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Adapted from episode 88 of The Perfect Stool podcast and edited for readability with Shaina Cahill, PhD, neuroscientist and Director of Medical Communications and Affairs at Novel Biome.

Lindsey:

So why don’t you start by telling us about Novel Biome and the work you’re doing there with fecal microbiota transplants?

Shaina Cahill, PhD:

Yeah, so at Novel Biome, we focus on providing high quality, medically-supervised fecal microbiota transplantation (FMT). Our focus is specifically on children or adults with autism spectrum disorder though we do treat people outside of that. Adults that have other conditions that can be helped with FMT. We have four treatment locations in Hungary, Panama, Mexico and Australia. We’ve expanded these to try to reduce the stress and burden it is to try to access this level of treatment. We’ve been around since 2019, with a focus and being Novel Biome. And this came about – two studies were published in 2017, and 2019, by Dr. James Adams, his group out of Arizona State University.

Lindsey:

That we’ve had on the podcast twice.

Shaina Cahill, PhD:

Yeah. And so his work, I think, really stimulated more interest in the possibilities of FMT with autism. And so parents started to reach out about how FMT might be a good fit for their children. And that has just expanded from there. And we’ve focused in on on ASD, because we think that the research to date has been so valuable, but as well, children with autism spectrum disorder are three times more likely to have GI issues. These GI issues really impact quality of life and there seems to be some correlation between the severity of GI symptoms and the severity of ASD-related behaviors. And so there’s a good groundwork of research that’s been around for a long time tying gastrointestinal issues to children with autism. While this research on FMT is new, there’s been an understanding that there is a GI component for not all children with autism, but a good proportion of children with autism. So that’s what led us to do what we do.

Lindsey:

Yeah. And so, Dr. Klopp is from Canada originally?

Shaina Cahill, PhD: 

Yes.

Lindsey:

Where’s your clinic there?

Shaina Cahill, PhD:

We don’t treat in Canada. In Canada, we’re a biomanufacturing company for export and working with Health Canada. Health Canada doesn’t want FMT to be a treatment that’s accessible right now to Canadians, so when working with them, we don’t advertise. We don’t treat Canadians and our website is not even accessible in Canada. We primarily just work as a biomanufacturer and that’s in accordance and following all the rules with Health Canada. And they’ve evaluated and looked at everything and we’re working towards getting a drug establishment license, which then further solidifies our export processes as a drug as well.

Lindsey:

And then your clinic in Mexico – that’s in Tijuana, right?

Shaina Cahill, PhD:

No, it’s in Rosalia.

Lindsey:

Is it near California though?

Shaina Cahill, PhD: 

Yeah, so it’s like driving distance from the US border, but that’s our closest, I guess, to the US site and that one’s been around for the longest. That was our first site and then we’ve kind of expanded from there working with clinics that have the capabilities and the understanding of FMT. We supply product and a protocol for them, and they provide the treatment there.

Lindsey:

And so why the focus on autism in particular? Does Dr. Klopp have any particular relationship with that or was it more just because of the patients asking about it?

Shaina Cahill, PhD: 

It’s the relationship with the patients asking, as well as having a good groundwork for why FMT would work. The research today has been really good, and then that understanding of those GI symptoms, those are there. And so we know that there’s a good groundwork of support for why this would work.

Lindsey:

And what kind of GI issues do children with autism typically show?

Shaina Cahill, PhD:

Kind of runs the gamut. A lot of the major ones are a mixture of constipation and diarrhea, which oppose each other, but those tend to be the two. Bloating and abdominal pain seem to be the ones that we see the most in the literature. Those are the consistent ones that come up.

Lindsey:

And these aren’t just cases of SIBO that could be treated in a different way, or do you do deal with other potential treatments prior to going to FMT?

Shaina Cahill, PhD: 

Yeah, so part of our protocol starts with a personalized pretreatment that’s done by a physician’s assistant. They go through basically what’s currently being treated, what tests have been done, what other tests should be done and what types of medication for before going into FTM. Sometimes we’ll find out that there are larger mold issues and things like this, and then we’ll hold off on FMT get all of those treatments done, so that the gut is ready to take on FMT. That’s a case by case and every case is different. So we make sure that we tackle any issues that could be solved before going into FMT.

Lindsey:

Okay, And so what percentage of your practice would you say is children with autism versus other issues?

Shaina Cahill, PhD:

That’s a good question. I would say probably 90% is autism and most of those are going to be children with autism, not to say that children with autism are only coming for autism. So we also see, some parents are really highlighting those gastrointestinal issues, or IBS or IBD, as well as, seeing that their child also has autism. It’s not always just that parents come in, they’re like, “We have an autistic child, we think an FMT will help.” It’s often that, well, we have these like gastrointestinal issues that are causing a lot of issues. We’d like to tackle that and if we see outcomes with autistic-related behaviors, that’s also great. What we try to instill is that the first outcome is always going to be GI, but we see these secondary outcomes with autistic-related behaviors. So it’s not that this is specifically a treatment for autism, it’s tackling one of the symptoms, which seems to be GI, which then leads to the secondary changes, which we don’t understand at this point. The research is not there to understand why these changes are happening, but it is showing that there’s a relationship between the two.

Lindsey:

Well, we can get more into the results in a minute, but first, I want to ask about your donors. So who are your donors?

Shaina Cahill, PhD: 

So we have really stringent donor screening characteristics that we look for. There are published standards. There’s about nine of them that are out right now and what we do is we look at what those initial screenings are. And then we have our own subset that we also look at on top of that. We’re looking for all of our donors not having taken antibiotics in their whole life, having been vaginally born and breastfed. And we know these things are the pillars of creating a stable gut microbiome from the beginning. And then of course, we’re looking at their diets, as well as their exercise habits. We look at a wide variety of both in them and in their family history of any disorders that we think could be or might soon be understood to be tied to the gut microbiome, to try to reduce any transfer. So we screen our donors, and that leaves us with very few donors that we can even use and then outside of that their blood and stool is tested. That’s done regularly every three months to make sure that there’s nothing there. And so, like everywhere, we find donors that meet our requirements, and we use them as long as they’re willing to donate.

Lindsey:

Is there a an upper limit for age with your donors?

Shaina Cahill, PhD: 

Right now, we don’t have any donors over the age of 30. I mean, right now, in the research, they’re saying there shouldn’t be huge shifts in the gut microbiome until somewhere in the 60s, 70s range, but most of the published cut offs are around 60. And we want to keep ours under that because we do know that there are changes and not just changes in the gut microbiome, but changes in how people live as they get older, which then impact that microbiome. So we’re trying to stay on the cusp of not having any of those issues. So right now, we don’t have anyone over the age of 30.

Lindsey:

Is that the exclusion age or is that just by chance?

Shaina Cahill, PhD:

By chance. Right now, our exclusion age – in our written documents, I think is 40. So that’s the same range, but we just want to ensure because we know that age impacts it. We’re still really understanding that and when that shift happens, There’s a whole bunch of issues in the aging gut microbiome research that I could go on for days about. So I think we’re just trying to stay on the cusp of what we know for sure, versus getting into ages where there might be impacts. With FMT, the more you can control what is going on with your donors, the better, because we want to ensure what we’re giving patients is consistent and safe. And so the more we can control what the donor is going to pass on, the better it is for the patients.

Lindsey:

And do you allow your patients to see the donor screening questionnaire that you use with their donors?

Shaina Cahill, PhD: 

Yeah, so any patient or anybody that wants to kind of understand that, we can give that Anyone that goes through treatment can see the reports of the blood and stool screening and stuff like that from the donors. But that just we’d have to be somewhat mindful, because it’s their health records. So we can give a general understanding of what the donors have that they’ve passed all of these screenings, but we can’t give everybody “Here are these people, this is where they live, this is everything they do,” because we also do protect the donors themselves. So there is some information we can provide and there’s some information we just can’t provide, but we try to be as transparent as possible, where privacy allows us. Our donor screening and all that stuff is something that is readily available for anyone that asks. It’s not on our website, because it’s a very long –

Lindsey:

Could it be something that  I could share with my audience? Would you
be willing to –

Shaina Cahill, PhD:

Yeah, I can send the questionnaire to you. It’s a couple pages long, but yeah, that’s easy enough.

Lindsey:

I can post that in my show notes.

Shaina Cahill, PhD: 

Yeah

Lindsey:

Cool. Can your patients see the pictures of the stool prior to processing?

Shaina Cahill, PhD:

I can’t guarantee you that anyone’s ever asked. We use the Bristol Stool Chart and  there’s a cut off where if stool don’t fall in these two categories, we don’t use it.

Lindsey:

Three and four?

Shaina Cahill, PhD:

Yes, but outside of that, that’s all there is. I don’t know if we take pictures of it. We have a lab manager who does all of those things. But I highly doubt –

Lindsey:

But if someone asked they might be able to?

Shaina Cahill, PhD:

Yeah, I think if someone really needed to, but I think what it’s like is: this is the categories they fall into and, and anything that falls out of that is always documented. Of course, that donor is not used and then we categorize that donor until they’re back into that time period and figure out what could have happened, as well. So that we want to make sure we’re only using the best and so that’s not part of my job, but part of hers.

Lindsey:

Do patients get stool pretty much from one donor or is it mixed together with multiple donors?

Shaina Cahill, PhD:

We usually use at least two donors for patients. And we just want to make sure that the goal here is that like, it’s diversity, ensuring that you get everything you can by using two donors. We actually suggest people rotate back and forth between what donor they’re taking, so that we can get the best benefits. There’s some disagreement and some agreement about using multiple donors versus one. But most of what we’ve read in the literature seems to support the use is there’s a benefit to having multiple donors versus just a single donor. So we’re hedging our bets with that.

Lindsey:

And how do you process your stool for transplant?

Shaina Cahill, PhD:

That would be a good question for our lab manager. I’ve toured her lab, but I have not watched her process anything because she’s very picky about cleanliness and who’s around when she’s doing stuff, which I appreciate wholeheartedly, but that would be something that she would know more about than I do.

Lindsey:

Well, maybe you could ask her and I could just put a paragraph in the show notes afterwards about what the process is?

Shaina Cahill, PhD:

Yeah, we have standardized procedures, so I don’t think it’d be hard for her to pull, but that’s not something I know anything about that off the top of my head.

Lindsey:

And so what is your protocol for preparing the recipient for the transplant? Do they take antibiotics?

Shaina Cahill, PhD: 

Yeah most of the time, everyone is going to take an antibiotic, but it’s individualized. So that’s part of our process.  We work with parents and their children to see what is necessary for them to be prepared. I think we’re as a field starting to really understand the importance of pretreatment. There’s actually been some new studies that have come out and said, “In cases where antibiotics were done before FMT, there’s more success there.” So that is one of our standards, but it’s not consistent and not everybody takes antibiotics. That’s also dependent on the comfort levels and where we think some parents don’t feel comfortable, we use alternatives to antibiotics. It’s completely individualized for the person, so there’s no like, “Here are the three steps we use for everybody.” Because no person fits perfectly into a puzzle every time, we alter it depending on them.

Lindsey:

Okay, so if you didn’t use antibiotics, would you use herbal antimicrobials?

Shaina Cahill, PhD:

From my understanding that has been done. I mean, consistently, it is almost always antibiotics. For people who don’t feel comfortable, we use a natural alternative to an antibiotic.

Lindsey:

Is there a particular antibiotic that you prefer?

Shaina Cahill, PhD:

I think it’s normally vancomycin, but I can’t be 100% sure.

Lindsey:

That’s what I’ve heard from I think, Dr. Adams.

Shaina Cahill, PhD:

Yeah.

Lindsey:

Okay and how long is the course of treatment?

Shaina Cahill, PhD:

Our protocol, we do a two-day, high-dose, and that’s going to be at one of our treatment centers. The total protocol is 16 weeks of FMT treatment.

Lindsey:

Daily?

Shaina Cahill, PhD:

Yeah, daily for 16 weeks. We do that, because there seems to be a huge impact on the amount of time that treatment is done. Studies that have done four weeks, versus something like Dr. Adams’ study, which did eight, you see significant improvements. We’ve extended ours and we see more consistent outcomes and we think part of that is because of that kind of extended treatment period.

Lindsey:

And are these all being done by retention enema or are you doing capsules?

Shaina Cahill, PhD:

Yeah, so at our treatment centers, you can do either an enema or loading oral dose, and that depends on the child or the person getting treatment. Some children can’t take capsules, so they will take a retention enema. When they go home, for kids that can take capsules, they’ll continuously take the capsules. Anyone that can’t swallow the capsules, we have an oral powder, which can be mixed with water, juice or milk. They can take it that way versus having to take a capsule.

Lindsey:

Okay, so it’s highly purified the way that Dr. Adams’ stool is – to the point where it doesn’t resemble fecal matter anymore I assume.

Shaina Cahill, PhD: 

Yeah, so it’s odorless, tasteless and colorless.

Lindsey:

Just the bacteria.

Shaina Cahill, PhD: 

Yeah. And so that allows us to provide an at-home version of the treatment for kids that can’t take capsules. And that’s really common in smaller kids. That allows a comfort for that and it’s easy to mix it into something they would normally drink anyways.

Lindsey:

So it’s really just a fancy probiotic pulled from someone’s stool when push comes to shove.

Shaina Cahill, PhD:

It’s an engraftable, I guess. Because it’s a higher diversity, and you’re getting everything.

Lindsey:

Including the anaerobic strains.  Does it have to be refrigerated?

Shaina Cahill, PhD: 

For extended periods. So we suggest four degrees storage, because of what we’ve seen. So far, that’s been done, and we’re doing our own stability studies to get a better understanding, because there hasn’t been a ton done. But when it’s at four degrees, when it’s been partially freeze dried, we know that it’s good for up to about a year. So we suggest keeping it in the fridge and then keeping it at a consistent temperature because those temperature variations can cause some some issues as well. Yeah, and everything that’s in your gut microbiota aren’t bacteria. There’s a whole host of things, right. So you’re
getting all of that and with a probiotic, it tends to be concentrated on a couple of strains. And we know that probiotics don’t engraft. So they’re good while you’re taking them, not good long term. There is a difference. I think because it’s purified and partially freeze dried, you’re looking at a more stable and something that can be used for a longer period of time. So there are differences. And as FMT is coming along, we’re seeing these improvements. Oral capsules weren’t a thing a couple of years ago. That’s really kind of changing what FMT looks like, and its accessibility. But as well now being able to partially or fully freeze dry it, now it’s becoming more shelf stable. The life, the longhood, the longness of it, how you can store it and how it’s able to be stored and then shipped and stored in someone’s house for longer periods of time makes it an easier product to have.

Lindsey:

So is that four degrees a typical – this is Celsius right?

Shaina Cahill, PhD:

Celsius, yes. Standard fridge temperature is the –

Lindsey:

Which is I think somewhere around like 40 degrees Fahrenheit or something like that.

Shaina Cahill, PhD:

Yeah.

Lindsey:

Okay, what gut health conditions, does the research say are most positively impacted by FMT?

Shaina Cahill, PhD:

It’s a wide variety. And we’re still learning. I think the biggest thing to say is, currently, it’s only approved for treating recurrent C Diff.

Lindsey:

In the US. 

Shaina Cahill, PhD:

And the outcomes of that are magical. Because it’s been so safe and consistent, research is growing in other areas. Across the board, we need more randomized clinical trials. We need larger clinical trials and we need more patients to see consistency. I think that’s the first statement to make across the board. For Irritable Bowel Disease, there have been a number of positive studies. While the results aren’t what we’re seeing in C. diff, which is like 90%, it seems to be consistently around somewhere between 30% improvements.

Lindsey:

Irritable bowel syndrome, or inflammatory bowel disease?

Shaina Cahill, PhD:

Irritable bowel disease, and there’s no consistency. There’s been 10 studies done in Crohn’s and –

Lindsey:: 

We’re talking about Crohn’s and Colitis (or inflammatory bowel disease).

Shaina Cahill, PhD:

Yes. And so that’s around about 30%. But because diseases that fall under IBD are inflammatory in nature, and they’re cyclical, I think that’s what we’re seeing in the research. When people aren’t in an inflammatory state, their response is different than when they are. So that’s complicating the research a little bit. There are certain disorders where when you treat will also matter. There’s some really great, new clinical trials coming out for Parkinson’s disease – the stuff that’s been done to D has just been case studies and preclinical, which are promising and I think there’s four clinical trials coming that are currently ongoing for Parkinson’s disease. There’s a couple for MS, multiple sclerosis, Autism Spectrum Disorder, of course, we’re seeing clinical trials and growth and research there. There’s been some research looking at cancers. There are some steps specifically for cancer, but a lot of the research right now is looking at treating side effects of cancer treatments. The biggest beacon we’re seeing is people who are getting stem cell treatments or bone marrow treatments, because of what has to be done to prep the body to get those treatments, they’re actually finding using either FMT or autologous fecal microbiota transplantation, which is using someone’s own stool. They take the stool before they get any of the prep done for the stem cell treatment, and then do the FMT. They actually see that improves both uptake and any issues with graft versus host. But as well, it just makes the process more enjoyable or more easily reduces side effects. IBS is another one that they’re showing studies in, which seems to be a little bit more consistent than IBD, which I think is like 40 to 50% improvement. There’s not a ton of studies. And again, there’s more coming. The clinical trials are growing in this area. But those are kind of the main areas we’re seeing a lot of growth and research.

Lindsey:

Okay, cool. It was a good summary. And so I know that there was some controversy surrounding Dr. Klopp and his use of FMT, so can you can you explain a little bit about what’s going on with that?

Shaina Cahill, PhD: 

Yeah, so we’re still in the midst of it. It’s been going on for too long. It started in 2020, where the main issues came out, and a lot of it was around manufacturing standards, the use of FMT in children with autism spectrum disorder, and advertising. So we’ve completely revamped how we advertise. And that’s something that we’re consistently changing as we enter new countries. We’re working with external help with that, because none of us are marketing people. We’ve been learning about that, as well as in Canada, worked with
Health Canada, decided to not advertise. We don’t treat Canadians so that’s been part of the change, as well, for manufacturing standards. We’ve had Health Canada in. They’ve looked at our procedures, they’ve looked at our laboratory. For us, Health Canada’s the governing health body here, similar to the FDA in the States. We’ve been investigated and cleared of any deviations from acceptable procedures. We have a beautiful and wonderful lab. I am jealous of it. I worked for very long time in labs, and it is very, pretty clean and nice. I wish that’s where I worked previously.

I think that we’re working with governing health bodies, making sure we’re meeting all their requirements. And that’s all we can do. Unfortunately, none of those things have been picked up by the media, but everything else seems to continue to live there. We’ve reevaluated how much information we put out into the public. We didn’t put a lot out there, so we completely revamped our website. We’re more transparent about our donor screening and our screening that we do to blood and stool. We also have really put our time into providing education. What is FMT and why is it important? There’s not a lot out there and some of the research that is out there is really hard to digest. We’ve taken it upon ourselves to try to provide easily-accessible education so people can understand what FMT is, and what we know about it right now. How we’ve decided to tackle the negative attention we’ve gotten, is by evaluating what we were doing and why this could have happened. Our first thought was that while we’ve always been science driven, we weren’t being transparent enough about that. And then when it comes to manufacturing, we’re on the up and up. We’ve been evaluated by everyone that
matters for that and that’s all we can do.

Lindsey:

And I know Dr. Klopp’s credentials were threatened. Has that been resolved?

Shaina Cahill, PhD: 

We’re waiting for for the decision on that.

Lindsey:

He currently still has them.

Shaina Cahill, PhD: 

Yeah, so he’s still a naturopathic doctor.

Lindsey:

Just wanted to make sure. Okay, so I know you were tracking your results internally. Are you tracking them with regard to the particular donors, or just in general?

Shaina Cahill, PhD:

Yes, right now we, internally, we collect a number of measures from our patients. So before, during, and after FMT, to monitor changes what we’re looking at across, we look at stool. We also look at GI symptoms, and then we look at a number of measures specifically associated associated with ASD. We also have a new observational study with Biohm that we’re looking at. The first thing is looking at the gut microbiome of children with autism to get a better understanding of what are the markers and what’s different about their gut microbiome? The second part is, we understand that there is an importance to donor and recipient matching. I think, as the field grows, we’re seeing that more and more so in this study, we’re measuring our donors as well as measuring our patients, but then measuring what the interactions and what the changes are based on how similar or different those gut microbiomes are, and what the outcomes look like. So we’re in the process of collecting data to understand the donor-recipient relationship, as part of our efforts to increase the research and data that exists.

Lindsey:

Have you had positive results or negative results of certain donors that have led you to no longer retain them?

Shaina Cahill, PhD:

No, we haven’t had any donors that we’ve not used. To become a donor is so stringent, I think standards based on what’s been published, about 50 to 80% of people don’t pass the initial screening.  Our screenings are in even higher levels than that, because in a lot of cases, it’s like you haven’t had antibiotics in three to six months. We – just you’ve never had them. And we tend to go to the extremes for a lot of things to ensure that we’re not missing anything. So the number of donors you even get just past that initial screening  s so few and then on top of that their blood and stool is screened and then regularly screened. The likelihood that a donor has something that’s specifically not good is very low. And then we retain our donors as long as possible, because they’re really hard to replace.

Lindsey:

Right? Are they coming in every day? Basically dropping off their samples? And these are all in Canada, right?

Shaina Cahill, PhD: 

Yes. So you have to be close to our site. So we’re in Chilliwack, BC, so they would all be within easy driving distance.

Lindsey:

So let’s get to the kinds of success you’ve seen with FMT and ASD and other conditions.

Shaina Cahill, PhD: 

Yeah, so I’ll focus just on ASD because that’s where we have the most. I don’t like to make conclusions about small things. But we do we know that the process is like, we know that when children take antibiotics, we do see changes in their behaviors and, when you start FMT, there’s always a period of time where you see changes like increases in hyperactivity, increases in some behaviors. We see that basically, once we think that the gut microbiome has started to kind of engraft and become part of the system, you start to see improvements. It varies, but most of our patients say between between the first and the third month, they start to see consistent improvements. in the first couple of weeks, it’s just the change. I think, a mixture of wiping out the first gut microbiome and engrafting the next one, you see a lot of changes. Before you see consistent improvements, we see those going into that one to three month mark. GI symptoms seem to be consistently improved and that’s supported in the research. The ASD-related improvements do vary, but a lot of them are the improvements in eye contact. Improvements in speech seem to be something we see consistently and then consistency is in behaviors. A reduction in stimming behavior and a reduction in aggressive behavior seem to be ones that we see more consistently, but we’re in the process of collecting more consistent data over longer periods of time, so that we can start. Our goal is to publish it so that it’s readily available for people to see, so that we have consistent data points that are done regularly and done by validated measures. We were only originally using one validated measure. We’re now using three and we’re also looking at quality of life changes, which is something we want to have a consistent measure on. These are all things that we’ve added in the last six months, so we’re still collecting data. Because our process takes so long, we have a 16-week treatment period. We’re just now starting to get people through their end of FMT and their follow-up. So we’re a little bit further away from having conclusive statements, but from what we’ve seen previously, and what’s been reported from parents, results are consistent. People do see changes and improvements in their quality of life, but we want to have objective measures across the board, because everybody’s perception of these things is different. We want to make sure that it’s validated.

Lindsey:

How long does that take? And are you also recommending diet changes or supplements? In addition?

Shaina Cahill, PhD:

Yeah, so we do consultations with our physician’s assistant at the beginning, in the middle of FMT and at the end of FMT. That’s used to monitor what changes are happening, answer any questions, but as well as put in place any supplements or anything that should be added to help stabilize that gut microbiome and feed it. We also work with parents by trying to provide them with information around what things in the diet are important, and to make sure that they understand how what you eat feeds that gut microbiome. And so you have to diversify the gut by diversifying the diet and ensure that you’re feeding every aspect of this new bacterial body that’s there. We try to provide them with information and we’re consistently researching what the most important things in the diet are for the gut microbiome. We always suggest you should eat 50 different foods every week. We try to help parents get to that point. Kids with ASD often have a lot of issues with certain specific foods. So what creative ways are there to increase what they’re eating and what foods to focus on first. So that’s all stuff that we provide, as the process goes along and try our best to answer their questions. It ranges from like, “Is this pack of lettuce better than this, because it has more things,” to, “What types of smoothies are better,” to ensure that they have the most support we can give them. It is a huge shift, but the more you can do that, the better that gut microbiome will be. That’s the goal – to make a stable, healthy gut microbiome once it’s been transferred.

Lindsey:

And what supplements do you typically recommend?

Shaina Cahill, PhD:

I cannot tell you off the top of my head, mostly because it’s individualized. I’ve said that before, but it really is like each person, depending on what they were taking before they started. Some people come to us with a very short list. Some people have a very long list of stuff that their children are already taking. And some of those are like, “We have to take some of these off.” Some of them that we add on for other people. So it really depends on each child and where their starting point is and where they end up as they go through the process.

Lindsey:

And is there any case study that you could highlight or any individual child that you could talk about, just to just to get a an idea of what’s going on?

Shaina Cahill, PhD: 

We have done interviews and stuff with parents like what improvements they’ve seen, but it really is dependent on where the children started. We treat children that start as being categorized as mild, as well as being characterized as severe. Those journeys look completely different, because of what’s going to change and what the driving force was. A lot of parents consistently say that they’re able to go about each day easier. Some of the things we talk to parents about at the beginning of their journey, and the first things that start for them is being able to get their child to have their coat on and into the car has now been less of a battle. For some people that’s where it starts and it continues to go forward. Being able to have a conversation, for them to feel like their child understands them and to be able to integrate more easily. For a lot of parents too is that everyone can eat the same food at dinner. And so these are changes that happen throughout the process that make huge impacts for quality of life for both the child and the family. And those continue to go. So it’s not always specifically about different changes in their diet, or in specific ASD-related behaviors like stimming, or eye contact or aggression. It’s also about those changes all coming together to make life easier. And I think that’s what we hear parents talk about the most is just the changes in their day to day lifestyle, and how things have become easier. So I think outside of what you expect to see in changes in ASD-related behaviors and GI symptoms, it’s those changes in quality of life, as well, that a lot of parents talk about.

Lindsey:

And so if somebody is coming to you for something else, like IBD, or IBS, is it a much shorter protocol?

Shaina Cahill, PhD:

From what I understand it’s average is between two to three or two to four months, depending on the person, what their journey looks like and where they’re starting. Our process starts always with a call and you talk to someone on our team, and we get a better understanding of why you think FMT would be a good fit, what your current situation looks like, and  that starts the process of, “Is this a good fit for you or not?” And then you meet with a physician’s assistant to talk about what issues you’re having, what kind of reports you have, from your doctors to see where are we right now and where do we want to be? That determines the length of treatment, and how we approach your pre-treatment and your post-treatment as well.

