitamin C and vitamin E and things like that. In fact, I can tell you scientifically or chemically, vitamin C is not an antioxidant. Vitamin C is actually a prooxidant. What happens is that, at low dose concentration, it gives that energy to revive the glutathione back into oxidized glutathione, to glutathione again. That’s why, if you look at vitamin C, the doctors will tell you, “Oh, at low concentration, it’s an antioxidant. At high concentration, it’s a prooxidant.” I said, “Vitamin C is not that smart. It’s a dumb molecule. It has one property, right? It doesn’t have multi properties.” So if you’re taking vitamin C, I would suggest please take low dose, because too much vitamin C is actually not good for you.
Lindsey:
Low dose like 500 milligrams?
Dr. Nayan Patel:
Less than one gram per day.
Lindsey:
Yeah.
Dr. Nayan Patel:
Yeah, but if you get it in your diet, it’s even better.
Lindsey:
Yeah.
Dr. Nayan Patel:
I don’t take vitamin C at all. If I do take vitamin C, it will be very rare. I do have vitamin C in my house, which I give to my kids once in a while. They hate fruits and vegetables, so I can supplement that for them, because I will not give them glutathione at that young age. So I give them other substrates, like these, to help improve their levels. My kids love avocado toast. Avocados have the highest amount of cysteine in them to help increase low glutathione levels that way. I have two daughters and they have acne, so I said, “Well, if you eat avocados it will lessen your acne!” So they load up an avocados every day, I guess. But I try to bring the diets in them, that’s actually doing good for them more than the supplementation.
Lindsey:
Right. So I know people are sort of getting tired, and I’m certainly one of them, of finding out there’s one more supplement that they need to take for life, and most people think, and need, I mean, I can see from the numbers that they need to supplement vitamin D and magnesium and then fish oil, if they’re not eating enough fish and then usually taking a multi or B vitamins, creatine. Would you argue that glutathione should be part of that basic stack of things? Or is there one of those things in there that it might be unnecessary if people are supplementing with glutathione?
Dr. Nayan Patel:
So I can tell you what I do, that way I’m not giving . . .
Lindsey:
Advice, okay!
Dr. Nayan Patel:
I’m just telling you what I do. So 2009, I was on almost 20 different supplements, because you hear things, you do things, and I belong to this anti-aging longevity club where everybody’s talking about how do we increase lifespan? How to increase health span? Blah, blah, blah. Anyways, fast forward today. I take two supplements, and one is glutathione, the other one is magnesium-potassium combo.
Lindsey:
Okay.
Dr. Nayan Patel:
And that’s it. That’s all I take right now. Now I do take acid/enzymes when I eat some bad food, because I try to be healthy all the time. At times that I go eat at a restaurant, I don’t know how they prepare the meal. I try to order the best meal possible that money can buy, but you never know what they have done sometimes. So if I eat out, I’ll definitely have acid/enzymes to go along with it, but that’s not a daily vitamin for me.
Yep, Betaine HCl with pepsin, with some digestive enzymes to go along with it, just to make sure that it can digest all my proteins. That’s what I do. I don’t take fish oils. I take vitamin E once in a while. It’s not a regular thing. I take vitamin E for my heart health. Again, keep in mind, when they say essential fatty acids, EFAs, it’s essential fatty acids, not abundant fatty acids. So I’m not a big fan of taking an abundance of supplements myself, but I do small things periodically. Probiotics, I don’t take any probiotics, but if I have to take a probiotic for about a week or so, I’ll do that part, but that’s about it. I will not take products for long term. But that’s all the vitamins I have. I take vitamin D during winter once in a while, it’s nothing crazy. If I take vitamin D, I have vitamin K2 with it, so I don’t want to get calcification of my arteries. But if I do take that, I’ll take it for maybe two weeks in a row and then stop it after that. Nothing is consistent, except for magnesium and my glutathione. And magnesium is because I have enough calcium in my diet and I want the electrical current to function correctly.
Lindsey:
And the potassium is part of the magnesium, you mentioned?
Dr. Nayan Patel:
Yeah, exactly. Magnesium potassium aspartate is the the combo I take and I take different forms of magnesium too. I take magnesium by itself. I take a magnesium with potassium combination. I take a magnesium glycerin combination. I have magnesium for neuro health. But magnesium is different. I think it’s completely different. And so the body needs a lot of magnesium because of all the electrical currents that we have throughout the body.
Lindsey:
So you showed your hand as you were describing the spraying on of the glutathione. But is there any benefit if you have sunspots or whatever, to put the glutathione directly on the spot that’s affected, or does it not matter? It’s really just absorbed into the bloodstream, essentially?
Dr. Nayan Patel:
It doesn’t matter. But if you have a spot that is bugging you, please apply on the spot, because there’s absolutely a localized effect immediately that you do see the benefit of it. But if you’re patient, if you’re going to use it every single day, regardless, it will not matter. You can apply it on your arms and your spots on your face are going to slowly go away.
Lindsey:
Yeah.
Dr. Nayan Patel:
Because your body is basically healing from inside every single thing anyways.
Lindsey:
Yeah. So it doesn’t really matter where you put it. You could put it on your arm, your leg, or your hand or wherever?
Dr. Nayan Patel:
Yeah, it doesn’t matter because the technology is such that it does not go through lipid layers of your skin. Your skin is completely full of cholesterol or lipids, right? It’s all fat. Every so often there’s a water channel, and no medications go through the water channel of the skin. And so this is the first technology that actually just goes through it completely, and within seconds to minutes, it’s already in the bloodstream, you’re able to measure the levels right away.
Lindsey:
Okay.
Dr. Nayan Patel:
The only thing is, don’t apply it on a hairy area, because, as I said earlier, the dextrin molecules that we use are a little sticky, so the hair is going to get stuck to your skin. It’s just uncomfortable.
Lindsey:
Back of the hand or maybe the forearm is a good spot?
Dr. Nayan Patel:
It doesn’t matter where you apply it. I just put it on a non hairy part, like even my arms. I shave my arms too, because I forget where to apply it. I just put it anywhere and everywhere. I forget. If it’s before a shower, I apply it anywhere, if it’s after a shower, then I apply it on my arms. In like an hour or so, I just wash my arms, because everything is in there. As I said earlier, right? At 45 minutes, I already saw peak levels. Why give it more than 45 minutes if I don’t have to?
Lindsey:
Oh, okay, so if it were bothering you, you could wash it off after.
Dr. Nayan Patel:
Oh yeah, if it bothers you, yes, we will just wash it off. But if it doesn’t bother you, then it’s fine. Sometimes I apply a cream over it, like a lotion over it, and that’s fine too. Then it will not bother you at all.
Lindsey:
Okay, so where can people find you and your products?
Dr. Nayan Patel:
Oh, my website, AuroWellness.com. We do have a lot of physicians offices where they have them in their office for sale, but typically, most of the people are coming to the website. They’re checking things out. They’re reading my blog articles. Please subscribe to my newsletter. I do spend some time and energy to educate my customers on glutathione and all the things it can do for us. I’m always working on multiple products. Right now I have two or three products that are very close to completion, and as soon as they comes out, the patient will have the first dibs at it to at least see things, check things out. So yeah, the newsletter is the best thing.
Lindsey:
Awesome, I did establish an affiliate account, so if people want to support the podcast, they can go to my affiliate link to Auro Wellness* (see tab in upper left-hand corner for Auro Skincare line).
Dr. Nayan Patel:
Yeah!
Lindsey:
And I’m excited to try it out myself.
Dr. Nayan Patel:
Yeah, please, if they mention your name or they click the link that’s provided, that’d be the best way to support the podcast, because we want to support the podcast, so please use that link, if at all possible.
Lindsey:
Awesome. Well, thank you so much for all this great information about glutathione and for working on these products to help people.
Dr. Nayan Patel:
Well, it’s my pleasure. I’m doing it for myself, and people are just secondary to me because I want to help myself first. The longer I can stay on this planet, the more I can do some work for you guys.
So if you’re dealing with low stomach acid or gut health issues of any type and need some help, I see individual clients to help them resolve their digestive issues and you’re welcome to set up a free, 30-minute breakthrough sessionto see if you’d like to work with me. I also have my own two products, Tributyrin-Max, which is particularly helpful for loose stool and diarrhea as it slows your motility and firms up your stool, and SBI powder, which is an all around gut pathogen binder, which is super safe and won’t harm beneficial bacteria, and is usually the first line of treatment I educate my clients about in order to avoid stronger antimicrobial herbs.
*Product and dispensary links are affiliate links for which I’ll receive a commission. Thanks for your support of the podcast by using these links. As an Amazon Associate, I earn from qualifying purchases.
Hypochlorhydria is the official term for a deficiency of stomach acid, which is hydrochloric acid (abbreviated HCI). If you don’t have enough stomach acid, you can’t digest food properly or absorb nutrients, because hydrochloric acid is essential for prompting the conversion of pepsinogen, released by the stomach cells, into pepsin, which breaks protein into peptides, composed of amino acids, as well as prompting the release of bile and pancreatic enzymes, which further aid in digestion. Amino acids are vitally important to all aspects of health, from building tissues to creating enzymes, which catalyze literally trillions of reactions in the body every minute, to creating antibodies, hormones and neurotransmitters and nitric oxide, which keeps the blood vessels open and blood flowing, to creating, storing and transporting energy. Amino acids also assist in buffering pH and maintaining the acid-base balance in the blood. I can’t actually overemphasize the importance of amino acids and protein in the body. Without an adequate supply, or if just one amino acid is in short supply and therefore you are missing one of the amino acids that is necessary to form a protein, of which there are 20, then you will not form a protein and your body will not perform some essential function. So if your body is slowly breaking down in a variety of ways, one of the first things to consider is a protein deficiency, which may have at its root a deficiency in stomach acid.
You may have also heard of essential amino acids. There are 9 of those: histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan and valine, which are considered essential because our bodies can’t make them and we must obtain them through our diet. If you’re taking an amino acid supplement, it should have 9 amino acids on the label. Many leave out histidine, I assume because it’s the precursor to histamine and many people with gut issues have histamine issues, but if you don’t, then you should make sure any amino acid supplement you take has all 9 essential amino acids.
Anyway, back to other symptoms of low stomach acid, which include indigestion, bloating, burping, nausea, heartburn, diarrhea, constipation, sulfur-smelling gas, feeling full quickly, undigested food in the stool, bad breath, nutrient deficiencies like B12 or iron, brittle nails, hair thinning, Candida and frequent infections, including SIBO or small intestine bacterial overgrowth and other bacterial infections or foodborne illnesses, due to stomach acid’s role in killing pathogens. I’ll also often see low amino acid levels on clients who have inadequate stomach acids, if we run a Metabolomix+ test*, which includes both an Organix brand Organic Acids Test and urine amino acids.
To understand stomach acid levels a bit, you should know that normal gastric pH while fasting is supposed to be under 3.0. While digesting food, you should have a pH of 1.5-3.5, but at least 2 or below some of the time as that acidity activates the enzyme pepsin, which breaks down proteins into peptides. Having a fasting pH above 7 is considered achlorhydria, or the complete absence of stomach acid, and if you take proton pump inhibitors (PPIs), you’ll have a fasting pH between 5 and 7.
You may have heard that aging is one cause of low stomach acid, and it would appear it is. Two (first study; second study) of the few studies on this question that went into some depth showed that while fasting, 89% of subjects with a mean age of 71 still had a low fasting stomach pH, but it was in re-acidifying the stomach after a meal that the differences showed through, compared to a group of subjects with an average age of 25. In the older subjects, it took an average of 89 minutes to re-acidify the stomach (defined as a pH of 2.0) after eating a meal, while it only took the younger subjects 42 minutes. And 16.4% of the older subjects took four hours to return to a pH of 2.0.
Oddly enough, low stomach acid can cause the same symptoms as too much stomach acid or hyperchlorhydria, that is, heartburn and GERD or gastroesophageal reflux disease. But typically, doctors will assume your symptoms are a result of too much stomach acid, if you have heartburn. They may diagnose you with GERD and prescribe proton pump inhibitors or PPIs. These medications can exacerbate the problem, preventing proper digestion of foods, nutrient deficiencies, in particular in vitamin B12, magnesium, calcium, iron and zinc, and when used long-term, can lead to bone fractures and osteoporosis, chronic kidney disease and dementia. So it’s vital to distinguish between too little and too much stomach acid. In order to avoid misdiagnosis – we can look to some other signs and side effects of hypochlorhydria.
First, one sign of hypochlorhydria is iron deficiency anemia. I’ve heard optimal ferritin levels quoted between 40 to 100 for women and 50 to 150 for men, or from another trusted source, 70 to 100 for everyone. But most people won’t get ferritin tested on routine blood work, so if you are below the reference range for RBC or red blood cells, Hemoglobin, Hematocrit, Mean Corpuscular Volume (MCV), Mean Corpuscular Hemoglobin (MCH), or Mean Corpuscular Hemoglobin Concentration (MCHC) or are above the reference range for Red Cell Distribution Width (RDW), iron deficiency anemia is possible and you should ask your doctor for a full iron panel plus ferritin. And by the way, if you are deficient, I always recommend the iron bisglycinate form of iron for supplementation, as I took the cheap ferrous sulfate from the drugstore for years, and had to take two pills a day, that was 130 mg total, and I could never get my levels up. But a couple months on iron bisglycinate and I got levels back up into the standard reference ranges and easily kept them there – at only 25 mg a day. Not to mention that because it’s absorbed more easily, you’re less likely to have it eaten by any overgrown bacteria or have it contribute to SIBO, or have side effects like constipation. Also, you should take your iron ideally on an empty stomach with vitamin C for maximum absorption.
Another sign of low stomach acid is low B12 levels, which can be caused by pernicious anemia, which is when there is a lack of intrinsic factor, often due to autoimmune destruction of stomach cells called parietal cells, which produce intrinsic factor, which is necessary for absorbing B12. This leads to impaired B12 absorption, resulting in anemia. Of course there are other causes of B12 deficiency, the most common of which is a vegan or vegetarian diet, so don’t assume it’s pernicious anemia if you are on a vegan or vegetarian diet and are not supplementing with B12. Prior gastric surgery can also cause a lack of intrinsic factor, and of course our old friend, the bacteria which causes ulcers, Helicobacter pylori or H. pylori.
H pylori can be at the root of atrophic gastritis, or inflammation and thinning of the lining of the stomach, which is a precursor to pernicious anemia and to low stomach acid, as the parietal cells lining the stomach are responsible for producing hydrochloric acid as well. Again, you will not likely see B12 tested on standard blood work, but low RBC, Hemoglobin, Hematocrit or high MCV, MCHC or RDW are indicative of a possible B12 deficiency, which should prompt your doctor to test B12 levels. And while the reference ranges for B12 start in the 300’s, optimal levels are going to be above 700 pg/mL. Or even better, you could ask to get methylmalonic acid tested, which is an earlier and more accurate measure of low B12 and is found on Organic Acids Tests*, but can also be ordered by your doctor from standard blood testing labs. If you are deficient in B12, you are likely to have a stomach acid issue, in which case I always recommend sublingual B12 in the form of methylcobalamin, which is taken in a lozenge form that you let dissolve under your tongue so it directly enters the bloodstream. Typical dosages are 1000 mcg/day or 5000 mcg 1-2 times a week.
Hydrochloric acid also prompts the release of bile, which helps metabolize fat in the small intestine, so you can get fat maldigestion, when you’re low on stomach acid, which can lead to nutrient deficiencies, especially in the fat-soluble vitamins, which are D, E and A.
Other signs on a blood test of hypochlorhydria are low chloride levels under 100 (with 101 to 106 considered normal), which can be from a lack of chloride in the diet, which comes primarily from sodium chloride, aka salt. It can also come in smaller amounts from seafood, tomatoes, olives, lettuce and celery, but usually when someone is deficient in chloride, it’s usually because they eat a whole foods diet without much processed food and have taught themselves to eat little salt believing it to be a harmful nutrient. But it’s a goldilocks nutrient, with too little or too much being an issue, so if your chloride levels are low, you may need to salt your food more generously, take electrolytes daily or at least when you exercise, or even sprinkle some salt in your water.
Another sign of hypochlorhydria is abnormal serum protein levels, which would be if they are under 6.9 or over 7.4 g/dL or abnormal globulin levels under 2.4 or over 2.8 g/dL. This is especially in the case that your liver enzymes are relatively normal (that is your AST and ALT, which optimally should be between 18 and 25, but for the purposes of determining if they are relatively normal, just use the normal reference range on the test). Another possible sign of hypochlorhydria is low phosphorus levels with a vitamin D deficiency and/or hyperparathyroidism. Additionally, a high BUN level or blood urea nitrogen level of over 20 or more, indicating a high amount of nitrogen waste found in the bloodstream from poor digestion, can be indicative of low stomach acid. And finally, a low alkaline phosphatase level can be linked to low stomach acid and poor digestion.