Lindsey:

And roughly how much does this cost for ASD or for shorter conditions.

Shaina Cahill, PhD: 

So for our ASD protocol, which includes meeting with a physician’s assistant, meeting with a behavioral or clinician who does assessments, we use the CARS assessment, as well as the treatment, and treatment at our sites is $14,300 USD. And then that’s kind of our standard. If you’re coming to us with something else that would be dependent on the length of treatment, and if it would all be at home or if you would be coming to one of the sites as well.

Lindsey:

So it is possible to just do it at home?

Shaina Cahill, PhD: 

Depending on who you’re referred by. We have patients that come to us for C diff and so their gastroenterologist or  their doctor will send us a request form and then we can send out just an at-home treatment for them to do.

Lindsey:

Can you send out at-home treatments for people in the US?

Shaina Cahill, PhD: 

Yeah, so for C Diff, we have done that.

Lindsey:

But not for IBS or IBD?

Shaina Cahill, PhD:

That would be something that you would talk to the team about, because it would depend. For some people, having those loading doses will be a requirement. It would depend on where they are and what works and if at home is the best thing then we work with them and their doctors to ensure that we can get it to them at home.

Lindsey:

But they have to come in via one of your clinics in those various countries.

Shaina Cahill, PhD:

Or they can have their doctor submit a request form for treatment and we can send it directly to them. There’s some flexibility but it would have to come as a request from a physician. That’s the way that we can do it.

Lindsey:

Okay. Because I know that obviously, in the US right now, it’s only FDA approved for recurrent C Diff. I’m curious how that works. Just because if a physician requests it, does it somehow get around that rule?

Shaina Cahill, PhD:

I don’t know. So all of our stuff has been done for C. Diff. I think for all of our secondary patients, it would depend on on their case, and that stuff I don’t know about, because I don’t work directly with patients. I have a PhD, not an MD, so they keep me away from all of the people. But we know we do have cases where, we work with them to try to make sure that the process is something that can be handled, but I’m not sure how it works. And it may be country specific, because for each country, the rules for FMT are different. And we treat globally. So that’s why we always say,  talk to the team, they will figure out where you are, and what the rules are, and then how to kind of approach that.

Lindsey:

Like you might be able to refer them to a doctor in their area?

Shaina Cahill, PhD:

Yeah. And if they’re in a different country where FMT is regulated differently than it is in the US, then the procedure would be different, because it always depends on what the health authority there’s requesting and what the procedures are. So, we treat in the US, but we don’t treat all in Canada, but we have patients in Europe and South America, everywhere. So it’s dependent on where they’re located. I think the procedure depends, and that’s why I always say, the best thing to do is book a call and talk with us. And we can work through all of that, because there is a lot of legality and rules around where you’re located and how treatment can be done. So it’s hard to make a singular statement, I guess. Yeah.

Lindsey:

Is there anything else you would like to share before we finish up?

Shaina Cahill, PhD:

I think that if you have questions about FMT, or if you think FMT might be a good fit for you, book a call and ask questions, and see where it is, because it is something that’s growing, and we’re understanding more and more about it. But I think for every person, it’s going to be different. And our goal is to ensure that you’re informed, and that you have an understanding of what the possibilities are.  I think that’s always the best is to just do your own research. Look at our website, we have a YouTube channel where we make educational videos. You want to get a better understanding of what FMT actually is, or what the gut microbiome is, but then book a call and talk with someone on our team to get an understanding if it is a good fit for you.

Lindsey:

Is there a cost for that initial call?

Shaina Cahill, PhD: 

There’s no cost and you’re not tied into anything. We’re just as likely to say it’s not a good fit for you, because we want to make sure that anyone that’s coming to treatment with us is getting treatment that we think will work or will be a good fit. It may be that maybe it’s not a good fit for you now, or maybe we don’t think that it will be be helpful for the symptoms that you have, just as much as we want to answer your questions for you to be informed about making that decision. So we have that as an open ended so you can you don’t feel locked in, you don’t feel tied up with anything and then you can get an understanding of how it fits for you.

Lindsey:

Okay, awesome. Well, thank you so much for sharing about all this. I’m sure that there’s a lot of people who are curious about it and considering it.

If you’re struggling with dysbiosis, diarrhea, constipation, leaky gut, candida, IBS, IBD, or other gut health or all over body problems, you’re welcome to set up a free, 30-minute breakthrough session with me (Lindsey:). We’ll talk about what you’ve been going through and I’ll tell you about my 3- and 5- appointment health coaching programs in which I recommend lab tests, educate you on what the results mean and the protocols used by doctors to fix the problems revealed. Or if you’re ready to jump in right away or can just afford one appointment at a time, you can set up an 1-hour consultation with me.

Adapted from episode 87 of The Perfect Stool podcast and edited for readability with Dana Kay, Board-Certified Holistic Health and Nutrition Practitioner

Lindsey Parsons

So I know from the intro that you have a child with ADHD. So can I ask you about your personal story and what led you to the holistic approach to ADHD?

Dana Kay

Yeah, definitely. And I think, like most sort of alternative health practitioners, there’s always that story behind their motivation. And there’s no different for myself, believe it or not, I was actually an accountant in a previous life  I plan to continue in that field. If the concerns over my son’s health hadn’t grown, I always dreamt of being a businesswoman in an office and my dream came true. But then my son’s health started to deteriorate. And by the age of two, he’d have these meltdowns just like any other terrible to child but then they sort of didn’t go away, and they seem to get worse and worse, and you just would be at the playground, and you’d have so much energy compared to any other child. And I kind of sort of felt like I was on this emotional roller coaster. I’d be dealing with so much energy, and then we’d have this massive meltdown. And then for an hour, he’d be okay. And then we’d have this massive meltdown again, and it just, it wasn’t really what I imagined parenting to be like. And so I’d I’d asked friends, I talked to teachers in the preschool, and everyone’s like, “Oh, don’t worry, he’s just a boy, he’ll grow out of it.” And so I just kept going along with that. And things started to get worse at age three, age four, and sort of by the time of mid fours, late fours.

That’s when sort of the teachers or the preschool started to notice a bit of a difference. And we went to the pediatrician who referred us to a neuro developmental psychiatrist, and he was diagnosed with ADHD. And we were immediately handed prescription medication. And honestly, between you and me, I was relieved with the diagnosis similar to myself. I’m not a bad mom, this is not my parenting and this is not my fault. There’s actually something that is contributing to what’s going on in our family. And I was excited to fill the prescription medication, bounced into the drugstore, bounce back out, gave it to him. And that was the thinking to myself that that was finally the thing that was going to help us get help for our family. At first things were okay until they weren’t. And we started having these side effects and went back to the doctor and they increased the dose. Then they prescribed another medication to counteract the side effects of the first so he was losing weight, not able to sleep and didn’t want to eat. And then he’d have these mammoth mammoth meltdowns that were worse than before, in the afternoon when he was like coming off that medication. And so it was like, Yeah, okay, he was able to sit still at preschool. But when he got home, it was actually ended up worse than what it was before. And so this sort of continued until my son who was now five was on three very strong medications. And the doctor suggested a fourth medication to counteract the anxiety that had now come up from it. And that’s when I sort of said, doesn’t seem right. And I just couldn’t do it anymore. And this is where sort of my career path completely changed. And back to school, I did my holistic health degree, multiple specific certifications in this particular area. I really learned that medicine wasn’t the only way. I began to learn that ADHD symptoms can be reduced naturally and I learned how food can affect so many aspects of our lives as you have too, Lindsey, and in your story and what you share. Look, today, my son is in middle school. He’s a teenager. He’s thriving. He hasn’t been on meds for years and he’s a straight A student. But right now he does have a B, which is very upset about which but for me, I don’t care. Like the most important thing for me is he’s happy, my family’s happy and we now have that peace and that calm and that balance in our house that I knew that we could get to. Once I learned this, and once I saw the changes that all of this had, on my own family, I really couldn’t keep this information to myself. I didn’t want anyone else to have to go through the struggles and the challenges that I went through. I’ve been lucky enough to have helped over 1000 other families get to the same place as me but just so much quicker, and without as much stress.

Lindsey Parsons 

That’s wonderful. Yeah, So tell me about how diet impacts ADHD and kids.

Dana Kay 

Yeah, so look,  I like to think of diet as the foundation. When children are diagnosed with ADHD, the first course of action that most doctors suggest is medication and many of them don’t mention that altering the diet can significantly reduce ADHD symptoms. This is very much exactly what happened with my son and I started to learn about the effects of gut health – that’s why I love being on this podcast – gut health on ADHD symptoms and how when we heal the gut, ADHD symptoms are reduced or removed completely. That’s why I like not only… I’ll go into the details of why diet does help, but I think that it’s so important that food should be first. Food should come first. I’m not against medication, but it shouldn’t be the first cause of action, not when food can sometimes be even more effective with absolutely no side effects. So if children continue to eat these processed inflammatory foods, like gluten like dairy, and soy which I’ll go into why, those ADHD symptoms are not going to go away, because the foods they are eating are exacerbating the symptoms. So when we take these foods out, they’re so highly inflammatory. And I like to sort of think of it like a bucket, and everyone’s born with this metaphorical bucket. Our goal in life is to keep the load on that bucket low. Some of our kids might have bought been born with stuff in the bucket already.

My son was born given antibiotics straight away, was in the NICU, was on a CPAP machine, wasn’t breastfed there was a lot going on. And so his bucket already had stuff in it. Now, the goal in life is to keep that bucket low. And some of us are really good at emptying that bucket outside of our body because our detoxification pathways are optimized, whereas, others may have some genetic issues, gene mutations in certain areas and they cannot empty that bucket effectively, which happened to my son. And so what happens is, we put this load on the bucket inflammation, and inflammation can come from food, it can come from toxins, it can come from environmental toxins, it can come from medication – which came from my son, and this will load and load will rise up until it gets the bucket gets so full. And if you can’t effectively empty it out or tip over into our body, and our body will be riddled with inflammation. And that’s when symptoms come out. For kids, they might be born with that bucket that has stuff in it already and then they start eating these foods. Now when you’ve got a high bucket, and you start eating other highly inflammatory foods, that load is going to get up very, very quickly. So I get a lot of questions. “Well, why does say gluten, dairy and soy affect one kid but doesn’t affect the other kid, even if they’re in the same family, and I bring it back to that bucket?” Well, that kid’s bucket might be full already and that kid’s detoxification pathways may not be optimized. That’s sort of the way that I look at it. Now, gluten, dairy and soy are the top three inflammatory foods that I think of, and they’re the top three culprits that are driving inflammation in our body and, and these highly inflammatory substances can lead to an immune response. And they lead to increased intestinal permeability or leaky gut. I’m sure your listeners probably know a little bit about leaky gut, am I right?

Lindsey Parsons

Of course.

Dana Kay 

Yes, so they can lead to leaky gut and kids with ADHD are more likely to also have compromised immune systems. So the effects of these substances tend to have a whole greater effect on the body. Now in terms of why do they cause leaky gut, I won’t go into detail about all of them. But I think gluten is probably the number one food that I recommend that all children with ADHD cut out of their diets. Pretty much everyone should not be eating gluten, in my opinion, but we’re talking about kids with ADHD here. Now, gluten is so inflammatory, that even if someone doesn’t have an allergy, it does cause leaky gut. It’s harmful for everyone and that’s because it triggers intestinal permeability in everyone. That refers to sort of the breakdown of the intestinal walls. Now when functioning properly – I don’t know if you want me to go into detail on this if your listeners already know this – but intestinal permeability is the breakdown in the intestinal walls and it allows that water and nutrients to pass through but blocking other things from entering the bloodstream. When there’s that breakdown, it can lead to leaky gut, which basically means the tight junctions in the gut, that are supposed to control what passes through the lining of the intestines. They’re not doing their job very effectively. So they’re allowing toxins and other harmful substances to get through into the bloodstream. When toxic substances get into the bloodstream, the body fights them off and tries to get rid of them, so when something enters the bloodstream that’s not meant to be there, it triggers that inflammatory response as the body seeks to rectify it. Gluten leads to increased intestinal permeability, which leads to leaky gut, which leads to inflammation, which leads to a load on that bucket. And when that bucket is high, it it leads to the symptoms like stomach aches, constipation, brain fog (which is like inattention), hyperactivity, reflux, anger issues, nose or wheezing. I could go on and on,  but a lot of those symptoms correlate with ADHD. By cutting out gluten, parents of children with ADHD are removing one food that significantly contributes to inflammation in their body and the load on that bucket. In my experience, if we remove that, along with those other highly inflammatory foods like dairy and soy, and feed the body with the right things, then ADHD symptoms diminished significantly, and sometimes disappear completely, because they allow the gut to repair. Does that explain it okay?

Lindsey Parsons 

that’s awesome. Yeah, absolutely. So I, as a parent felt at one point that my son was likely gluten intolerant when he was in his middle school years, and I tried to get him to go gluten free. And I only got him to agree to about a two week trial of this. So that was it. I mean, it was just a losing battle, because even if he was, say, restricting it, the best I could get him to agree to was say, you still eat it once a week. And I’m thinking, well, that’s kind of meaningless in the end. So I’m curious whether you had better success. And obviously, your child was younger at the point at which you started doing this. But how in the world do you get these other families to do it?

Dana Kay 

Yeah, look, it is a lot. And that’s why I’ve sort of designed my program, the way that that I have. My son was a lot younger – the younger, the better – because they grow up with it and that’s what they know. With the older kids, it’s a lot harder, and you do need to get a little bit more buy in. But the way that you do it with the older kid is really getting them to understand the feelings in their body and how that affects their body and if they are having that gluten intolerance, and they’re experiencing symptoms, when they stop the gluten, they can actually feel the changes in their body. That’s where you jump on it to try and get that buy in. And so when they do eat something, they would experience the symptoms coming back. I can tell you that I’ve seen it time and time again and so it is really important that you’re constantly having those conversations with the older kids. There are so many challenges that can come up with it. What I tell with families is that it’s not an overnight change. I tried to change everything on day one, I literally took out gluten, dairy, soy, artificial flavors, artificial colors, salty food and sensitivities that were in his food sensitivity panel on day one. Let’s just say I had multiple panic attacks on the floor of my bedroom. That is not what I teach in my program. I always tell families that Rome wasn’t built in a day, transforming their family’s diet won’t be completed in a day either and so it’s okay to take it slowly. When you’ve got an older child, that’s important, because you need to take them along in the journey with you. If you just throw it on them, they’re going to rebound. So it’s okay to take one step at a time. And if that pace that’s doable for you and your life is one change a week or one change every two weeks, then that is okay. Families really need to give themselves permission to take things slow, because it’s not a diet. It’s not a phase. It really is a permanent lifestyle change, but when it becomes part of your lifestyle, it’s second nature. You don’t even think about it anymore. So very much, I think that having support when doing it with a family is key to this. Trying to do it alone is so hard. Take my word for that one. I did it by myself and it was so extremely hard. And so we my program, we’re literally there every single day with families holding their hand step by step, telling them exactly laying out that blueprint for them on what they need to do next. So they don’t need to think about it. When that challenge does come up, which it will, we can help them overcome it because that is our powerhouse. That is what we know best. Having helped over 1000 families, we know what works, we know what doesn’t work. And we know if there is a challenge most likely we’ve dealt with it before.

Lindsey Parsons 

Yeah, so obviously it helps if you have buy in from both parents. I’m curious whether your husband bought into the entire idea of changing the diet because my husband wasn’t bought in at all. Yeah

Dana Kay 

I love this question. No, he wasn’t bought in – probably still not 100% body and either, but you know this wow, this is that’s just the way it is. We’ve seen so many changes but he’s a man of science, as most men are, and also stubborn and I love him. He’s upstairs and I always throw him under the bus. The positives outweigh the negatives. I’ve run into many non believers in my time and I will tell you like it was the science that first made me rethink the direction we were traveling with my son. And same for him. And the fact that we obviously had significant side effects from the medication. But there are so many studies out there to support this. And I think that, really, when you’re trying to convince the unconvinced, you’ve got to hit them with science. I’ve got so many studies out there that just really, really drive at home, that diet is so important. Look, it’s not just about diet. I don’t just teach diet, but it’s diet. It’s detox. It’s lifestyle. It’s reducing toxins. It’s all of that. But I mean, I could list off studies and studies. I don’t know if you want me to but I could I could list off some studies and I think that you hit the unconvinced with the studies. And sometimes mums just need to take it into their own hands. And honestly, that’s what I did at first. I said, Look, this is what I’m doing. Too bad. Come on the journey, or you don’t. I just went forward and did it Aand they they start to come on board when they actually see the changes – and the changes are amazing. And mean the first change that you see with reducing that inflammation in the body, is a reduction in tantrums, a reduction in meltdowns, a reduction in anger, the severity, the length of time, the frequency all reduced. For my son, it was literally within two to three weeks of changing the diet. And honestly, the emotional dysregulation is the hardest thing for a family to deal with, because it’s so loud.

Lindsey Parsons 

Absolutely,

Dana Kay 

It puts a family on hold basically. It’s that roller coaster of emotion. So it’s actually really nice to see that that’s one of the first changes that happen.

Lindsey Parsons 

Absolutely. So, obviously, taking out the bad stuff is necessary, but what about what kids with ADHD did eat more of?

Dana Kay 

Yeah, look, it’s really like the same thing for anyone else. It’s really about not what just to take out. It’s also what to put back in the diet because I always say to people, “Gluten and dairy free is not necessarily healthy.” If you’re gonna replace packaged goods with packaged goods, you’re not gonna get to where you go and sometimes gluten free can actually be worse than the non gluten free. As far as what to weight, my best tip is to focus on whole nutritious, fresh fruits and veggies, grass fed animal proteins, such as meat, poultry, seafood, eggs and also plenty of healthy fats like avocado, coconut and olive oil –  really avoiding those refined oils. You also want to be drinking plenty of spring water. I mean, the numbers of families that come to me whose kids, the only thing they drink is juice, soda and milk, they you take the juice away, you take the milk away and the soda away and there are different kid and you don’t even need to make the dietary changes, but you do for their health. By drinking plenty of spring water to avoid harmful chemicals that are in some waters, but also, obviously water helps detox the body and remove the toxins that are already there. I find that all of these foods really provide us with the nutrients we needs so we can function at our best along with our kids. When buying ingredients, my rule of thumb is (ingredients in terms of like a package food), “If there isn’t something that you can’t pronounce, put it back,.” If you don’t know what it is your body is not going to know what it is. Try to stick with an ingredient list that’s less than five or six on there. The more ingredients, the more worry that there’s going to be those other things in there as well.

Lindsey Parsons 

Right. So you mentioned detoxification a couple times. I’m curious, are you testing kids in your practice? With with what kinds of tests might you use to check the detoxification? Yeah,

Dana Kay 

Look, I think functional lab testing definitely plays a role. I would like to say that about 50% of the families I work with, we just do sort of the diet lifestyle, like detoxification, and reducing toxic exposure and they get to where they need to go without doing lab testing, which is amazing. What that tells me is probably 50% of the kids that are diagnosed with ADHD are not in fact, having ADHD. It’s probably a byproduct of what’s going on in their body. You apply that to the 6 million children in the US today that have been diagnosed with ADHD. That’s probably 3 million children that have been wrongly diagnosed, but the other 50%. Yes, it helps dramatically, but there’s something deeper going on in their body that we need to check out. And we use functional lab testing to identify those HIDDEN stressors. There are four basic tests that I suggest to families. There are many more and I have access to many more but I find these four a really great starting point. Now, the first test is a stool test. It gives us a really clear picture of the state of the gut and things like parasites.

Lindsey Parsons 

Which one do you use?

Dana Kay 

I currently use biomeFX from microbiome labs, I have used a number of different ones over the time, but I do actually like to look at the most real up to date technology. PCR testing is one that is getting out of date now and so this is using a DNA sample of each of the bacteria or the parasites so it’s much more accurate in that way. So we’re looking for what’s going on in the gut. We’re also looking for inflammation and leaky gut and digestive enzymes – things like that. The next one we use is a food sensitivity test and not just a standard one that you can buy online. They’re not all created equal. I use a lab called vibrant wellness, and we do their food Zoomers. And so I’ve had people that have got an IgG food sensitivity test from online, and just say for example, eggs come up negative – because what that is doing is just testing the food at the top protein level. But with the food Zoomers, what they actually do is they check the food down to the peptide level of the protein. So for example, egg has something like 18 different peptides in it. So what the Zoomer is doing, is actually checking all of those 18. So I’ve had times where it’s come up negative on a food sensitivity paddle, but we do an egg Zuma this so highly reactive at the peptide level, just not at the top protein level. And so a lot of the time we won’t be successful if we didn’t remove egg. Now, food sensitivities, are not true allergies, but they do cause inflammation in the body that would a load on that bulkhead. So you can actually heal from the sensitivities. Once you heal the gut, you can start to add them back in.

Lindsey Parsons 

Do you make sure they’re off of the gluten dairy and soy before you run the food Zoomer just so that the level of leaky gut is essentially reduced prior to checking for other sensitivities?

Dana Kay 

No, I don’t and that’s because we’re doing it sort of side by side. Obviously families just start with our phase one. If they start with our phase one, then gluten, dairy and soy will be removed for six months. If they go to phase two, which is testing, then they will do it that way. Some families – when we talk about their health history, they’ve got very traumatic health history, and we know that we just need to get to it. Now I will tell you, I have had families that have come to me three years of being gluten, dairy and soy. And we do a wheat Zoomer on them. And they are so reactant to gluten, it’s not funny. They’ve been eating gluten and are probably not aware of it.

Lindsey Parsons 

I’m just curious though, whether they’re coming up with pretty much every food that the the child is eating on the food Zoomer, such that, they’re left with nothing to eat.

Dana Kay 

Yeah, look, a lot of the some of the time they do. But what we’re there because we’re there every single day holding their hand, we’ve got five weekly group coaching calls, there are so many foods out there that they can eat. We’re really guiding them through that process and if we just get so many, we prioritize – we just take the biggest hitters, and we leave the rest. We use a rotation diet on the rest. And so really, with a kid, we sort of feel where they are. We feel where the family is, we don’t want to overwhelm the family too much. Some come back with only like five sensitivities, others coming back, like my son, had 40. I actually did every single one, obviously, that’s the best, but at the same time, we need to make sure they’re getting the nutrients and everything to grow. So it is about “Let’s work out what’s best for this child based on the knowledge that we have.” So the third test that we do is an organic acid test, which I love.

Lindsey Parsons 

Great Plains?

Dana Kay 

Yeah, I loves Great Plains, but at the same time, it’s really keeping an eye on the different technologies that are out there, which one is the most up to date and which one is going to give us that best result at that time. I’m always open to making sure that I am currently using the best. Now, I love Great Plains. This organic acid test really gives us an overview of the whole body and how its functioning the need for specific nutrients, such as B vitamins, which are super important for our compromised kids – further diet modifications, so things like oxalates and salicylates, which again can be an issue for our kids. At the same time, there are many practitioners out there that will say, “Go on a low oxalate diet. Go on a low salicylate diet,” but I focus on is, why they are high. When you’ve got high oxalate, it’s usually because of mold or candida that is producing those elevated levels of oxalates. So some fruit for kids, a lot of the time in the first round, I don’t tell them to go on a low oxalate diet, because when we fix the gut, it actually comes back down into normal ranges. It’s also looking for detoxification and that’s where by looking at that, and seeing that they detoxifying properly. It’s looking at neurotransmitters, so your serotonin and your dopamine, yeast, mold, clostridia, C diff, mitochondrial function – lots of markers, there’s over 70. That’s why I love that one so much.

Lindsey Parsons 

Yeah, I love that test too.

Dana Kay 

And then the final test, which not many people know about, because it’s really specific to mood and behavior, and it’s called a cryptopyrol test. Pyrols are a normal chemical byproduct in the body. They attach to vitamin B six and zinc and draw these elements out of the body when they’re excreted through the urine. So, if a kid has elevated urine cryptopyrol levels, it can result in a dramatic deficiency of zinc and B six, and those are two critical nutrients needed for mental health. But pyroluria, which is what they call it is frequently identified in behavior disorders, ADHD, depression, aggression, violent behavior, and the symptoms are like, one for one with ADHD symptoms, or tolerance to physical emotional stress, or anger control, mood swings, poor short term memory, sensitivity to light/sound and tactile sensitivities. Another one is poor dream recall, or inability to tan. You don’t have to have all of them. You could have one or two. You could have all of the symptoms or you can have half of the symptoms. That really doesn’t matter, but I see that in probably about 50 to 60% of the kids that I test. And really, it’s about bringing in some key nutrients. The pyrols is part genetics, part oxidative stress, so a breakdown in the cells. And when there’s high inflammation, that’s when you get oxidative stress. So we reduce that oxidative stress, we reduce that inflammation. But some kids actually need a lifelong management of the Zinc and B six if there is a strong genetic component to it.

Lindsey Parsons 

Yeah, so I’m curious how high do you typically have to supplement thing can be six, if they have pyroluria

Dana Kay 

It’s based on weight. We do a metabolic weight factor and look at the weight of the child. We also bring in some key antioxidants to reduce that oxidative stress. So like vitamin C, vitamin E, selenium, I’ve actually created my own payroll supplement, because when you add in sync B six in two different forms, C, E, selenium, I actually added magnesium to it as well. You’re cutting down on sick five different supplements, and I bought it all into one, and then I adjust the dosages based on weight.

Lindsey Parsons 

Oh, okay. So like, once they hit adulthood, how many pills a day? Is it of your supplement? I’m curious.

Dana Kay 

With 100 pounds, like I only sort of go up to 100 pounds in mind. So with that, it’s probably five in the morning, five at night.

Lindsey Parsons

Okay, so that’s it another small number. With magnesium in there. I knew it had to be high, because that alone takes a lot of space. Exactly.

Dana Kay 

Exactly. Yeah. But with kids, it’s only like it’s either two in the morning to a night or three in the morning, three at night based on that weight.

Lindsey Parsons 

Of the chewable?

Dana Kay 

No, we’ve got we’ve got a powder and we also have captures up into juice, or else. Yep.

Lindsey Parsons 

Got it. So did I say I would love to have some of those studies just to link in the show notes?

Dana Kay 

Okay, sure. I can definitely dothat for you.

Lindsey Parsons 

Yeah. So obviously, since this is a show about gut health, I want to be sure we talk about the gut brain connections. So how does this apply in the ADHD world and we talked a little bit about the leaky gut. I also know that a good portion of kids with autism tend to have gut issues. Is this true for ADHD as well? Do you see a lot of gut infections?