Hypochlorhydria has also been postulated as one potential root cause of SIBO, or small intestinal bacterial overgrowth, according to studies on children taking PPIs. There may be a rise in pathogenic bacteria that are not killed off in an acidic stomach, such as certain pathogenic strains of E Coli, Clostridium, including Clostridium Difficile or C Diff, which you often see people getting after hospital stays and which causes explosive and frequent diarrhea, Enterococcus, including Enterococcus faecalis and faecium, Streptococcus, and overgrowths of yeast such as Candida albicans and Candida glabrata or other fungi, and/or other more pathogenic strains of H. Pylori. And taking PPIs has also been connected to SIBO, so it is clear that lowering stomach acid puts you at risk of SIBO. If you do have to take PPIs because of a condition like a hiatal hernia or a true case of high stomach acid, there is a probiotic that has been shown to prevent SIBO during PPI use, which I’d recommend alongside the PPIs, called L reuteri DSM 17938, which is found in both Biogaia Protectis Infant Drops* or Biogaia Gastrus* chewable probiotics. Nevermind that those are marketed to infants and children; the dosage is good for protecting adults too and I’ve heard great reports from several clients taking them.
So those are the main red flags and indicators of hypochlorhydria. Now let’s move on to the root causes of low stomach acid. It is widely accepted that an H. pylori infection is a common cause of hypochlorhydria. This is caused by the release of an enzyme from H. Pylori called urease, which breaks down in the stomach into carbon dioxide and ammonia, which neutralizes hydrochloric acid and causes burping and bad breath, in addition to the destruction of parietal cells from the bacteria burrowing into the lining of the stomach. However, in the early stages of an H. pylori infection, you can have high stomach acid and symptoms of gastritis, like burning in the stomach, particularly on an empty stomach.
Tests done by gastroenterologists for H. pylori are usually limited to urea breath tests, stool antigen tests and upper endoscopy exams, which usually include biopsies for H. pylori. Rarely, you might be offered an esophageal pH test or a Heidelberg Test to check if you have low or high stomach acid. I currently use stool tests like the US Biotek GI-Advanced Profile, which is my current favorite, or the GI Map to see if there is H. pylori and to see if it has virulence factors present, which indicate a risk for ulcers or stomach cancer. I only recommend treating it when levels are elevated, there are virulence factors or there are clear signs of issues as a result of it. Also, when you have a low stomach acid situation brought on by H. Pylori or other reasons, like aging, you will often see also low pancreatic elastase on a stool test, which is a digestive enzyme secreted by the pancreas. But it is worth mentioning that you may also see this decrease in pancreatic elastase for other reasons, such as gallstones or a vegetarian or vegan diet.
There are other possible root causes of hypochlorhydria, including autoimmune atrophic gastritis. I honestly haven’t heard much about this in the functional medicine community, but a few possible root causes of this autoimmune form of gastritis include H. pylori, as well as the other causes common to any autoimmune disease: genetic predisposition, a leaky gut, toxins from your food or environment and vitamin and nutrient deficiencies. It also commonly occurs along with other autoimmune diseases and is more common in older adults.
Chronic use of proton pump inhibitors may also result in hypochlorhydria, even after you’ve discontinued their use. And not surprisingly, acid-reducing medications like antacids and H2 receptor blockers can cause low stomach acid, which is probably why you would be taking them in the first place, but after you stop using them, there is no evidence that they cause ongoing hypochlorhydria. Some people do take H2 blockers for histamine issues as well, so that’s something to be aware of. Examples of H2 blockers are Pepcid, Tagamet, Zantac 360 and Axid, and examples of antacids are Tums, Rolaids, Milk of Magnesia, baking soda, Maalox, Mylanta and Alka-Seltzer. Acid-reducing medications, especially PPIs, are something to be particularly wary of because if you’re misdiagnosed with high stomach acid, doctors may prescribe you these very medications – only worsening your symptoms, if you do indeed have hypochlorhydria. For that reason, PPIs should only be used as treatment for a 14-day period. Examples of PPIs, some of which are over-the-counter in the US, some prescription, include Omeprazole, Prilosec, Zegerid, Nexium, Prevacid, Protonix, AcipHex, Dexilant, Losec, Zoton, Pantoloc, Somac, Pariet, Rabeprazole, Pantoprazole, Lansoprazole, Esomeprazole and Ilaprazole.
So in terms of correcting low stomach acid, I have been educating my clients on the Betaine HCl challenge for a few years now. I based that on the work of Sarah Ballantyne in her book The Paleo Approach,* which is an exhaustive and incredibly well-researched book on autoimmune disease and the Autoimmune Paleo diet. I have since heard criticisms that this approach to supplementing with Betaine HCl has no science behind it. So one of the reasons I wanted to do the episode was to have the time to research this question. What I found was a 2020 study on using Betaine HCl for re-acidifying the gut. They used PPIs to raise the pH in subjects’ stomachs, and once the pH was above 4.0 for 15 minutes, they gave them 1,500 mg of betaine HCl. They found that the average gastric pH in all subjects dropped from an average of 5.2 in the half an hour prior to ingestion to 0.6 a half an hour after supplementation. On average, it only took 6.25 minutes for the pH in the stomach to get under 3.0, and the re-acidification lasted on average 73 minutes, with a pH of 3 hitting at 73 minutes and a pH of 4 at 77 minutes, with a good amount of individual differences of up to 30 minutes for that rebound effect. Note that all of this was while fasting.
In another study using the design with pretreating with PPIs, they had subjects consume a light meal of only 336 calories, followed 5 minutes later by 1500 milligrams of Betaine HCl. In this case, it took an average of 67 minutes (plus or minus 33 minutes for the different subjects) to reach a pH of 0.838 (±0.391), which suggests it takes a lot longer to reacidify the stomach when you’re eating. Then it took an average of 76 minutes ±20 minutes to get back up to a pH of greater than 4, although the majority of the participants (5 of 8) didn’t even reach that within 3 hours.
The researchers from the first study suggest that dosages for Betaine HCl may need to be higher than 1500 mg to compensate for meals, and that taking Betaine HCl just prior to a meal may be a good idea for acidifying the stomach in advance. Of course, this is all assuming that you have some condition that is greatly reducing your stomach acid. It may be that a person who has low stomach acid doesn’t have as low stomach acid as someone who is on PPIs. So you have to take that into account.
So based now on this peer reviewed research paper, I’m more confident in recommending that if you suspect you have low stomach acid or hypochlorhydria, you may want to start with the Betaine HCl challenge. The way you would do that is to start with one capsule (which are sold in the 500-750 mg range) per full meal in the 500 calorie or greater range, only if the meal includes protein foods, then increase your dosage by 1 capsule/meal every 2 days. So if after taking it for the first time or at any point in the protocol, you feel a tingling, burning in your stomach, heartburn, diarrhea, unease, digestive discomfort, neck ache, backache, headache or any odd symptom, then it may be you have sufficient stomach acid or perhaps a hiatal hernia or some other issue. You can take an antacid or a teaspoon of baking soda in water or milk to neutralize the acid if it’s bothering you. If you were already doing well on a previous dose, you can decrease to the previously tolerated dose of Betaine HCl. You can go up to as much as 4-5 capsules, or 3000 mg maximum. If you’re trying to reduce the number of pills you take, I have only actually found one Betaine HCl that has 750 mg per pill and that’s the Designs for Health* one , which also has pepsin in it, which is recommended too. However, I often recommend the Vital Nutrients* one with Gentian Bitters for people who seem to have bile-related issues and obvious problems digesting fat, either based on their own experience or on seeing elevated fecal fats or steatocrit on a stool test. And do note that Betaine HCl is different than plain Betaine, also known as trimethylglycine or TMG, which is used as a methyl donor. And I’ll link to the study that outlines this suggested protocol in the show notes. If you scroll down, there’s a gray box with the protocol. But based on what I’ve read in this study, I think it is probably best to start the Betaine HCl 5 minutes prior to eating, and then periodically dose the additional pills as you’re eating.
Also note that there are some contraindications for using Betaine HCl, which include Barrett’s esophagus, diagnosed malformation of the lower esophageal sphincter, a history of stomach ulcers, any diagnosed disease or pathology of the pancreas, or if you’re taking NSAIDs, like Aspirin, or Tylenol, or Ibuprofen or have a diagnosed blood-clotting disorder. One alternative to taking Betaine HCl is to have 1-2 tbsp. of apple cider vinegar or lemon juice mixed in water 10-15 minutes before meals. And it’s super important to dilute that vinegar, because it can erode your tooth enamel, and some people even suggest drinking it through a straw. But again, if you have a diagnosis of Barrett’s esophagus, esophageal strictures or reflux esophagitis, you shouldn’t use these either, and of course, none of these things should be used if you an ulcer or a suspected ulcer.
So if you’ve determined you have hypochlorhydria, I’d suggest supplementing for a while as you work on other gut health issues, stress management and reduction, good sleep, adequate nutrition and supplementation of identified deficiencies, and adequate salt intake. If you have retested and determined that all these other things are in order and there are no more signs of low stomach acid on your blood tests, then it may be time to start reducing the Betaine HCl and see how you do.
If you’re still having issues or the blood numbers still indicate low stomach acid and you have H. pylori present in your gut, but at normal levels, then it may be time to try to eliminate or severely reduce the H. pylori to see if that’s what’s causing your low stomach acid. However, be aware that many gut health practitioners caution against eliminating H. pylori, as some people end up with acid reflux after eliminating it, which is one of the topics discussed in Martin Blaser’s classic book Missing Microbes: How the Overuse of Antibiotics Is Fueling Our Modern Plagues*, in which he describes his life’s work studying H. pylori. So maybe if you have low stomach acid and no H. pylori you should find someone to kiss who has H. pylori and get some back, as it’s transferred via saliva. People have certainly done crazier things to help their gut health! But I’m just kidding. In my experience, herbal antimicrobials, as opposed to triple or quadruple therapy using antibiotics and PPIs, tend to reduce but not eliminate H. pylori. Mastic gum* is the primary one used for that purpose, but other antimicrobial agents like berberine and hydrosol silver*, as well as mucilaginous agents like marshmallow root, DGL, slippery elm, aloe* and okra are also useful in healing the gut lining.
So if you’re dealing with low stomach acid or gut health issues of any type and need some help, I see individual clients to help them resolve their digestive issues and you’re welcome to set up a free, 30-minute breakthrough sessionto see if you’d like to work with me. I also have my own two products, Tributyrin-Max, which is particularly helpful for loose stool and diarrhea as it slows your motility and firms up your stool, and SBI powder, which is an all around gut pathogen binder, which is super safe and won’t harm beneficial bacteria, and is usually the first line of treatment I educate my clients about in order to avoid stronger antimicrobial herbs.
*Product and dispensary links are affiliate links for which I’ll receive a commission. Thanks for your support of the podcast by using these links. As an Amazon Associate, I earn from qualifying purchases.
Adapted from episode 133 of The Perfect Stool podcast with Dr. Ali Navidi, a licensed clinical psychologist and co-founder of GI Psychology where he has helped develop innovative treatments combining Clinical Hypnosis and Cognitive Behavioral Therapy (CBT) for patients with GI disorders and chronic pain, and Lindsey Parsons, EdD, and edited for readability.
Lindsey:
So I’m curious how, as a psychologist, you ended up with a focus on GI issues?
Dr. Ali Navidi:
That is a great question, that kind of cuts right to it. Well, I can tell you, I did not expect that to be the case. I came in as a generalist. I just enjoyed treating all different kinds of patients, different ages, kids to elderly. Yeah, there was no plan to focus on GI. If someone had told me that while I was starting, I don’t think I would have believed them. But what I did have was a love of clinical hypnosis as a tool in therapy. And at the time, at the beginning, I didn’t realize what an amazing tool it was for the GI and how much research there was already supporting it. I slowly discovered that, and slowly started to use it with patients. And it was just such an incredible response that I just kept doing it and adapting it, building it, and eventually it became like 80% of my practice, because the gastroenterologists in the area would find out about me, and then they would tell other gastros, and it was like, those are all the people that were coming to me. And there was no one else, there was no one else in the area that was trained to do this stuff. So I really felt bad turning any of these people away.
Lindsey:
Yeah, and so initially, these weren’t people who had come to you for GI issues? They were seeing you for other things, but they had a GI issue, just by chance, and you happened to realize that that could also be dealt with?
Dr. Ali Navidi:
Yeah, I had done a training years and years back about treating IBS with clinical hypnosis.
Lindsey:
Oh, okay.
Dr. Ali Navidi:
It was part of a larger training in clinical hypnosis. And I was like, this is interesting, but I’m never going to use it. So I just put it in my back pocket, and it turned out to be useful. But yeah, the first patient I used it with was someone I was treating for anxiety, and I already knew they responded well to hypnosis, and they were talking about going through this process of figuring out what was going on with their gut, and they had gotten scans and tests and then scoped, and they didn’t find anything, and eventually they came back to them with this diagnosis of IBS. And that’s why I said, “Well, you know, I’ve done this training, so if you want, we could try this thing.” And it ended up working.
Lindsey:
Wow, wonderful. And was that person a person who tended towards loose stool and diarrhea, or towards constipation . . . or . . . I’m curious?
Dr. Ali Navidi:
I’m going back into my memory banks, I want to say it was IBS-D.
Lindsey:
Yeah, because I can imagine that that’s probably more the type that would be associated with anxiety, because when you’re nervous, the bowels tend to loosen.
Dr. Ali Navidi:
Yeah, I found that while IBS-C is treatable with these techniques, IBS-D tends to respond even better, and it might be good to get into the model behind why this works, because the anxiety is a part, but there’s more.
Lindsey:
Yeah.
Dr. Ali Navidi:
Not just anxiety. And I think that’s a big misunderstanding. A lot of times with patients, they’ll be like, “Well, I don’t think I’m that anxious. I don’t think that’s the reason this is happening,” And it’s more than just anxiety.
Lindsey:
So yeah, go ahead and delve in.
Dr. Ali Navidi:
Yeah, so basically, there’s four elements to understand. First off, something you’re super familiar with is the brain-gut axis. So that communication system between the brain and the gut and between the gut and the brain. I was just looking at your podcast list, and you’ve got quite an impressive list. You’ve been doing this for a while, and you’ve covered a lot of interesting stuff. A lot of what I saw is from the gut up, what’s happening in the gut, how it affects the brain and how it affects the body. In my world, it’s what’s going on in the brain and how that affects the gut. So the elements are the brain gut axis – so this powerful communication between the brain and the gut, and then hypervigilance, catastrophizing and something called visceral hypersensitivity. And so when I talk about hypervigilance, I’m not talking about general hypervigilance, I’m talking about body focused.
Lindsey:
Yeah
Dr. Ali Navidi:
And so usually people lock in on something. Maybe there’s a certain area of the gut where they usually get pain or discomfort, maybe that’s in the upper GI. But there’s an area where they’re getting symptoms, could be nausea, it could be pressure, bloating. So there’s this hypervigilance, and then when they notice there’s something happening there, then they’re like, “Oh, oh, man.” And then they start catastrophizing. And then that anxiety feeds down into the gut, and it can cause a worsening of those symptoms. And then before that gets sent back to the brain, we’ve got visceral hypersensitivity, which is essentially the brain turning up the volume on those sensations and distorting them. So what might feel like a little bit of bloating can feel like an intolerable amount of bloating. What might just be hunger cues could be pain or the feeling of digestion could also turn into pain or nausea. So there’s an amplification and distortion that’s occurring. And so you’ve got all these four elements happening.
Lindsey:
Yeah, in my list of podcasts, the most recent one I published was Ashok Gupta, The Gupta program, and that is a brain retraining program, specifically. And I’m doing the program because I have autoimmune SIBO, so I figured, why not give it a try? But it’s an interesting question, because I would also say, I don’t feel like I’m anxious about this. I feel like I’ve got it roughly under control. It flares up. I treat it. Yeah, I bloat a decent part of my meals, but I also overeat a decent part of my meals. So, you know, I’m curious, if you are somebody who doesn’t feel like you’re hypervigilant of your symptoms, would that be somebody who’s probably not such a good candidate for this kind of treatment, or not a necessary component?
Dr. Ali Navidi:
Not a necessarily the case. So people will differ in how they’re acting out these different variables. Like I said, there’s the hypervigilance, and there’s catastrophizing. But let’s not forget about our good friend, visceral hypersensitivity. And this is a tricky one, because most people have a very linear concept of how pain works in their body. It’s like something happens, the sensation of pain travels up to our brain, and we’re aware of the pain. When in actuality, it’s much more complex, and that sensation is processed in multiple areas of the brain in different ways. And the idea that our brain has this kind of tuning mechanism where it can turn up the volume, or it can even turn down the volume, and so it’s hard to say how much that is playing a role in somebody’s symptoms. And then there’s just this mind-body connection where there can be these feedback loops created, where what we expect to happen is being made to happen in some way. I’ve seen many patients that, you know, you talk to them, their self report and what you observe, you don’t see much hypervigilance. You don’t see much catastrophizing. They’re pretty level-headed people, so you believe them, just doesn’t seem to be the case, yet they still respond well to treatment.
Lindsey:
Yeah, I mean, to some extent, it really just shows the power of our brain to alter our physiology. Whether or not it was fully brain-caused, it can be brain-solved, right?
Dr. Ali Navidi:
Yeah, yeah. A lot of patients that I’ve had with functional dyspepsia, where they’ve got a lot of bloating, a lot of gas kind of decreases their appetite. It’s hard for them to eat big meals because it feels like it just kind of sits there. For example, when using hypnosis, a number of those patients, we’ve had experiences where they can literally feel the gas going away during the hypnosis session, and at the end of it, they’re like, “Wow, I feel hungry for the first time in however long.”
Lindsey:
That’s awesome. So if someone has GI issues, do you suggest they start with the gastroenterologist doing the full workup, or maybe starting with a psychological approach?
Dr. Ali Navidi:
Definitely want them to, at the very least, see their primary care. Often primary care, with a good history and a few simple tests, they don’t need a full workup. I think that’s what they’ve been finding more and more nowadays. They used to do a full workup on everybody, and they’re finding, I think, that that’s not really needed. With a good history and a few simple tests, they can usually figure out if it’s IBS or another of the DGBIs. So in case people don’t know, that’s a disorder of gut-brain interaction (DGBI), and it’s a class of maybe about 30 different disorders. So I would say definitely start with some sort of a physician, and then you can maybe come to us earlier, rather than later. What I think people do a lot of times is they’ll go to their doctor, doctor’s pretty sure it’s IBS. They do the few simple tests. They say, “Hey, it doesn’t look like there’s anything wrong with you.” And then the person responds with, “Yeah, but I’ve got all this pain, and you must have missed something.” So they want more. And so they complain enough that they’re going to get the endoscopy, they’re going to get the colonoscopy, they’re going to spend six months to a year chasing their tail before they end up seeing somebody like myself.
Lindsey:
Yeah, and so you mentioned a few simple tests. So I don’t see a lot of people getting anything related to GI from their primary. What simple tests are we talking about?
Dr. Ali Navidi:
I wish I remembered, because there are these certain kind of red flag things.
Lindsey:
Like fecal lactoferrin or calprotectin or things like that for checking for IBD?
Dr. Ali Navidi:
Yeah, exactly. They need to rule out IBD. At least rule out minimally IBD, they need to rule out something like Celiac. You probably know them.
Lindsey:
Yeah. Probably H. pylori, I would think, and then maybe occult blood, parasites, whatever, things like that.
Dr. Ali Navidi:
Yeah, and look at their blood and make sure there’s no indications that it’s maybe some kind of cancer or something like that.
Lindsey:
Right or maybe CRP to check for inflammation, things like that. Yeah, I do see all the time people who are like, “Yeah, they want to do a colonoscopy, and I’m young, and I think I can see the root cause of this, like I took a bunch of antibiotics,” or maybe they had food poisoning, something like that. And, “Do I really need to go get the colonoscopy?” and people wanting to avoid that. And I always sort of wonder, well, why don’t they just do a fecal lactoferrin? I mean, I don’t know how sensitive and specific it is for IBD, but there’s both calprotectin and fecal lactoferrin, if you do them both, then it seems like together, that would be a pretty good indication if you really need to do the colonoscopy. But I guess for a doctor who does colonoscopies every day, it’s probably like, no big deal for them, but for a person, you’re just like, “Oh my gosh, I’m going to have to drink this stuff, and then I’m going to have to go through this whole medical procedure, and it could be expensive” and yeah.
Dr. Ali Navidi:
And what you said reminded me there’s two main paths that you can develop these kinds of disorders. So IBS is the most well known of the DGBIs. Like I said, there’s a bunch of others. The two main paths are trauma, gut trauma, like they ate some bad sushi and they’re feeling sick, or they got a virus or they got a bacterial infection, and even though that has passed, their symptoms are remaining. And so the brain-gut has kind of learned a pattern, and now it’s just rolling with it. The other way this can happen is if they are going through something in their life, and it could be positive or negative stress. So if somebody’s getting married, somebody loses their job, they’re fighting with somebody in their family, like something that’s stressing them out, often is associated with the beginning of these. And then there’s certain classes of people that tend to be more vulnerable. So someone with an anxiety disorder, history of trauma, someone who’s on the autism spectrum or someone with a history of eating disorders. Those four groups, they all tend to be more vulnerable to developing these DGBIs.
Lindsey:
Interesting. Okay, so, yeah, tell me a bit more about the approach, about the hypnosis.
Dr. Ali Navidi:
So I’d say the majority of people may be listening to this, they hear hypnosis, and they’re immediately thinking of entertainment hypnosis. So what are they thinking of? They’re thinking of the movies with magic or mind control or a stage show. If we take all of that stuff, which is usually what most people know, and just put it to the side and say, “Okay, that’s entertainment hypnosis. What is clinical hypnosis?” Then you get something really interesting. What you get is a technique that has been studied for 40 years, for IBS, let’s say, if we just talk about IBS. It’s been studied for 40 years, and we’re talking about serious medical studies, randomized control trials, all that good stuff. It’s in the guidelines for the American College of Gastroenterology. In England, it’s kind of a standard of treatment, also. It’s really legitimate, and sadly, very few people with IBS would even think of it for their treatment. So what is it exactly? If it’s not entertainment hypnosis, it’s just deliberately teaching someone how to go into a state of trance. And trance is something that happens naturally, that everybody does. So I’m driving to my office. I drive the same way every time, and I’m listening my book on tape right now, and then I get there and I’m at the office. And how did I get there? I’m not sure what happened. I don’t know, but I know what happened in my book on tape. And that’s an example of trance. It’s happening all the time.
Lindsey:
Yeah. Or worse, you’re going somewhere else, but you still drive to your office.
Dr. Ali Navidi:
Yes, yes.
Lindsey:
Which is something I do a lot.
Dr. Ali Navidi:
Yeah. Or, like, you’re used to dropping your kids off and you drive to their school. So you’ve got this naturally occurring state, and so we’re just teaching people how to go into this state on purpose, rather than accidentally. And why do we care about trance? Well, it turns out that in trance, one of the things we can do is we can turn down that visceral hypersensitivity, turn that volume down. And there also seems to be more of an ability to access that brain-body connection in trance. So I’ll do a lot of work with patients with chronic pain. I’ll do a lot of work with patients with GI issues, also. Because in that trance, for whatever reason, they have a stronger ability to make shifts in that brain body connection.
Lindsey:
And then what about the cognitive behavioral therapy and how that plays in?
Dr. Ali Navidi:
Yes, so most people, I think, would have heard of cognitive behavioral therapy. For this kind of work, it’s not generic CBT. So CBT is cognitive behavioral therapy. It’s not generic CBT. It’s a more focused protocol, and I make that distinction, because a lot of patients get sent by their doctors, “Oh, you’ve got IBS, go get some CBT.” That’s a good instinct, but your standard CBT practitioner doesn’t know what to do with IBS. They don’t know what to do with functional dyspepsia or chronic functional nausea. They’ll treat the anxiety, they’ll treat the depression. But a lot of these patients will come back, and when we talk to them, we’ll say, “Okay, we’re going to use CBT in your treatment.” They’ll say, “Oh, yeah, I tried that. It didn’t work for me.” But what they tried was kind of general CBT, not those protocols that are specifically designed for GI problems.
Lindsey:
And what does that look like?
Dr. Ali Navidi:
Well, we want to address various components. So we want to address that habit of hypervigilance. We want to address the catastrophic thinking. We also want to address the various types of avoidance. You often will get avoidance of places and situations, like I don’t want to go on that car trip, or if I’m giving a talk at work, I’m worried that I’m going to have GI issues, so maybe I talk my way out of it or something. So there’s a lot of different kinds of avoidance that occur.
And then there’s also avoidance of foods, right? And some of that is legitimate, and some of that actually is based on factors that are not related to the food. The poor food gets lumped in there with a bunch of other things. And then there’s actually what’s called interoceptive avoidance. So they develop a kind of anxiety that’s associated with their body and specifically the sensations in their gut. So we want to address those levels of avoidance. I usually like to save the food until the end because while people’s systems are hypersensitized, if you try to introduce the foods back in, they’re just going to have a bad reaction to it. So what you do is, once you desensitize the system, turn down the visceral hypersensitivity, reduce the hypervigilance, the catastrophizing, get the system calmed down, then you can go back and start trying to reintroduce foods, and you’ve got a better chance of doing it without them having a negative reaction.
Lindsey:
Yeah, I see a lot of people who are down to a very small list of foods, and in almost every case, they’ll say, “Well, I had that once, and I had this reaction.” And I think, “Well, I suspect that that wasn’t the only thing that was at the meal.” Right? I mean, it’s not usually that you did a one item trial. And you might have had something else going on, like it may not actually be that food. But yeah, slowly but surely, they just keep crossing things off the list or entire categories, say it’s histamines, oxalates, categorically eliminating foods until they’re down to a ridiculously small number of foods.
Dr. Ali Navidi:
And then we’re in the realm of ARFID, avoidant/restrictive food intake disorder. It’s a type of eating disorder where they’ve limited what they’ll eat to such an extent that it’s affecting them in life, socially, physically, mentally. Yeah, and exactly, you hit it right on the head, exactly what you just said. So they’re having a meal. Maybe they’re just having a bad day. They’ve got a higher background level of anxiety for whatever reason that day. So that’s feeding also into their system, so their stomach is more reactive. They eat their slice of pizza, or whatever it is they eat, and they have a bad reaction. Then they conclude, “Well, it seems like pizza is bad for me.” So then the next time they have pizza, they come into that pizza with the level of anxiety and fear, which, of course, is going to cause more symptoms, and then those symptoms are going to confirm that they’re right and pizza is bad, and that’s how pizza gets crossed off the list, right?
Lindsey:
Yeah, I do find it’s interesting, because obviously, when you work with someone, you’re not seeing them, at least I’m not, I might see them every two to three months. So I’m not able to monitor their diet and the minutia of what items they eat and don’t eat on a regular basis. And there are some types of clients that restrict and just stay restricted. They can live off of 12 foods, if that’s what makes them feel good, they’ll live off of 12 foods for the next 10 years. And then there’s others that just kind of keep going, “Well, can I reintroduce? Can I reintroduce?” And I’m like, “Yeah, yeah, definitely reintroduce.” Sometimes I forget to say, “Hey, are you trying now to reintroduce some of these things?” Because you’re more interested in making sure their symptoms are gone than you are in reintroducing foods. But of course, it’s much better if people are pushing and saying, “Hey, When can I start retrying these foods?” Just a note to people out there.
Dr. Ali Navidi:
Yeah, and you’re right, it’s so much easier for me also when they have that desire, that excitement about reintroducing and they even start testing on their own.
Lindsey:
Yes, yes.
Dr. Ali Navidi:
Versus those other people you’re talking about that they’re firmly lodged into, “Okay, this is safe, and things outside of that aren’t safe, and I want to stay safe,” and almost have a belief that they’re injuring themselves if they have the wrong food, like it’s doing harm to them.
Lindsey:
Yeah, that actually makes me think of a podcast I was listening to that was talking about just physical pain, and that you might have a physical pain in doing some type of action or sport or whatever. And if your belief is that that physical pain is injuring you and is hurting you, then it will seem worse, and then if somebody tells you, “No, it’s just a pain, it’s just your brain’s perception of it, but it’s not actually making you any worse.” Then all of a sudden they were like, “Oh okay, well, now I can walk or now I can play tennis.”
Dr. Ali Navidi:
Oh, my god, yeah, you’re opening up a subject that I love to talk about. I work with a lot of patients with chronic pain also, and that’s one of the fundamental concepts that people should understand is that not all pain equals harm. And there’s a really cool story about that. Have you ever heard the story of the two nails?
Lindsey:
No.
Dr. Ali Navidi:
It’s kind of classic in the pain literature. Essentially, somebody’s working in a construction site, and they jump down, and they accidentally jump on one of these long nails that were sticking up out of a board. Goes through their boot and it’s sticking up the other side. They look down. They freak out. Everyone around them freaks out. Pick him up, they carry him, the guy is screaming and yelling and he’s in all this pain. And then you get to the hospital and they give him a bunch of painkillers. It’s not helping. They’re losing it. They cut off the boot and the nail had gone right between the toes. There was no harm, but there was lots of very, very real pain, because when the brain thinks it’s been harmed, it’s going to take those sensations and again, amplify and distort. So this person believed he had been badly harmed, and so his brain gave him the pain that it expected to see.
There’s another example. So the second nail is another construction worker who, I guess, was holding a nail gun, and it kind of went off accidentally, and, like, bashed him in the face, the back of it. Then for about a week or so, it was just kind of hurting, it was a dull pain, not too bad. Eventually, he was like, “This isn’t going away. I should probably go the doctor.” But no urgency there. I think they did maybe an MRI or something, maybe an x-ray, and they saw that he had shot it, and I guess it had ricocheted and come back and lodged in his sinus, and it had been there for at least a week, maybe two, and very minimal pain, because just the way things had happened, his brain did not expect to be finding any pain or much pain at all, right?
Lindsey:
Yeah, that makes me think of a trick that I do every time they take blood. I pinch above the arm where they’re taking the blood on the inside real hard, just as they’re poking me, and half the time I literally don’t feel the needle going in, because your brain can only interpret so many signals at one time, especially on the same arm, right?
Dr. Ali Navidi:
Yes, yes. That’s an awesome trick. Everyone should listen to that. And I think that follows what’s called the gate control theory of pain. It’s why, also, if a kid hurts themselves, knocks into something, if you kind of rub around it and give them all this other stimulus, their brain will mask the pain and the pain will decrease.
Lindsey:
Yeah, that’s why I sometimes see dads like punching kids in the shoulder when they hurt themselves, because it’s like, “Yeah, get over it.” It’s just a distraction.
Dr. Ali Navidi:
And there’s good truth in that. It actually works!
Lindsey:
Yeah! Okay, so I’ve been playing with the Reverie app, and they have this thing where you look up and then close your eyes and then keep looking up as you close them. And that’s supposed to be a test for being hypnotizable. So I’m wondering first, is everyone hypnotizable? Because you did mention everybody can be in a trance state, and how do you test for it? Or how do you find out?
Dr. Ali Navidi:
Yeah, that’s a great question, and what they were doing is what’s called the eye roll. That’s been around for a really long time. And so hypnosis is interesting because it’s probably one of the most studied concepts within psychology. I mean, if you go on to PubMed and just type in hypnosis, you will see thousands of articles, studies, various things have been done with hypnosis. So you’re asking about hypnotizability. That’s been really well studied. And so they’ve done population studies using these concepts. And so what they’ve found is that it’s a bell curve. It’s essentially a bell curve. And so you’ve got a few people on the end who are just amazing at it, a few people at the other end who it’s like talking to a brick wall for them in hypnosis. And then most people are average. The vast majority of people are average. And what I say to people is, “We don’t need you to be amazing. We just need you to not be terrible for this kind of treatment to work.” And so the vast majority of the people it can be helpful if you’re wanting to do chronic pain work, if you’re wanting to do GI work, we just need you to be average or better, and it can be helpful for you.
How do you test? There’s certain tests that have been developed over the years. The eye roll test is one of them. They’re kind of fun, actually. For example, there’s one called finger magnets, where you have them put their fingers out like this, and you give them some suggestions. And I’d say 95% of the time, the fingers come together, almost like they’re being pulled together by magnets. The thing to understand is that trance is natural, and it’s happening all the time. And how do people enter trance? Well, pretty much, you just need two things, focusing your attention and engaging your imagination, and that’ll usually do it. So for example, if you’re thinking deeply about all the different things you want to do today, and so you’ve focused your attention, and now you’re imagining your day, you’ll probably go into a light trance just doing that. If you’re reading a book, you’ve focused your attention, and maybe the story is really interesting, and you’re imagining the characters and all this stuff. You’re going to go into a trance just doing that. Does that answer your question?
Lindsey:
Yeah, yeah. I mean, I was curious too about the eye roll, because I don’t feel like I can do it. I mean, maybe I’m wrong, because, it seems like my eyes go down when I close my eyelids.
Dr. Ali Navidi:
Well, let me see, maybe it’s their instructions. Here’s how I do it, and it takes a little bit of practice. So what you do is, first you look up as if you’re looking through the top of your head, and then you slowly close your eyelids until you feel a flutter, while keeping, yep! Perfect, right there, yep! And then let your eyes relax. So that was it!