Dana Kay 

Definitely, definitely do. And as I said, like, we change the diet. For some kids, we open up detoxification pathways, and we reduce that inflammation and their gut starts to heal on its own. And so I think that the reason why the gut is so important to this, I just want to bring it back to a couple of statistics. We know that all of these disorders and illnesses are on the rise. Everyone’s like, “Well, why is there this epidemic?” It’s actually estimated that 54% of American children have been diagnosed with a chronic illness in 2018. That figure was only 15% A couple of years ago, and I look at that increase and I’m like, “Oh my gosh, this is just awful.” One in two have anxiety, asthma, diabetes, epilepsy, cystic fibrosis, learning disabilities. One in five have allergies. One in six out developmental delays, and one in I think it’s 42 now, have autism. The reason in my opinion, the rise is happening happening so rapidly is it all begins in the gut. And that’s because 80% of the body’s entire immune system is within the gut walls, along with billions of nerve cells and extensive amount of gut bacteria. So all of our children’s health is quite literally connected to everything that occurs in the gut. And obviously, all of ours as well. It’s not just our children. The amount of families that I’ve spoken to, we always ask them, “Have you been on antibiotics when you were younger,” and a huge percentage have. I actually wish I’d kept a tally, which I haven’t. But as you probably know, and as the listeners probably know, most antibiotics work by killing bacteria or preventing it from growing. But unfortunately, most antibiotics can’t distinguish between good and bad bacteria. That means that they wreak havoc on the gut’s, healthy bacteria. And actually, many people suffer lasting changes to their gut flora as a result of taking antibiotics. So a huge percentage of these kids have been taking multiple rounds of antibiotics. That in turn is compromising the gut and when the caught the gut is compromised, because 80% of the body’s entire immune system is in there, it’s not a huge surprise to see that these disorders and illnesses on the rise. Now, to tied gut health to brain health and ADHD – that’s really the gut brain connection and that means that our brains are deeply connected to our guts. If our guts aren’t functioning well, our brains won’t be able to function well either. Now, the main area involved in gut function is the frontal lobe and that’s the area of the brain that talks to the gut via two way chemical messengers and nerve branches. The frontal lobe is involved in things like attention, focus, executive function, planning, organizing and problem solving, which are often issues that kids with ADHD struggle with. Because the frontal lobe is in the brain, many people are under the impression it’s the brain that needs care, when in reality, it’s actually also the gut that’s causing the problem. I think the biggest thing for me, and this is why we see such a dramatic change with kids when we just change the diet, 95% of the body’s serotonin and 50% of the body’s dopamine is produced in the gut. These neurotransmitters or hormones are the ones that help us manage emotions. They balance mood. They help our cognitive function and emotional dysregulation is a common symptom of ADHD. But many parents don’t realize that this emotional dysregulation actually starts in the gut where the serotonin and the dopamine are made. So the problem is not the emotions themselves, but the fact that the correct amount of these vital neurotransmitters are not being made in the first place. So by working to improve gut health, many parents of children with ADHD find that the emotional disregulation problem solved themselves. The frontal lobe starts to get optimize. A lot of those symptoms can be helped with with healing that gut.

Lindsey Parsons

Awesome. So beyond the food question, are there supplements that are evidence based for supporting kids with ADHD or adults for that matter?

Dana Kay 

Definitely. I do like to preface this to say that one thing to keep in mind with supplementation is that everybody is a bio individual meaning that every child is unique. So what works really well for one child, might show little effect for another. But that being said, there are a number that like there are there are four supplements that I love for ADHD in particular – the most studied – and one is a good quality fish oil that has Omega three and Omega six fatty acids. It’s really important to get them in the right balance. It’s really important to get a quality one and not a gummy that has sugar on it. There are a lot of studies out there that support the Omega three and Omega six fatty acids can support things like memory, hyperactivity, clear thinking, behavioral disorders and organization skills in children. The next thing is a good quality probiotic. There’s a lot of research we know that that taking a probiotic that contains either certain types of gut bacteria or spore forming probiotics can really help with boosting that gut brain connection helps supporting detoxification, it helps with anxiety and mood and also support the body against the damaging mental and physical effects of stress. Probiotics are not created equal, so really ensuring that you have a good quality probiotic is is important.

Lindsey Parsons 

So what are the ones that you like?

Dana Kay 

I like megaspore biotic*, which is a small forming probiotic. I’m not sure if you’ve discussed this on the podcast before. The reason why I like it so much is it’s kind of like springtime, where you want to make sure your grass starts growing and you put down seeds. So you’re reseeding the grass so it can grow, and the plants can grow and they can prosper. And so this is kind of like what that probiotic does it. It seeds, the the gut and lets the good bacteria grow in what that needs for that person, whereas, a lot of the strain based ones don’t survive digestion. So they go in,  they go into your stomach and they go out, and you’ve just got a lot of expensive poop. That’s why I do prefer the spore forming ones. I’m actually in the process of creating my own custom blend that has those spore forming probiotics. It will also have saffron which is supported in helping brain health as well. And it’s also going to have a couple of other strains of probiotics that help with calmness and mood as well. So I’m in the process of doing that right now.

The next one that I love is magnesium and magnesium is great for everyone. There are so many studies out there. Magnesium is needed for over 300 biochemical processes in the body. There are many different types, but parents find that it makes a surprising difference in their kids anxiety or depression, aids in sleep and also helps hyperactivity. Research suggests that children with ADHD and anxiety often have low magnesium levels, so using supplements can have a calming effect on behavior, insomnia, agitation, muscle cramps and things like that. It can help so many different things. There’s two forms that I like. One is glycinate, which helps with that calming. The other one is the three and eight, which crosses the blood brain barrier, which helps with the brain. So that helps with ADHD, for sure. The final one, which everyone should be taking, is vitamin D.  find that it works wonders are with children with ADHD and anxiety, especially when taken with omega three fatty acids. We all know that the best way to get vitamin D is to get outside, But when you live in Seattle like I do, there’s not a lot of sunshine, except for maybe five weeks of the year. My kids and I are on a vitamin D and K to supplement like most of the year except for maybe four or five weeks of the year. It’s definitely beneficial for most people.

Lindsey Parsons 

Yeah, of course. So, are there other common underlying stressors that you see in kids with ADHD – beyond the diet question?

Dana Kay 

Yeah, look, there, there are a number of things that exacerbate ADHD and we really are focusing on reducing that inflammation, those four base tests will give us a high level view. Other things that can contribute to it are things like nutritional deficiencies, and making sure that they’ve got the right balances of those nutrients. Other things like minerals and heavy metals is a big one as well. We find copper overload quite consistently in kids with ADHD, if you actually Google, copper overload and ADHD, there’s actually there’s a lot of information out there about that. The problem with it, though, is we need to be very careful of copper dumping. You’ve just got to really do it slowly, especially with with kids. Food intolerances – that’s obviously another one. Heavy metals, environmental toxins, dysfunctions in body systems and even cultural or lifestyle factors can contribute to it. Hormone imbalance, inflammation, leaky gut, pharmaceutical medications create underlying issues as well, because they can contribute to the toxic load on that bucket. There are a number of common underlying stresses that can contribute to symptoms and really, the way that I look at this journey is we are trying to reduce inflammation as much as possible to allow healing to occur. And we do that in multiple ways. We do that with diet. We do that with detox. We do that with food, which I’ve just discussed, lifestyle changes, reducing toxin exposure, reducing heavy metal exposure, reducing the infections in the gut and optimizing the gut brain connection.

Lindsey Parsons 

Awesome. So tell me about your new book and where listeners can find it.

Dana Kay 

Yeah, it was a labor of love. It is called thriving with ADHD, which is a guide to naturally reducing ADHD symptoms in your child. Years ago, when I was going through with this with my son, I wanted a book, a program a call or whatever, on ADHD that would clearly spell out exactly what I needed to do to support him with ADHD naturally, but I couldn’t ever find it. I was constantly googling for something, anything that might actually help us get some relief from my son’s challenging behaviors. And when I was looking for that book years ago, I just struck out over and over again and there was just nothing out there. There was a novelist named Toni Morrison and he once said that if you find a book you really want to read, but it hasn’t been written yet, then you must write it. And that’s what I did. And I still can’t hardly believe it actually. It’s an international bestseller in multiple categories, including children’s health, which just blew me away and it’s my life’s work. It’s the guide I needed when I started this journey with my son, but couldn’t find. It’s different from other books out there, because I’m not only a practitioner, but I’m also a mom who gets it 1,000%.I just, I just want families out there honestly, at the end of the day, yes, I’ve got a business. Yes, I do this for a living. But my goal will my passion to get this word out there to found there are so many families out there struggling. They do not need to struggle, and I’m not going to be able to work with everyone. Hopefully, this book makes it more accessible to other people out there. One day my dream and my vision is for the doctor, instead of handing a prescription medication when the child’s first diagnosis, they have this book. They say, “Go and implement all of this and if you still got issues, come back to me and we’ll talk about something different.”

Lindsey Parsons 

It’s a great dream, but I’m not picturing it

Dana Kay 

I know, it is a great dream, but I’ll do whatever I can to just get this message out there to as many people as possible, because parents do not need to suffer. Listeners can find more about my book at ADHDthrive institute.com/book. It’s available on Amazon.

Lindsey Parsons 

Yeah. Okay. And where can they find your program? Same place?

Dana Kay 

ADHDThriveinstitute.com. I’m also on Instagram, Facebook, and other social platforms @ ADHDThriveInstitute.

Lindsey Parsons 

Okay, great. Well, I will include all those links in the show notes, and any parting thoughts for everyone?

Dana Kay 

All I want to say is that we’ve probably got some parents listening who are like, “Oh, my gosh, that sounds amazing, but it sounds so overwhelming.” I’m just going to take them back to the fact that Rome wasn’t built in a day. You do not need to make all of these changes on day one. Get support when you need it. I’m very much how about I’m not an expert in everything. I will pay for experts time and advice in the area that I need specifically when it comes to my business or even my even in my personal life. All I wanted back in the day was a program like mine, and it wasn’t out there. It is possible to reduce ADHD symptoms naturally. If you’re on this vicious cycle of trial and error of medication or trial and error of anything, and you just can’t get off that roller coaster, then there are things that can help. Don’t lose hope. I’ve seen it with over 1000 families. I’ve seen it with my own family. There are solutions out there that can help.

Lindsey Parsons 

Wonderful. Yeah, that is that is my theory for everything. I might be exaggerating, but you could certainly make a good dent into almost any kind of chronic health problem through functional holistic medicine. So diet changes and such. Okay, well thank you so much for sharing all this information with us and it was great talking to you.

Dana Kay 

Thanks, Lindsay. It’s been fun

If you’re struggling with dysbiosis, diarrhea, constipation, leaky gut, candida, IBS, IBD, or other gut health or all over body problems, you’re welcome to set up a free, 30-minute breakthrough session with me (Lindsey). We’ll talk about what you’ve been going through and I’ll tell you about my 3- and 5- appointment health coaching programs in which I recommend lab tests, educate you on what the results mean and the protocols used by doctors to fix the problems revealed. Or if you’re ready to jump in right away or can just afford one appointment at a time, you can set up an 1-hour consultation with me.

Adapted from episode 86 of The Perfect Stool podcast and edited for readability with Stasha Gominak, MD,  neurologist and sleep coach.

Lindsey: 

I wanted to start by just summarizing what we went over in the last podcast. People should definitely go back and listen to it, but nevertheless, here’s a brief synopsis. Correct me if I have anything wrong on this, but basically, you as a neurologist were seeing patients who had problems with sleep, and you determined that it might be a deficiency of vitamin D. You started supplementing people with vitamin D and got them to that optimal range of 60 to 80, at which point their sleep seemed to improve and everything seemed to be going well. Some amount of time later, people started developing other symptoms like burning in their hands and feet, the sleep started going bad again, or they had arthritic like pain. Based on a book that you had read about B5 or pantothenic acid, you determined that must be a deficiency.

You figured out that there was a synergistic relationship between vitamin D as a growth factor and the B vitamins, because the bacteria are taking in the vitamin D and they’re producing the B vitamins. They then exchange the B vitamins amongst themselves between the different phyla of bacteria that are the primary residents of our guts. You then start trying to put people on just a B complex, a B100 complex*. And you saw people’s symptoms go away (with all the ones that had come back), and even saw some patients who had IBS symptoms clear up as their phyla became more balanced. You also saw that for some people, the B100 Complex (where it was 100 milligrams of most of the B vitamins) was too much. You dropped to B50* for some people, but would just keep them on the B complex for a limited period of time, (around three months), unless problems started developing again. Does that sound about right?

Stasha Gominak, MD: 

It is and can I go from there?

Lindsey: 

Please.

Stasha Gominak, MD: 

None of these things individually make any sense. Keep in mind, I’m operating in the same belief system, as most people. We aren’t doing well because we eat wrong, we live in a toxic environment, we have IBS or food sensitivities because we have the wrong microbiome. I’m operating in that same belief system. After I start to give vitamin D, their sleep gets better. I presume that vitamin D is a growth factor to the bacteria. We had no proof of that at the time. The reason why I presume that is because IBS showed up at the same time as D-related diseases of multiple kinds, including sleep disorders in the early 80s. My thought was, “D goes low, the bacteria need D. And oh I’m going to be a hero because I’m going to give back this D and everybody’s going to lose their IBS, as well as lose their sleep disorder.” That’s not what happened.

At the end of two years, there were three things that didn’t get better with D that I thought should. One, my patients did not lose weight. They were exercising, they were energetic, they were feeling better, because they were sleeping better, but they didn’t lose weight. It turns out that’s linked directly to what’s living in your belly. The second thing was their IBS didn’t go away. So even though I thought it would go away, it didn’t go away. The thing was, golly, it wore off. The third thing that happened was this effect of improved sleep wore off at two years. So many people were complaining, “My sleep is bad, and my D is 65. I’m doing exactly what you told me, but my sleep is terrible and my joints are hurting me.” I’m about to see the rheumatologist and, personally, I’m doing exactly the same thing as my patients. I had this really weird buttock pain where I couldn’t sit down at the end of the day. It didn’t have anything to do with injury. In the build-up to this, I built in my mind this idea that sleep is about becoming perfectly paralyzed for this part.

So we’ve talked about sleep apnea, and that we can get too paralyzed here, but if you’re not paralyzed enough, your legs may still be moving.  I wondered whether or not the leg movements that we see on sleep studies contribute to poor healing in certain joints. I was assuming that maybe my hamstrings are activated while I’m asleep. I’m in a fetal position and I’m holding on my butt bones. I’m making this up because I don’t really know why. So I have this urgency of thinking I’m doing something to my patients with this D that has other repercussions that I don’t understand. That makes me really uncomfortable. In two years I’m giving D, I’m left with this suspicion that something else has gone deficient, or there’s some long effect of D. It doesn’t make any sense to me that D should be causing this in two years. It’s at that point that a patient brings me a book about a B vitamin deficiency and it was well timed because I’d had two gals who had burning in their hands and feet. And the only thing they had was a headache. They didn’t have diabetes. They were already on B12. My experience in neuropathy as my specialty told me that this has a B vitamin ring to it. I read this book about pantothenic acid, and research publications from the 50s. They block pantothenic acid, a vitamin that nobody’s talking about and they caused burning in the hands and feet within two weeks. There was a scientific basis. I’m thinking, “Okay, I don’t have a good explanation for why this would happen. Why don’t I just give them this pantothenic acid.” I went to the store and I bought 400 milligrams.  But at the same time, I remember them saying in medical school, “If you give one B, you should give all of them.” I have no understanding of why.

I’m completely a novice, I am not an expert like you are Lindsey. I go and I grab this B100 stuff*, because I can at least guarantee that each person I give the recommendation to will be taking the same thing. B complex is very confusing. It can have 3Bs, 2Bs or 1Bs. You never know what’s in there. I wanted to be sure I was recommending the same thing and B100 is a non-proprietary mix of 100 milligrams of each. It’s a large dose of eight B vitamins. That piece is really important. I take it myself and I give other people 400 milligrams of pantothenic acid and B100. That means I’m taking a total of 500 milligrams of pantothenic acid. It did not interrupt my sleep, but my restless legs went berserk. Immediately, I think, “Oh, it’s taken me four days to realize this. This is probably too big a dose.” Just like that vitamin D stuff, you can’t believe what’s in the literature. I stopped the 400 milligrams of pantothenic acid and I just took the B100. Everything went away. My butt pain went away in a day, which was very bizarre. I know nothing about vitamins, but I know that they’re not supposed to help your pain and make your sleep good, especially overnight. Now all my patients are coming back and they consistently answer in the negative, which is, “This 400 milligrams of pantothenic acid nearly killed me.” “I got very anxious or revved up,” or “I couldn’t settle down.” They’re using the same phrasing. I stopped it after two days because I couldn’t sleep. This is like the ADD medicines. This is a vitamin that goes right up into the brain and makes you agitated. Some people say, “I stopped the 400 milligrams, and I just took this B100.”

The surprising part of this was that there was a vitamin that was actually running our ability to pay attention, our ability to sleep and our feeling of anxiety and agitation. That vitamin given in certain doses would actually cause those symptoms. It was not obvious to me what was actually happening, but it turns out the final answer is that vitamin D makes the final enzyme choline acetyltransferase, which makes acetylcholine. Coenzyme A and choline are used by that enzyme. The actual formation of acetylcholine is dependent on both D and B5. Choline is usually not deficient in most people. Making acetylcholine is how we stay focused. Not surprisingly, the epidemic of ADHD started to be reported in the 1980s. Your ability to focus using the frontal lobe is directly related to how much acetylcholine you have in the frontal lobe. When it goes up too high, you can actually become anxious from it, so anxiety is a direct measure of how much acetylcholine you have. We use acetylcholine to run the parasympathetic side of the autonomic nervous system which allows us to rest and digest. This means that side is all about GI tract motility, and is about calmness during the day and sleeping at night.

It turns out that you can become B5 deficient by losing your microbiome because the actual truth is that there is no B5 in any of the foods we eat. It does not come from the food. Its only source is the bacteria in our gut. If that means if you happen to be D low or deficient, and you don’t have the right gut bacteria, you can actually lose one of the most important parts of your body – an organ that runs many of the neurotransmitters that allow us to sleep. The bringing back of the microbiome was really by accident. I gave the D that the microbiome wanted, but the correct four pieces of the microbiome weren’t still down there. They were missing the B vitamins that they needed from their buddies. When I happened to give them B100, as I was thinking about what I was doing, I thought, “If I’m right that these B’s are really coming from the bacteria themselves, I just saw what it was like to have too much pantothenic acid.” If we take this too long and the bugs grow back, pretty soon, you’re going to have two sources. You’re going to have the pill you’re taking, and your normal microbiome. Your sleep is going to fall apart and your pain is going to come back.

It turns out, if you take the B50 plus D, for three months, your bacteria come back, and you stop the pantothenic acid. It did not interrupt my sleep, but my restless legs went berserk. Immediately, I think, “Oh, it’s taken me four days to realize this. This is probably too big a dose.” Just like that vitamin D stuff, you can’t believe what’s in the literature. I stopped the 400 milligrams of Panasonic acid and I just took the B 100. Everything went away. My blood pain went away in a day, which was very bizarre. I know nothing about vitamins, but I know that they’re not supposed to help your pain and make your sleep good, especially overnight. Now all my patients are coming back and they consistently answer in the negative, which is, “This 400 milligrams of pantothenic acid nearly killed me.” “I got very anxious or revved up,” or “I couldn’t settle down.” They’re using the same phrasing. I stopped it after two days because I couldn’t sleep. This is like the ADD medicines. This is a vitamin that goes right up into the brain and makes you agitated. Some people say, “I stopped the 400 milligrams, and I just took this B100.”

The surprising part of this was that there was a vitamin that was actually running our ability to pay attention, our ability to sleep and our feeling of anxiety and agitation. That vitamin given in certain doses would actually cause those symptoms. It was not obvious to me what was actually happening, but it turns out the final answer is that vitamin D makes the final enzyme choline acetyltransferase, which makes acetylcholine. Coenzyme A and choline are used by that enzyme. The actual formation of acetylcholine is dependent on both D and B5. Choline is usually not deficient in most people. Making acetylcholine is how we stay focused. Not surprisingly, the epidemic of ADHD started to be reported in the 1980s. Your ability to focus using the frontal lobe is directly related to how much acetylcholine you have in the frontal lobe. When it goes up too high, you can actually become anxious from it, so anxiety is a direct measure of how much acetylcholine you have. We use acetylcholine to run the parasympathetic side of the autonomic nervous system which allows us to rest and digest. This means that side is all about GI tract motility, and is about calmness during the day and sleeping at night.

It turns out that you can become B5 deficient by losing your microbiome because the actual truth is that there is no B5 in any of the foods we eat. It does not come from the food. Its only source is the bacteria in our gut. If that means if you happen to be D low or deficient, and you don’t have the right gut bacteria, you can actually lose one of the most important parts of your body – an organ that runs many of the neurotransmitters that allow us to sleep. The bringing back of the microbiome was really by accident. I gave the D that the microbiome wanted, but the correct four pieces of the microbiome, weren’t still down there. They were missing the B vitamins that they needed from their buddies. When I happened to give them B 100, as I was thinking about what I was doing, I thought, “If I’m right that these B’s are really coming from the bacteria themselves, I just saw what it was like to have too much pantothenic acid.” If we take this too long and the bugs grow back, pretty soon, you’re going to have two sources. You’re going to have the pill you’re taking, and your normal microbiome. Your sleep is going to fall apart and your pain is going to come back. It turns out, if you take the B50* plus D, for three months, your bacteria come back, and then you stop the B50.

Lindsey: 

That’s amazing that you discovered all that, and were able to help people recover their sleep and the bacteria.

Stasha Gominak, MD: 

It’s pretty freaky. I have to say, I still think it’s pretty amazing.

Lindsey: 

I did have one client who told me that when he first started B complex, he felt very agitated. Is it the B5 in there that could have been causing that?

Stasha Gominak, MD: 

Yes, and it’s not just B5. B12, B5 and several of the Bs are working together. They never work alone. That original comment that “if you give one B you should give all of them” is usually, not always the right recommendation. Because the nervous system really uses all of the Bs to make the neurotransmitters. What we feel and what we experience is about dopamine, serotonin, norepinephrine, epinephrine, acetylcholine. The paths to make those are all linked to the B vitamins. I have patients who get agitated with B12 as well, so they’re linked in some way that isn’t completely clear to me.

Lindsey: 

Do you use Organic Acids Testing at all, in your practice?

Stasha Gominak, MD: 

I know what organic acids testing is, because I’m a neurologist. We did that in early childhood development diseases, but I do not use any of those tests. I use a very simple set of tests. I’m interested in the B12 and the D level and that’s it. I’m mostly focused not on what is your unique genetic problem, which is still important. I believe that people like you, Lindsey, that are expert in other areas, will get more success or greater range of success by putting back the normal microbiome and getting the D. All the stuff that you guys know about zinc, or copper, and all the specialized things that are only partially known, I’m not even sure anybody knows that yet. I’m hoping that this natural part, when we put it back, will then lead to being able to build on it have better success in the interventions that you’ve discovered.

Lindsey: 

I only asked because on the Great Plains Lab Organic Acids Test, there’s a marker for B6, but I’ve literally only had one client ever who’s had a normal level of B6 on that test. I’ve heard other people talking about this as well, so I’m just curious whether B6 deficiency is a super common thing, but you don’t test B6, in any case.

Stasha Gominak, MD: 

I don’t, but it’s interesting to note that B5 and B6 were studied together back when they were actually studying vitamins. Back in the 50s, 60s and 70s, they used both of those. B6 is really important because it’s necessary to make dopamine and that means it is absolutely a player in making the neurotransmitters that make us sleep. It appears to me that B5 acts like there’s no controller on the enzymatic formation of acetylcholine. To me, it’s completely sloppy and dangerous that something I should take as a supplement would mean I can either sleep or not sleep. That just freaks me out. There should be a modifier. If my bugs happen to make enough B5, or they don’t, there should be somebody up at the brain level saying, “We can still make an even amount of these neurochemicals. I think that’s the case for most neurotransmitters; that you don’t see someone make too much dopamine when you give them B6. There aren’t clinical symptoms that go along with that. To me, this is still an unexplained error. It does suggest that our gut bacteria is pivotal to making us be calm and sleep. That’s really important. It’s certainly something we’ve observed. People have gotten higher incidences of depression, anxiety and suicide over the last 40 years. At the same time, we’ve made up separate explanations for that. It would then suggest, maybe we should explore this possibility to maybe this abnormal gut biome is actually making us have these emotional states that we don’t want.

Lindsey: 

Yeah, it’s kind of tough nowadays to pull apart what’s happening nutritionally, the sun exposure, the social media and the devices. There are a lot of confounding factors. In your experience, was the onset of IBS symptoms after giving vitamin D or did they already have IBS, and then when you give them the B vitamins that help cleared it up?

Stasha Gominak, MD: 

I never induced IBS with vitamin D. In my experience, what I saw was probably a quarter of my patients who remember, are seeing a neurologist, so they’re not coming in with IBS as a complaint. I personally became very sensitive to onions, garlic and things like that in my 30s. We were actually trading recipes for probiotics at the time. I’m taking something and they’re saying, “No, my GI doctor has something better.” That was really the only answer to IBS at the time, but it hadn’t worked, or they wouldn’t be trading recipes with me. I thought this deal was going to fix that, but it didn’t. Not everybody has complaints, but the people who had IBS still had IBS. I thought that was a good idea, but it didn’t work. This idea came to me. They’re making the B’s. Why would we have things called B’s? Maybe that’s what they’re lacking. I stumbled into this completely by accident, but it works beautifully in the people with IBS. By the end of the three months, we learned to stop the B’s and their IBS was gone.

Lindsey: 

How many people are we talking about?

Stasha Gominak, MD: 

1500 at the time.

Lindsey: 

1500 with IBS?

Stasha Gominak, MD: 

No, 1500 people total that I’m doing this with in my process; so maybe a quarter of that many. It’s been very successful since then. Here’s the problem. As soon as you get those bugs back, you have to pay attention to the fact that once you’ve gotten back the bugs, they are not the only reason why your belly may be out. If the nervous system of the belly starts to complain, that’s the same nervous system that does rest and digest. Your belly system is directly related to how your sleep is. It usually turns out if you don’t have the B’s or if you’re taking them when you don’t need them, if you’re giving your nervous system an extra one that doesn’t want them, you can see agitation, anxiety, sleep problems and a belly that feels just like IBS.

Lindsey: 

That’s interesting. I have a client who stopped sleeping. Now I want to go back and make sure what’s going on with the with B vitamins. I suggest B vitamins for a lot of people.

Stasha Gominak, MD: 

They are important and they work. It’s a different framework to think about them as their job to bring the bugs back. Once the bugs come back, we have to sit for a while with the B’s off board and say, “What does my body and my nervous system say about the production that my bugs are giving me now?

Lindsey: 

It seems like we’re having an epidemic of sleep apnea and I know some of it is connected to obesity, but obviously some of it isn’t. What do you think is at the root of that?

Stasha Gominak, MD: 

One of the things that happened to me when I went into these B vitamins was my husband handed me this article that was out of the economist journal, which was peculiar because it’s a journal about making money. This article is still, in my view, a very brilliant article about all the things that the GI doctors had learned about poop bacteria. It’s not my specialty. You can access it on my site or you can just go to the economist journal and ask for Me, Myself and Us. It’s a three page article. One of the important things they have in there is this: you take a mouse, and you do a gastric bypass on it or you’ve got to do a gastric sleeve. You take the poop bacteria from that mouse, and you transplant it into another mouse, the second mouse loses weight. It’s really not the sleeve. It’s that the bacteria that live inside us actually govern our appetite. They make small chain fatty acids that go up into these little receptors in your nose, and make high fat, high calorie foods smell better to you. They have actually been running our appetite. They also run what we do with the calories we eat. There’s a huge argument on these health and wellness internet sites about what it is that makes me fat. Some of the controls are really not in the hands of the endocrine system of the person who is obese – it is really their microbiome that is saying, “We’re in winter. Winter means I take the calories you eat, and I put it into fat.”

When you look back, I happened to go to my 50^th high school reunion. There are very few people who are obese in my entire school in 1972. This epidemic is not just about what was available. Because pizza, hamburgers and cheeses were available, then, part of it is that you have the wrong microbiome. That turns out to be playing a huge role in your endocrine system. It is a part that generally all the MD’s have missed. They’re starting to pay attention to the fact that when we do fecal transplants, you better ask who your donator is, because if they’re skinny, you can get skinny. If they’re obese, you’ll get obese. There was a connection between the D that we make on our skin, which runs whether or not we’re in a winter microbiome, or a summer microbiome, there was a change. Bugs would train our body to conserve and make fat. We, oddly enough, follow bears around and collect their poop during the year. We showed that their microbiome changes throughout the year and that the bear gets into a, I’m going to put on fat mode in the fall to allow the bear to make it through the winter. And we don’t we don’t shame fat bears. We just think that it’s helping them survive. Medicine hasn’t seen it through this lens. It’s not about eating very much. Those people who are still hungry after they’ve eaten two full meals are being run chemically to still be hungry.

Lindsey: 

That explains some of the some of the obesity connection to the microbiome, but what about the sleep apnea?

Stasha Gominak, MD: 

Oddly enough, the acetylcholine that we talked about is a chemical that allows us to get perfectly paralyzed. It’s not the only chemical. There are multiple neurotransmitters that are actively involved in not only allowing us to switch in and out of sleep. You have to fall asleep. That’s a complex process, and it’s run by chemicals. When you go from light sleep to deep sleep, you become paralyzed and there are specific chemicals that are running that process. Acetylcholine turns out to be one of those that you can come become deficient in by having a low D and losing your microbiome. That means you can actually get too paralyzed when you’re supposed to be in this space where you are perfectly paralyzed. We first found that disease in men who were post op from a cardiac surgery in the post op population. That means we found it at its most severe.

Those people that had sleep apnea for 20 years, got cardiac disease because their microbiome was screwed up, they had low D, and their sleep was bad. Sleep apnea is one of the worst manifestations, but it’s really on a continuum and it includes not being able to sleep. Insomnia is greatly overlooked. You spend all this time talking about sleep apnea and blaming the oral pharynx. There is an anatomical part to getting incorrectly paralyzed so that when you’re sleeping and deeply asleep, you’re supposed to be able to keep the airway tube open. If it doesn’t work, then you stop being able to keep the airway tube open. Part of that is anatomy, but part of it is the central controller that makes us paralyzed in certain phases, and that links back to acetylcholine, D, and the B’s that we make in our belly. Normal animals do not get sleep apnea. Those normal animals that live outside and have a normal microbiome don’t get sleep apnea.

Lindsey: 

They don’t get a lot of the stuff we get.

Stasha Gominak, MD: 

It is interesting, because they are exposed to the same toxins are. One of the things that struck me was if we look at this as humans just being one of millions of animals on this planet. Why is it that only the humans globally have developed sleep apnea? By the way, we’re not really the only animal. Our dogs and cats, (dogs especially) already have these legends of running while they’re asleep. They are actually acting out their dreams just like we do, because they are not paralyzed because their D is wrong, and their microbiome has changed. It’s not that the toxin stuff is not correct. It’s important for us to pursue that. In terms of what I can do personally, for myself, going outside, more getting the microbiome to the right are things that can still help.

Lindsey: 

So sleep apnea sufferers: get more sun, get your D corrected, possibly go on a B complex as well.

Stasha Gominak, MD: 

And go to my site and learn about how you’d want to use those two together.

Lindsey: 

What relationship do you believe sleep has had to the rise in mental health issues and children?

Stasha Gominak, MD: 

I think that in the background, when we don’t acknowledge that most kids who have emotional disorders during the day also have a sleep disorder. The hard part is realizing that we only see what’s normal sleep. We see what other parents say to us like, “My kid gets up twice during the night.” I’m talking to my colleagues that are 30 years old at the same time, and their kids get up the same way. My mother says, “You guys didn’t get up in the middle of the night.” We don’t pay attention to what mom says. We say, “Everybody I know has kids who get up in the middle of the night.” You really have to go back to the 1960s and ask what the sleep studies were showing then and is there something that could be affecting every pregnant mom (i.e., they’re doing what their doctor tells them), which is to put on sunscreen and not go out in the sun. They’re also not exposing their newborn to the sun. Are there things that could be going on in these last two generations that are relatively new? Emotional problems are related to how well we make our neurotransmitters, and the neurotransmitters are made while we’re sleeping. They’re made in certain deep sleep episodes. We also make growth hormones. We make all of the hormones that are important to our behavior and our well being, so the hormonal systems as well as the neurotransmitter systems are tightly linked to whether or not we sleep normally. All of us know that we feel better, we’re more patient and we just feel better about ourselves when we sleep better.

So basically, get your kid out in the sun and go to my website to learn about D, because you’re going to have a very difficult time talking to your physicians about putting your kid in the sun. You have to learn more about it. There’s a huge controversy right now about taking D as a supplement versus going out in the sun. If your child has an autoimmune disease, has food sensitivities, is very anxious and has lots of things that we’re talking about in adults, those things are linked to the microbiome. You’re going to want to do the D plus this B complex for a while. It’s a little bit bigger. If you just have a kid and he wakes up once a night to ask for a glass of water, and everything else is fine, then I would just put that kid outside more. If it’s much more complex than that, then there’s a bit of depth that you have to understand. I actually have a set of videos that help with pregnancy, fertility and first year of life because you’re giving breast milk to that baby. You have to know about the B’s and the D through breast milk. There’s another set of videos about how to do this in a child, what age groups and what is really normal sleep for toddlers or teenagers.

Lindsey: 

You mentioned as you were talking about children that D is something the mother is giving to the child. Is the child not getting sufficient D from the mother?

Stasha Gominak, MD: 

Yes, the child is not getting sufficient D from the mother. Most women now are trying to get pregnant when their Ds are quite low and D by itself is a major player in infertility. That’s in the OBGYN literature on fertility and early premature delivery. The D covers the placenta. You are really carrying another being inside you. You do not want your immune system to recognize that other being as not belonging there and D is heavily involved in what the immune system sees, doesn’t see and tolerates. Low D leads to increased delivery at prematurity. Low D is also now in the literature about pre-eclampsia and, unfortunately, things that have to do with physical malformations of the baby. Mostly, it’s about being able to carry your baby to term that is in the OBGYN literature, yet, the fertility experts are not using it. All you really have to do is get your D above 40 and you will get pregnant (for a great majority of women). It also probably affects fertility in males, but predominantly in females. When the D is low, it suppresses the ability of the ovary to ovulate. It doesn’t make the woman able to have babies. Once the woman gets pregnant, the only D that baby will get is coming from the mom through the blood into the fetus.

The second piece is that the only B source is not the prenatal vitamin. There are some B’s in there and the prenatal vitamin is a disaster, but the gut bacteria of the mom are the primary supply for the Bs for the baby. That means in early development, the first 12 weeks where all the basic functional development of the arms, legs, heart, etc. takes place. That means we already have a whole body of literature that talks about cleft lip, cleft palate being related to B vitamin deficiencies. The neural tube defects are related to B vitamin deficiencies. That means all you have to do is get the moms D above 40, get her on a B50 and get her microbiome back – her risk of early natal development issues in the baby goes way down. Once you know that, you can actually listen to things people tell you about their experience in the delivery of their first, second and third kid having these additional problems. The birth order also plays a role – by the time mom is having her third child, if she hasn’t been going out in the sun, her D is even lower than it was before. Her Bs are now depleted and that child is more likely to grow up starting with problems with waking up frequently and having microbiome problems. A lot of the interesting stuff the other practitioners who are working with me say, “This kid isn’t sleeping. You give them iron, and they start sleeping.” That’s because the microbiome is naturally set up to help you absorb the small charge ions. The mom is iron deficient because she’s been walking around since the second kid with a microbiome that doesn’t allow her to absorb iron. It’s much more complex than just the B’s and the D – there’s a bunch of other things that the microbiome is doing. When you don’t have the normal microbiome, you’re at risk for all sorts of things.

Lindsey: 

Interesting. It’s also is interesting, because I think about how I went through infertility for many years, and I’m sure that nobody tested my D or looked at that. At some point I got into eating organic foods and I’m not sure if, I don’t recall taking many supplements, but I eventually got pregnant. So something went right.

Stasha Gominak, MD: 

Sometimes you can trace back to going on vacation and a sun-filled environment. I have one friend who had five miscarriages and then went to the Bahamas. Oh, got pregnant. It’s really straight D related.

Lindsey: 

You were saying above 40 and I’ll tell you this. I have clients get their D tested if they were not supplementing with D and without fail, it’s somewhere between 20 something and early 30 something. I don’t think I’ve ever seen a level in the 40s from somebody who’s not supplementing.

Stasha Gominak, MD: 

That’s correct. You can occasionally see it in somebody who’s 17 who just was at the tanning booth for the last three weeks because she’s just about to get married, but that’s really the only occasion where I’ve where I’ve seen that happen.

Lindsey: 

Right? I just think unless or maybe somebody perhaps who works outdoors and has decided not to wear sunscreen, but that’s pretty unusual.

Stasha Gominak, MD: 

Very unusual.

Lindsey: 

Tell me a little bit more about acetylcholine. I’m interested in this because I’m not very familiar with the topic. You touched on it, but I need to hear it again – about its role and origin in the body and what disorders are associated with the lack of it.

Stasha Gominak, MD: 

First off, acetylcholine is something that no layperson should be familiar with. Nobody talks about it. I’m a neurologist, I should know. When we’re taught early pharmacology, we are taught about the parasympathetic nervous system, lay people know about the sympathetic nervous system, because we talk about it. The autonomic nervous system is two halves, one of which calms you down and runs the GI tract. The other one is the sympathetic. The parasympathetic is basically run by this chemical called acetylcholine. I saw all these things I just described to you in my patients, and I’m a neurologist, but I don’t really understand why they’re getting agitated and anxious. I just really don’t have a chemical basis for that, but when I’m starting to give lectures about it, I think I really have to come up with a better answer than, “It acts like caffeine.” I just typed into Google “coenzyme A and the brain.” What was in the book I told you about was: coenzyme A, (B5 becomes coenzyme A) is pivotal in making cortisol. So that was the underlying reason why they were giving B5 to people with rheumatoid arthritis. We knew that they had a problem. We gave them prednisone and they got better – so maybe there’s a cortisol link.

I really didn’t understand why giving B5 caused people to be agitated, anxious, etc. I found, “Coenzyme A is pivotal to make acetylcholine,” and I think, “I’m a neurologist. Acetylcholine, what does it do in the brain? I don’t even know.” I mean, I know it’s related it to Alzheimer’s disease. I know it’s at the neuromuscular junction, because we have myasthenia gravis, and people get weak, but what does it do? I started to look around and it turns out these sleep diagrams that show us how we get paralyzed, have acetylcholine as a player there. The next thing I realize is, why don’t I know what acetylcholine does in the brain? I know what serotonin does. I know what norepinephrine goes. It turns out we learn as neurologists what neurotransmitters do by giving them drugs. I have dopamine, I give it to Parkinson’s disease patients. I have a serotonin reuptake inhibitor. That means it prolongs the action of serotonin and I give it somebody who’s sad.

There are no drugs for acetylcholine. There’s nothing except nicotine. Nicotine turns out to be one of the oldest drugs we have available, and early on in the early 1910-1920s we were studying the nervous system. We started to realize that there are nicotinic receptors for acetylcholine, and muscarinic receptors. That means we’ve actually written our textbooks with nicotine as part of it and it turns out that acetylcholine acts like nicotine. In some receptors, it acts like this other drug, and I’m looking at this going, “This is weird. Does that mean that the people who smoke a cigarette and feel better could have an acetylcholine deficiency state in their brain? Does that explain why I smoked a cigarette and immediately felt agitated and threw up? Could it mean that the people who get addicted to this chemical are actually feeding their brain with a chemical they’re deficient in – much like I’m taking a serotonin reuptake inhibitor, they’re smoking something. If you’ve been around smokers, if they’re really addicted, they get up in the middle of night, they smoke a cigarette and go back to bed. For those of us who don’t smoke, it’s bizarre. It means that they are actually treating themselves with a chemical that we have vilified, but we should really start thinking of it in a different way.

Now, the next thing that leads to is, I’m reading these articles about the frontal lobe and the ability to concentrate. Some of these articles are said to be by clients and they say, “Hey, have you looked at this? This is about acetylcholine.” It turns out that the basic scientists have been studying acetylcholine and its actions in the frontal lobes. They say acetylcholine is what allows us to get distracted and come right back again. When you get to the conclusion of the article, they say, “This really means we really shouldn’t be giving ADD kids things like methamphetamine”, which is what we’re giving them. The amphetamines up the norepinephrine. They say, “We should really be giving them nicotine.” There’s no way I’m going to convince a 32-year old mom with two kids to give their kid a cigarette at recess, but it means that we’ve missed an opportunity, because there are no drugs. There are now studies using nicotine patches in kids with ADHD and in autistic kids. Acetylcholine is actually a neurotransmitter that you can develop a deficiency state of, looking like a normal human, but really not being, because you don’t have the poop bacteria that you need. It turns out there are multiple different acetylcholine deficiency states, Parkinson’s is one of them.

Alzheimer’s disease is another one. There are other ones that grow out of that, having to do with tremor and gait disorders that are important to neurologists – that have been documented that pathology and by various studies using MRI and other imaging studies that show the acetylcholine tone, or how much of that chemical you have, is actually deficient. Oddly enough, in the last three years, there have been a couple of articles out of a specific lab that’s actually studying B5 deficiency states at autopsy in both Huntington’s disease and Alzheimer’s disease. I thought I wouldn’t be alive when they finally got around to that, but they kind of stumbled into it by accident. So there are many acetylcholine deficiency diseases. It turns out that anxiety is one of those and it may turn out that in autism, some of the features of autism are related to that. Absolutely. ADHD is basically a description of this person not having the right chemistry minute to minute. A lot of my clients now will be able to say, “When I get my B5 dose to this, I’m just calm and organized. I reorganized my entire basement and I’m not yelling at my kids.” It’s just weird and it really is something that lasts for eight hours before it goes away. Some of my clients have to add an additional tiny dose towards the afternoon.

Lindsey: 

Of B5? It’s what’s bringing up the acetylcholine in the context of a B complex.

Stasha Gominak, MD: 

Usually I use it in the B complex. There are certain people who wind up in huge doses of B5. Here is the part I left out for you. On that original group of people, there’s 40 people I see in a week. I recommend 400 milligrams of panothenic acid and B100. There were a couple of outliers who didn’t come back and say, “Were you trying to kill me?” The two gals with a burning in their hands and feet were much better in two days. There were two or three people who had a little bit of a tremor and a little bit of signs that looked kind of Parkinsonian. They came back six months later, still on 400 milligrams of pantothenic acid, suggesting that there are some circumstances in which 400 milligrams of pantothenic acid is exactly what their nervous system needs. That’s really a big topic and there are all sorts of genetically related things. There’s a whole bit about choline, iron, and a few other things that are necessary to make acetylcholine. Iron is actually a regulatory cofactor also, and I’m just starting into that path.

Lindsey: 

What’s the relationship chemically between choline and acetylcholine?

Stasha Gominak, MD: 

I can show you the equation if you’d like, but there’s choline, then Acetyl Co A. Those two have an enzyme that’s called choline acetyl transferase. That enzyme is made by D. When D hits two receptors in the brainstem sleep receptors, choline acetyl transferase is made. It’s the final enzyme. So you need the two basic pieces, the enzyme and you get acetylcholine.

Lindsey: 

Okay, so not the exact same things. They’re not just like the active form, but actually chemically different.

Stasha Gominak, MD: 

There’s another piece to this: within the last 15 years, there’s another process called the acetylcholine anti-inflammatory pathway. That is related to vagus nerve stimulation, which is the big wire that makes the parasympathetic. Vagus Nerve Stimulation was being used to control epilepsy. When they stimulated it electrically, they saw that the spleen responded to that stimulus by secreting T cells out into the body. Those white blood cells (a specific type) secrete choline acetyl transferase. They secrete the enzyme that makes acetylcholine. That means there are pathways that adjust our inflammation minute to minute in our body. I saw a bunch of things with people that I didn’t understand. We get to D and B5 to a certain place and now they have eczema and a rash. Now they have weird skin stuff that I can’t even understand. What about all those people with that joint pain? What was that about? It turns out the inflammatory system is also in controlled minute to minute by acetylcholine as well, but it’s a completely different pathway that doesn’t even involve D.

Lindsey: 

Can you supplement directly with acetylcholine? I feel like I’ve seen supplements.

Stasha Gominak, MD: 

The problem is that it will be broken down as soon as you take it. It needs B5 to become coenzyme A, and it needs enough choline, which is deficient in some people, that it needs this enzyme.

Lindsey: 

A lot of choline in egg yolks.

Stasha Gominak, MD: 

Egg yolks. It’s famous for that.

Lindsey: 

I know we’ve run out of time and again, I’ve really enjoyed getting into the geeky level science stuff on this and perhaps we’ll have to have you back to get into the whole endocannabinoid stuff.

Stasha Gominak, MD: 

Yes, I would love to do that because that plus the B vitamins, childhood development and autism are really important.

If you’re struggling with dysbiosis, diarrhea, constipation, leaky gut, candida, IBS, IBD, or other gut health or all over body problems, you’re welcome to set up a free, 30-minute breakthrough session with me (Lindsey). We’ll talk about what you’ve been going through and I’ll tell you about my 3- and 5- appointment health coaching programs in which I recommend lab tests, educate you on what the results mean and the protocols used by doctors to fix the problems revealed. Or if you’re ready to jump in right away or can just afford one appointment at a time, you can set up an 1-hour consultation with me.

*Product, test and dispensary links are affiliate links for which I’ll receive a commission. Thanks for your support of the podcast and blog by using these links.

Adapted from episode 85 of The Perfect Stool podcast and edited for readability with Danielle Daem, Certified Holistic Nutrition Coach & Sugar Addiction Expert.

Lindsey Parsons:

Can you tell me a little bit more about your own journey with sugar addiction?

Danielle Daem:

I’ll try to keep it short. Obviously my journey stems back as for most of us to childhood. From the minute I was born, obviously things are impacting my gut and my dietary preferences. I grew up in a traditional household as many of us did. Sugar was just a really big part of our every day. I was a really picky eater growing up as well. I often joke that I only ate things that were white – white bread, bagels, white pasta and just white sugar. Those simple, processed carbs were my go to. My poor mom – she did get some vegetables in me at some point. Now obviously the start of this huge desire to have sugar as a big part of my life more than just the physical pieces. Looking back, sugar was such a part of how we celebrated. If I got a good grade or scored a goal at my soccer game, “Oh, let’s go and get some ice cream.” There was always that sugar being a huge part of how we celebrated, how we showed love and just all the pieces that we know now go into just our relationship with sugar.

About six years ago, I had my “sugar wake up call.” My husband and I quit our jobs in the finance industry and went traveling to South America for a year. That was really obviously a soul-searching journey. We did a lot of work on ourselves and really just rediscovered what mattered to us and what we wanted out of life. On that journey, I got to witness how people of such a different culture in South America live compared to here where I live in Canada. In a lot of these countries that we visited, people related to their food a lot differently. They went to the market and they actually cooked all their meals. It was very rare that people would go and eat out. Obviously, it’s becoming more and more prevalent with the fast food chains like McDonald’s and Burger King just getting into all these countries; however, it really showed me a lot of where I was getting sucked into this fast, convenient food sort of lifestyle that so many of us live in, and how that wasn’t going to serve me in the long run. I started really reflecting on my health and the way I was not actually nourishing myself. We didn’t eat well on that year-long trip – eating things that could survive on a 30-hour bus ride was pretty much just bread, cookies, cakes and things in packages. At the very end of our trip, we ended up actually living off the land in the middle of the Colombian jungle for a yoga retreat for two weeks. It was there that I say I went we went through our accidental sugar detox because I wasn’t really aware of what was going on. We were still having a little sugar because we were actually eating mangoes from the trees and we were eating off the land, but I went through my withdrawal symptoms there. I didn’t know it at the time. I thought I was sick. I also happened to get a parasite at the same time, which was absolutely horrible. Don’t drink the juice if it’s made with water from the land. I should have known that. It got me and it was horrible. That combination obviously made for a very interesting stay. It really was the catalyst for me to start reflecting on the changes that were happening in my tastebuds. As I was in that accidental detox, getting off of the processed food that I’ve been living on my whole life, I really started noticing my taste buds change. I noticed my cravings change and I noticed that I’m not really needing a cookie today like I used to. That really just started percolating those thoughts for me. “Oh, I think that there’s some sort of control that sugar has over me.”

Coming home from that trip, (about two weeks after that), we actually came to Canada and I started really diving into learning more about health and nutrition and just how to nourish my body in a better way. I started learning and studying at the same time as starting to get into my own spiritual and meditation practices. That’s when I really started discovering my passion for nutrition and for actually making these shifts. I started having some big light bulb moments – looking at my genetic lineage and the state of health of my mom’s side of the family and my dad’s side of the family riddled with every single chronic disease that you can think of. I started really understanding the role of what I put in my body and the stress in my life. That’s been a big, big inward journey as well, for me, and really realizing that if it wasn’t stress that was going to kill me, it was going to be sugar and these hugely toxic foods in my life. I just started noticing those patterns and really making that connection for myself that I didn’t want to live a life like my mom does. Her and my dad’s entire families are just being riddled with issues that have prevented them from fully living life. I’m someone who wants to just fully live like I want to be traveling and hiking and exploring when I’m 90. These light bulb moments really helped me understand that the way that I treat myself (and especially the food that I put in my body), my mindset and calming my nervous system, and all these important things have a direct link on turning those genes on and off. I do have a big say in what my future looks like when it comes to my body and its ability to actually do things like travel when I’m 90.

I feel very lucky and unique in my journey that nothing bad happened for me to shake me up. Obviously watching my grandparents pass away from various diseases; I never met my grandpa on my dad’s side because he died of a heart attack when he was 50. Nothing dramatic happened to me. I know a lot of people wait for something horrible to happen, especially when it comes to gut health. People wait until they get diagnosed with Crohn’s disease, SIBO or something really bad happens before they they start to make a change. For me, it was just a series of really deep understandings and connections with what I wanted out of life and the role that I had played in that. That was kind of the start of it. It was about six years ago that I really went into nutrition. I started my business in helping women build a healthy relationship with food and themselves and it’s morphing every year. It’s an ongoing process, as I’m sure you know.

Lindsey Parsons:

Yeah, thanks for that background.  When I gave up sugar, that impacted my weight. It mostly just ended that battle with a baby belly that I kept thinking I’d get rid of somewhere in between my first and second child – I adopted my second child so then I had no more excuses. I had to do something. I’m curious, did it impact your weight when you gave up sugar?

Danielle Daem:

Yes, it did. I’m also someone that’s never been overweight. I’m grateful for that. I’ve been able to outrun and exercise it, especially in the first 30 years of my life. As things change, obviously, we go through different changes of life, it becomes more prevalent, but yes, I definitely remember like the inflammation of my body going down – feeling more energized and my tastebuds coming back online. I definitely did notice a little bit of weight balancing. My body was getting back into balance when I started eating real, whole foods. Who would have thought?

Lindsey Parsons:

Who would have thunk it? So let’s talk a little bit about how sugar impacts the gut.

Danielle Daem:

Yes, let’s do it. I’m sure that you’ve touched on this lots in many of your episodes as well, because sugar is one of the biggest culprits when it comes to what we’re actually putting in our body and how it affects our gut. A couple of things are going on here. We can dive a little bit deeper into some of these. Caveat here, I’m not a scientist and you definitely are more in this area of all the specifics around gut health for sure. When I’m talking about sugar, I’m mostly talking about really simple carbohydrates like white bread, white pasta, sugars, honey, maple syrup or agave. I’m not necessarily talking here about complex carbohydrates, although some things like yams and beets that are higher in sugar can be really sensitive for some people.

What most people are struggling with are highly processed foods, all of the added sugars, all of the juice and all of the things that really sneak in to give us that crazy blood sugar spike. One of the things that’s really going on here, and we can talk a bit more about this is, is understanding that sugar and processed foods feed the bad bacteria in our gut. We’re getting a huge surge of all of this yummy food for all of the “bad guys.” right? These nasty pathogens, or yeasts and bacteria that live in our gut that normally lie dormant. Sugar is the preferred source of fuel for these bad bacteria. They can really start to take over and obviously that leads to all sorts of issues. Our over consumption of sugar increases the acidic environment in our gut (and our whole body). Our gut is becoming more and more acidic, because sugar is extremely acidic. This leads to inflammation and can lead to degenerating the intestinal lining, which we know is not a good thing. So many diseases ultimately stem from inflammation, from gut damage, which is why I love what you’re doing so much, Lindsey, focusing on the gut, as it is really the hub and the number one area to look at and focus on when we’re looking at total body health.