Lindsey:
Okay, yeah. I was wondering, because I didn’t do it super easily. But then there was a, “Are you hypnotizable?” little thing you could run through, and I did that, and one of the things was, “Your left arm is floating up, even though you’re not purposefully doing it.” And I’m just like, “I’m not going to just lift it, I’m not going to just lift it,” but I’m like, “I do feel like it’s being drawn up.”
Dr. Ali Navidi:
Nice!
Lindsey:
And then at the end, they tell you, you’re either a poet or, I don’t know, there were three people, you know, if you’re like a poet type. And I’m like, I am the least sort of poet-like person. I’m not very woo woo. So I just was sort of surprised that I was hypnotizable, because I thought, I’m not the kind of person I would expect to be.
Dr. Ali Navidi:
You do not need to be a woo woo poet person to be hypnotized. Absolutely not. We’ve worked with plenty of doctors and scientists and various medical professionals. I think the one factor they found to be really important is people’s ability for absorption. How good are you at getting absorbed in things that you do, the kind of person who could be working and then just lose track of time.
Lindsey:
Oh, yeah, that’s me.
Dr. Ali Navidi:
Right? Yeah, or, you know, you’re working for so long, and then you don’t even notice your body, and then you’re done, and you’re like, oh, and you’re like, all stiff and whatever, but you didn’t notice any of that stiffness, or any of that while you were working. That is the key. You don’t have to be woo woo, but if you have the ability to get absorbed in things, you’ll probably be pretty good at hypnosis.
Lindsey:
So are people who have ADHD, who are super distractible, are they not good candidates?
Dr. Ali Navidi:
Well, that is actually a misconception, because I think a lot of people with ADHD, they have this thing called ADHD hyperfocus.
Lindsey:
Right, right. But it’s usually on, like, computer games, isn’t it?
Dr. Ali Navidi:
Yeah! Well, it’s on things that they like, right? And that’s the problem with ADHD. They have real trouble getting focused on things that they don’t like, whereas people without ADHD can force themselves to lock in, whereas they have a lot of trouble doing that. But they can be amazing hypnotic subjects, because they really can get hyper focused if you can make the experience enjoyable for them.
Lindsey:
Yeah, so how long is a typical course of CBT hypnosis before a person will find resolution of their GI issues?
Dr. Ali Navidi:
Yeah, I don’t think I mentioned, so about four years ago, I responded to the fact that there was nobody out there that does this treatment. I think they did the numbers, and there’s like 500 in the world, right?
Lindsey:
Okay.
Dr. Ali Navidi:
Myself and another psychologist, we got together and created a bigger group practice called GI Psychology. And the idea of GI Psychology is that we were going to make this kind of treatment more accessible to people. We worked really hard to make it available. Now it’s available in all 50 states by telehealth. And so looking at the data from our practice, what we found is that, on average, people take about 10 sessions. That seems to be the average. To put in perspective, that’s a relatively short term treatment when you’re talking about behavioral health stuff.
Lindsey:
Yeah, for sure. And do you take insurance? Or is this all out of pocket?
Dr. Ali Navidi:
We’re out of network for insurance and our patients tend to get about half back.
Lindsey:
If they’ve got a non-HMO plan?
Dr. Ali Navidi:
Yeah, if they don’t have Kaiser or something like that.
Lindsey:
Right, right. Yeah.
Dr. Ali Navidi:
The other thing though, is that there’s something called a single case agreement. It’s also called a gap exception, and we help the patients get this. And basically you’re saying to the insurance company, “Hey, are there any other gut-brain therapists in network for you?” The answer is always no. And so when they grant that, and they grant it like 90% of time, then the patient gets reimbursed as if we’re in network for them. So they end up getting a lot more back.
Lindsey:
Okay, great! So I know that some people may have concerns about hypnosis, and maybe even more so if it might involve a child. So what would you say to reassure them about that?
Dr. Ali Navidi:
Yeah, I think that the concerns, for the most part, I think, rest in that category that we talked about at the beginning, which is entertainment hypnosis. If all I knew about hypnosis was the stuff I saw in movies and TV and stage shows, I would be concerned too! I wouldn’t want to do it! As long as they can understand that there’s a very big difference from what Hollywood is showing you about hypnosis and what it clinically is. So then we get common fears that you’re going to be under somebody’s control. Nobody would want that. But is that actually reasonable? When you’re daydreaming, you’re in a trance. Can somebody control you? Can somebody just suddenly tell you, like, “Hey, give me all your money!” No. Can you get stuck in a trance? If you’re watching a football game and you’re really into football, and you kind of zone everything else out, is somebody going to be able to control your mind, or are you going to get stuck in that state? No, of course not.
What I’m saying is this is actually a very natural thing that we’re teaching people to do. And what I tell my patients is, when they’re learning this, instead of losing control, they’re actually gaining more control over themselves, because we want to teach our patients self hypnosis, also. And what that means is, then they have this skill that they can use to decrease pain, to reduce GI symptoms. It’s a great way to calm down if you’re feeling stressed or anxious. I mean, I’ve had patients come back 5-10 years later and say, you know, I’m still using self hypnosis. They’re just using it for other things. They’re using it, you know, if they’re stressed or they need to figure something out and they need to get away from everything. And you brought up children. It turns out, children are even better at hypnosis, especially between like 8 to 12 years old. When we look at the data, children are even better at hypnosis, and they respond better to the treatment. So for example, adults, 75% of the time, they’re going to reach their treatment goals. That’s a super effective treatment, but kids are even better. They’re like 80-85%, are going to reach their treatment goals. They’re even better candidates for this kind of treatment.
Lindsey:
Yeah, that’s great. One thing that surprised me in using the Reverie app is that the introduction to moving you into a state of hypnosis is very quick. It’s like, do the eye thing, you’re in, basically and practically. And is that really the case in the therapeutic setting?
Dr. Ali Navidi:
Yes. So there’s stages to hypnosis. There’s the pre-hypnosis stage, where you want to explain things to people. Then there’s what’s called an induction. All that is, is the transition between normal consciousness and a trance state. Then they have what’s called a deepening so that’s where you’re getting deeper into the experience of the trance and kind of letting go of that outside world. And then there’s the intervention, whatever that intervention is going to be. And then there’s the re-alerting phase. They’re going to shift you back into your regular state of consciousness. There’s thousands and thousands of different ways to do that induction. It sounds like what they’ve chosen to do is a pretty rapid one, and based on what you’re saying, I don’t know what they’re doing for a deepener.
Lindsey:
Well, it’s probably just part of what they’re saying after that.
Dr. Ali Navidi:
Yeah, that’s probably not the way I would go with someone who’s learning hypnosis. Because just like anything in life, there’s a learning phase to hypnosis, and people will get better at it with practice. And so when people first start, you want to give them time to make that transition. And you want to work with them, which is the difference between an app and a human working with you. I want to work with them to figure out what works best for them. What’s the type of language? What’s the type of imagery? What’s the style that’s going to work for them? Because, like I said, there’s thousands of ways to do it. And then once people have been working with me for a while, they can go into trance in like a minute, once they’ve learned and trained themselves. But at the beginning, I would opt for a longer period of transition, to give people time.
Lindsey:
Yeah, and so if somebody’s experiencing GI issues, when do you think it’s gone beyond, my kid, when he’s nervous, for example, or me, when I’m nervous, I have to run to the bathroom, versus like, this is actually an issue that requires intervention of this kind.
Dr. Ali Navidi:
That’s a good question. I would say that when you start adapting your life to the problem. If you’re just going along and you’ve got to run to the bathroom every once in a while, but it doesn’t actually cause you to do anything different in your life, and it doesn’t really cause you a lot of stress or anxiety, or you’re not up at night thinking about what might happen tomorrow, or your life is not getting influenced by this. Just kind of keep on, keeping on. But once you start shifting your life around this problem, I think it’s time to start thinking about getting it treated. Because these problems are so treatable that it’s almost to me, like a no brainer. It’s a short term treatment, they’re highly effective, and they last. So when they do studies longitudinally, the results stay. These patients are not having to come back to keep this up. For the most part, they’re good to go. Very occasionally, they might come back, and it usually takes like one session to remind them of some of the skills they learned, and then they’re off and running again.
Lindsey:
Yeah, so we were talking a lot about the functional GI disorders and IBS and such, but I assume that there is also a mental component, even to the ones that are autoimmune, even IBD. Is there a role for hypnosis or CBT in those types of conditions?
Dr. Ali Navidi:
Yeah, there recently was a protocol that came out for IBD also, a hypnosis protocol, and it found that it was helpful for IBD patients. Patients with IBD, it’s a different type of treatment, obviously, it’s a different disorder. But there is a lot of overlap. There’s dealing with chronic pain. If you can help people get better at dealing with chronic pain, they’re going to have better quality of life. We know that stress is a big component in almost all the autoimmune disorders.
Lindsey:
Absolutely.
Dr. Ali Navidi:
When people are stressed, it’s going to be worse on their immune system. So if we can reduce that stress, they’re going to tend to do better. There’s also, I forget the right name for it, but basically I think of it as like an overlap. So you might have IBD, and then at different points in your life you’ve had flares, and that’s when your GI system is really going to be causing you trouble, and then the flares go away, or the flares are treated and they’re gone. But what happens with a lot of IBD patients is, they have a flare, the flare is treated, but some of the symptoms don’t go away. And that’s usually because they’ve developed a DGBI on top of the IBD symptoms. And so there’s an autoimmune component, and then there’s also a brain-gut component. The final part is that with IBD, there’s a lot of comorbid anxiety and depression. Especially for us, we understand IBD, we know what’s going on, and so treating that anxiety or depression with somebody who’s already familiar with IBD, and some of the challenges that are involved there, just tends to go better. So we do work with a lot of IBD patients. In fact, we’re working on a joint project with the Crohn’s and Colitis Foundation right now. We’re developing a therapeutic group, which is another option. So patients can see us individually, but we also have groups where we’re trying to teach patients core skills that are going to be useful for helping their gut, and that’s a much more financially accessible option than individually.
Lindsey:
And if someone’s doing work with, say, someone like me working on their gut health from a microbiome standpoint, or working with a GI doctor, maybe they’re taking their immunotherapy or steroids, or whatever they may be getting from their regular doctor. Would you recommend that they do all that first before coming to see you, or do it simultaneously or in sequence? Or see you first? What’s the best order for these things?
Dr. Ali Navidi:
I think, for the most part, it works well in conjunction. What we say is we play well with others, meaning we’re often dealing with patients that have complex medical issues.
Lindsey:
Yeah.
Dr. Ali Navidi:
They don’t just necessarily have IBS. They might also have SIBO. They might also have fibromyalgia, POTS, chronic migraines, other musculoskeletal issues. So there might be a lot going on, and so we frequently work with other providers on the treatment team. For example, there’s a naturopathic physician who specializes in SIBO. We’ve kind of worked together really well for many years, because often he’ll treat the SIBO and there will still be symptoms. There’s always something to treat, usually. It can be pretty resistant. We might have to do multiple rounds. So he’ll continue that treatment while we start the brain-gut therapy. And there tends to be really good results, because there’s often a brain-gut component in a lot of these problems.
Lindsey:
Any final thoughts before you tell us where people can find you?
Dr. Ali Navidi:
Yeah, I think my final thought is, I was in private practice for years and years, and I started this bigger practice because I just felt it was just a terrible shame that people might have these disorders, and they’re so treatable, and we have so much good evidence showing that these treatments work. They might go their whole lives and never get this treatment, and I thought that was really just a terrible thing. My hope is that people will understand that these treatments are out there, and that they don’t have to live with these symptoms, and that if they have a loved one that is going through this, let them know! People should not have to go through this, because these treatments, they really work well. And to answer that final question, the clinic is called GI Psychology, and that’s the website also, and they can get a free phone consult. We have a clinically trained person, they can answer all their questions, see if it’s the right treatment for them.
Lindsey:
Perfect. Great, well this was really interesting and useful, and I’m sure there are heaps of people who can benefit from this that I’ve seen and that are listening. So thank you.
Dr. Ali Navidi:
Yeah, I appreciate you providing this opportunity. Like I said, you’ve got so many great topics on here, so I’m just privileged to be one of the many, so thank you.
If you are struggling with bloating, gas, burping, nausea, constipation, diarrhea, soft stool, acid reflux, IBS, IBD, SIBO, candida overgrowth, fatigue or migraines and want to get to the bottom of it, that’s what I help my clients with. I see individual clients to help them resolve their digestive issues and you’re welcome to set up a free, 30-minute breakthrough sessionto see if you’d like to work with me. I also have my own two products, Tributyrin-Max, which is particularly helpful for loose stool and diarrhea as it slows your motility and firms up your stool, and SBI powder, which is an all around gut pathogen binder, which is super safe and won’t harm beneficial bacteria, and is usually the first line of treatment I educate my clients about in order to avoid stronger antimicrobial herbs.
*Product and dispensary links are affiliate links for which I’ll receive a commission. Thanks for your support of the podcast by using these links. As an Amazon Associate, I earn from qualifying purchases.
You’ve got a beautiful backdrop there of the nature, and I wish I were sitting outside as well, but I have too much traffic noise where I live.
Dr. Jenna Weeks:
I feel so blessed because this year, I finally have a home, and I have my very first garden, and I’m actually sitting in front of it. I’ve been sitting by it all day. Took the day off to recalibrate my soul back to what is good, right? And what better to do than sit beside your garden to figure that out?
Lindsey:
Awesome! Could you start us off by describing what DNA is and what it does?
Dr. Jenna Weeks:
Oh my goodness, that is such a huge, vast question and a wonderful question. Let me see if I can distill that down into something that’s going to be useful for any human on this planet. DNA is the instructions. So imagine having a factory, and imagine in the factory, there were no persons there that knew what to tell you to do, or how to do it, or when to do it or all of these different things. It would be kind of chaos, or chaotic. Your DNA is the thing that sends down governance from all the levels of your cells to tell you, tell your cells how they’re supposed to work and how they’re supposed to be and what they’re supposed to make, what they’re supposed to do. It’s kind of amazing. I think of it like Santa’s workshop and all the little elves working together to create harmony inside the body and to sustain life. It’s kind of amazing. Yeah, so that’s what DNA is, and what DNA does, as far as I’m concerned.
Lindsey:
Okay, so knowing that about DNA, now can you explain the difference between genetics and epigenetics?
Dr. Jenna Weeks:
That is also such a phenomenally interesting question that nobody knows the answer to yet, to be honest, and it keeps changing. It’s a moving target, and if anybody tells you that they know the answer to that question, they’re probably wrong. So long story short, the way that I look at it is kind of like a house, and your house has a foundation, and your foundation is your DNA and your DNA doesn’t really change. And then your epigenetics are kind of like the house above the foundation. You can change the curtains, you can change the blinds, you can change the color, so it can be different than what it already is. Where people get a little confused, though, is they think that by the word epigenetics, they mean that they can change their genetics. So a lot of times, you can’t actually change your genetics, necessarily. Kind of like a river going down stream, the river can become dammed up, and that dam is there, that DNA marker is there, but what we can do is we can circumnavigate around that dam so that we can still have the water flow to the other side as the outcome.
So for example, in your DNA, you are born with certain DNA markers. Those things can either be turned on or not turned on. It’s kind of like having a horizon, is what I usually tell my patients. And underneath the horizon, you can have light switches. Just because you were born with a light switch doesn’t necessarily mean it’s turned on, but maybe through your life, you may dip through deficit states, and then eventually the light switch can get turned on. And this is sort of where people go like, “Oh, I never really had that problem before, but now all of a sudden I do and I don’t know why.” So you have your DNA. It is yours, but there are ways to mitigate the problems that your DNA can cause. And there are also certain ways that you can influence your DNA. And where people kind of get a little bit confused, is going, “Well, can’t I influence my DNA by what I drink and what I eat and all these different things?” Yes, it does work that way, because DNA is what we call methylated.
Methylation, we go back to that reference of the factory, and imagine a conveyor belt. And imagine on that conveyor belt you have a Hot Wheels car, and you have a little house where you have a worker who’s going to pull the lever down, and that little Hot Wheels car is going to go through, and there’s another worker there that’s going to put either the windows, the doors, things on the car. And so there’s a reason why the conveyor belt needs to be turned on, and then maybe the Hot Wheels goes down a little further and it needs to be painted, and that conveyor belt needs to be turned off. The worker there represents methylation of your DNA, meaning methylation turns your DNA on and off. And there’s a reason for it to be on, there’s a reason for it to be off. Both are beneficial. Not – on is better, off is worse. Both are beneficial at different times. And so the way I like to describe it and how we can affect our genes is if we had a worker that’s there and they’re drunk, or they ate a bunch of crappy food and now their brain is really foggy, then that’s going to change how that lever gets pulled, turned on, turned off. And then that’s going to change everything that comes down the assembly line.