As I just mentioned, this bad bacterial overgrowth can really take hold and can produce this dysbiosis. Balance between the good bacteria and bad bacteria in the gut is thrown off. These harmful bacteria that love sugar that in a perfect gut, live dormant, and live peacefully being managed by the good guys. Any of the bacteria that can be considered pathogenic, or yeast-like will be fed by sugar. Some of the specific bacteria, Staphylococcus aureus is definitely one that that gets fed in a big way by sugar, and obviously produces a variety of toxins that can really lead to disease and damage.

Lindsey Parsons:

That’s, by the way, if you’ve heard of MRSA, it’s Methicillin-resistant Staphylococcus aureus, which is that skin infection that doesn’t go away unless you get antibiotics, but you catch it in the hospital.

Danielle Daem:

Another one that can obviously be loving this increase in sugar is Clostridium perfringens. This is something that you get from contaminated food and it can live dormant and the amount of sugar that we’re feeding it just just allows it to grow and take hold. Obviously, there’s E coli as well. That’s a big one that gets fed by sugar. Like I said, the list is long so if you know a lot of the fancy technical names for these strains of bacteria, just know that they’re really being fed by sugar. I was doing some some extra research actually before this interview Lindsey, because I wanted to really have some more facts to share with all of you. I found this one study published in the PNAS journals that was actually showing the link between fructose and glucose, which are the simplest sugar molecules. This study showed that it decreases the abundance of a protein in our gut that actually regulates gut colonization. It’s possible that this increase in consumption of sugar is  actually preventing our gut from being able to colonize with the healthy bacteria. We know now that over the years with how we’re eating and how we’re living, the amount and the variations of our amazing microbiomes and the beautiful bacteria that we want in there, the thousands of strains that we actually want existing in our gut is becoming less and less. Just like we look at the world, and we see cultures and languages being lost as we sort of come together in this one world energy. This is happening in our gut too and that’s a big problem, because we need the variety. We need these these ancient strains to provide this total body health.

Lindsey Parsons:

Because I think you’ve also seen too how all the studies show that the more diverse your gut microbiome is, the better your health outcomes.

Danielle Daem:

Yeah, totally. This is where the studies are proving that children who are born vaginally versus C section get more of that initial gut bacteria on birth and that actually gives them stronger immune systems and just in total. It’s kind of serious. We need to be paying attention to what’s going on at a bigger level, not just even personally, right. That’s why I know you’re doing such amazing work here with the podcast, because this is of huge importance. We’re losing diversity in all areas on the planet. When we lose that in our gut, we essentially are just continually weakening ourselves and leaving ourselves susceptible to disease, viruses, diabetes, cancer and mental illness. All of these things are stemming from that imbalance. I found another study that I just wanted to mention actually out of Oxford, that was really interesting. It was called “The Adaptation of Gut Microbiota to Modern Dietary Sugars and Sweeteners.” It’s essentially hypothesizing that the gut bacteria living in there, even the ancient strains, are actually shifting and genetically modifying based off of the types of sugars that we’re eating. The type of diet that we’re eating is now impacting our internal environment in a big way. It’s actually changing the cellular structure of our gut microbiome, of our gut and of all the cells in our body to adapt and to live and to thrive off of these, whether it’s artificial sweeteners or regular sugar as well. Our human body is trying to adapt to all this processed nonsense that shouldn’t be in it in the first place, and unfortunately, we’re getting caught up in this wave of inflammation, cravings, addictive behaviors, let alone all the things that are happening in the brain when we’re eating sugar as well. I found that to be a great reminder for all of us. This is having a long term impact not only on our gut microbiome, but also on our children. If we’re wanting to procreate, we’re passing that on.

Lindsey Parsons:

Absolutely. You mentioned artificial sweeteners and I thought that’s an interesting topic. I was going to talk a little bit more about better sugar alternatives, but I just want to for just one second, talk about things like acesulfame potassium, NutraSweet, aspartame and those types of artificial sweeteners? Can you talk a minute about that?

Danielle Daem:

I don’t know all of the science and studies specifically on them. There’s a couple of things actually to really know and to consider when it comes to what I just called alternative sweeteners. There’s so many sweeteners out there now being produced, obviously, in laboratories. This is the first red flag for me. This is not something that came of the earth, so why is it in my body? This is just something really important to consider when we’re putting any foreign substance into our body. Our body is going to be a little bit confused about what’s going on and it’s not going to have necessarily the pathways to metabolize it, to flush it out or just recognize it and let alone use it for any use in the body. When it comes to a lot of these sweeteners, and obviously a lot of them are slightly different.  Artificial sweeteners and alternative sweeteners are really designed to be way sweeter than even normal table sugar. A lot of them are designed (especially aspartame and sucralose) to be like more than 100 times sweeter than sugar. We’re still giving our tastebuds a crazy hit of sweet and that’s still sending signals to to our dopamine centers saying, “Sugar is coming!” It still releases the insulin into our blood, because our whole body thinks sugar is coming. It alerts the whole digestive system that sugar is coming even though sugar doesn’t end up coming. A lot of these these sweeteners don’t have glucose or fructose in them so that they’re being touted as being safe for diabetics and those sorts of things, when in fact, there’s still a response in the body taking place that’s really abnormal and actually leading to inflammation around our insulin receptors.  It’s really important to understand how the food industry actually does a lot of trickery. The billion dollar food industry knows that we’re on to them about sugar. They know that the masses are understanding processed foods, seed oils and sugar is bad for them. They are one step ahead of us trying to find ways to sell us on their food products, so they can label things as sugar free. All of these nutritional labels are a red flag in my opinion. We need to really be careful in making sure that we’re staying with whole real foods as much as we can. These sweeteners are processed and made in a lab. I would put them in the pharmaceutical category. These are things that are foreign to our body. We’re still discovering and research is still being done. We’re never really going to know the overall effects, but there’s a lot of information coming out there now. It’s very easy to find and do your own research on a lot of these sweeteners. I have a lot of clients who would have things like Erythritol or sucralose and they would get extreme diarrhea or bloating. That’s obviously a telltale. Your body is telling you to stop that because it’s not working. There’s there’s definitely a lot of things to consider there, especially around the actual addictive tendencies that we all have. We’re not actually solving a sugar addiction problem, or a sugar eating problem, when we’re just swapping out natural sugar for unnatural sugar that’s 100 times sweeter. We’re still using it in the same way. We’re still using it to treat ourselves or to emotionally eat and avoid stress at the end of the day. We’re still doing that when we switch over to these “healthier sugars.”

Lindsey Parsons:

Thanks for that elaboration. I asked the question, because I had a nonprofit advocating for healthier food in the Montgomery County Public Schools in Maryland and the studies show because of course they were saying, “Okay, we’ll take the sugary sodas out of schools, but we’re going to leave the diet sodas because those are good for kids.” Studies came out showing that there was a higher correlation between diet soda and type two diabetes than there was with sugary sodas and the action mechanism hadn’t been elucidated, at least at that time. Some of the suspicions were that (and there were studies showing) people ate more when they were drinking diet soda. It wasn’t like you could just replace the sugar craving with diet soda.  That sugar craving kept them eating, which was fed by the diet sodas.

Danielle Daem:

That is really fascinating. I’ve heard of that as well in different studies and also just in my own experience seeing my clients the last six years. When we eat these alternative and artificial sweeteners, a lot of them are actually like exactly that. The mechanism in the body actually drives more cravings. Our body thinks we’re about to eat something with nutrients in it and it doesn’t get nutrients. Things like fructose are now being shown to actually turn off our hormone that makes us feel satiated. That ability for your brain to know you’ve had enough. Fructose is something that we can just eat constantly – hence high fructose corn syrup being used in every processed food. The food industry knows that it’ll just keep us coming back for more, keep us craving and disconnect us from our body’s natural ability to know when we’re satiated. There are very intricate things happening in the body that are keeping us going. I love that example in the in the school systems, I’ve heard of other examples like that as well – where it’s just leaving more and more cravings, more sugar intake and not solving any problems.

Lindsey Parsons:

I’m curious whether you recommend a cold turkey approach to cutting out sugar or gradually decreasing your consumption? What works better for people?

Danielle Daem:

I love this question because my answer is, “It depends.” There’s no right answer to this. I would really encourage anyone here to really just tune into yourself. It’s kind of a 50/50 split. Some of my clients love going cold turkey. Funny enough, actually, the day we’re recording this interview, my current group program just started sugar free today – their 4 week detox. They’re going cold turkey today, but we’ve actually spent the last four weeks in that program getting them ready mentally and physically to take that leap and go off sugar. It’s going to be really dependent on your personality, your lifestyle and how much prep you’ve done in advance. If you want to go cold turkey, it’s really important that you prepare yourself in advance. There’s a lot of prep that needs to go into that to make you successful to stick with it. Meal planning, keeping your freezer stocked with emergency foods, keeping healthy snacks, and  really thinking through how you’re going to handle challenges that come up – birthday parties, holidays, vacations and all of those pieces that can really us throw us off course. If that terrifies the living c-r-a-p out of you, then maybe a gradual approach is more manageable for you. For a lot of women especially, there’s this huge fear of losing our best friend when we begin getting rid of processed food. I know this fear is very real. There’s this belief that we’re not going to have anything fun in our life, we’re not going to have any joy and my best friend is going to be gone. In that case, it is really helpful in my opinion is to gradually ease into it. I find that people who do gradually ease into it with the proper plan and support tend to be way more successful because they’re ready for the challenges that come or ready for the hiccups, the withdrawal symptoms or the things that might show up in their body once they’ve slowly built in some whole, real foods. It’ll also be a lot easier on the body if we spend four weeks gradually minimizing our sugar intake before taking it all out. It’ll be a lot easier on your body than a sudden cold turkey.

Lindsey Parsons:

What kind of withdrawal symptoms do people experience?

Danielle Daem:

Another great question. When we think of withdrawals, that can be headaches, there’s often digestive upset in the beginnin,g especially someone who’s going cold turkey and switching from processed food to real food. Your bowels and your gut are going to be very confused for a while, so there’s going to be digestive issues. Pain can really come out as the toxins are being pulled out of your joints and muscles. You might notice some extra pain, headaches and exhaustion, especially for the first couple of weeks.

Lindsey Parsons:

I’m sure there’s got to be a die-off reaction because the pathogenic bacteria aren’t being fed and they’ve got that lipopolysaccharide, which is an endotoxin.

Danielle Daem:

Exactly. We’re realizing a lot that some people also have cold and flu like symptoms. They feel really tired and sick. Just knowing that all of that is normal is really, really helpful. There’s quite the process. It’s almost like it has to get worse before it gets better kind of feeling. You have to push over the hump. And it usually only lasts one to two weeks, maybe three. Everybody’s very different, obviously. I know for some some of my clients, it lasted three days, and then they start feeling great again. It depends, but it’s important to stay on course and pay attention.

Lindsey Parsons:

It’s going to be exactly like a Herxheimer reaction. When you start taking antimicrobials, the first two or three days could be really bad for some people who have a really severe overgrowth. So you mentioned seed oils. Let’s talk for a minute about why seed oils are bad and what they are.

Danielle Daem:

Seed oils are heavily processed fats that have been designed by the food industry because they’re very shelf stable and you can put them in a lot of processed foods to add some flavor. This is one of their sneaky ways of trying to add flavor and fat, especially if they’re not going to be using sugar in a product. These are pretty much any of the oils that you see in the grocery store shelf in a clear plastic bottle. Things like canola oil (rapeseed oil), sunflower, oil, vegetable, peanut, soybean, corn or margarine – any of these oils that are from plants. These oils are essentially just toxins to the body. They oxidize like nobody’s business, and can create a lot of free radicals in the body and start augmenting and causing damage to our cellular structure. What they also do is inflame our cells They also inflame our insulin receptors, which can support and lead to more insulin resistance.

Lindsey Parsons:

That’s a relatively unknown piece of it. I think I listened to an hour and a half podcast on the very sciency details of exactly how you need Omega six oils to have type two diabetes. This is a little, well known trick. I think if you told someone, “The only thing you need to pull out of your diet is is seed oils.” Everything else would come with it because there’s no processed food that does not have seed oil. You could just tell them the only thing you’re not allowed to eat is that.

Danielle Daem:

I’ll have to try that. That’s a neat trick. Another thing that they do is get into our fat cells and damage our body’s ability to actually burn fat for fuel. This just really damages our metabolism and the processes that are able to, in an ideal world, be metabolically flexible and burn glucose or fat for fuel. I mentioned earlier already about the oxidation and they’re just extremely inflammatory. Just think of seed oils as cancer-creating inflammatory substances that should not be used. I don’t know, Lindsey, if you or any of anyone listening has ever seen the YouTube video of how they make canola oil. You can find it on YouTube. It’s a very old video with horrible filming footage, but watch that and never again will you ever want to eat a seed oil in your life. It’s really eye opening what they actually do to produce it, making the sludge and what they mix it with. It’s pretty shocking too. I encourage anybody to just do a YouTube search for how Canola is made and it will come up. It’s a really powerful visual.

Lindsey Parsons:

I’ll try and find it and link to it in the show notes.

Danielle Daem:

I know a lot of experts in the nutrition space. We have debates of like, “What’s worse sugar or seed oils?” It’s kind of a 50/50 debate. They’re on par and there’s a lot of people out there touting that seed oils are even worse for you than the sugar that we’re ingesting. Either way, they’re both equally as toxic and produce a lot of cellular damage, free radicals and toxins in our body. We’re dealing with a toxic load just living in the world that we live in and we don’t need to be putting these added toxins into our body if we if we don’t have to.

Lindsey Parsons:

Briefly, what oils do you recommend people use?

Danielle Daem:

Things like butter, ghee, avocado oil and olive oil are good for no heat. You don’t want to heat those oils. We can get into flax oil and walnut oil. Those need to be kept in the fridge. We want oils that are really delicate. These are these are going to be the ones that are more packed with omega threes and the saturated fats that we do need. Coconut oil is another good one. Any animal fat is recommended. I actually have lard in my fridge, who would have thought that we would actually be promoting lard again? I remember the whole “don’t eat fat” craze back in the day. We need to get over that because we do need fat in our body. Tallow is another one – any of those fats that can be rendered from animals. When it comes to high heat cooking, you should do your best to use fats that are solid at room temperature. Those are the ones at least that I use in my home and that I definitely recommend. Pay attention to that heat amount, because fats can become very unstable very quickly. Things like beautiful olive oil is absolutely an incredible addition to your diet. You don’t want to heat it or agitate the cellular structure of the oils, because if you do, we’re ending up in the processed seed oil category again.

Lindsey Parsons:

You certainly don’t want it to burn. Like if you see your oil smoking, pour it out, in the garbage, not down the sink, and start over. 

Danielle Daem:

I’ve done that. I’ve been heating coconut oil on the stove and I forget about it and I’m like “Oh no, it’s burnt!” In my line of work, the emotional connection that we have to food is one of the biggest root causes around sugar addiction, beyond the physical addiction that’s actually going on. For most of us, this is actually the stronger addiction. It’s the emotional piece. There’s so much that I could talk about with emotional eating and this emotional connection, but when it comes to our gut, these heavy emotions or the difficult emotions that we might be dealing with on a day to day basis are driving us to actually want to eat the processed food. We’re going for comfort. We’re going for the junk. When we’re eating the junk, it’s doing all these things that we just talked about. We need to start looking at our triggers and our patterns around this. When it comes more specifically to eating time, and our digestion, we are often not in a relaxed state. Most of us are not when we eat. I look around to see that we’re eating in our car, we’re eating quickly at our desk, we’re eating in front of the TV, not even paying attention to what we’re eating. We’re eating maybe while we’re arguing with our husband. All of this puts our body you know, essentially in a stress state and in a state where we’re not relaxed. We’re not aware that we’re about to digest food. This obviously can do a lot of things to our body. The biggest thing it that really does is shutting down our digestive system, especially if we’re not mindful eating. Our digestion starts with our eyes or our nose. A lot of my clients don’t even look at their food or don’t even know that they’re eating. They’re watching TV, and scrolling on Instagram at the same time while they’re shoving things in their mouth.

Lindsey Parsons:

Let’s talk a little bit about the emotions around eating and how that impacts gut digestion. And the chips are just going into the mouth, right?

Danielle Daem:

They’re just appearing in the mouth as if from nowhere; it’s magic. When we do that, our body and the rest of our digestive system doesn’t get the signal that there’s food coming in. We need to release the enzymes. We need to release all the protein. We need to release the bile and all of the things that we need to actually break down these foods to properly be digested into our bloodstream. This is the argument for mindful eating and learning to get back to actually prioritizing, sitting down, going slow and being present with our food – even if it’s for 10 minutes. Even if it’s just for that quick bit of time to really do our best to minimize distractions. When we do that, we also support our body in calming the nervous system. We need to be in the rest and digest state. Because when we’re not, if we’re in a stress state or we’re ruminating over an argument that we had with a friend yesterday or we’re just feeling heavy and nervous or we’re worried about work and we’re just in a tailspin of nervousness and stress, what that tells our body is that we’re in danger. When we’re in danger, all of our energy and our internal resources are being sent to our brain and our limbs. The digestive system is the last place that gets energy if we’re in a stress state, whether it’s mental or physical stress. Our body has that reaction, even if it’s not actually in our reality. When we relax, our body can actually send the appropriate energy and resources to the digestive system so it can function properly. This is a great example and maybe experiment for anybody. If you’re eating when you’re stressed and you feel like you’ve got stomach cramps, gas and other digestive symptoms, it is probably because you weren’t focused on your food. You weren’t relaxed in that state actually allowing your digestive system to do the magic that it does. Those are a couple of the ways our emotional state really plays a big role in keeping our digestive system calm and working optimally. It’s more than just meditate and relax every day. There’s a big practice here that I’m not perfect at.

Lindsey Parsons:

Nor am I.

Danielle Daem:

I’m going to be the first to admit that this is still something I work on.This is harder said than done, but it’s important.

Lindsey Parsons:

It’s something I teach some of my clients, especially the people who come to me for weight loss. If you sit down to the table, really feel your stomach tense, you just stop and do a couple minutes of 5-5-7 breaths – five in, hold for five and out for seven – in two minutes, you can just completely change into that parasympathetic, rest and digest state and have such a better chance at assimilating your nutrients.

Danielle Daem:

People often complain about eating healthy being expensive, but how much money are we wasting by not digesting the food that we’re actually paying for? It’s a very interesting kind of argument, maybe for another day.  And I don’t have the answer for that, but how much are we actually wasting financially and energetically when we’re not paying attention and we’re just shoving food in all day long and really not being present with that process?

Lindsey Parsons:

I do still a little bit coach people on weight loss, but a lot more at the beginning of my career, and breaking the sugar habit. Of course, some of my clients came to me with eating disorders, not necessarily bulimia, but certainly binging cycles, followed by punishing cycles and starving themselves. I’m curious how you work with people who do have an eating disorder. I found that to be one of the most challenging things for me personally.

Danielle Daem:

This is such a good question, Lindsey. This actually came up on one of my group calls in my current group a couple of weeks ago, because there is this easy trap to fall into when we talk about giving up sugar. “Are we not just on another diet? Are we not just limiting, controlling and starving ourselves of something over here?” I’m actually of the belief that we do need to really be careful with what we tell our brain we can’t ever have again. This goes especially for food. This can be really a slippery slope, because as soon as we are told we can’t have something, we want it more. We feel like we don’t have the freedom to make our own choices. A lot of my work is really about tuning back into our true selves, and rebuilding a deeper relationship with ourselves, and thus a relationship with food. When we feel fully empowered, and we fully know and love and respect our body, it becomes a choice to avoid certain foods. I’m making a loving choice to not eat processed seed oils and sugar. It’s not that I can’t have it. It’s that I’m choosing not to because I know what it does to my body. And I love myself too much to do that. This is really like just scratching the surface on a lot of the deeper work that we need to do if we want to actually make a healthy relationship with healthy food in a lasting way. There’s no quick fix here. We need to really go inward and take a hard look at why we’re eating sugar in the first place, what the relationship with food is, our beliefs about food, our beliefs about ourselves. I often say that our relationship with sugar is just a byproduct of our relationship with ourselves. We have to start repairing that relationship with ourselves. You need to really be paying attention to what’s coming up for you. If you notice that restricting sugar in your diet is triggering that old pattern of bingeing and purging, that’s really important information for you to then lay off. Maybe you need more guidelines. Maybe you need less hard rules. Maybe there’s some more work to be done there. I really believe that all of our patterns stem from a deeper level. There’s an old neural pathway and your ego is using that pattern to get something or to accomplish something from a survival mechanism standpoint. We need to look at that stuff and actually do some deep healing. Does that answer your question?

Lindsey Parsons:

Yeah. Obviously, it’s a complex problem to solve. It’s not an overnight problem. Sometimes I think about working with clients who start out with a self-professed eating disorder. Don’t anticipate in 12 weeks that you’re going to lose weight, if that’s your goal. Anticipate that you might maintain, which probably is a step forward. Maybe another 12 weeks, you might actually get to the point of losing. It’s not an easy proposition undoing a lifetime of an eating disorder.

Danielle Daem:

Yeah, for sure. There’s a lot of baby steps and obviously, unfortunately, there are of a lot of detoxes and things out there that might not work for you if these are your old patterns. It’s definitely a tricky rope to walk. It’s very person specific. It’s very individual. It’s hard to give any specific advice here, of course, but just be gentle with yourself. Understand that this is a process and a journey. The more that you connect to your true self, go inward and repair that relationship with yourself, making better choices becomes a lot easier. The mindset work is really about not guilting or shaming or making up stories about yourself, right? We need to find a way to understand that we’re human and understand that most of us have spent decades to get to where we are, especially when it comes to our addictive patterns. This isn’t going to change in 12 weeks. This isn’t going to change overnight. I’m still learning, growing and finding weak spots that I’m working on. This is six years into my sort of self discovery and healing journey and it’s going to continue onward, because I’m human.That’s okay. I’m always learning and growing and being challenged.

Lindsey Parsons:

That’s one of the first things that I tell people after the first meeting is, I want you to go and watch without judgment, just with curiosity, what you’re doing around food. When you eat sugar, what is going on in you? Just to try and not be judgmental of ourselves for the first time, perhaps, in your life. Because there’s so many people out there who are just beating themselves up every time they eat sugar or every time they overeat. The first piece is to pull out the judgment and just understand.

Danielle Daem:

Yeah, yes! That’s definitely where I start as well. I’m glad you mentioned the word curiousity. That’s a huge focus when I work with my clients too. Curiousity and awareness number one. And also number two, I have to remind everyone about this, our addictive patterns and our unhealthy habits with food are not our fault. It is sick, when you actually do the research and you learn, this world that has been created around us by the food industry, and the pharmaceutical industry and the government, and just all of the way that we have been taught to use food for emotional reasons to you know it’s everywhere, it’s in the media, it’s in false news and studies that have been paid by politicians. There’s a lot of documentaries out there now that are really great, really pointing to some of the injustices that have happened. That’s important for any of you listening who are putting this on you, that there’s something wrong with you. “Why can’t I give up sugar, why can’t I eat healthy, what is wrong with me?” I think we all massively need to take that pressure and blame off of our shoulders because we’ve been raised in a world to use food for every possible emotional reason, to treat ourselves, to show love, we’ve been constantly bombarded with the message “feel bad, eat sugar”. It’s everywhere and it’s been hidden in our food. And there’s so many things that have been out of our control. I often say this: “It’s not your fault, but it is your responsibility if you want to turn the corner and live a long, healthy life.” There’s nothing wrong with us. Ugh! We need to throw that out. It makes me so sad that every woman I meet is going around with this belief that there’s something wrong with me because I can’t get off sugar.

Lindsey Parsons:

Meanwhile every single store you go to, it’s in the checkout aisle at the hardware store.

Danielle Daem:

Right? Why is there a huge candy section here? I want nails and screws! Every restaurant adds it to sauces. It’s just, we’ve become addicted for many reasons and most of them are not our fault, nor were they our choice. This is not a you problem, everybody listening. This is a massive societal problem, which you can do a lot about. You can absolutely take your power back. You can absolutely do this deep healing work that we started talking about. Arm yourself with this beautiful knowledge from this podcast and actually make changes. There’s so much that you can do. Please know that you’re not powerless, but it is important to take that blame off because that blame is just going to crush you and keep you in the shame cycle. You’re going to stay in the guilt cycle and you’re never going to come out of those patterns if you stay there. There needs to be some self compassion and curiosity is a great place to start.

Lindsey Parsons:

Tell me where people can find you and the break free from sugar program that you host.

Danielle Daem:

My website’s a great place. It’s DanielleDaem.com. You can come and find me on my podcast as well. Lindsey, you’re going to come and be a guest on the “Beyond Sugar Freedom Podcast.” That’s probably the best space to connect with me. I’m on Facebook and Instagram as well @DanielleDaem. I put my podcast up on YouTube too. I’m in many areas, but I’d say my website and podcasts are probably the best places to start if you want to start diving deeper into your relationship with food, your relationship with sugar and dive into some of those inner pieces that we touched on today.

Lindsey Parsons:

We’ll link to all those in the show notes. How long is the break free from sugar program?

Danielle Daem:

It’s a 10 week program. I’m just in the middle of a run now. I only host it a couple times a year. Actually I haven’t hosted in a year. This is the first time in a year I’ve hosted it, but I have a couple other programs as well that I host. I am going to be hosting it again in 2023 so you can get on the waitlist on my website and definitely check out some of the other resources there.

Lindsey Parsons:

Okay, great. Do you coach individually as well?

Danielle Daem:

I don’t anymore actually. There’s group and then I have a VIP option with my group programs as well for people who want one-on-one sessions in the container group.

Lindsey Parsons:

Thank you so much for sharing your knowledge about sugar and how to get off of it. And I hope some people can check you out and who need help in that area. 

Danielle Daem:

Thank you so much for having me on Lindsey. This was such a great, great conversation. I really enjoyed it and thanks, everyone for listening. I would love to hear from you. Please feel free to reach out and looking forward to having you on my podcast, Lindsey.

If you’re struggling with dysbiosis, diarrhea, constipation, leaky gut, candida, IBS, IBD, or other gut health or all over body problems, you’re welcome to set up a free, 30-minute breakthrough session with me (Lindsey). We’ll talk about what you’ve been going through and I’ll tell you about my 3- and 5- appointment health coaching programs in which I recommend lab tests, educate you on what the results mean and the protocols used by doctors to fix the problems revealed. Or if you’re ready to jump in right away or can just afford one appointment at a time, you can set up an 1-hour consultation with me.

*Product, test and dispensary links are affiliate links for which I’ll receive a commission. Thanks for your support of the podcast and blog by using these links.

Adapted from episode 84 of The Perfect Stool podcast hosted by Lindsey Parsons, EdD with Erin Dunny, a registered dietitian specializing in Integrative Gastroenterology in her online private practice, Blunt Nutrition.

Lindsey: 

So why don’t we start by talking about your gut health issues? I know that your history includes methane SIBO or SIBO-C or what’s now called IMO. And perhaps you can explain those terms and then tell us about your own story.

Erin Dunny, RD: 

Absolutely, I never started out being a beacon of health. Nutrition wasn’t really on the top of my mind. I actually started out in communications and public relations. I was very overweight. As a child, I grew up basically eating pop tarts on the way to school. In college, it kind of caught up with me and I started having a lot of abdominal symptoms. I couldn’t eat anything without feeling nauseous, I probably lost about 75 pounds in a month. At that time, I went to multiple doctors, and they found out it was actually a gallbladder issue. It wasn’t functioning well. They ended up taking the gallbladder out, which if I would have known what I know now, I probably wouldn’t have gone that route, but it is what it is. Not having a gallbladder created further digestive issues. Personally, I had a really hard time with protein, so I went vegan for about seven years. I couldn’t digest anything else and it’s what I could tolerate at the time. After about seven years, I started getting really bad constipation and abdominal cramps. Anything I ate made me feel incredibly bloated, so I got the whole rundown, EGDs.

Lindsey: 

What’s an EGD?

Erin Dunny, RD: 

I had an endoscope (the tube that goes down to look at the stomach). I got colonoscopies. In a roundabout way I was diagnosed with irritable bowel syndrome, which basically is a diagnosis of symptoms. It’s not an actual diagnosis. It’s sort of a, “We don’t know you have these symptoms. So we’re going to label you with this, right?” So I decided that I just couldn’t take it anymore. I wanted to figure it out. I went actually back to school and that’s when I got my degree in dietetics. Next, I started working for a gym that introduced me to more of the functional medicine. The more I looked into it, I discovered small intestinal bacterial overgrowth. I got tested and I actually had hydrogen sulfide of small intestinal overgrowth. So I treated myself for that, and was able to become fully recovered, which is how I became passionate about just helping women in general managing IBS, which about 84% of the time, SIBO is a major contributor.

Lindsey: 

It’s interesting that you had hydrogen sulfide SIBO, because I associate that normally with a high meat-fat diet. Although, I guess if you did not have a gallbladder, you probably weren’t digesting fats terribly well.

Erin Dunny, RD: 

I was not. It’s always kind of an anomaly, but likely without a gallbladder, like you said, you can’t do fat.

Lindsey: 

Right. And you were eating dairy?

Erin Dunny, RD: 

Yes.

Lindsey: 

Okay, that makes sense, then. So because you’ve had your gallbladder out, I’m curious how you support your digestion now, and your protein digestion, and how you would support a client’s digestion of fats without a gallbladder?

Erin Dunny, RD: 

Yeah, so the one of the recommendations out there is ox bile. That one is very, very popular and works well for people. Personally, I couldn’t really tolerate ox bile. It would cause really bad diarrhea. I use digestive bitters. I do a couple of drops before every meal. That’s where I support, from a digestive standpoint, from the fat standpoint, but as far as the proteins, I don’t need that much support anymore. Once I worked on the gut and got everything healed up, those enzymes came back. Originally, I did have to start with a broad spectrum digestive enzyme. I also had to do a hydrochloric acid/pepsin combination in order to get my stomach acid backup as well. I remained on that treatment for a little while until I could get everything healed up and ready to go. I was able to move off of it, so now I only have to support with the bitters.

Lindsey: 

Were you seeing a functional medicine person then when you got diagnosed with hydrogen sulfide SIBO.

Erin Dunny, RD:  

I actually, believe it or not, wasn’t, but my doctor, (my PCP at the time) was more in the functional medicine space, so she worked with a naturopath. They were actually doing the testing in office and she consulted with the naturopath at the time. So in a roundabout way, technically I was.

Lindsey: 

And how many years ago was that?

Erin Dunny, RD: 

Oh man, I think probably 10 or 15 years ago now. It was a little while ago.

Lindsey: 

So I’m thinking maybe you had hydrogen SIBO, not hydrogen sulfide, because hydrogen sulfide testing has only been around for like, three years. Yeah. I mean, honestly, it was at the time where they just started introducing it. It wasn’t yet super reliable over whatever they were doing anyways, so I think they were just guessing, and it ended up working. Obviously, we know a lot more about it now, but back at the time, when I was being treated, there wasn’t a lot out there. So they were kind of like, “Here, try this.” Oh, okay. Well, I did want to focus on SIBO-C, or constipation SIBO or IMO (intestinal methanogen overgrowth) today. I wondered if you could tell me first of all, do you see a lot of patients with that?

Erin Dunny, RD: 

Yeah, absolutely. A lot of times, constipation is more of a different kind of beast in and of itself, even to the extent where they’re thinking about renaming it. When we’re looking at methanogen dominant SIBO, the species or the organism is actually an archaea. It’s not even a bacteria, so I feel like the name is kind of misleading (which is why they’re looking at renaming it). So because we’re looking at a different type of species, if you will, we’re looking at a different treatment method. This is what happens: we have archaea in the body. It’s not anything foreign. Our small intestine is very sterile. There’s not supposed to be a lot of stuff in there. These little guys can get an overgrowth either in the large intestine, or the small intestine, and it starts creating issues.

Lindsey: 

Right. Yeah, I guess that’s another reason to call it IMO, rather than SIBO-C is because it’s not just SIBO (small intestine bacterial overgrowth). It could be a large intestine methanogen issue.

Erin Dunny, RD: 

When you’re looking at a methanogen dominant [SIBO], there’s a couple of things to consider. One, you want to potentially test for other things. You might not only have that methanogen. You might have a yeast, you might have a fungus or you might have a parasite. Double check and make sure that that’s not the only thing contributing to the symptoms. From there, where you start with as far as treatment, you need kind of a broad spectrum of herbals. You want to rotate them a little bit just to prevent any sort of resistance. With methane dominant, specifically, some of the herbals that work really while are going to be your oregano oil, which is very popular to use for that. Allicin, which is coming from garlic, has been known to really help absorb that methane, and pairing with maybe a neem oil or berberine. Your primaries are going to be your oregano oil and your Allicin. You can then add a supportive, but I mean, really, everybody responds to herbals differently. Another thing that you can potentially use is Atrantil*. It has a peppermint oil, so it can help with some of the abdominal symptoms. Other things that have been shown to work really well for methane specifically, monolaurin can help. There’s also probiotics, which is very controversial as far as a treatment method. However, Lactobacillus plantarum* has been shown to work really well for methane or like a spore based, so as long as you don’t have an overgrowth in the large intestine, it kind of bypasses that. Those are just some of the options that you’re looking at as far as treatment and like I said, everybody is going to respond differently. You don’t use all of these. It’s just you have different things to manipulate based on how somebody responds. As far as length of treatment, it’s going to be different for everybody as well. Usually anywhere from two to three months is possible – just for the killing off phase, if you will.  Exactly.

Lindsey: 

What do you do for patients with this? With hydrogen SIBO. I see clients respond pretty quickly once you start to give them the antimicrobials Do you see the same thing with methane SIBO or does it seem to take a lot longer to begin to notice an effect?

Erin Dunny, RD: 

It seems to take a little bit longer in my experience, and I don’t know if that’s the same for you as well. They’re just pesky little guys and it’s also possible because archaea feed off of hydrogen. It’s possible that you could have some bacterial overgrowth that are producing the hydrogen and it’s feeding the methane. You have to potentially kill both, which is also going to take a little bit longer as well.

Lindsey: 

Right. It’s sort of a vicious cycle, right? You’ve got to kill the food source as well as the archaea. Do you have a product that you like?

Erin Dunny, RD: 

Yeah, I really like Allimax* (find in my Fullscript dispensary) I use that primarily. It’s a good product, and I really haven’t had a lot of issues with it.

Lindsey: 

Okay. Do you find though, that the methane SIBO is more intractable than other types of SIBO, just harder to eliminate?

Erin Dunny, RD: 

SIBO, in general has a very, very high reoccurrence rate. It’s essentially like a giant puzzle, because there’s a lot of different factors that can trigger the progression of it. Not only do you have to kill it off, but you also have to figure out that root cause on how it got there in the first place. A lot of times, we’re looking at motility issues as well. We’re looking at low stomach acid; we’re looking at low pancreatic enzymes. If you have a history of abdominal surgery, that can cause issues, medication use. So depending on what that root cause is, how long you’ve had it and how severe the motility issues are, it definitely can make things harder as well.

Lindsey: 

Do you use breath testing? Or do you do stool testing? Or both?

Erin Dunny, RD: 

I primarily do stool testing. But I also go through Vibrant Labs. I actually do the testing for cytolethal distending toxin B. So what is that, basically? A lot of times when people get SIBO, it can be from food poisoning. When you get food poisoning, which is very, very common, (it could be you don’t even know you have it), the bacteria is going to produce this toxin. We’ll just call it CdtB. That toxin is going to start attacking a part of your digestion called vinculin. Vinculin basically regulates your migrating motor complex. I’m using a lot of big words. What does that mean? Basically, that migrating motor complex, you can consider it the Roomba of your digestive track. Every 90 to 120 minutes, as long as you’re not eating, this migrating motor complex is going to create a wave; it’s going to take all of that debris sitting in your stomach and wipe it out. It’s kind of like that Roomba going through and cleaning any debris that’s on your floor. So what happens is, if you get damage to the vinculin, then that’s going to make it to where your body is not scrubbing out that debris, so it’s just sitting there and it’s creating this breeding ground for bacteria, archaea, all of that to feed off. I tend to test that as opposed to doing the breath testing just because it’s another measurable way to detect whether or not SIBO is present. You can use that with the stool tests to figure out whether we’re dealing with some SIBO.

Lindsey: 

Does Vibrant Labs have that marker then?

Erin Dunny, RD: 

Yes.

Lindsey: 

Okay, because I’ve used the IBSsmart that has the anti-vinculin antibodies and the anti-CdtB antibodies, which incidentally, I have elevated. I have post infectious IBS, essentially. I didn’t realize that Vibrant Labs was but I can’t access their tests because they don’t let health coaches order them [Note – I can now through my new Rupa Health account]. So you mentioned rotating, tell me about how you rotate.

Erin Dunny, RD: 

Gotcha. Yeah. As far as the supplements?

Lindsey: 

Herbals, yes.

Erin Dunny, RD: 

So I typically will start somebody out with a Candibactin AR and BR* (find in my Wellevate Dispensary), just because I like that it’s a broad spectrum. Plus, I find that your oregano oils, it’s just very potent. Typically, I don’t necessarily like to use that right away because also that die off reaction can be very intense for people. Sometimes people tolerate the Candibactin AR and BR* just fine. We might just do a little bit longer with that. If that’s not working, that’s where I then will do the heavy hitters like the oregano oil. The other thing to consider with oregano oil is just double checking and making sure that people are getting the enteric coated; because, if it’s not enteric coated, it’s just going to go in your stomach. That’s not going to help anything either. That’s typically how I would do it and I would just keep people potentially on the oregano, potentially throwing in that neem or the monolaurin. Keep them on a little bit longer. The other thing I didn’t mention is berberine. Berberine is also another one, although that specifically responds a little bit better to diarrhea and the berberine is nice because it does have a little bit of a biofilm disrupter. If you need something to kill that protective shield that some of the bacteria can have, or archaea can have, that’s nice, but it’s also if you have a fungal overgrowth or some sort of yeast, the berberine is going to help with that as well.

Lindsey: 

Right, right. So when you say rotating, I was thinking you meant short term rotations. I’ve heard of practitioners using four day rotations, but you’re talking more like six week rotations?

Erin Dunny, RD: 

Exactly, I don’t rotate that much. If somebody’s not responding, that’s where I’ll add some of these other things. So, you’re not necessarily changing too much. You’re kind of using the same thing. You’re just playing around with the dosages and also adding some of these other supplements to see if they might respond better to that.

Lindsey: 

Yeah. And have you found that some people need to stay on something long term? That it comes back so quickly, you just have to keep them on it.

Erin Dunny, RD: 

Yeah. So typically, with the right dosages, I like to have people test every three months and I think that’s another thing that I see. At the end of the day, I know it’s a hard investment for people to make, so they don’t necessarily want to retest. I know a lot of practitioners out there are saying, “Okay, well your symptoms are at 90%. We don’t have to retest.” That’s why I like testing the endotoxin that we talked about in the vinculin because it’s a way to see if we are making progress. I think that because most of the protocols are only around six weeks. Herbal people are feeling better and they go off of it. They get the reoccurrence because they didn’t retest to ensure that it was completely gone. So the question is, “Is there a high reoccurrence rate because it’s really hard to kill? Or is there a high recurrence rate because people aren’t retesting?” Ideally want to test at three months and at six months, and make sure that it’s 100% gone. And then getting into more of the supportive measures where we talked about including some herbals, to support that migrating motor complex to make sure that you’re getting that motility and getting things pushed out. To support that migrating motor complex, you’re going to be on six months to a year. That’s a little bit longer term than the initial kill off, if you will.

Lindsey: 

And are you keeping people on antimicrobials up through the testing then?

Erin Dunny, RD: 

Ideally, yes, because I don’t want to stop treatment until I know it’s gone.

Lindsey: 

Interesting. Are you retesting with the full stool test or full vibrant labs with the antibodies? What are you retesting, just the antibodies?

Erin Dunny, RD: 

Just the antibodies because it’s a lot cheaper to do that. it’s nice, because you can just pick that one and just retest that.

Lindsey: 

And you see those numbers come down on the antibodies after treatment?

Erin Dunny, RD: 

Absolutely.

Lindsey: 

Okay. I never I never actually thought to retest the antibodies. That’s an interesting technique. Do you find that people with IMO or SIBO-C have worse bloating? Are they in more pain? They seem to be just more uncomfortable than people with hydrogen SIBO?

Erin Dunny, RD: 

Yeah, absolutely. If you think about it, bacteria kind of sit and feed off of the stool, right. If it’s just sitting there and not going anywhere, basically, it’s full on feeding ground, where when they are eating the food that’s essentially just sitting there for them. They produce so much gas, and methane gas is so uncomfortable.

Lindsey: 

I’m curious because obviously, if you’re looking at an elevated CdtB antibody, you could be dealing with any type of SIBO, so are you basically judging on the this is a constipated person versus this is a person with diarrhea at that point to decide? Often I’ve discovered that when I look at stool tests for methane, I see the presence of the archaea, but I don’t necessarily see that it’s elevated. It doesn’t show as elevated.

Erin Dunny, RD: 

Vibrant Labs’ stool panel is very, very comprehensive. They have the archaea, they have. They have the Methanobrevibacter smithii. Yeah, it might not necessarily be high, but you can tell based off of the symptoms as well where they’re at. I would say, just in my clinical practice between those two, I’ve had really good results to where I haven’t really had to do the breath test. The breath tests, you can argue back and forth, are not always going to be accurate either. In my experience, just using those two markers has been enough to say, “Okay, this is what you have.”

Lindsey: 

I do find though that when you get somebody with H. pylori sometimes you get this overlap with H. Pylori and the methane SIBO and they both cause constipation. Now you’re not quite sure which one you’re dealing with and you deal with the H. Pylori,  I feel like sometimes that might cause the methane to overgrow, because you’re killing off bacteria that respond to the mastic gum, perhaps, but those aren’t the archaea.

Erin Dunny, RD: 

Exactly, and like you said, H. pylori itself can produce methane as well. If you have both, you’re getting just doubled up on the methane and yeah, that’s real uncomfortable.

Lindsey: 

Okay, I didn’t realize that H. pylori was a methane producer.  So I understand that your history also includes a severe case of COVID with complications. So can you tell me more about that story?

Erin Dunny, RD: 

Yeah, my digestive health has been real fun. There was a series of events leading up to it. To kind of backtrack a little bit: I had knee surgery in November. I was out for a little bit with that. In December, my husband brought home what felt like the world’s worst stomach bug in the world. I don’t even know where this thing came from, but he’s a grown man literally, keeled over on the floor with such bad body aches he couldn’t even move. So he recovered from that in about 24 hours, but my son who was three at the time – what can happen after a stomach infection, which we learned, the lymph nodes in your stomach can swell. He ended up being sick for a month. He threw up between 2 and 3 a.m., every single night for a month with severe body aches. Needless to say, I was under a very large amount of stress for a good three months at that time. I say that because it’s important leading up to the COVID situation and why I got it so bad. It took about a month for my son to get better and when I say he threw up every night for a month, he threw up every night for a month; it was insane. Two days later, I was going to go back to work, but we got COVID. My husband got it from work and didn’t know. They were fine. During the actual COVID, I was fine. I just had a little bit of body aches, but a couple of weeks later, I would start waking up in the middle of the night. My heart rate then would be 150 beats per minute, which if you ever wake up in the middle of the night with your heart rate that high, I will tell you, it’s terrifying. You’re from a dead sleep, you don’t even know what’s going on. So that would actually happen a few times. I would just be sitting on the couch and my heart rate would just jump up or my right left arm was starting to get numb. Sometimes starting from my chest, it felt like lava started to flow through my body. Needless to say, that shouldn’t happen to an individual. I contacted my primary care physician. Because I had COVID, they wouldn’t see me in office, even though I was two weeks out, I wasn’t contagious anymore. They wouldn’t see me. I would go to urgent care and they couldn’t really help me. They found me a new PCP. That PCP was like, “Well, have you’ve had a lot of stress lately and so it’s silent anxiety.” He just wanted to give me Lexapro and sent me on my merry way. It kept getting worse and worse. I went back. I went to the ER, because all my heart blood markers were fine, they’re said, “We can’t do anything for you.” They just labeled me long haul or COVID and sent me home. I went back to my PCP and he changed his story to, “Well, you’re a COVID long hauler,” and just gave me a steroid injection. In a two-week time span went to the ER four times, as it was getting worse and worse. They kept sending me home, like to a point that a nurse came in saying, “I don’t know why you’re here, we’re not going to do anything for you.” For a time, I was literally begging and pleading for my life and saying, “Something is wrong, do not send me home.” Luckily they admitted me. So I ended up in the hospital for about three days, I ended up with myocarditis, which is an inflammation of your heart, I had a small scar on my heart, as well. So that’s where the irregular heartbeats were coming from. I developed a massive stomach ulcer that actually was about to puncture if they hadn’t seen it. First moral of the story: you know, something’s wrong, advocate for yourself. Don’t just say, “I’m just gonna go home and live with it.” Second moral of the story: So I started diving into the literature and come to find out COVID can actually cause a lot of stomach issues. Part of that is because COVID impacts ACE-2 receptors and that’s how it gets into the body. Basically, you have ACE-2 receptors in the lungs, which is causing all the lung issues in the heart, your heart is lined with those. However, your intestinal tract has a bunch of them. You have them in your stomach, you have them in your small intestine, you have them in your large intestine. What we’re starting to see is that one can cause ulcers. A combination between high-stress medications, because I mean, at the end of the day, when your heart is going nuts, I’m going to do whatever they want me to do, because it’s incredibly scary. You’re getting residual impacts, because of that, the steroid use and things like that. So one, COVID is causing ulcers due to the medications and treatments. The other thing that it’s causing is intestinal permeability, because it’s breaking down that lining of the stomach that’s supposed to be blocking out things. You can look at your intestinal tract like a cheesecloth, it’s supposed to keep out the the bad things and only let certain amount of things in. Basically, COVID can cause these little holes or bigger holes in the cheesecloth. What’s happening is you’re getting these proteins and other things into the body that are not supposed to be there. It’s causing this incredibly large inflammatory response and that can create digestive issues like bloating, constipation. You can get postinfectious –  they’re looking at postinfectious COVID now – triggering IBS. Lastly, it can create dysbiosis as well. So you’re getting some bacterial imbalances in there as well. I did run the Zoomer on myself and actually confirmed all of these things. I had leaky gut, I had my secretory IgA, which if it’s low, your immune system is going to be crap, that was low. I did all the research and ran the panel, and my results lined up perfectly for that. Yeah, it was really cool/not cool for me, but it was cool that it basically confirmed I had intestinal permeability which lined up perfectly with the research.

Lindsey: 

So what did you do for yourself?

Erin Dunny, RD: 

Yeah, great question. So in my particular case, I had to bite the bullet and I did have to take a PPI for a couple of months. I did a couple different things. I did the mastic gum, I did a GI microbial. I did licorice root. I did Aloe – literally none of that worked.

Lindsey: 

Did you have H. Pylori too?

Erin Dunny, RD: 

No.

Lindsey: 

Okay, yeah.

Erin Dunny, RD: 

When I was in the hospital because they did check that, they biopsied it. I didn’t have H. Pylori or anything like that, and I had no other risk factors. I was a little frustrated because none of these things worked. So really, the PPI was the only thing. I did the standard leaky gut profile. I did a combination of EPA DHA. For my anti-inflammatory, curcumin, I did as an anti-inflammatory. Berberine actually can really help support the mucosal tissue and start regenerating that. L glutamine – I did that, vitamin C and zinc. I also did a little bit of magnesium, because I think because with COVID, your adrenals are impacted with that. If your adrenals are taxed out, which given the series, I was very stressed out obviously. So I needed to do some sort of support there as well, because if your adrenals are taxed out, your immune system is low, and it’s going to be harder to manage the gut. The gut isn’t going to heal as fast because you just don’t have the capacity. So I did add some of that in as well.

Lindsey: 

How long did it take you to recover from all that?

Erin Dunny, RD:  

I would say I’m at 90% right now. So about seven months, a long time.

Lindsey: 

And did you have fatigue?

Erin Dunny, RD: 

For probably about six weeks, I could only handle walking to the end of my driveway and back.

Lindsey: 

Wow. Did you did you use any L-arginine?

Erin Dunny, RD: 

I did not.

Lindsey: 

Oh, yeah. That’s what I’ve heard for the blood vessel impacts that happen. What did they do for your heart, though?

Erin Dunny, RD: 

For the heart stuff, I just was put on Metaprolol. I am on that basically until we are confirming that the inflammation is gone. After that, I’ll wean off of it, but it’s just one of those things where I think sometimes it’s hard in functional medicine. You really don’t want to take medications and you almost go too far the other way, where sometimes you need to do a combination of the two, but it can’t be all or nothing. I think is hard is that sometimes it’s either doing all herbals or you’re doing medication, and then there’s this argument between, but really I found some good results doing a combination of both.

Lindsey: 

I wouldn’t goof around with like a heart problem. It’s one thing to take herbals for your diarrhea or constipation; it’s a whole nother thing when your heart is at risk. I’ll take what the doctor said.

Erin Dunny, RD: 

Exactly. There are some things that you need to concede on. That’s definitely one of them. No, I mean, I am just so honored to have the opportunity to come on. And I think I really enjoyed having the opportunity even to talk about the COVID stuff, because I feel like it’s really not talked about a lot. And the more I see people and the more I  work with them, I’m finding that it’s really becoming a huge issue having so many digestive issues post COVID. So I think the biggest takeaway I want to let people know even from my experience, and through all of this is that it’s never in your head. You’re not making stuff up. You know your body best. If you’re not finding results from one person, keep finding and I think that there’s something to be said about using functional medicine along with conventional medicine. The two can definitely work together. It doesn’t have to be this either or situation. I think just  looking at your care team and making sure that you have some good people behind you to help figure this out. You don’t have to do it alone and these conditions are very complicated. There are a lot of layers to it and I think it helps working with practitioners, both in the functional medicine and conventional space to help you kind of deep dive into what’s going on specific for you and figure out the best plan of attack based on what’s going on.

Lindsey: 

Well, all that is very interesting and I appreciate hearing about your story. Anything else you want to share before we get off? Yeah, yeah. No I do and have heard and do know from my own experience, that if you have existing gut issues, that COVID is likely to give you gastrointestinal symptoms. You definitely want to get your gut in order, because COVID is still circulating and, you’re much better off if you have healthy gut – that and good vitamin D levels

Erin Dunny, RD: 

Absolutely and get off those PPIs if you can. Like I said, if you need it you need it; one study I even looked at COVID becomes inactivated with a stomach pH of less than two. So you really do need that stomach acid as another layer of defense to basically increase your chances of not having a severe outcome. Think about how many people are on PPIs right now. COVID isn’t going away. It’s going to be living with us. Not to sound like doomsday, but we’re going to have other viruses that are coming out. If you look at history, we have one coming out every two to three years. So we just need to make sure that we are supporting the gut because that’s a huge part of our immune system. That’s 70 to 80%. We just need to make sure that that’s intact, so when the next thing comes, we’re strong, and we’re going to be able to fight that off as well. Tell me where people can find you. You can find me in all the places for the most part – Facebook and Instagram. I also encourage you to go to my website, Bluntnutrition.com. I have a blog on there, so if you want to learn more about topics surrounding IBS, right now, I’m writing a series specifically about COVID and its impact the gut. If you’re interested, hop on over. Join my email list. I have a nice little freebie on there – a roadmap to becoming symptom for IBS. That will get you on my email list, so you get some exclusive content every month as well. Just other nutrition tidbits and other little goodies with that.

If you’re struggling with IMO, constipation or other gut health or all over body problems, you’re welcome to set up a free, 30-minute breakthrough session with me (Lindsey). We’ll talk about what you’ve been going through and I’ll tell you about my 3- and 5- appointment health coaching programs in which I recommend lab tests, educate you on what the results mean and the protocols used by doctors to fix the problems revealed. Or if you’re ready to jump in right away or can just afford one appointment at a time, you can set up an 1-hour consultation with me.

*Product, test and dispensary links are affiliate links for which I’ll receive a commission. Thanks for your support of the podcast and blog by using these links.

Adapted from episode 83 of The Perfect Stool podcast hosted by Lindsey Parsons, EdD and edited for readability.

What is SIBO (Small Intestine Bacterial Overgrowth) and how does it relate to IBS?

There are 1-10 trillion bacteria in our intestinal tract and most of them can be found in the colon or large intestine. These bacteria take care of the final breakdown of food into a form where it can be absorbed into the body for nutrients or discarded as waste. These bacteria play a critical role in maintaining health throughout the body.

The small intestine normally contains far less bacteria compared to the large intestine. SIBO (small intestine bacterial overgrowth) occurs when the bacteria in your small intestine become unbalanced and overgrow. SIBO can damage the intestinal lining, leading to leaky gut, which can cause further health complications. For example, an imbalance in bacteria could lead to nutrient malabsorption, which causes you to get sick from a lack of vital nutrients, or histamine reactions, which surface as food sensitivities. If untreated, SIBO has the potential to snowball into even worse health conditions.