And eventually, if the person is really under it, drinking, smoking, crappy food, all that stuff, then that lever gets pulled at the wrong times, and now you have some messes in your cells, right? So this is how we can affect and change our DNA, by making sure that our worker is drinking a green smoothie, and they did yoga that morning, and so their body is primed and ready to do the job properly, to methylate the DNA, to make the DNA optimal, to make their bodies optimal. It’s my long winded way of explaining what DNA is, genetics are, epigenetics and how you can affect your genetics. It’s a complicated topic, so I try to do my best to give it to people in a way that they can hold it in their hands, use it and digest it and actually do something with it, right?
Lindsey:
Yeah. Well, now that we have that great analogy, tell me about what a SNP is and how they can influence your health.
Dr. Jenna Weeks:
Yeah. So a SNP is a single nucleotide polymorphism. The way that I like to talk about it with people is I usually get them to imagine a computer system, and behind the computer screen, inside of the software, there are zeros and ones, and the zeros and ones are kind of running the show. And behind the scenes, if you have a line of code, and if you have a zero where they’re supposed to be a one, you could have a little glitch, maybe another line of code, another glitch, another line of code, another glitch, in another area. And so depending on how many glitches you have in which different areas, that will determine how fragged your system shows up on the screen.
And so our body’s DNA, our SNPs are kind of like that. We could have an A, where there’s supposed to be a T, a C where there’s supposed to be a G in our DNA base pairs called adenine, cysteine, taurine and guanine. I usually just say red ball, blue ball, yellow ball, green ball. If you have a green ball where there’s supposed to be a red ball – glitch – yellow ball where there’s supposed to be a blue ball – glitch. And then when we take that whole thing, and put it in the framework of thinking about a giant Plinko board.
So remember The Price is Right? And we think about putting that Plinko chip in at the top of the board, and it filters down through and it falls down through a slot in the bottom, and you might get $500 you might get $1000 you might get nothing. Your body is like that too. You put food or drink in, drugs, alcohol, whatever it is, it filters down through pathways. And those pathways, out of them, you get certain things that get made. So the pathways are pathways for vitamin A, pathways for B vitamins, pathways for vitamins C, D, E, Zinc, feel-good brain chemicals, hormones and also your gut flora and your collagen. So if you have a little bumper representing a little glitch in any one of those pathways, then you can’t necessarily have made what you want to have made out of that pathway. And then that will have its own set of issues with it.
Just a real quick example of that, so people can have an idea. A lot of times I see patients in my practice that will have a bumper in the pathway of vitamin A. So that’s a SNP, a single nucleotide polymorphism, in your vitamin A. And what that means is that they don’t necessarily convert beta carotene into active retinol. And when that happens and you don’t have active retinol, well what’s active retinol’s job in Santa’s workshop? Active retinol’s job is to make sure that skin cell turnover happens. So if you don’t get skin cell turnover, then these are my people who have acne, psoriasis, dandruff, eczema, dry eyes, cracks in the corners of their mouth, cracks in their heels and their feet, and they will never, ever know it, unless we do this testing, find out and go, “Oh yeah, no wonder you have those issues. You don’t make your vitamin A properly.” So let’s look at supplying your body with what it’s been missing all along, in a safe, healthy way, through a practitioner and the right dose and the right kind, because vitamin A is also very dangerous at high doses for everyone listening. You don’t go supplementing with it willy-nilly. But then we can start to see changes that we’ve never been able to see in the body before, because we’re finally giving that individual the raw materials that their body’s been missing all along.
Lindsey:
And since you brought up the vitamin A example, and I know I actually have that SNP, so beta carotene comes from fruits and vegetables, right? Whereas the active form, like retinol palmitate, or whatever retinol forms there are come from meat, don’t they?
Dr. Jenna Weeks:
Yes, absolutely. Liver is the highest form of vitamin A, the active form of vitamin A, so that’s definitely where you would want to source that, or possibly through supplementation, because you’re right when you’re consuming carrots, that’s beta carotene, those orange foods. But if you don’t have the enzyme, because you have a little SNP, it doesn’t necessarily convert into that active form. So then you want to be consuming the active form again in right dose, because vitamin A can be toxic for the liver and can cause birth defects in childbearing women. So we just want to make sure we’re dosing it specifically, correctly. And anything said on this podcast today is for information purposes and never meant to diagnose or treat anyone.
Lindsey:
Got it. So can you tell us about some SNPs that could impact gut health?
Dr. Jenna Weeks:
This is my favorite topic of life, and the reason why I wanted to come on your podcast in the first place and shout this from the rooftops, because the amount of lives I’ve seen this change has been unprecedented. It’s been incredible. And I just wish that more people had this information in their hands so that they don’t have to suffer. Because when you go to your doctor, unfortunately, if you show up with a bunch of gut issues, they will give you a diagnosis of exclusion, which is IBS, usually. And they don’t know what that is, and they don’t know how to treat that, and that’s okay, because every aspect of medicine or anything has its limitations, even naturopathic medicine, right? So good on everybody for doing the best that they can where they’re at and your genetics, the two gene mutations that I would just love to talk about today, one of them is called a FUT2 gene mutation, FUT2, not Footloose, FUT2, have you ever heard of that one?
Lindsey:
Yeah, I was going to ask, because I’ve had my own DNA done by The DNA Company, and I’ll ask you about mine after you’re done describing it.
Dr. Jenna Weeks:
Awesome. Do you have a FUT2?
Lindsey:
I have AG.
Dr. Jenna Weeks:
Okay, so you’re an AG.
Lindsey:
So heterozygous.
Dr. Jenna Weeks:
Yeah. Okay. So yeah, generally, the one that I’m speaking about is an AA, a non-secretor. So what does that even mean? What I’m going to get everybody that is listening to imagine the wall of your intestine like one of those spongy bath mats that has those finger like projections that are really absorbent. That’s the side of your intestinal wall. And then just above that, usually I draw a picture, and I put these little microbes, and then just above that, in the sky, I put a little Pac Man. And that Pac Man is spitting out what I usually call glitter, but really what it is, is that little Pac Man is your red blood cell, and it’s spitting out a carbohydrate that’s meant to feed your gut flora. And if you don’t have a FUT2 AA non-secretor SNP, this is what happens. If you have a FUT2 AA non-secretor SNP and it is active, meaning that that light switch is triggered in you, and you’re having signs and symptoms of digestive disturbance, then what can happen is that red blood cell doesn’t necessarily make the carbohydrate to feed your good gut flora, which means that you don’t really have your good gut flora.
It’s crazy when I say that I had one patient that was one of my very first patients ever, and she was trying to figure out the root cause of her MS, and she came to me and she had done a stool test, and her stool test showed no good gut flora, no bad gut flora, no flora. She was working with another doctor down the hall at the time, and they put her on a high dose probiotic and six months later, we tested her stool, no gut flora, no good, no bad. What? Okay, they put her on another round of soil probiotics, tested again, same thing, no gut flora. They put her on kimchi, sauerkraut, kefir, you name it, no gut flora. Three stool tests in, no good, no bad. She came to see me. We did her genetics. We found that she had a FUT2 SNP. It was like a holy hallelujah moment. Both of us cried in my office because we were like, “Wow, we finally understand why this is happening once we were able to see that, we were able to give her the specific nutrients that feed her gut flora and the specific probiota that she would be missing. And we tested after six months, and sure enough, finally, gut flora. It was a beautiful day.
This has had such an impact on so many of my patients, especially with IBS. I remember one man came to me and he said, “I’m 50 years old, and finally, I’m pooping the right way for the first time in my entire life, every day, two, three times a day.” He’s like, “That wasn’t ever a possibility for me.” He was somebody that went the other way and was five or six or seven times, and kind of diarrhea. And then my other patients, sometimes with this gene mutation will have constipation too. So it’s just a real blessing to learn about this one and assist it.
Lindsey:
Yeah. So as I mentioned, I have the AG, not the AA. So I have maybe one part of it that’s working right and one that’s not. And I have autoimmune SIBO, so I’m curious if this gene could have impacted my getting SIBO in the first place when I was exposed to food poisoning.
Dr. Jenna Weeks:
Yeah, let’s talk about this one. It’s been my experience that the root of SIBO, which is such a big statement to make, but I remember being in naturopathic medical school, like 10 years ago, and I remember SIBO being a really big, huge thing coming down the pipe and learning about it, and hearing that SIBO is really resistant in some patients, but not in others. And whenever I heard that, that was always a big red flag for me, and I’m very much a why person. Well, why is that? I want to know why. So I put my investigative cap on, and sure enough, somewhere down the line, I kind of figured it out. And what I learned is that the people, the patients that are resistant for SIBO treatment, where they’ve treated SIBO and it keeps coming back, they have what’s called a COL1A1 or 5A1 gene. Are you familiar with those ones?
Lindsey:
No!
Dr. Jenna Weeks:
Okay, put on your hat, we’re going to go for a journey that’s going to change your life! So, long story short, with a collagen gene mutation, what happens is we’re supposed to have collagen made in our body in a way in which it’s a strong cross-linking fiber. And if we have a collagen gene mutation, then what can happen is that cross-linking fiber can sort of have holes in the mesh of it. I figured this out about a year and a half ago, because I have these gene mutations myself, and I still had digestive issues, and I still could not figure out where they were coming from and why, why they wouldn’t just finally subside. And I went back to the drawing board, looked at my genes, and I dug deeper, and I found out, oh, I have this double collagen gene mutation.
Okay, well, where else is collagen in the body? We know it’s in the ligaments and tendons and joints, and we know it’s in the skin and the hair and the nails. Well, where else is it in the body? And I did some research, and found out that 98% of your intestinal wall is made up of collagen. Oh, how interesting. Okay, so theoretically, if I have a collagen gene mutation, I don’t make my collagen as well as I should, I probably have mesh in my intestines that has got holes in it. So, leaky gut – chronic, leaky gut. So then we can let bad bacteria in, and we can let good bacteria out and it just all becomes kind of a mess that we call SIBO. And these are the people that generally tend to be resistant to treatment, because the holes in the mesh never get addressed.
People think that the holes are caused by the SIBO and the bacteria being bad, and it’s causing leaky gut. But 9 times out of 10 my patients have collagen gene mutations underlying this and their net was leaking from the beginning. So if we can look at that, see that, pop that hood, find those collagen gene mutations, then we can address the root cause of the issue, which is a collagen synthesis issue, and support the body in making their collagen properly. Not just taking collagen supplements, but doing things to supercharge collagen production. Then things start to really change and take hold in a better, amazing way.
Lindsey:
Yes.
Dr. Jenna Weeks:
Life changing.
Lindsey:
So, I know vitamin C is one of the necessary ingredients for collagen production. What else is involved?
Dr. Jenna Weeks:
Glycine, proline. So generally speaking, I will use some combination of that, depending on the human, what their needs are, and what concomitant factors exist for them and what’s safe and what’s not for their body.
Lindsey:
And I know that there are different types of collagen. Is there a particular type of collagen that’s specific to the gut?
Dr. Jenna Weeks:
Yeah, so there’s collagen one through five, and collagen one, two and three are more specific to the gut. There is some collagen number five in there. There’s a little bit of four, but those other ones are the main, predominant ones to focus on. So if you’re looking for a collagen to support you in that way, then you would want to look in those areas, one, two and three.
Lindsey:
And if you’re just taking those basic collagen peptides, that would include all types, right?
Dr. Jenna Weeks:
Most of the time, yes, it’s usually collagen type one and type two.
Lindsey:
Okay yeah, I was just curious about that. And with glycine, this is something I’ve been sort of pondering of late, because both of my parents, I test them regularly, like once a year, they do their Metabolomix or NutrEval or whatever it is, and they’re always deficient in glycine. And glycine is one of the building blocks of glutathione. So I assume I probably got their genetics, and I’m probably deficient in glycine too. But now thinking, okay, if glycine is related to collagen, and we’re deficient in glycine, that might be sort of the triple whammy for our family.
Dr. Jenna Weeks:
Oh my gosh. I love conversing with people like you who can see the web of the big picture and understand how it’s all interconnected into a constellation that actually makes sense for your own self and also your whole family unit. That’s what I find to be the brilliance of genetics, is that it allows us that span of understanding, I guess. So you hit it right on the nail with glycine. My question for you is, how is your sleep?
Lindsey:
Not great. I wake up in the early morning, well, I also have hot flashes.
Dr. Jenna Weeks:
Let’s talk about it for just a second, because people will probably be helped by this. So imagine a bicycle that has a funnel on the front of it, and imagine a shelf next to you, and on the shelf you have collagen, vitamin C, glycine, proline, some B vitamins and different other things that make up what you need to make collagen. And so imagine you’re taking those ingredients off the shelf, putting it into the funnel, and you’re biking to spit out a ribbon behind you that’s supposed to be a nice solid ribbon of collagen, but your ribbon has a bunch of holes in it. So then you’re going to keep needing to take ingredients off the shelf and keep pouring it in the funnel, because it’s not really getting made properly, right? So eventually you’re using up your resources. When somebody walks into the room from another department and they say, “Hey, do you have any glycine in here? We need it for the sleep department.” Then the glycine isn’t available. So that’s actually what happens.
And this was a secondary discovery, when I figured this out, was that my patients who have a lot of sleep issues, that have these collagen gene mutations, their glycine is being used up by the collagen gene mutation so it’s not available to dampen their brain at night to make them go into a deep, restful sleep. And when I figure this out, they sleep like babies, most of them. It’s been a really wild and wonderful discovery that one.
And the other discovery that I made through this, was that this is the root cause of fibromyalgia, in my opinion. I know that’s a very huge, bold statement to make, but I have had so many patients come back after being on Gabapentin for 12 years, 5 years, 7 years, 3 years, and they’re no longer on their Gabapentin because they no longer have pain, because their gut is no longer leaking poo particles, which ignite their inflammation. And the body shoves that inflammation to the joint spaces, because that’s the safe place for it to go. They just no longer have those issues, right? And the same with arthritis, Rheumatoid Arthritis, we’ve been able to gain so much traction for those patients. And as well autoimmune thyroid conditions, because, again, poop particles roaming around in your system, roguely, will create inflammation in your whole body.
Lindsey:
Wow, that is interesting. And I know that SIBO is very much correlated with fibromyalgia and is often a precursor. So if you see this common root in collagen issues around both of them, that would make sense why they’re connected.
Dr. Jenna Weeks:
Oh, hallelujah, you get it!
Lindsey:
Yeah and I was going to say about the glycine was, I think one thing that often happens in the world of supplements is people, they go, “Oh, well, glycine is a great supplement for sleep, right? That helps sleep.” Well, it will help sleep if you were deficient in glycine, if you weren’t deficient in glycine, it probably won’t be a mover for you.
Dr. Jenna Weeks:
Yeah, absolutely, absolutely. And I mean, that’s where I have completely dedicated my life to understanding genetics. Because when I was in naturopathic medical school, it was so wild because they were like, “Curcumin, this is the number one thing. Everybody take curcumin! It’s so good!” And I would take it, and I would feel like absolute garbage. Or they would say this particular herb, valerian, or whatever it is, is for anxiety. And I would take it, and I would feel so anxious. And so I started going, I’m not made like everybody else. I need things that are individually for my own specific snowflake, make and model of body. And then I had to think, well, there must be other people out there. And so I thought, I can’t, in good conscience, prescribe to people things, knowing that maybe it’s not going to be the right fit for their body, unless I know what the right fit for their body is. So this is where genetics allows us to peek through that window for that specific make and model of body and give that specific make and model of body what it needs and understand its little recalls and the things that it needs extra support with, right?
Lindsey:
Yeah and so back to the collagen one. So you said COL1A1 or 5A1, is that what will appear if we have gotten our DNA done, or are we looking for specific letters or mutations on those two genes?
Dr. Jenna Weeks:
Generally speaking, the COL1A1, 5A1 should be enough information to tell you. I’m not really sure exactly what all of the companies are going to illustrate. I know for my own self, the way that I go about it, as I go through, usually Ancestry, 23andMe, and I take that raw data and I put it through my third party medical reporting software, which is called Pure Insight, and that’s where I gain all of the backstory on my patients, so I’m not really sure all of the different DNA sites out there will illustrate that.
Lindsey:
Yeah, I’ve I’ve taken people’s SNPs and put them through Genetic Genie, and what you get is, this ishomozygous, this is heterozygous. You get that kind of information. So I guess it would probably appear like that. One thing that I did find out when I did my DNA through The DNA Company, which was, with the Ancestry and the 23andMe, you can have group data, you can have mistakes, essentially, because they’re doing it en masse versus much smaller batch or individual. And I found out that when I put my 23andMe through Genetic Genie, I had APOE4/4, which is correlated with a higher risk for Alzheimer’s. And then when they did it through The DNA Company, I found out it was only a 3/4, so it was not quite as bad. And so I’m curious if there is something on there that’s kind of disturbing, do you send people for secondary testing, to confirm?
Dr. Jenna Weeks:
Yeah, generally speaking, I do. I don’t think any test, really, in the world is failsafe. Being realistic, we’re humans, we’re doing the best we can on this planet, so 9 times out of 10, I do feel like it really matches. Like 99.5% when I speak to my patients, they’re just like, “Yeah, this is so me to a T.” So in terms of discrepancies, I don’t really see a whole lot of them, at a clinical level.
Lindsey:
Okay, and so any other SNPs that specifically relate to gut health?
Dr. Jenna Weeks:
The ones that really surprised me, were B vitamin gene mutations. I had never learned anything, eight years of schooling, numerous days, hours of research and everything, and I had never heard anything about, necessarily, B vitamins playing a huge role in digestive health. And then, whenever I would treat the SNPs for B vitamin gene mutations in my patients, they would come back and say, “Wow, I used to be so constipated. I would go once every three days, and now I’m going three times a day. This has never happened in my life before.” And whenever we would do their genetics, I would always start them on one thing at a time. And so B vitamins are generally the thing I start people on first, because you need to kind of unkink the hose in the system. And from the moment they start the B vitamins, they’re like, “I really notice a difference in my bowels and my body in that way.” I’m like, “Yep, there it is. Okay.” And now there’s more research coming out that activated B vitamins play a really big role at the junction cells of the intestinal wall and helping to facilitate energy movement, peristalsis through the intestines, which is really kind of amazing.
Lindsey:
And so is this the famed MTHFR we’re talking about?
Dr. Jenna Weeks:
Yes, there is the MTHFR as part of that, which is never to be negated. It’s so important to know about the MTHFR gene mutation. What I’ve learned, though, is that generally speaking, when people have one or two MTHFR gene mutations, they’ll generally always also have a B12 gene mutation, maybe a couple of them, B6 gene mutation and also a choline gene mutation.
The way that I kind of make it make sense to my patients is I just say, “B9, imagine, kind of like a figure eight, and on the figure eight you’ve got B9 in one place, and B9 kind of makes B12 in the middle, and then B12 goes on to the other side to make B6 and B6 makes choline, and choline makes B12. And so they all kind of facilitate that infinity symbol of helping and making and facilitating each other. If you have a gene mutation in one of them, then you kind of have a gene mutation in all of them. And that whole cycle goes on to do methylation.
And that whole methylation thing that we were talking about, it’s such an important word for humans to know, learn, understand, have in their dialect, be able to speak about. That methylation, again, is that person standing there at the helm of your DNA, literally turning your DNA on and turning it off so that it works properly. This is why it’s so key to the function of your whole entire body to have that B vitamin cycle, that methylation cycle, working properly. And when we have gene mutations in there, that’s when things go kind of crazy and off kilter and haywire. And that whole B vitamin cycle goes off to make feel good, brain chemicals too. So when that doesn’t work, we’ll be deficient in serotonin and dopamine, and that’s where a lot of people think that they have anxiety, they have depression, they have ADD they have all these different things, and really they just have a B vitamin gene mutation, bunch of them, deficiency. And when we sort that out, those other issues, the volume on them turns down a lot, if that’s the root cause of what they’re dealing with.
Lindsey:
And what are the other genes that might show up on mutations related to B vitamins?
Dr. Jenna Weeks:
Those are the ones, B6, choline, B9, B12. I can talk a little bit about what they do. And if you have those gene mutations, what happens if they’re not working properly?
Lindsey:
Okay.
Dr. Jenna Weeks:
Let’s go with choline first. Choline, I’d lump it in with the B vitamins, because it kind of hangs out with them. But choline is so important to your liver function and metabolizing fats in your liver. A lot of my patients will go and they’ll get scans randomly because their intestines are doing something strange, and then inadvertently, they’ll find out that they have fatty liver. Then their doctor will say something along the lines of, “Well, it’s not really that bad, so we’re just going to wait and watch and monitor it and see what happens.” And if you do that, eventually it will get worse. When it gets worse, then it can actually turn into bad things. So I don’t know why that’s exactly the way we go about doing it, but that’s how it works.
And so what I really want people to know about there is that often what will happen is that there’s an underlying gene mutation, or two of them in your choline genes. So these are MTHFD1 and PEMT2. If you have a gene mutation in either of those, then what can happen is, the way I describe it is like this, if you had a cold slab and above it you had a screen, and that screen was warm, and on the screen there was a chunk of butter, and through the screen, little droplets of butter were dropping through and landing on the cold slab below. This is what happens in our liver when fat passes through it, and choline is the nutrient to heat up that slab below to allow the fat to keep rolling through your liver. But if you don’t have the choline, that slab doesn’t get heated, it doesn’t get metabolized, those fats don’t get emulsified, and then they just build up in your liver. And so then that’s what’s causing the fatty liver.
But when you go to the conventional medical system and you’re not really drinking a lot of alcohol and you’re not really eating a lot of fatty foods, they’re like, “Well, it’s non-alcoholic fatty liver disease, and we have no idea why it happens.” Well, actually, it’s a choline gene mutation, and when you know this, you can do something about it. I had a patient who came and they had an 80% fatty liver, age 27, and it was causing their brain to have so much brain fog that they could hardly function or work. Once I saw their genes, once I realized what we were dealing with, we were able to give their body what it had been missing all along and with, in the right dose, right form, right kind, right timing and right combination of choline and other factors. Within three months, I thought it was going to take nine months, maybe a year, for this to happen, but within three months, they went in for another scan. No more fatty liver. From an 80% fatty liver.
Lindsey:
Wow!
Dr. Jenna Weeks:
Tell me that’s not wild.
Lindsey:
Yeah, would somebody who has fatty liver because they’re doing the bad stuff like drinking and eating sugar, could they take choline or other cofactors and help with it?
Dr. Jenna Weeks:
Are they going to?
Lindsey:
Well, maybe! Maybe they’re willing to take a pill, maybe they’re not willing to stop eating sugar, but they’re willing to take a pill.
Dr. Jenna Weeks:
In good conscience, I can’t really say that, because my take on life is don’t put yourself in that position to begin with. Yes, maybe the cards are stacked against you and yes, maybe there are things that you can do to support your body better, but one of the best things you can do to support your body if you do have fatty liver, is to not drink alcohol and not eat sugar.
Lindsey:
Sure, sure. But say my 80 year old parents, they made it this far. They don’t have cancer, they don’t have heart disease. They’re drinking their two drinks a day, and that’s going to happen. They’re going to be eating desserts a few times a week. That’s going to happen. That’s never going to change. They’re in their 80s. They made it this far. So would choline be a good supplement for somebody who, I mean, I don’t know that they have any fatty liver, but I’m just curious, in that sort of scenario.
Dr. Jenna Weeks:
That one’s crossing an ethical boundary in me.
Lindsey:
Okay, that’s fine, you don’t have to answer!
Dr. Jenna Weeks:
The reason I say that is because a patient of mine the other day said something along those lines, where they they went to their doctor and they were eating a bunch of ice cream and a lot of Lay’s potato chips, and the doctor put them on a statin, which totally depletes your nutrients and is actually really not a healthy substance. Some drugs are not mean, and some are. Anyways, this is a mean drug, a statin. And the doctor just said, “Well, eat your chips, eat your ice cream. Just take the statin. It’s all good.” In my soul, I cringed, and I just said, “No, don’t eat the chips. Don’t do the thing to your body.” And I get that the parents are old, they made it to 80, so maybe they just eat whatever they want, do whatever they want, and that’s their prerogative!
Lindsey:
Yeah, no. I mean, I also am sympathetic to the fact that there are some people really have binge eating disorders. They have really complex issues around trauma and ACEs and everything else, such that it’s not even within their conscious to control not to eat the wrong things. Like some people have fatty liver and may always have fatty livers. You got to work with people who are imperfect.
Dr. Jenna Weeks:
Yeah, with that kind of a case, then maybe, yeah, for sure. That’s a good topic to explore, really. Thank you.
Lindsey:
Yeah. You mentioned what we were just talking about, choline, how about the other B vitamins you were talking about?
Dr. Jenna Weeks:
Oh my gosh, pick one! Which one do you want to know about?
Lindsey:
Folate! Let’s talk about folate.
Dr. Jenna Weeks:
Oh, wait. Okay, so that’s your MTHFR gene mutation, methyl tetrahydrofolate reductase. Okay. So what does this mean? Why do we care? Usually, what I tell people is that Clark Kent needs a phone booth to turn into Superman, so that Superman can take the Riff Raff out make the hearts of people happy, keep people happy so they can keep reproducing properly in your body. Your folate, just plain old folate needs an enzyme inside of your body to work, which is a reductase, methyltetrahydrafolate reductase enzyme in order to work in order to turn into, so Clark Kent needs the phone booth to turn into Superman. Your folate needs the enzyme to work in order to turn into activated folate to then take and bind to excess hormones, excess heavy metals, excess plastics, toxins, pesticides, you name it. So if it can’t do that, then those things can roam around our body and create havoc. That whole methylation cycle, again, goes on to methylate our DNA. So that’s part of it.
Methylfolate makes a lot of the methyl groups that go on to methylate DNA. And then it makes, like I said, your feel-good brain chemicals serotonin and dopamine. And then the other thing it does is it makes the cells on your cervix divide and grow properly. So women who have abnormal paps, a lot of times will have B12 and B9 gene mutations and not ever know that this is actually part of the root cause of why they’re having their abnormal paps in the first place, because you need activated B vitamins to turn that cellular turnover on the cervix the same as you do to make a baby. And so women with MTHFR gene mutations as well sometimes will have a history of miscarriage or premature birth or abnormal births. The way that I describe that to people is, if you are making a cake, you need resources to make the cake. If you don’t have enough resources, then sometimes the cake has to come out of the oven sooner, right? So premature birth, or sometimes the cake just doesn’t work. And so that can be the miscarriage, right, if we don’t have enough of those proper resources. But again, if we can find out that this is what’s going on, then we can mitigate this before women ever go into their birthing era and facilitate there being more healthful births as well.
B vitamins play a crucial role in energy metabolism, just making energy. And so I have a lot of women who will have gone through giving birth, and they’ll say, I’ve just never been the same since I just have not gained my energy back. And this will be 10 or 12 years later, and they just feel flat like a pancake. In the morning, they can’t get out of bed. And then at 10 in the morning, their energy is sort of okay. And then two, three in the afternoon, it dips. And then 8, 9, 10 at night, they’re really tired. But then 11, 12, at night, they start to wake up again. And this is called a reverse curve on your adrenals, and your B vitamins are intimately connected to your adrenals. And so this comes back to these women having underlying B vitamin gene mutations and never knowing it. And when they go to make a baby, they use all their B vitamins to resource making that baby. And then once that’s done, they’ve got nothing left inside their body to replenish with. So then they are low on energy going forward, just the way it is. We give these women the things that they’ve been missing all along, they start to literally feel like someone turn the lights back on in their body and they’re coming back to life, and they have energy, and they’re finally sleeping again, and they actually have a zest and a joy for life again, as opposed to just dragging themselves barely through the day. Those B vitamins are huge, right?
Lindsey:
And then, of course, they put folic acid in most of the prenatal vitamins, which is not the active form.
Dr. Jenna Weeks:
I mean, yeah, that is something for everybody to be very aware of that the statistic on it is that about 44-47% of the population has an MTHFR gene mutation, that’s not taking into consideration as well the other B vitamin gene mutations. So in my experience, it’s somewhere closer to around 70% of people may have one or more B vitamin gene mutations, which means that they’re working at a deficit for resources, for energy.
Lindsey:
Yeah, and so most people need to be looking for B vitamins that have methylated folate of some sort, yeah?
Dr. Jenna Weeks:
So here’s my little rule of thumb. This is how I find a B complex on the shelf, which is really hard to do to find a good one. But everybody knows what B12 is, right? Like, just B12. Yeah? I know B12. No, B12. Okay, cool. So the way that I describe it is the ABCD rule. So I will tell if a product has integrity, integrity, meaning that it has activated forms of things, if it follows the ABC rule. So you get an A if you look for B12, right on the back of the bottle, look for B12, and if next to it you see a C word D, don’t do it. So that C word will be cyanocobalamin, and that’s the non active form. You want to see any other word next to B12. You want to see, the real word is methylcobalamin. And then you go and look at your folate. And if it’s just a simple word, folate, folic acid, simple word. No complicated word next to it, don’t do it. You want a complicated word, you want L5 MTHF or L5 calciummethylfolate, or one big, complicated word.
Lindsey:
Okay, is there one like Metafolin or. . .
Dr. Jenna Weeks:
Yeah? Metafolin is a trademark name that a company uses, so, yeah, something like that.
Lindsey:
It’s also methylated.
Dr. Jenna Weeks:
Yeah, absolutely, okay.
Lindsey:
And does it matter if the B6 is P5P?
Dr. Jenna Weeks:
I prefer if the B6 is P5P, that’ll be the activated form of B6 as well. But I also prefer to know if people have a B6 gene mutation before they take a B complex. Because if they don’t have a B6 gene mutation, I won’t leave my patients on B complex longer than one bottle to rebolster their body, because B6 actually can build up in the nerve to shoot and cause numbness and tingling in the hands and feet if it’s not needed.
Lindsey:
Yeah, I’ve come across many clients who have to use B complexes without B6 because they’re deficient in other things. And what’s the name of that gene for B6?
Dr. Jenna Weeks:
There’s two of them that I know and work with intimately, and one of them is called NBPF3, and the other one is called CBS, cystathione beta synthase. Those are two different kind of things. One is you have a problem just even making or having enough B6 around NBPF3, and then CBS uses B6 So if it’s going too fast, then you can use up your B6 too quickly.
Lindsey:
Isn’t there a fast and slow CBS?
Dr. Jenna Weeks:
Yeah, there is. It’s really weird. But in my experience, most of the time it’s going fast, but most of the research that’s out there is on the slow ones. In terms of percentages, I would say 12% of my patients have the slow one, and the rest of them have the fast one, and the fast one, then is generating too much ammonia in their body. And that just for anybody listening, if you go to the doctor and you have panic attacks, they will basically tell you, and the literature tells you that there is no real, known cause for panic attacks. Nobody knows why they happen. If anyone’s ever had a panic attack, I really haven’t, but I’ve seen people have them. It looks like the worst, most terrifying, the most horrible thing on the face of the planet. And then to not have an answer or a conclusion as to why that’s happening would also be horrifically terrifying. So this is why I want to share this. I would say 88% of my patients who have panic attacks have a CBS mutation in which their CBS gene is making too much ammonia, and that ammonia crosses the blood brain barrier and acts like a poison in the brain, and then that sends off signals to the body to dilate blood vessels, make heart race, make breath shorter, brain fog, vertigo, dizziness, digestive issues, brain racing towards all the problems that you can see, because that’s what happens when our fight or flight gets ignited. And these people, really what’s going on with them is that they’re having an overdose of ammonia in their body. And we can figure that out. We can change that, change their diet, remove the sulfur foods that are spurring on ammonia. Because we know that that gene mutation is there for them, that it literally changes their panic attacks. I don’t have one patient that doesn’t have panic attacks that no longer has them once we figured this out.
Lindsey:
And so the sulfur foods, are we talking like garlic, onions, cruciferous vegetables or like meat?
Dr. Jenna Weeks:
So the whole situation with the CBS is that essentially, what’s happening is that you’re supposed to be able to convert sulfur through cystathione beta synthase into active glutathione. With this gene mutation, what happens, instead of it going to glutathione, instead it gets shunted over and turns into ammonia. And so the idea is to put in less sulfurous foods to make less ammonia. So your sulfur foods, the highest concentrations are going to be your onions, your garlic, your broccoli, cabbage, cauliflower, kale, Brussels sprouts, green onions. So those are the highest amount. What I then tell my patients is to try to avoid those ones. And then I give them a list of all of the foods that contain sulfur, and I just ask them not to 2x, 3x, 4x or 5x them all at the same time if they’re going to eat them. So they can still eat the meat, they can still eat the cheese, they can still eat the cashews and the almonds that all have sulfur in it, and the eggs, but just not eat them all in combination to overload the system and push that ammonia.
Lindsey:
So there’s more sulfur in garlic and onions than there is in meat? I mean, because I’m just thinking, you might have a clove of garlic in your food, but you’re eating four ounces of meat, I’m just curious, like, proportionally, it really . . .
Dr. Jenna Weeks:
The potency of the medicine of garlic is stronger.