Typical SIBO symptoms include bloating, gas, diarrhea, soft stool, constipation or a mix of diarrhea and constipation, burping, abdominal pain or cramps, food intolerances, B12 and iron deficiencies, fat malabsorption, and if left untreated long enough, autoimmune diseases, skin disorders or systemic diseases like fibromyalgia or chronic fatigue syndrome. SIBO is broken into three types – SIBO-D or diarrhea, which is not exclusively diarrhea, it can just be soft, messy stool, which may or may not be very frequent. This is caused by either excess hydrogen or hydrogen sulfide producing bacteria. Then SIBO-C for constipation, also known now as IMO or intestinal methanogen overgrowth, which is not necessarily in the small intestine but can be throughout and may be more a question of dysbiosis, or an imbalance of bacteria and methanogens, which are archaea, a different kingdom of microorganisms, rather than an overgrowth, per se. Methanobrevibacter smithii is the primary and most well-known methanogen, meaning methane producer. And then SIBO-M or mixed, which may have some constipation and diarrhea, sometimes because you have breakthrough diarrhea when constipated, or because as your diet, eating habits or underlying root causes change, things shift back and forth in your intestines. About 70-80% of what’s called Irritable Bowel Syndrome, basically a diagnosis of exclusion, is caused by SIBO, so I think of them almost synonymously.

What causes SIBO or IBS?

There are a range of possible root causes of SIBO/IBS, some of which can lead to recurrent SIBO if not addressed. Some relate to impaired digestion – such as low stomach acid or hypochlorhydria, which is important for breaking proteins into amino acids, or a lack of pancreatic or brush border enzymes (which can come from celiac disease). Enzymes help digest all types of foods so undigested food can serve as fuel for bacterial overgrowth.  Other potential causes are low secretory IgA, your gut immune defense system (which can follow from chronic stress) or poor bile flow, which is essential for digesting fats. Of course if you’ve had your gallbladder taken out, which stores the bile produced by your liver, then you can assume you have insufficient bile. Medications such as opiates, narcotics, antidepressants, proton pump inhibitors, cholestyramine, antibiotics and antispasmodics can also cause SIBO or IBS-like symptoms. Then there are physical issues like Ehlers-Danlos Syndrome, adhesions from abdominal surgery, endometriosis, and ileocecal value dysfunction that can cause SIBO. Then there are environmental causes like mold toxicity and other health conditions like diabetes, pre-diabetes, hypothyroidism and traumatic brain injuries that can be at the root of SIBO symptoms. Then what I suspect is the most common cause – an autoimmune dysfunction caused by an episode of food poisoning that impacts the migrating motor complex is the final cause, and this one will definitely cause recurrent SIBO. This is what’s called post-infectious IBS and is the reason I personally have recurrent SIBO.

Testing for SIBO

You can get tested for SIBO either using a breath test, there are a number of hydrogen or methane breath tests out there for SIBO, or test for all three possible gases, including hydrogen sulfide, with the triosmart test, the only one that includes hydrogen sulfide currently. Or stool tests like the GI Map or GI Effects can also point to the presence of SIBO in conjunction with symptoms, when you see many elevated opportunistic bacterial markers or even elevated commensal or good bacteria markers. And you can also see whether certain bacteria associated with different types of SIBO are present or elevated, such as Desulfibrio piger, Bilophila wadsworthia or Fusobacteria for Hydrogen sulfide SIBO or Methanobrevibacter smithii for IMO.

Treating SIBO

So the first round treatments for SIBO are either herbal antimicrobials or rifaximin (the generic name of Xifaxan®),  a very expensive antibiotic that only impacts the gastrointestinal tract. And for people with methane-dominant SIBO, the antibiotic neomycin is often prescribed as well. I ended up taking a round of rifiximin, which was 2 weeks long at 3 pills a day after I didn’t feel that herbal antimicrobials had done the trick for me (this was years ago and I have since taken different herbal antimicrobials that have worked better for me). The main drawback to rifaximin is that it will only kill bacteria. And many people I see have an overgrowth of candida (a yeast that’s a normal part of our digestive system) as well from a history of antibiotic use, or from the same root causes that caused SIBO. And while the herbals kill both yeast and bacteria, rifaximin only kills bacteria, which then offers yeast an opportunity to overgrow or overgrow even further.

I should also mention elemental and semi-elemental diets. When all else fails, this is another route for dealing with SIBO that has shown good success. These are liquid diets of predigested nutrients, which seem to work equally well, with the semi-elemental being a bit more palatable than the elemental diet. One study in 2004 of a prescription elemental diet on 93 patients showed a SIBO lactulose breath test normalizing after 2 weeks for 80% of subjects, and 85% by three weeks, with a 65% improvement of IBS symptoms at 2 weeks. But since this requires you eating no real food for 2-3 weeks, I don’t think of it as a first line option, as that doesn’t sound like much fun to most people.

There is also good evidence supporting the use of probiotics in SIBO, but since this is controversial and debated, I’m not going to go too far into the topic right now.

Lifestyle Factors in Preventing SIBO Recurrence

If you’re going the route of antimicrobials, in conjunction with taking them, there are other things you can do to ensure success and prevent recurrence. First, making sure that you’re observing good meal hygiene: trying to eat in a relaxed parasympathetic, or rest and digest state, not while stressed out, working, at the computer, on the run, etc. This will help your body produce the stomach acid and enzymes it needs to digest properly. A minute of 5-5-7 breaths (5 in, hold for 5, 7 out) can help bring you into this state prior to eating if you sense you’re in a stressed state. And then maintaining this parasympathetic state while digesting, which can range from 30 minutes to 4 hours, depending on the size or your meal. Then chewing each bite very well, like 25 times well. And they say not drinking too much liquid with meals, but this is something I struggle with, but you can experiment with that and see if it’s helpful.

Second, not snacking between meals, and spacing your meals out to every 4 to 6 hours. The migrating motor complex stimulates peristalsis, which is how your body moves food and bacteria through your digestive system. When you’re in a fasted state, specifically, when there is no more food in the duodenum, or the first section of the small intestine, it secretes motilin, which starts off the peristaltic wave, emptying out your intestines. This helps clean out bacteria and move them towards the large intestine. This happens generally around 90 minutes after eating but up to 2-3 hours after eating, and lasts around 2 hours. If you’ve heard your stomach gurgling when hungry, what you’re hearing is the migrating motor complex, which is a good thing. If you never hear stomach gurgles, it’s either because you’re eating too frequently, or you have had some disruption to your migrating motor complex.

And then third, trying to have a solid overnight fast of 12, even better 13 hours. Or even longer if you’re trying to lose weight (in 14-16 hour range). This will give your body a good chance to clean out the intestines.

How does my diet impact my SIBO?

And I should mention that with particular types of SIBO, a diet change may be in order. So methane dominant SIBO, or SIBO-C or IMO, tends to occur more in vegetarians and vegans, as the archaea that are dominant in this condition, like Methanobrevibacter smithii, feed on carboyhydrates. And protein sources in vegetarians and vegans, like tofu, beans, lentils, etc. are pretty much all high in carbohydrates. Moving more towards an animal-based diet with higher fats and low in fermentable carbohydrates, like a low fermentation diet or low FODMAP diet is in order. It is possible to do a vegetarian low FODMAP diet, but in my experience, its people on vegan diets who have the most stubborn cases of IMO.

SIBO-D, which is characterized by an excess of hydrogen-producing bacteria, typically responds well to a low FODMAP diet or if you want to get really fancy, a biphasic diet.

And then Hydrogen Sulfide SIBO, which is characterized by an overgrowth of hydrogen sulfide producing bacteria, also presents as diarrhea but with the added benefit of it smelling like sulfur, and often accompanied by visceral sensitivity, which is a lower threshold for pain in your internal organs and excessive flatulence. This is more likely to occur in someone who is on a ketogenic or primarily animal-based diet. So moving more towards a plant-based, low-fat, Mediterranean diet with no dairy but avoiding sulfur-containing vegetables like garlic, leeks, onions, scallions, and shallots and cruciferous vegetables, if they bother you, is recommended in this case.

And sometimes of course there is overlap, because methanogens eat hydrogen, and hydrogen sulfide producers eat hydrogen, so killing off all types of bacteria and/or archaea and their food source (the hydrogen producing bacteria) at once may be necessary to quell the overgrowth.

But note that diet alone will not likely get rid of your SIBO, and all of these diets will result in nutritional deficiencies if followed in the long-term, so doing some other primary treatment while using diet as an adjunct or for symptom relief is generally how I view SIBO diets.

Is my SIBO/IBS autoimmune?

So if you have a history of food poisoning, meaning you’ve ever had unexplained diarrhea, the stomach flu, Montezuma’s revenge or the like, and you’re dealing with ongoing bloating and or diarrhea, you may want to check if your SIBO is autoimmune. And mind you, if you have persistent diarrhea or soft, messy stool, this is also abnormal, it doesn’t have to be full on diarrhea. Autoimmune SIBO almost always tends towards the diarrhea type, rather than the constipation type. It starts because your body starts attacking its own protein, vinculin, that helps with the migrating motor complex, because it ressembles the toxin produced by the offending bacteria – CdtB – Cytolethal Distending Toxin B. So if you’ve succeeded in fixing your problem at least once using antimicrobials, prescription or herbal, and it’s come back, it’s time to determine whether your underlying cause may be autoimmune.

If you are constipated, you should also double check that your constipation is not from H pylori, a bacteria that can cause ulcers and stomach cancer, if you have the virulence factors, because it can also cause bloating and constipation. I like the H Pylori profile from Diagnostic Solutions as a simple H pylori test, although the full GI Map is a more thorough test that includes the H pylori profile and the virulence factors. And don’t assume you don’t have H pylori because your doctor tested you on an endoscopy. They miss it all the time.

So to check for autoimmune SIBO/IBS, there is a test called the ibssmart test that will tell you. It’s $199 and you can order it yourself online from the US. They even show some international distribution of it now as well on their web site but that may require a doctor’s prescription. It will show if your antibodies to vinculin and cdtB are elevated. If vinculin is elevated, you’ll probably have a lifetime battle with SIBO. Then the steps above I mentioned regarding meal hygiene and timing are especially important for you. In addition, you will likely want to start trying prokinetic, or small intestine motility agents, to help your migrating motor complex do its job. I’ll go into those more in a moment.

If your ibssmart test is negative, but are seeing SIBO recur, you may have some other underlying condition that’s at the root of it your symptoms. Some obvious ones are your prescription medications – check their list of side effects and wean off them as directed by your doctor to see if that will impact you. Another is hypothyroidism that isn’t properly addressed with thyroid medications and/or autoimmune reversal protocols for Hashimoto’s thyroiditis. Another common one, blood sugar dysregulation can cause IBS symptoms. If you know that you’re prediabetic or diabetic and do not have your blood sugar under control, then getting completely off sugar and simple carbs, reducing carb intake to 100 grams/day, including protein and healthy fats at every meal and if you’re having any snacks, and including some intermittent fasting in your days or weeks are first steps to reversing that and getting things under control. And of course seeing your doctor and getting prescription medications as necessary. Or a traumatic brain injury or a mental health trauma that’s causing vagus nerve dysfunction could be at the root. If you have a traumatic brain injury or history of concussion, check out my episode 73 with Dr. Corey Deacon, Head Injuries, IBS, SIBO and the Gut-Brain Connection. If you have a serious history of trauma and also experience depression, I’d check out the book Accessing the Healing Power of the Vagus Nerve by Stanley Rosenberg. And if you have endometriosis, or adhesions from abdominal surgery, visceral massage, hormone based treatment, or surgery may be necessary to address it.

Prokinetics for Recurrent SIBO

If you determine that your SIBO is or will be recurrent, one of the best things you can do is take a prokinetic before bed or possible between meals as well. There are some prescription ones, which would require a very SIBO-informed gastroenterologist to prescribe. These include Prucalipride which is the generic name of Motegrity at ½ mg/day, which you get by cutting a pill in half, low dose erythromycin, which is 50 mg, or low dose Naltrexone, which is also often used for autoimmune conditions in doses ranging from 2.5 mg to 5 mg, usually more for constipation. There are actually services online for prescribing low dose Naltrexone where you can talk to a doctor virtually and then get a prescription.

Then in terms of over the counter prokinetics, there’s Iberogast*, which is used before bed, 30-60 drops. It’s a combo herbal product. And then there’s GI Motility Complex (find in my Fullscript Dispensary*), which contains a formulation called ProDigest, which is a combo of ginger that’s formulated to not produce that ginger burn effect but helps with small intestinal motility and artichoke extract, which helps with stomach emptying) and apple cider vinegar powder. Then there are a few more formulations like Motility Activator, MotilPro, Prokine, SIBO MCC (find all in my Fullscript Dispensary*) and Bio.Revive Kinetic. Some of these have 5-HTP which is not just good for your intestinal motility, because it’s a precursor to serotonin, most of which is made in your gut and helps move the intestines, but also good for your mental health, because serotonin is your feel good neurotransmitter which helps for anxiety and depression. These may be more helpful for people with IMO or SIBO-C. And the last one I mentioned, Bio.Revive Kinetic is sold in the UK, not sure about the U.S. has some of the ingredients of the ayurvedic preparation triphala, which is known to be good for constipation in particular.

What to do when my SIBO comes back?

So say you’ve gotten rid of your SIBO and you’re taking your prokinetic but then you notice the telltale bloating, soft stool, diarrhea, or constipation coming back. What to do?

Well you might start by increasing the dose or frequency of your prokinetic. I take mine before bed, but you could also take it between meals. Or you could try a different prokinetic. But if things get back to where they were, then you will probably want to take another course of antimicrobials. I have also seen clients who just give themselves ongoing small doses of antimicrobials on a daily or every 2-3 day basis. For this I’ve heard of them using products like oregano oil or Biocidin drops (find in my Fullscript Dispensary*). Of course the danger with any single agent like oregano oil, is that the bacteria could become resistant to it, as I know that this can happen when treating yeast with oregano oil.

But recurrent SIBO has been my story for years now since I am positive for the antibody to vinculin, which is a protein essential to the functioning of the migrating motor complex, which is what the ibssmart test tests for, so I pretty much have gone the route of just taking another course of antimicrobials whenever things get bad again. But before I do that, I try to curtail snacking, eat a clean diet, stop eating dessert before bed (yeah, I know you probably think because I’m a gut health coach I’d follow my own advice but we’re human right, and I get lazy and self-indulgent like everyone else). But if that doesn’t work, then I know it’s just time to kill off more bacteria.

So if you’re struggling with ongoing bloating, constipation, diarrhea, soft stool, etc. and want to get to the bottom of it, that’s what I help my clients with. You’re welcome to set up a free, 30-minute breakthrough session if you think you might like to sign up for a 3 or 5-session package. Or I offer individual consultations as well.

*Product, test and dispensary links are affiliate links for which I’ll receive a commission. Thanks for your support of the podcast and blog by using these links.

Adapted from episode 82 of The Perfect Stool podcast hosted by Lindsey Parsons, EdD with guest Kyrin Dunston, MD, OBGYN, host of the Hormone Prescription Podcast and pioneer of female hormonal justice. After discovering the hidden cause of midlife weight gain and fatigue in women, Kyrin lost a life-changing 100 lbs. and fixed her adrenal issues.  She is fellowship trained in Anti-Aging, Metabolic and Functional Medicine and has practiced this exclusively for over a decade. She is also the founder of Her Hormone Club, an end to end all inclusive membership providing women access to state of the art natural hormone therapy treatment throughout the US and the Midlife Metabolism Institute, providing educational and coaching programs for women at midlife to fix their hormones, their metabolism and their health.

Lindsey: 

Well, of course, as a host of a podcast on hormones, I wanted to start with a general overview of the various hormone systems in the body and how they interact with the gut microbiome. After that, we can dig deeper into some of them.

Kyrin Dunston, MD:

Sure! I always say there are seven main metabolic driving hormones. There are actually hundreds of hormones. Hormone just means chemical messenger. You’ve got many, many of them throughout the body and they’re brothers and sisters to neurotransmitters. They’re a part of your nervous system and most people don’t realize that. The majority of them originate in the brain. It’s just that they travel a long distance through the blood in order to get their message across, whereas neurotransmitters travel a short distance across a neuronal synapse to get their message across, but they’re part of your nervous system. I like to tell people that because most people don’t know that, and it really gives them some perspective.

Even though I went through OB GYN training, and we’re supposed to be the experts on women’s hormones, we were always kind of taught, and hormones were treated as if they were this accessory pack – like women’s hormones, that’s a little accessory pack you women have that confers reproductive capacity on you, right? It’s kind of like that black bag, you take down from the back of your closet when you have to go to the black tie dinner once a year at Christmas. What I discovered is that nothing could be further from the truth. They’re really fundamentally and foundationally a part of who we are as women, and that’s because they’re a part of our nervous system. I like to emphasize that because otherwise, I find that men and women alike relegate hormones to that “other” category. That’s that other thing you have to deal with. No, it’s like you have to deal with your brain cells in your brain. You also have to deal with your neurons.

The seven main metabolic driving hormones, I always say are insulin, thyroid, cortisol, DHEA, estrogen, progesterone and testosterone. They really set the tone for the level of your metabolic rate, how you process the calories, macronutrients that you eat and what you do with them. Do you store them as fat, do you burn them as fuel and your basic biologic processes. Your sleep-wake cycle, your energy level and your weight is a basic biologic process. Most people just think of it as, “I don’t like how I look in the mirror, it’s unwanted fat.” When you really think about it, what is excess fat if not excess fuel storage? Your body has the fuel it needs to operate and your main fuel source is glucose, or sugar. You use that up usually within a few hours until you dip into your stores, which is fat. When you have a weight problem, you have a fuel storage problem. Most people don’t think about it like that. That’s a basic biologic process. If you can’t burn your fuel, then you can’t make energy and the currency of energy in our body is ATP. You’re tired and a lot of times sleep disorders are coupled with that too. These are the things that drive it.

Now how does it interact with the microbiome, which is your thing? Basically, we’re donuts. We have a big hole inside of us and that is our gastrointestinal tract from top to bottom, and the surface area is as large as two doubles tennis courts. And we’re taking the external environment, food, and we are putting it inside of us, seemingly inside of our bodies. But really, that too, is outside of us, even though it’s inside of us. Hopefully that makes sense, kind of like a donut. Our biggest interfaces with the external environment, and one of our body’s main jobs is security. Everybody knows how important security is if you’ve tried to log on to any program on the internet lately or your bank account. Remember how two-factor authentication has become a thing because security can be easily breached on the internet? Well, it’s the same with your gut. Most of your gut lining is only two cell layers thick and you’re taking the external environment and putting it inside this tube in your body, and it’s contacting all this surface area. Security has to be very high and it is at the highest level in your body all along your gastrointestinal tract. There’s something called GALT, Gut Associated Lymphoid Tissue, which is little patches of lymphocytes all along. And your immune system is mostly clustered in your abdominal cavity around the gut, because it is security; it is your body’s military system designed to protect you against foreign invasion.

Now, what does this have to do with your hormones, Kyrin? Well, it has everything to do with your hormones, because your hormones’ number one job is also security and survival. If your body can’t survive, you’re done. Any living thing prioritizes survival and security. You as a human are no different. You’ve got your security system, which is part of your survival system in your gastrointestinal tract, and you’ve also got your adrenal glands right there in the mix on top of your kidneys, which produce cortisol, which is your survival hormone. It works hand in hand with the immune system to balance your hormones. Have you ever heard a woman say, “Oh, I was stressed out and I missed a period.” That is because your body will sacrifice periods. Your body really does consider reproduction an accessory function although the hormones that it uses to create that reproductive cycle are not accessories. They’re vital for many processes – number one I’ll mention is brain function, but it will sacrifice a period and a reproductive cycle for survival and immune system function. That has to do with gut health.

Now, the microbiome, which I’m sure your audience knows very well, represents trillions of bacteria that live in the gastrointestinal tract and are essential for our survival; we’re back to that security and survival. We cannot live without these bugs in our gut and those bugs directly speak to our immune system and indirectly speak to our cortisol stress hormone. They’re really having this three-way conversation. And it’s much bigger than three ways because other hormones are involved and other systems in the body. You’ve got to have the right members in the bug council in the gastrointestinal tract to send the right messages and have the right conversation. If you have abnormal bugs that shouldn’t be there, too many of certain good types, parasites, fungi or other unwanted visitors that are having a very negative conversation, it’s kind of like the UN – there are certain countries and I am not a government expert, but there’s certain countries that aren’t part of United Nations. If they show up speaking in a language no one understands and they don’t really know how the UN operates, it’s going to be a not so nice conversation. It’s the same in your gastrointestinal tract. You need to have enough of the right ones and you don’t want the wrong ones to have the conversation. This directly works with your cortisol. I call her Queen cortisol. She is the queen hormone and she will be served at all costs, because you cannot live without her. Your body will take down all the other systems in order to preserve your survival, reproduction being number one. Your gut health, your microbiome, is directly and intimately involved through your hormones (very much through your cortisol), but we could also talk about estrogen, which I think we’re going to get into. I don’t want to go on too long if you want to interrupt me and ask something else.

Lindsey: 

Yeah, let me let me interject with a question. I’ve actually seen a number of clients with really big gut problems following a period of high stress, but also following steroid medications such as prednisone. I’m wondering if you’ve seen the same or if you understand and can explain the mechanism of how that happens.

Kyrin Dunston, MD:

Oh, yeah. So when we as physicians give people exogenous from the outside corticosteroids, (that’s what cortisol is, and it falls under that category of hormone) it’s because your own cortisol isn’t working properly. We do that for conditions that are usually inflammatory (things like asthma exacerbations). For example, I had an injection in my knee once for bursitis or when I used to have back problems they would inject steroids. Maybe some people have had that or if you get bad bronchitis, they might give you steroids. They’re very common. In fact, I like to say in mainstream medicine, the two drugs of choice are antibiotics and steroids. When in doubt, antibiotics and steroids. But that’s a key indicator that your own queen cortisol is off the job, not doing a good job. Usually, the first places you should look are gut dysfunction and immune system dysfunction, because they’re going to be a part of that.

When you give a human steroids, cortisol or prednisone, or whatever it is, you basically give them a high dose of cortisol higher than their body usually makes. That will serve a few functions. One is anti-inflammatory, and it works to shut down the inflammatory response in the body. Bronchitis, that’s chronic, if you have all that inflammation mucus going on, get a steroid and it cuts down the inflammation because it tells the immune system, “Go have a seat, I’ve got this.” Unfortunately, it also temporarily shuts down your own cortisol production. You were saying that they have problems after this. What’s the mechanism? Because cortisol is your stress hormone, it has beneficial aspects and it has deleterious aspects. You can’t get one without the other.

Anyone who’s ever taken steroids knows, yes, it’s going to cut down inflammation. I remember, when I first moved down to the south, I had never heard of fire ants. I was from the north. A patient came in one day with her ankles swollen. I said, “What happened?” She said, “I stepped on a bed of fire ants.” I’m thinking, “What in the world is a fire ant?” I had to get an education in what fire ants were and learn that the treatment of choice is steroids. Everybody knows steroids cut down inflammation and pain. It does that. But you also get the deleterious side effects. What are they? Number one, it’s going to jack up your blood sugar. What happens when your blood sugar gets increased artificially? Well, sugar is inflammatory and sticky so you get the decrease in the short term inflammatory response, but in the long term, you’re driving up sugar. If people are on chronic steroids, oftentimes they become diabetic. I had a lot of people or had dogs. I had a dog that has that. She had been on chronic steroids and she became diabetic. Well, that can damage all the cells in your body because of sugar in the body that’s too abundant.

Sugar is sticky, right? Think of a sticky bun. Why is it sticky? It’s because it has sugar that’s been heated. Sugar that’s in your bloodstream, and in your body is no different. It’s heated to body temperature. It’s warm. It’s sticky. It’s inflammatory. It sticks to all your cells. It can fix to the cells in your kidneys or even fix to cells in your blood vessels. There could be long term damage. Why does it mess up the microbiome in the short term? A lot of these bacteria in the gut, especially the unsavory ones that you don’t want, consume sugar. When sugar is higher and plentiful, they will proliferate and propagate. If you’ve got a lot of sugar, you’re feeding your unsavory bugs. You get a disbyotic picture, and especially if there’s Candida, or fungi. They love sugar, right? If anyone’s ever made bread, what do you need? Just add warm water, sugar and yeast and you put it in the dark, (and it is dark, moist and warm in your gut already) and you add sugar, phew! You get that nice yeasty concoction you make bread out of. Well, that can happen in your gut and it’s not a question of, “Do we have Candida?” We all have Candida! It’s around. It’s in us. It’s everywhere. When the conditions are right, and there’s too much sugar, then you’re gonig to have too much. It fosters a dysbiotic picture.

Lindsey: 

That’s an awesome and thorough answer that helps me understand and explain to clients. So I personally reversed my Hashimoto’s thyroiditis by both changing my diet and by eliminating gluten and dairy and most added sugar, and just by healing my dysbiotic and leaky gut. I imagine you must see a lot of patients with Hashimotos. In your experience, is there a best order of operations for reversing this type of condition and have you seen patients who’ve been on thyroid meds like Synthroid who’ve been able to come off of them?

Kyrin Dunston, MD:

Great question about Hashimoto’s. We can actually lump some other autoimmune conditions in there because they’re all caused by the same thing. I know some people are thinking, “What are you talking about Kyrin?” Most people don’t realize that all autoimmune conditions have the same root cause and most physicians don’t understand that either. But what does autoimmunity mean? It means auto, yourself, immunity. Your own immune system is attacking you. What causes that? In mainstream medicine, we’re up in the leaves, in the branches of the health that is our tree. We’re trimming this leaf, and over in another branch, right? And one branch we’re over at the neurologist getting those lesions in our brain looked at in an MRI because we suspect we have MS. For urinary leakage, we’re over at the gynecologist at another branch. Nothing’s related in mainstream medicine.

The truth is, if you go down the trunk of the tree into the roots and soil, all diseases have the same root causes. Every disease has a driver, and every disease should have a brake, that is not present (and that’s why it’s happening). Your body naturally will heal itself. Anyone who’s ever cut themselves knows that. Do you need to do anything when you cut your hand other than put something over it to protect it? Your body naturally heals. Well, your body will do that for everything. It naturally has innate healing mechanism. So every disease has to have something that’s the foot on the accelerator, accelerating dysfunction. And every disease has a lack of a break because you should have a break in your body on disease. So with autoimmune disease, what’s the accelerator? The accelerator is inflammation, most of which comes from the gastrointestinal tract.