Lindsey:
Okay, got it. Interesting. Yeah, yeah, I actually had something with the CBS mutation relatively early on in my coaching, and amazingly, figured this out. I don’t know how I did. I ran his DNA, and this thing popped up, and I started just Googling everything, and then I was like, this guy’s got too much ammonia. Well, I knew he had too much ammonia because I’d done an Organic Acids Test, and so I was already working on clearing his ammonia, but then we figured out that the mutation was a part of it.
Dr. Jenna Weeks:
And you knew why?
Lindsey:
Yeah. I mean, I think I found an incredible post by Dr. Jockers that explained the whole thing and I’m like, okay.
Dr. Jenna Weeks:
Dr. Jockers is amazing for the CBS for sure.
Lindsey:
I wanted to ask quickly about SNPs that might influence autoimmunity.
Dr. Jenna Weeks:
Oh, yeah. Okay, so snips that may influence autoimmunity, the ones that come to mind first are actually IL6, interleukin 6, interleukin 17, IL4 as well, TNF alpha. When I see this in a patient’s report, I’ll ask them, Are you experiencing autoimmune conditions? Is this part of your picture? The collagen gene mutations are very much a foundation for this. Because, again, if you have poop particles leaking around through your body, your body’s immune system is going to be ignited continuously. It’s like that bouncer that’s just always on and like, “What? What? What’s wrong?” Never gets a chance to sit down and not be on. So they’re hypervigilant.
And then with the IL6 and the TNF alpha, these sorts of things, what happens is you have a TH1 immunity. And the way I like to describe this to my patients is imagining a wall and imagining green blobs on one side and blue blobs on the other. Your green blobs represent TH1 troops. They fight things kind of outside of your body, like cold viruses, all that fun stuff. The TH2 are like the blue blobs inside, and they fight things inside of the body. And sometimes, sometimes they can fight your own tissues, so you don’t really want too many of them around in case they kind of misfire or hit something wrong. So we want more green guys than blue guys. And essentially, what can happen is the green ones can jump over the wall and turn into blue and then you have too many on the blue team raging havoc inside of your body.
And sometimes that is needed when there are triggers like those particles kind of roaming around. So again, it’s removing the insult. But we can also apply things like plant sterols to help facilitate the blue ones jumping back over and turning into green. So that’s also part of the possibility, and as well as antioxidants, because if the antioxidants are not working, for example, your SOD2, or your GSTP, your glutathione, or your NQ01, those are your main janitors of your body. And if they’re not working properly, the way I describe it is you’re supposed to have ushers to take people to their seats, but if the ushers aren’t there, maybe the bouncers get involved. But the bouncers, that’s not their job. So then maybe they start getting like rowdy or feisty, or think that somebody’s causing a problem when they’re really not that kind of thing. So if we can put the right things in the right place to do the right jobs, meaning the antioxidants are just taken care of, the poo particles flying around, or any other insulting, inflammatory things going on, then the immune system doesn’t necessarily have to get involved.
Lindsey:
Yeah, well, I’m sure there’s way more detail than we can possibly cover in this hour-long podcast, but let me just ask you where people can find you. And you do virtual consultations, right?
Dr. Jenna Weeks:
Yeah, I do. I work out of New Brunswick, Canada, but I do work online and I just have people sign a waiver form, basically absolving any liability, because, again, insurance only covers so far of the world, so as long as people are okay with that, then I’m okay to work with them. You can find me online @dr.jenna.nd on Instagram, and also you can find me on Facebook and all of my contact info is there. You can also find me a little bit in YouTube. And if you are in Canada and you have Bell TV, you can watch me on TV, because we have a TV show out called Health Your Home that I singlehandedly spearheaded to help people understand what things they’re doing in their homes that may be sabotaging their health. It’s shameless self promotion. Hopefully this year, around Christmas time, my book called The You Code, meaning the code of you, your DNA, will be out and will be a more deep dive into all of the things we’ve touched on today with more dilution oriented focus.
Lindsey:
Awesome. Well, I’m really looking forward to seeing that, so I hope I’m on your list to get the notice when that comes up.
Dr. Jenna Weeks:
Yeah, if you want to be on my early readers list, we can totally do that.
Lindsey:
Awesome, awesome. Thank you so much for sharing all this really interesting information with us. I appreciate it. You’re so welcome.
Dr. Jenna Weeks:
I hope that it helps any human on this planet feel better because we don’t need to struggle so hard.
If you are struggling with bloating, gas, burping, nausea, constipation, diarrhea, soft stool, acid reflux, IBS, IBD, SIBO, candida overgrowth, fatigue or migraines and want to get to the bottom of it, that’s what I help my clients with. I see individual clients to help them resolve their digestive issues and you’re welcome to set up a free, 30-minute breakthrough sessionto see if you’d like to work with me. I also have my own two products, Tributyrin-Max, which is particularly helpful for loose stool and diarrhea as it slows your motility and firms up your stool, and SBI powder, which is an all around gut pathogen binder, which is super safe and won’t harm beneficial bacteria, and is usually the first line of treatment I educate my clients about in order to avoid stronger antimicrobial herbs.
*Product and dispensary links are affiliate links for which I’ll receive a commission. Thanks for your support of the podcast by using these links. As an Amazon Associate, I earn from qualifying purchases.
I have covered SIBO and IBS several times on the podcast, but in this episode, I want to distinguish between SIBO and dysbiosis. The two are different and usually involve somewhat different symptoms, causes, tests and treatments, although I know there are some people who would argue that all SIBO should be considered dysbiosis and that SIBO isn’t really a thing, but I’m convinced it is. If you’re interested in my other episodes on SIBO, see Episode 36 on IBS Treatment, Episode 83 on Recurrent SIBO and Episode 114 on hydrogen sulfide SIBO.
But let’s start with the basics. SIBO, for those listeners who may or may not know, stands for Small Intestinal Bacterial Overgrowth and it occurs when there is an abnormal increase in the bacteria in the small intestine, which occurs most of the time because of an episode of food poisoning, but can have lots of other root causes, which I’ll get more into later, but things as diverse as Ehlers Danlos Syndrome, a traumatic brain injury, long-term PPI use, GLP-1 drugs or hypothyroidism. But for the SIBO that stems from food poisoning, you may have the initial signs of food poisoning, like vomiting, cramping, diarrhea, maybe fever, which you’ll usually get over in a day or two, but then maybe a few days to one to several weeks afterwards, things don’t quite get back to normal. You will end up with loose stool, what we liked to call multi-wipers in my house, or maybe even recurrent diarrhea, which may include urgent trips to the bathroom or histamine reactions like allergic symptoms when you eat certain foods. This is particularly the case with hydrogen sulfide species which produce histamines. But most SIBO is caused by an overgrowth of hydrogen-producing bacteria in the small intestine, which Dr. Marc Pimentel from Cedars-Sinai, the main SIBO researcher, has pinpointed as strains of Klebsiella pneumoniae and E Coli, primarily. They will end up fermenting the food you eat, in particular foods high in prebiotic fibers known as FODMAPs, and creating lots of gas, which is why the absolute most common and determinative symptom of SIBO for me, without which I look to other causes, is bloating. For some people it tends to increase throughout the day with dinner being the worst meal, usually because it’s the largest, but some people say that they end up bloated even from drinking water. But unless you’ve severely restricted your diet, with SIBO, the bloating is ever-present, at almost all meals.
Other common symptoms of SIBO include getting full fast, having a smaller appetite, alternating constipation and loose stool, which can happen if you have IMO, intestinal methanogen overgrowth and SIBO, excessive burping, abdominal discomfort or cramps, food sensitivities, deficiencies in B12 and iron, or signs of that on blood tests, and fat malabsorption. If left unaddressed, SIBO can potentially lead to more serious conditions like autoimmune disorders, mental health issues, skin issues or systemic diseases like fibromyalgia or chronic fatigue syndrome.
They used to delineate SIBO into SIBO-D for diarrhea, SIBO-M for mixed type (meaning diarrhea and constipation) and SIBO-C for constipation, but now they’ve renamed SIBO-C IMO, intestinal methanogen overgrowth, because methanogens can be overgrown in the small or large intestine and cause similar symptoms, and because methanogens aren’t bacteria, they are archaea. And they have also just renamed hydrogen sulfide SIBO (H2S SIBO) Intestinal Sulfide Overproduction or ISO, because it can also be present in the large intestine as well. And SIBO-M or mixed would now get you two diagnoses amongst the three, IMO, SIBO or ISO, depending on what the symptoms were and the actual bacteria causing it.
So IMO is a different beast because it is characterized by an overgrowth of specifically methane-producing organisms called methanogens in the intestines, which are from the kingdom archaea. Archaea are single-celled organisms that differ from bacteria enough to warrant their own kingdom. The singular of archaea is archaeon, and archaea are known for their ability to survive in extreme environments like hot springs, hydrothermal vents and our digestive tracts. Unlike bacteria, archaea aren’t susceptible to most types of antibiotics, which is why people who’ve taken lots of antibiotics may end up with an overgrowth of methanogens. Methanobrevibacter smithii is the best-known methanogen and primarily responsible for IMO. IMO always presents with constipation and lots of painful bloating and distention as well, although not everyone with bloating has IMO or SIBO for that matter. Some people are just so constipated and backed up that they’re bloating because gas is simply getting stuck in their systems and once cleared out, the bloating clears. In theory you might smell methane gas, which is a more metallic smelling gas, in IMO, but in my experience, people will sometimes have smelly gas with it and sometimes not, and often it depends on what they’re eating. IMO is definitely more common in people on a more plant-based or vegan diet, because methanogens like carbs, and for that reason, also hard to get rid of for people who want to stick to that diet.
Then the final type, hydrogen sulfide SIBO, now called ISO, can be present in the small intestine, usually due to an overgrowth of Desulfovibrio, Fusobacterium or Proteus Mirabilis, the latter in particular in the small intestine, but also in the large intestine. I’ve heard Bilophila Wadsworthia as another hydrogen sulfide producer, which it is, but don’t see it mentioned in Dr. Pimentel’s most recent work as a likely culprit in ISO. Dr. Pimentel’s group has experimented with giving Desulfovibrio and Fusobacterium species to rats and has successfully provoked diarrhea in them, which is the most common presentation of ISO, but not the only one! I have seen cases of ISO that present as constipation, which can happen when the overgrowth is in the colon, not the small intestine, and also when it co-occurs with IMO. This often presents as someone who is constipated most of the time, but occasionally has a bout of bad diarrhea. But it’s usually diarrhea in the case of ISO that has a sulfury, rotten egg smell, at least some of the time. Along with diarrhea, ISO sufferers will often mention a painful, gurgling gut, known as increased visceral sensitivity, of course bloating, excessive burping, urinary urgency, a burning bladder or interstitial cystitis, systemic inflammation, rampant food intolerances and often histamine reactions after eating. You might also see weight loss, postprandial hypotension, meaning low blood pressure after meals, an elevated heart rate, exercise intolerance, brain fog or insomnia. And I did a whole episode on Hydrogen Sulfide SIBO or ISO, it was Episode 114, so do check that one out if you want to dig more in on that topic.
Then there’s also the possibility of an autoimmune component to SIBO or ISO, but much less common in IMO, although I have seen it. I did a whole episode on recurrent SIBO that details how that happens, but suffice it to say, if your SIBO or ISO goes away after antibiotics for SIBO like Rifaximin or herbal antimicrobials but then comes back after 2-4 weeks, then you likely have the autoimmune kind. If your IMO comes back or never goes away after treatment, you likely just need a stronger or longer course of treatment.
As I mentioned before, there are numerous potential root causes of SIBO/IMO/ISO. Beyond food poisoning, some of these causes stem from impaired digestion, such as low stomach acid or hypochlorhydria, which is crucial for breaking down proteins into amino acids. There may also be a deficiency in pancreatic or brush border enzymes, which can result from conditions like Celiac disease. Enzymes play a key role in breaking down all types of food, so when food isn’t properly digested, it can fuel bacterial overgrowth. Other root causes include low secretory IgA, a key component of the gut’s immune defense (often depleted by chronic stress), or poor bile flow, which is essential for fat digestion and also for killing pathogens. So, if you’ve had your gallbladder removed, which stores bile produced by the liver, it’s likely that there is a bile insufficiency. In addition, certain medications, such as opiates, antidepressants, proton pump inhibitors, cholestyramine, GLP-1 agonists, antibiotics, narcotics and antispasmodics, can trigger SIBO or IBS-like symptoms or SIBO itself even once you stop them. Physical conditions like Ehlers-Danlos Syndrome which is associated with extreme flexibility, adhesions from abdominal surgeries, endometriosis or ileocecal valve dysfunction can contribute to SIBO as well. Environmental factors like mold toxicity or underlying health issues such as diabetes, prediabetes, hypothyroidism and even traumatic brain injuries, may also be at the root of SIBO. But the most common trigger is autoimmune dysfunction caused by a bout of food poisoning, which disrupts the migrating motor complex.
Now that we have a basic understanding of SIBO, IMO and ISO, we can differentiate between those disorders and dysbiosis. Dysbiosis refers to an imbalance or disruption in the normal composition of the gut microbiome. It occurs when harmful bacteria, fungi, parasites, viruses or other microorganisms outnumber beneficial ones, leading to various digestive and systemic health issues. Unlike SIBO, IMO and ISO, which are more specific conditions involving bacterial and methanogen overgrowth, which we’ve now targeted to specific bacteria and methanogens, and that people often can have for years without getting treatment, dysbiosis is a broader term that encompasses any microbial imbalance in the stomach or intestines, some of which may necessitate more urgent treatment.
Symptoms of dysbiosis can include bloating, gas, diarrhea, loose stool, constipation, reflux, stomach pain, abdominal pain and more systemic issues like fatigue, mood changes, skin issues or weight changes. Dysbiosis often overlaps with conditions like SIBO, IMO and ISO, but is a more general term for a disrupted gut environment.
Dysbiosis can be caused by multiple factors, oftentimes distinct from those root causes of SIBO and friends (which I’m going to use to refer to SIBO, IMO and ISO from here forward). Single organism bacterial infections, for example, can cause dysbiosis in the gut. The presence of harmful pathogens like Clostridium difficile (abbreviated as C. diff) or Campylobacter can lead to an imbalanced GI system, especially when there are predisposing weaknesses in the digestive process, like low secretory IgA, your gut immune defense system, or few beneficial microbes due to poor diet or the use of antibiotics. C. diff is a bacterium that causes diarrhea and colitis (inflammation of the colon) and explosive all-day diarrhea, which causes about 30,000 deaths in the US annually. C. diff germs spread via stool, but can also be found in the environment, living on surfaces or in soil. People with already weak immune systems or people who are taking antibiotics are more likely to become sick after ingesting C. diff spores and are therefore more likely to develop a dysbiosis in the gut. Campylobacter is another bacterial diarrheal illness, but is often spread from animal to human as chickens, cows and other animals can carry it without becoming sick. Humans can contract Campylobacter by eating raw or undercooked meat or seafood, drinking untreated water or touching certain infected animals. After coming into contact with Campylobacter there is a risk of becoming sick and developing a dysbiotic gut. And there are a number of other single-organism bacterial infections that are not dissimilar to C. Diff and Campylobacter, including Enterohemorrhagic E. coli, E. coli O157, Enteroinvasive E. coli/Shigella, Enterotoxigenic E. coli LT/ST, Shiga-like Toxin E. coli, Salmonella, Vibrio cholerae and Yersinia enterocolitica.
Other infections, like those caused by parasites, can also attack a healthy gut creating dysbiosis. One example is giardia, a protozoan parasite that lives in the intestines and is often contracted through contaminated water or food. Other protozoan parasitic infections include Cryptosporidium, Entamoeba histolytica and certain subtypes of Blastocystis hominis. Other parasites are worms called helminths. These include parasitic worms like tapeworms, roundworms and hookworms, which can infect the intestines, causing symptoms like diarrhea, abdominal pain, malnutrition and weight loss. And the worms can be contracted through undercooked meat or contaminated soil. Although you may have heard that some people are using helminths as a therapy to treat an overactive immune system manifesting in allergies, autoimmunity and/or migraines. I’ve been trying to get someone on the podcast to discuss helminth therapy for ages, but an expert on this keeps eluding me. And then there are of course viral illnesses that can manifest in GI symptoms, like norovirus, rotavirus, adenovirus, astrovirus, picobirnavirus, cytomegalovirus and even COVID-19, which has even been found to cause gastric ulcers in a small number of cases. In any case, all these organisms can contribute to dysbiosis, and their presence may make other infections or dysbiosis appear or get worse.
And if overgrown bacteria and parasites weren’t enough, you can also have fungal overgrowth contributing to dysbiosis, and often present in biofilms with bacteria. SIFO is an umbrella term that refers to small intestine fungal overgrowth, which is caused by candida and other fungi, and there are different species of candida that can overgrow. Candida naturally lives on your body: in your mouth, on your skin and in your intestines, but can become unhealthy when overgrown, often caused by the use of antibiotics, which deplete beneficial bacteria, allowing yeast and harmful bacteria to thrive. And then also, of course, a poor diet of processed foods, sugars and additives can also contribute to dysbiosis (and you can learn more about additives and preservatives in Episode 128, which covers those in detail). So when candida becomes overgrown in the gut or even extending into the bloodstream or other organs, it’s called systemic candidiasis. Candida is also the cause of oral thrush, which you can see when you have a thick yellow or white coating on your tongue in the morning, and vaginal yeast infections, which cause itching, redness, pain with intercourse or urination and a cottage cheese like or off-color discharge from the vagina. I often suspect candidiasis if there have been lots of antibiotics plus one of these other types of bodily candida, including fungus in the toenails, and in people who tend to run cold or have cold hands and feet, as candida thrives in a cooler environment.
And sometimes dysbiosis isn’t caused by any one single pathogen, but just shows up on a stool test as a gut that’s depleted of most of the keystone beneficial species, but enriched in one or more of the opportunistic bacteria or genuses of bacteria that aren’t problematic unless they overgrow, like certain Bacillus species, Enterococcus faecalis, Enterococcus faecium, Morganella species, Pseudomonas species, Pseudomonas aeruginosa, Staphylococcus species and Staphylococcus aureus, in particular, and then Streptococcus species. Although I have to say I see very few guts that don’t have at least one of those overgrown. And there are also opportunistic bacteria that are associated with autoimmunity that can overgrow, including Citrobacter species, Citrobacter freundii in particular and Klebsiella species, M. avium subspecies paratuberculosis, which is associated with Crohn’s disease, Proteus species, and Proteus mirabilis, in particular. However, these dysbiotic bacteria may not present with bloating and are usually overgrown in the colon, or at least that’s where the sampling is taking place when you do a stool test, and where I’m seeing them. And Dr. Pimentel’s work on SIBO shows that what’s going on in the small intestine in SIBO, as measured by an aspirate of the contents of the small intestine, is completely different from what’s found in the stool, which better represents the colon’s contents.
And I think it’s worth distinguishing between SIBO and friends and dysbiosis, because although they may present similarly in the body, they are distinct, with different causes, testing and treatments.
Breath tests are recommended as the first line of testing for SIBO, ISO and IMO because they are the only way to access what’s going on in the small intestine. Patients will take a sugar solution and their breath is analyzed at 15 or 20-minute regular intervals for 2-3 hours to measure hydrogen and methane levels. Lactulose and fructose are the best two substrates to use for the sugar solution for testing, at least according to Dr. Jason Hawrelak’s work, but glucose has been used historically, and lactulose is only available by prescription in the US. Currently, I think the best choice for breath testing if you suspect hydrogen or methane is the FoodMarble device you can buy and reuse (which I did a deep dive on in the last episode) and the trio-smart Test, which is the only test that includes hydrogen sulfide currently. I have had issues with breath tests and clients though, as many times the testing returns invalid results for some of the specimens sent in, which seems to happen a good bit on the trio-smart. I think probably because it’s a very sensitive testing for hydrogen sulfide. And I often get negative results but the symptoms are so specific to SIBO and then the client responds to SIBO treatment, so I assume the test was wrong. And you also have to be careful that you’re instructed to take the correct amount of substrate. Since I only recently started using the FoodMarble with clients (normally I would just send them to do the test and how it was done was not something I was that concerned with), I only recently started doing more research on how much of these sugars to take before the test. As I described in my last podcast, I got the Aerodiagnostics test and did the FoodMarble at the same time, but the Aerodiagnostics test had come in the mail because my doctor’s office had sent in an order, and they sent a pack of glucose with instructions to take a certain amount based on my body weight. So I ended up taking 22 grams of glucose, only to learn later that the consensus on the amount of glucose to take is 75 grams – not 25 or 22! So no wonder I got a negative result. The consensus for fructose is 25 grams and lactulose is 10 grams. All are mixed in one cup of water. But apparently fructose catches a lot more cases of SIBO, so I’m now instructing my clients to take fructose as their substrate unless they live somewhere where they can access lactulose easily (it’s only by prescription in the U.S.).
And I should also mention that testing for the elevations in antibodies to the bacteria that cause SIBO called cytolethal distending toxin B or CdtB, and to the protein in your body responsible for the migrating motor complex, that resembles that bacteria, vinculin, is not only another way to test for SIBO but also to test for whether you have autoimmune SIBO or officially called post-infectious IBS. The first test of this kind was developed by Dr. Pimentel’s group and it’s called the ibs-smart Test, although there is at least one copycat test out there. I knew I had recurrent SIBO for years, but it was only when I saw that my vinculin antibodies were elevated on this test that I knew officially why my SIBO kept recurring. Apparently the Pimentel group is studying something to bring down these antibodies and ultimately cure SIBO, I’m not sure what, but I think my next personal experiment will be to try LDN or low dose naltrexone, which I suspect is what they’re testing, a prescription drug you can get with an online doctor, which has been successful in lots of other types of autoimmunity for bringing down antibodies.
Anyway, despite current recommendations, I sometimes prefer a stool test like the GI Map, US Biotek GI-Advanced Profile, GI Effects or Tiny Health PRO if I suspect hydrogen sulfide or methane overgrowths, that is, ISO or IMO. And sometimes I think it’s best to order both the SIBO breath test or the FoodMarble (email Lindsey to request a FoodMarble invitation) and the stool test, if I suspect multiple pathogens. Stool tests have PCR or metagenomic shotgun sequencing data that will tell me the levels of specific pathogens like Desulfibrio piger, Bilophila Wadsworthia, Proteus Mirabilis, Fusobacterium and Methanobrevibacter smithii that can point me to the likely cause of someone’s distress. And then of course if you want to test for candidiasis, you need to order an organic acids test, preferably with the marker Arabinitol or D-Arabinitol, the most validated marker of candidiasis, as candida rarely shows up as positive on a stool test. I also like that the stool tests I just mentioned include markers of intestinal health, which gives me an idea of whether someone’s digestion is impaired, if they have sufficient pancreatic enzymes, fat in the stool, sufficient secretory IgA, elevated markers of inflammatory bowel disease like calprotectin or lactoferrin or low levels of short chain fatty acids like butyrate. Most tests also have at least one marker of gluten sensitivity, which when discovered can really turn things around for some people.
So to finish up, I wanted to share a case study of one of my clients who had a few different types of dysbiosis without having SIBO, IMO or ISO, because there are a few good lessons to learn related to why testing is so important before being treated. So he came to me with diagnosed gastritis, which is inflammation of the stomach, GERD or reflux manifesting as spitting up after a meal, constipation, a white coating on his tongue, shortness of breath, tightness in his jaw, pain between his shoulder blades, cramping in his hands and shooting pain down the arm that came after eating, headaches, dark urine, a funny body smell, dizziness, low blood pressure overall, but episodes of high blood pressure, tinnitus, insomnia and internal hemorrhoids, and diverticula found during a colonoscopy, which are small pouches that form in the colon’s muscular wall that can get infected causing diverticulitis, plus undesired weight loss. He didn’t describe bloating as an important symptom, so I chose the route of a stool test and we did the US Biotek GI-Advanced Profile, which is one of my new favorites because it includes zonulin, a marker of leaky gut, and the short chain fatty acids, and H pylori and its virulence factors, which tells you whether the H. pylori could cause an ulcer or stomach cancer, and its price is in between that of the GI map and the GI Effects, but it has more markers than both of those tests.
So what showed up on his test was whipworm, which is a parasite, high Streptococcus species, high Fusobacterium species, which I really don’t like people to have much of, because one member of that species, Fusobacterium nucleatum, is associated with cardiovascular disease, rheumatoid arthritis, respiratory tract infections, Alzheimer’s disease, colorectal cancer, pancreatic cancer and inflammatory bowel disease. And most of his commensal bacteria levels were low, but he had high Clostridium species (but not C Diff), which can constipate. In terms of digestive health markers, he had low butyrate despite being constipated, high calprotectin, a marker of inflammatory bowel disease (although that wasn’t diagnosed on his recent colonoscopy, so I assumed that was not in this case showing inflammatory bowel disease), high zonulin, meaning a leaky gut, low pancreatic elastase, meaning not enough enzymes being produced by his pancreas to digest his food, and high beta glucuronidase, which can put you at risk for colorectal cancer and for women, breast cancer.
And I want to pause a moment and say, if you have high beta glucuronidase on a stool test and have a history of breast cancer or colon cancer, this is marker that says that your gut is dysbiotic and has too many of the wrong bacteria that are producing this molecule that will untag estrogens and toxins from your bile and send them back into circulation. These toxic forms of estrogen are what causes some breast cancers, so thank your lucky stars that you took the stool test and you know what’s going on, but take it very seriously if you want to prevent a recurrence of breast cancer. I have a client who was in this very situation and I recommended interventions, including a vegetarian, low-fat diet, to help turn it around and educated her on the supplements to prevent recurrence and to bring down that beta glucuronidase and change her gut microbiome, but I then didn’t see any of them purchased on Fullscript, maybe she found them elsewhere, I don’t know, but she didn’t respond to any of my follow-up emails. Who knows where she was in the disease process at the time I saw her, but she contacted me about 10 months later, diagnosed with a stage 4 metastatic uterine cancer. So please everyone if you get a high level of beta glucuronidase on a stool test, take it seriously, see someone who understands the marker, follow their instructions and retest after doing interventions. I had a little bit elevated beta glucuronidase on my last stool test and I markedly decreased my meat and saturated fat intake and went on 4 different supplements to counteract it.
Sorry for that interlude but sometimes gut stuff can be a signal for much more important things, so I don’t want you to blow off gut-related recommendations. Anyway, back to my original client. We also did a NutrEval test because of the all over body complaints, weight loss and to check on candida, because of the white coating on his tongue. I won’t go into all the details of everything we found, but he did have high Arabinitol on the NutrEval, which means he had systemic candida.
So one of the first things I taught this client about was SBI powder, because that’s safe to start with even before you know what’s going on. So he opted to get on that right off the bat, which helped him feel much better, even before we got back his test results. It works by adhering to gut pathogens of various types and ushering them out in the stool. Then my usual go to’s for constipation are magnesium citrate and vitamin C, so he opted to take those to get his bowels flowing better. He ended up getting antiparasitic medication from his doctor to treat the whipworm, which is usually easier as prescription worm treatments in my experience are just a 1 or 2 pills for a few days.
Then I educated him on how a multivitamin and vitamin D/K would help in bringing up his own immune system to fight infections. With Vitamin D, I always recommend testing 6 months later then adjusting to hit optimal levels and I always recommend taking D with K, preferably mk4, as it’s the form our body makes, in order to direct the calcium the D will help you absorb to your bones and not your arteries. An optimal level of vitamin D is 50 or 60 to 80 ng/mL, so after testing you can adjust your dose. Most people settle on a dose of 3000-5000 IU/day to maintain that optimal level, but usually start around 5000 IU/day, just to bring it back up.
Then I taught him about digestive enzymes to help when pancreatic elastase isn’t great, and most importantly, suggested a high-fiber, vegetarian diet and calcium d-glucarate for high beta glucuronidase. I also educated him on how Iberogast can help with reflux after meals and slippery elm can help with healing the lining the digestive tract and my favorite all-around probiotic, Seed Synbiotic*, which can help bring up commensal bacteria levels and better shape the microbiome to reduce beta glucuronidase. But keep in mind, most probiotic species are transient and don’t settle in the gut, but pass through making your microbiome healthier as they go. Given his low butyrate levels, but constipation, I also taught him about how a one pill of a low-dose butyrate or tributyrin supplement every 1-3 days can help heal the lining of the colon. This is a situation where I don’t recommend my own tributyrin supplement, Tributyrin-Max, but rather another tributyrin supplement in the 300-500 mg range and usually starting every 3 days and up to once a day, because it does have a constipating effect. And then perhaps the most important part, along with a high fiber diet, is a gut shake that I shamelessly stole and adapted from Marc Hyman’s recipe to bring up commensal bacteria. In this client’s case, his shake included Dr. Formulated fiber, pomegranate powder, cranberry powder, matcha powder (these are all good polyphenols that help promote healthy bacteria), l-glutamine, collagen peptides, continuing on the SBI Powder to keep the pathogens at bay and added Nutraflora FOS, a prebiotic that helps bring up beneficial bacteria in order to bring down beta glucuronidase, and freshly ground flaxseed, which may have related to specific bacteria we wanted to bring up, and then add frozen fruit and water and your favorite milk and voila! He told me he loved the smoothie. I also taught him about how adding creatine and branch chain amino acids could help with building muscle, which was based on his test results, which didn’t indicate general amino acid deficiencies.
Now one particularly interesting thing about his case was that after he was feeling way better from all this and most of his symptoms were gone or improved, he took a trip to Costa Rica and Panama and got food poisoning from some seafood. Now I did suggest he take some SBI powder and sprinkle it on all his meals to try to avoid traveler’s diarrhea, which he did, but sometimes the pathogens are stronger than the amount of IgG you can throw on it. So he and his companion did have one day of diarrhea, but it did not continue. So when he came back, he was retested, incidentally after a round of antibiotics for an unrelated thing (and I’ll get back to why these antibiotics were ill-timed in a minute). So on the retest, his butyrate was high now, pancreatic elastase was almost to optimal levels, his zonulin was normal now, so no more leaky gut, his beta glucuronidase was normal, but he had a new marker that was high, steatocrit, which is indicative of fat in the stool, which was likely coming from the Enterohemorrhagic E. coli that was highly elevated on his test, which must have been the source of the food poisoning. Now back to why the antibiotics were ill-timed but fortunately didn’t have a bad effect in his case. When you have Enterohemorrhagic E. coli, taking antibiotics can destroy that bacteria causing a release of even more toxins, which can cause something called hemolytic uremic syndrome, which is from the toxins damaging and inflaming the small blood vessels throughout the body, which can cause clots to form in the blood vessels, which can damage the kidneys and other organs, and in the worst cases, can lead to kidney failure and be life-threatening. Bloody diarrhea, abdominal pain and cramping, fever, vomiting, loss of color in the skin, easy bruising or bleeding, swelling in the hands, feet or ankles and high blood pressure are some signs of hemolytic uremic syndrome. Do get help immediately if you’re having those symptoms. Now fortunately, in his case, he was taking the SBI powder the whole time, so he was protected from these toxins, as the SBI powder binds to them, and it’s a great thing for continuing to fight off the E coli even after that, so he just chose to stay the course on SBI powder. So if you are planning a trip to a developing country that doesn’t have great water or food sanitation, I can’t recommend SBI powder enough as a preventative measure and as a possible treatment if you do get sick. And then not just taking antibiotics without knowing what you’re treating, because of the possible danger of hemolytic uremic syndrome. If you have a diarrheal illness, getting liquids and electrolytes and letting your body fight it is the best plan, if you don’t have something on hand to deal with it and can’t get tested. But if it doesn’t subside after several days, getting tested before treating it is recommended.
Other things to note on the retesting were that his Staph species were back to normal and his Fusobacterium species were now at normal levels (they had been at 30 x 104 now at 1.33 x 104). An interesting thing to note, even though he still had the Enterohemorrhagic E. coli elevated at the time of testing, he had returned to being constipated, which is interesting for a diarrheal illness, right? But it was likely because the levels had come down a lot from the original infection and his Clostridium species were high, which can be constipating. So it wasn’t a perfect resolution quite yet, but I like this case as a demonstration of the fact that 1. Diarrhea can come from all sorts of different sources that aren’t SIBO and you need to know what you’re treating to treat it safely, unless you’re going to choose something super safe and harmless like SBI powder; 2. Constipation can be present for many reasons from a magnesium deficiency to high levels of constipating bacteria that aren’t methane producers to typical IMO, which he had none of in his gut, by the way; and 3. You never know when you’re going to find a parasite, although honestly, I would say I have only seen parasites show up on about 5% of all the gut tests I’ve done. Now some people will argue that they’re lodged in the digestive tract or under biofilms or otherwise hiding and we all have them, and maybe that’s the case, I’m not sure, but in terms of testing results, that’s what I’ve found. So if you do try everything to deal with digestive symptoms and aren’t having any luck, aren’t seeing any SIBO or other dysbiosis, there’s no mold in your background or other potential problems, and even if you don’t see parasites on a stool test, you may want to try taking some anti-parasitics. And for this I’m a fan of the CellCore Biosciences Para 1 and Para 2 products (use patient direct code to access their products: I0rdLMOm).
So that’s all for today. If you’re suffering with any of the symptoms I’ve mentioned in this podcast, I see individual clients to help them resolve their digestive issues and you’re welcome to set up a free, 30-minute breakthrough sessionto 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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