Like you said, Lindsey, you remove gluten and dairy, heal your gut. That’s aim number one with Hashimoto’s, or any autoimmune disease. You go immediately to the gut. I love the gut and unfortunately, she is the source of most of the inflammation because we treat her like a trash can, not the temple that she is. If you treat her like a trash can, guess what you’re going to get back – trash. Autoimmune disease has its foot on the accelerator gut and no brake. What the brake on autoimmune disease should be is your cortisol stress hormone. We just talked about how, when your own steroids or cortisol fail, you go to the doctor, they give you whatever steroid and they give you pills – and that becomes the brake. You only need that brake when your own brake isn’t working and your own brake is your body’s natural cortisol.

Every autoimmune disease has gut dysfunction and cortisol problems at its root cause. When you fix those, you can reverse autoimmune disease. Fix the microbiome and remove food sensitivities, which may not be allergies. I’m not talking about if you go to any board certified allergist. They’re going to tell you that there’s no such thing as a food sensitivity. That’s not true. Science knows way more than you’re going to find at your mainstream doctor’s office. Go take a visit to somebody who can help you. Your allergist doesn’t believe in that as if it weren’t science. It’s science. It’s not religion. You can be sensitive. Your immune system has many different branches, just like our military. Your immune system is your military. We’ve got Army, Navy, Coast Guard, we’ve got seals, we’ve got… I don’t even know all the branches of the military.

Lindsey:

Air Force, Marines.

Kyrin Dunston, MD:

Marines, right? Well, your body is the same. We’ve got IgG, IgM, IgA, we’ve got cell-mediated immunity and mast cells. We have different types of lymphocytes, all with numbers. We’ve got CD 4, CD 8. We’ve got so many branches in our immune system, it probably outstrips the military. When your immune system is attacking itself, it’s not doing it for no reason. It’s because it’s been triggered into that. It’s like if America started bombing ourselves, right? Well, everyone would say that’s insane. What caused that? It’s the same in the body. Your immune system is throwing bombs on you. Why? What caused it? So we were talking about food sensitivities. You have many different ways you can be sensitive to a food.

Mainstream medicine pretty much only recognizes that if they inject you in your arm and you get IgE sensitivity, that’s an allergy, right? That’s not true. It can be so many other things. You’ve got to get tested for both sensitivities. I love to test. Test, don’t guess. You can energetically test. There’s so many ways you can figure out what foods you are sensitive to, but gluten and dairy have to go for Hashimoto’s. And I think for all autoimmune conditions.  After that you go to work on the cortisol. Why aren’t the adrenals functioning properly? You’ve got to support and nurture and love them and give them what they need. I have had plenty of patients. If you ask most doctors, “Do people ever get rid of autoimmune disease?” They’re going to say, “No, it’s progressive and you’ll have it forever.” That’s just not true. I see people all the time who have Hashimoto’s antibody, whether it’s thyroid peroxidase, anti-thyroglobulin, or both, and they don’t have any Lindsey.

Lindsey: 

Right. That’s, that’s my situation.

Kyrin Dunston, MD:

Right? And so, it happens regularly. Now, your other questions, do they get off thyroid medicine? Let’s take that one. The problem with Hashimoto’s is that these antibodies are destroying thyroid tissue, if you catch it early enough, and I’m a big proponent of checking auto thyroid antibodies, early and often on everyone, because they’re so common in women. I’ve seen plenty of people with an optimized TSH an optimized T3, T4, reverse T3 who actually had auto antibodies. If you can catch someone who’s in that stage before, you can fix their gut and their cortisol and they don’t ever have to get Hashimoto’s. Their antibodies can go away. I love it when I find someone like that. That’s before there’s anatomic damage to the thyroid.

Now, once you’ve had these antibodies long enough, they’re in there destroying your thyroid and causing anatomic damage. Once you have an anatomic problem, it’s much harder to reverse. There’s a spectrum of how health disorders occur. You don’t just wake up one day and have no cartilage in your knee. It doesn’t happen that way and everybody knows that. You had great cartilage and it got eaten away by inflammation and pressure until you didn’t have any anymore. All disorders happen that way. You just don’t know it or see it. They happen on a spectrum and they start on a functional disorder spectrum. That’s why we say we practice functional medicine. We’re working on the function before you see any anatomic problem and it’ll start as a small functional problem. That’s why I’m a proponent of checking auto antibodies in women early because if you can catch it, it’s just functional, then there’s no anatomic damage, you could fix it.

Lindsey: 

Let me stop you for a second on that. When you’re checking the auto antibodies are you doing this by default with every person you see or is this something that you do when you see gut issues or something that would indicate to you that they might have something going on?

Kyrin Dunston, MD:

I only work with women with health problems so at all of my people get it.

Lindsey: 

Okay. Got it

Kyrin Dunston, MD:

I don’t do just regular screening care. I don’t do physical exams, pap smears or any of that. I only see women who have problems. If you’re a woman and you are a man and you have health problems, in my opinion, the thyroid is so vastly affected.

Lindsey: 

Just to specify you’re saying that women need it in particular, because the majority of Hashimoto’s occurs in women?

Kyrin Dunston, MD:

The majority of thyroid disorders occur in women. It’s like 80/20. 80% in women and 20% in men – the majority of Hashimoto’s and the majority of thyroid disorders. The thyroid is so fundamental to our health. It determines the rate at which we burn calories, which means it determines the rate at which we make energy, which means it determines the rate at which we do anything, because if you don’t make ATP for energy, you can’t fix anything in your body. If there’s ever a health problem, as a part of that health problem at its cause, is an energy production problem, because you don’t have the energy to fix it (as mentioned before the body naturally wants to fix itself). It can’t with something preventing it. One of the things that usually is preventing is your body not making the ATP to fund that activity. Why isn’t it? The thyroid is tied into everything. If you’ve got liver dysfunction, which is huge, in women who have hormonal problems, thyroid is converted into the active form partly in the liver. You’re going to have thyroid problems. Everything has its hand in the thyroid, and thyroid has its hand in everything. So it’s just so fundamental to me, it’s like, you should get weighed, you should get your blood pressure, respiratory rate and you should get your thyroid checked.

Lindsey: 

Okay. Let me also dig in a little further. You mentioned food sensitivity testing. In my experience, anybody with a leaky gut, which is pretty much anybody with a gut infection, just kind of has every single thing they eat come up positive on those food sensitivity tests. I’ve written them off as not terribly useful. Maybe I would think after we’ve done some work, and after we feel like we’ve sealed up the gut, and we healed gut infections that the food sensitivity testing might be useful at that point, but but beforehand, it just seems like everything. And that’s what happened with me, by the way. I did an IgG test and pretty much every food that I ate came up positive.

Kyrin Dunston, MD:

Right and if you have leaky gut, which most people with autoimmune do, everything you’ve been eating is going to come up. Let me say this. There is no perfect food sensitivity test or we have yet to find it. Because there’s so many different branches of the military immune system, you can react in so many different ways. Most people are creatures of habit and eat the same stuff over and over and over again. Their immune system is so over it. It’s screaming, “Oh my gosh, not again. You’re not eating and drinking milk again.” There is no perfect test. Now having said that, I find that a lot of people are in denial about what they’re actually eating with themselves and they also are very resistant to give up what they love.

They’re also addicted to the things that they eat all the time. It’s why they eat them all the time. In fact, if you are sensitive to a food, you are highly likely to be addicted to it. It’s going to make you feel really good when you eat it. Part of what happens when your immune system is deployed against the food you’re sensitive to, is your endorphin system being deployed and that makes you feel really good. Maybe people listening can relate to like that euphoria you get after you eat pizza made with cheese and gluten at some point in your life. That’s because the cheese produces something called casomorphin after you eat it. That is a morphine-like substance which makes you feel really good. Gluten produces gluteomorphin, which is a substance like morphine which makes you feel really good. This is why people love bread and cheese. It’s because they’re addicted to it. They’re getting a morphine hit every time they eat it. Now, lets get back to the food sensitivities. I find if you just tell someone to stop eating all the foods that they regularly eat and eat all these things they never eat (because you don’t like them) and do it on a four day rotational basis, most people are going to doubt me. They will just refuse to do it. I like a food sensitivity test sometimes just to be able to show them in black and white. Look at all the things you are sensitive to and they say “Oh my god, it’s all the things I eat all the time!” Exactly. Stop!

Lindsey: 

Tell me about the four day rotation. How does that work?

Kyrin Dunston, MD:

Your body was made to eat rotationally on a seasonal basis like back in the stone age. That’s part of what keeps our microbiome healthy. Our microbiome doesn’t want to eat the same thing every day anymore than our immune system does. It’s our human nature. We don’t like change. We like security. We like sameness. We like safety. What do you eat for breakfast?  I have two scrambled eggs and I have a piece of toast and one slice of bacon and I have coffee with two scoops of sugar and a drop of milk. We we are such creatures of habit, but the only reason we have that luxury is because we are (particularly in America) relatively wealthy. We can have whatever we want, whenever we want, how we want it over and over and over again. Back in the stone age, how nature made us is we could only eat seasonally and locally. Until we came up with canning methods, we could only eat blueberries in blueberry season. We could only get a deer, when we could kill a deer, which wasn’t every single day. Maybe a couple times a year, we could hunt a deer, then we would have deer. That kept our microbiome healthy, and it kept us healthy. Our immune system didn’t freak out because we weren’t eating the same thing all the time.

We already talked about how our gastrointestinal tract is our biggest interface with the external environment. It is the main central for our immune security system. Your immune system gives a bypass to food. It has to allow certain things. It has to back off when a woman becomes pregnant, otherwise, it would be attacking the baby, because the baby is not genetically the same as the mom. It knows and your body has systems set up to tell it “Okay, calm down. That’s not foreign,” and it has the same type of awareness when it comes to food. Your immune system rings your mouth, you have your adenoid glands and all kinds of lymphoid tissue that circle your throat. Why are they there? It’s not to make kids have to get a tonsillectomy and adenoidectomy, but because they are monitoring everything that comes in your mouth. Friend or foe, friend or foe, friend or foe. Your immune system gives food a bypass. If it only sees blueberries at blueberry season, it’s thinks, “Yeah, I know you’re good. You only come once a year blueberry season.” If you’re eating blueberries every day, it starts to freak out. The example I use is if you go out of your house and you see a stranger standing in the road by your house, you see them one day, you might just look around and go, “I don’t know them, what are they doing here?” You’re not going to worry about it. You come home the next day, they’re standing outside your house, you might wonder about their name and say, “Do you know who that is? I don’t know who that is? Why are they standing outside our house in the street.” If you come home every day, for a week or a month, and you see this stranger standing outside your house, you are going to call the police and say come, “Something’s wrong. They’re doing something wrong.” It’s the same with your immune system.

I know there’s some of you listening who eat certain things. Every single day your body sees something that’s wheat, or gluten, or something that comes out of a cow. Your immune system does not like that; it starts reacting. Not to mention that if you’re eating the same things that are highly inflammatory, gluten is inherently inflammatory, particularly the GMO strains in the US that have such a high gluten content, or cow’s milk dairy; we are not baby cows and are not made to digest cow’s milk. They’re inherently inflammatory, and you’re going to have inflammation from that which will affect the gut. It’s going to be destroying your microbiome. You’re going to start to get your tight junctions that are going to start separating in your gut and you’re going to start to get a leaky gut. After that it becomes a chain reaction where you don’t break down and digest your food properly, then you have these ginormous particles of broccoli coming through, because they still look like broccoli in the small intestine when they’re not supposed to. They’re just supposed to look like magnesium and some carbs and amino acids, but they don’t look like that. If they look like broccoli, well, then they can get through these tight junctions and your immune system really freaks out about that.

So you need to eat on a rotational basis. So in the stone age, we ate seasonally, locally. We don’t live in that way. Today we can have whatever we want whenever we want it. A way we can emulate the stone age is to do a four-day rotational diet. This means any food you eat on a Monday will not pass your lips until four days later. If I eat olive oil on a Monday, I won’t eat olive oil or anything containing olives until Friday because it’s the particular antigen of the food. So you can have olive oil, or maybe olive tamponade. So that all falls in the same category. If I have arugula on Monday, I’m not going to have it again till Friday, but I can have spring mix on Tuesday because that is a different antigen than arugula.

Lindsey: 

Is this just with the things that come up positive on the test, or is this a way that you eat normally?

Kyrin Dunston, MD:

I recommend for people in a gut healing protocol period to eat all foods on a rotational basis. Once you get your gut healed, then I say everyone has to find their own edge of what your body can tolerate and what it can’t tolerate. Like gluten for me, I’m not celiac. I do have the DQ 2 and 8 genes heterozygous, so I have a genetic predisposition to a gluten sensitivity and that was a big part of my leaky gut went before I got healthy. Gluten came up sensitive on my first food sensitivity test and like I said, I love seeing in black and white, oh yeah, those are all the things I eat. So I got rid of it for six months. I always say, three strikes, you’re out. I tried to add it back. I tried one food at a time, no more than one every four days and I reacted to it. That was the second strike, so I took it out for another six months. Six months later, I tried again, and I reacted to it. That was the third strike. This was 12 years ago. I love Indian food, probably a lot of other people do too, and I particularly love naan bread. I have had a hard time finding gluten free naan bread, and I’ve tried to make it and alas, I can’t make it like they make it. I have found that I can have one piece of naan bread about once every three months and I am okay.

You have to find your own edge with this food situation. I really don’t recommend that people go back to eating the same things over and over every single day once they feel their gut because I think it’s just asking for a problem. It’s trying to go against our biology. It’s not how we’re wired and as much as we want to watch blue lights until 1 a.m., then immediately fall asleep because that’s just how we want to be. We want to be able to thrive on five hours of sleep. I know people who say, “I’ll sleep when I’m dead. It’s a waste of time.” No matter how much we want to do that, your body doesn’t care. The body will have the final say. If you’re not getting seven or eight hours of sleep, you will pay for it, you will die sooner, you will have more health problems and your sleep will be disrupted if you look at blue lights until right before bed. The eating patterns are just like that. Now, having said that, I do know some people who have healed their guts, but I will say they don’t go back to eating bread and cheese every single day.

Lindsey: 

Yeah.

Kyrin Dunston, MD:

And I find that those who do really struggle. I think that people have to learn their own edge of what their body will and will not tolerate and they have to live that edge. Though it’s a living edge. It’s not a hard edge. It’s not like the wall in your bedroom. It can change if you are under a lot of stress at work. Your body is not going to be able to tolerate certain foods with a certain frequency that maybe it can at other times.

Lindsey: 

And of course the irony is that’s exactly when people eat those bad foods.

Kyrin Dunston, MD:

Exactly. So everybody’s has to figure it out individually.

Lindsey: 

Yeah, okay, but getting back to the hormones, although that was certainly tangentially related. One relatively common complaint I have for some of my female clients is PMS type symptoms like migraines, bloating, etc., prior to their period. Do you think this is gut related?

Kyrin Dunston, MD:

First off, let me say that PMS, bloating PMDD, premenstrual symptoms or menstrual symptoms like dysmenorrhea pain on your period, heavy periods, painful periods, passing clots, none of this is normal. Let me say this. I just want everyone to hear that. We have normalized menstrual dysfunction in our modern society, and it is not. So is it microbiome related? I definitely think that could be part of it, and usually is part of it. What all those things generally mean is that you’ve got too much estrogen or estrogen dominance and not enough progesterone. We also live in a culture that fosters our lifestyle, our diet, estrogen dominance, lack of estrogen and detoxification. We end up accumulating too much estrogen. We take in a lot of pseudo estrogens like phytoestrogens from plants or xenoestrogens from our environment, like in plastics. I heard it estimated that we eat a credit card of plastic on average, every month. I was appalled by that.

The plastics act like estrogens in the body. Parabens, phthalates and all these additives in our cosmetics or cleaning products act as estrogens and endocrine disrupters in the body. Most of us have too much estrogen and if you’ve got any of the symptoms you mentioned, you generally have too much estrogen and not enough progesterone. Why don’t we have enough progesterone? It’s because we’re all stressed out and we already talked about how Queen cortisol will be taken care of and served at all costs. There’s something called pregnenolone steal that happens in your body and the adrenal glands. A lot of these hormones are made from the grandmother hormone which is pregnenolone, and they all are made from cholesterol, which comes from animal protein that’s turned into pregnenolone. The grandmother can be made into estrogen, testosterone, progesterone, aldosterone (which regulates your kidney, water and electrolyte balance), cortisol, DHEA and a bunch of other minor hormones on the pathway.

We already said cortisol will be served at all costs at the expense of progesterone. This is why when you’re stressed out, you might miss a period. This is also why when you’re worried about missing a period, you might miss a period. It’s because you’re worried your stress. Cortisol goes up and your body stops making progesterone. Progesterone is the antidote to estrogen. Estrogen is the builder and progesterone is the developer.

Think of it this way: Estrogen would make a tree grow tall. Progesterone makes that tree grow wide with a lot of branches and a wide trunk. You need both for balance. You don’t want a 200-foot tall tree that’s a little toothpick. It’s going to fall over in the wind and is not sturdy. You also wouldn’t want a one inch stub of a tree with a million branches, so that it just looks like a hairy monster. You want a healthy height tree and you want good branching architecture so that it gets good sunlight exposure and it can have photosynthesis. It’s the same with estrogen in your body. Your breasts, uterus and all your tissues respond to estrogen and progesterone. You want good growth and development, so if you have too much estrogen and not enough progesterone, you’re going to have symptoms like PMS, PMDD, bloating and painful periods (PMDD is premenopausal dysphoric disorder; it’s more severe than PMS).

What does it have to do with the microbiome? Like we mentioned with estrogen earlier, estrogen metabolism is regulated not only by what your body makes, in terms of estrogen or takes in, but what it discards or doesn’t discard. A key step in estrogen detoxification occurs in the gut and there are certain bacteria that are dysbiotic that you can have that can cleave off the tag that your liver put on the estrogen to tag it to go in the trash, which is your poop, which goes in the toilet. This beta glucuronidation can cleave off the tags, so your liver tags the estrogen to go in the trash, and these bacteria cleave it off. Next you reabsorb it. Not only are we getting all these exogenous estrogens from the outside, but we’re not pooping our estrogen that we need to detox out.

Constipation is epidemic in our country. Nature made you to poop every time you eat. You have something called the gastrocolic reflex. Eat, poop. Eat, poop. Eat, poop. If you aren’t doing that, your doctor is not going to call it constipation because based on the Rome criteria doesn’t meet the criteria. It’s some insane thing like not pooping regularly more than once every four to seven days which is insane. Basically if you’re not pooping when you eat, I consider it abnormal. I don’t care what you call it, constipation or not. I can’t tell you. I’m sure you do too, when we talk to people who say, “Oh, I poop once every seven days.” If you’re not pooping, you’re not taking out the trash and you’re not getting your estrogen detox. Your body’s just sucking it back up along with everything else it’s taking and making. This is why we are a nation of estrogen dominant people.

Lindsey: 

Yeah, I had that problem. Can you supplement it? Obviously, you want to fix the gut, and you’re going to fix the root cause issues, but can you supplement progesterone by itself or do you just try and detox the estrogen? What do you do to fix that?

Kyrin Dunston, MD:

I’m a proponent of root cause resolution. Fix the cause of the problem. Don’t mask it. Typically, in younger women, if you start taking exogenous progesterone from the outside, it can help you in the short term, but long term, you can wonky your cycle worse. You’ve got to detoxify the estrogen. Stop using cosmetics and cleaning products that have xenoestrogens. Stop drinking cow’s milk. Stop eating hormone-laden animal protein and get your liver tuned up. You can take supplements to help your liver detox, get your poop tuned up. You can do coffee enemas, to get your liver getting rid of that stuff and just get your gut, which is the sanitation department. You can do supplements, diet and activities to get the poop moving and get the estrogen moving out. That’s usually the best place for everyone to start.

There are also things you can do if you’re not making progesterone. The number one reason is because you’ve got a cortisol problem, so you have to work on your cortisol. We all have cortisol problems. I’ve only ever seen one person who didn’t and that was a woman who already took impeccable care of herself and brought her daughter to me, because her daughter was having problems. I’ve never seen another perfect one.

There are supplements you can take. I’m at a yoga retreat right now, Lindsey, and I’ve been here three weeks. Sometimes it is so painful for me to sit in the classes and see how slow they go, because they’re all about mindfulness and that deep belly breathing. I love it and helps your cortisol, but I even think that in my day to day life, I do way less than many people and I think that I’m doing it slow – then I come to a place like this and I find out just how not slow I am. We really have normalized a very unhealthy level of stress. Now, some of it we can’t get rid of, but a lot of it we can. The intention with which we approach the activities that we do undertake, and the rapidity with which, like I noticed how I speak really fast. I noticed how that’s stressful, but it’s just a habit and I can choose to do it differently.

Back to the progesterone, the number one thing we need to do to fix our progesterone is cut our stress. I think you should do those things first. Address the root causes. Sometimes if women are trying to get pregnant, they do need to supplement with progesterone. Sometimes at a certain age, women just do need progesterone, and that can start as young as 30-35. By the time you’re 40 or 45, it’s almost guaranteed to feel like your normal self. Most women are going to have a hard time, but I will say there are some supplements you can take to help the ovaries function better, if they have enough reserve, like chasteberry. That can help if you have enough reserve. Once you get over 40, your number of eggs in your ovaries is going down and your reserve is going down for most women. You might get some benefit with that but you have to see and then you might just need to go to progesterone and progesterone is pretty easy to get. It’s over the counter and you don’t need a prescription. It’s pretty easy to use and it’s pretty forgiving, so it’s certainly something people can do.

Lindsey: 

Are we talking about creams or over the counter pills?

Kyrin Dunston, MD:

Oh yeah cream.

Lindsey: 

Yeah, I have used those. Well unfortunately we are out of time and this has been such an interesting conversation. I really have enjoyed talking to you about this stuff.

Kyrin Dunston, MD:

Yes I’ve enjoyed it too. It was super fun. Thank you so much for having me

Where to find Dr. Dunston:

Herhormoneclub

Kyrin Dunston’s Stop the Menopause Madness Facebook Group

Kyrin Dunston, MD’s Instagram

Kyrin Dunston’s Youtube

The Hormone Prescription Podcast with Dr. Kyrin Dunston on Apple Podcasts

Lindsey’s episode of the Hormone Prescription Podcast with Dr. Kyrin Dunston

If you have follow up questions, a great place to ask them is in my Facebook group called Gut Healing.  And if you’re struggling with gut and/or other health issues and need some help, I offer a free, 30-minute breakthrough session to talk about your issues and to see if health coaching might help you resolve them.

*Product, test and dispensary links are affiliate links for which I’ll receive a commission. Thanks for your support of the podcast and blog by using these links.

Adapted from episode 81 of The Perfect Stool podcast hosted by Lindsey Parsons, EdD with guest Camila Smith, LCSW, DHSc, licensed psychotherapist, anxiety expert and Chief Clinical Officer at bekome, a mental wellness supplement company and sponsor of this episode of the podcast.

Anxiety and the Gut: Evidence-Based Interventions to Calm the Mind

Lindsey:

Why don’t you start by telling us about your own journey with mental health and how that relates to your education and dissertation topic?

Camila Smith, LCSW, DHSc:

Absolutely. So for me in 2012, I was in grad school. It was the first time that I experienced what I could then relate as anxiety, but a little bit beyond the normal anxiety that we might experience. From then on, I started having panic attacks. In 2012, my dad was having surgery. The surgery took six hours longer than expected. During that time, I got nervous and following that, I started to experience these panic attacks whenever I was in a hospital. It also didn’t help that I was interning at a hospital.

Lindsey:

So you were there all the time.

Camila Smith, LCSW, DHSc:

Yeah! Every time I went in, I would start sweating and shaking. It was a really abrupt encounter with anxiety and panic disorder. As it went on, I started finding ways to treat it, and started working as a therapist. I decided to go back to school to get my doctorate in health sciences. I have always been very passionate about anxiety disorders. It makes sense to me. I love the science. Given my own journey, and all of my research, you know, I thought it was a great way to blend my personal quest to find ways to soothe my body, along with the things that I love, which is the science part of it as well.

Lindsey:

Great. So what was your dissertation topic?

Camila Smith, LCSW, DHSc:

My dissertation topic was on the use of nutraceuticals for the treatment of anxiety as a standalone and/or an adjunctive treatment. This means that I looked at amino acids, vitamins and different herbs, then compared the research on them. I only looked at ingredients or vitamins that had been tested, that had had randomized control trials, and then I looked at the treatment efficacy. How good were they compared to traditional medication? After a side by side, I came up with a recommendation as to whether or not botanicals – nutraceuticals essentially, could be used as standalone or adjunctive.

Lindsey:

Okay, and so what’s the relationship between gut health and mental health?

Camila Smith, LCSW, DHSc:

Well, this is interesting. Let me backtrack a little to say that I was very surprised when I found out what that relationship was. After working in the field for about five years, I knew very little about the actual mind-body. We hear that term used a lot (the mind-body connection), but learning about it from the physiology part was extremely eye opening for me. Our brain is what we consider our primary hub and it’s our central nervous system as well that it attaches to. We also have a second brain – the ENS system. That connection-

Lindsey:

The enteric nervous system.

Camila Smith, LCSW, DHSc:

Yeah, exactly, yes. The enteric nervous system that has been referred to as our second brain also has the ability to process information, stimuli, response. So the gut-brain really impacts us, because we have this whole other nervous system that has the ability to feel, to sense, to respond and to react. This is especially so for anxiety, because anxiety is such an instinctual response. There is definitely a direct correlation.

Lindsey:

And they’ve done the experiments where they cut the vagus nerve, which is part of that enteric nervous system, and they change out the bacteria. The bacteria doesn’t have the influence it does on the brain when that vagus nerve is cut.

Camila Smith, LCSW, DHSc:

It’s amazing. I always refer to it as the highway, and the bacteria travels up the highway into our brain. This is where probiotics are so helpful. At the same time, though, every time that we have bacteria, that’s not good for us, it also travels. They actually did a study not too long ago and found a specific bacteria in the brain of individuals with dementia. This was one of the first times that we were able to prove, and also in the oral flora, they found bacteria that usually doesn’t exist there. Now we’re starting to be able to prove that this bacteria not only travels, but also colonizes in our brain tissue, which is why it’s so important to have this healthy balance of bacteria in our body.

Lindsey:

Yeah. So how did you become involved with bekome and what’s the company’s mission?

Camila Smith, LCSW, DHSc:

I became involved with bekome end of last year, but the way that it occurred is actually, I think, a  beautiful synchronicity in everything coming together. I was on a board for a nonprofit organization with one of the co-founders, Vanessa, many years ago. From then until now, I went to school, got my dissertation. Last year, I put on a vision board that I wanted to get started on or launch a nutraceutical company. I got a call from Vanessa at the end of last year, stating that she was looking to start a nutraceutical company and thought that I would be a good addition. We reunited and it just was perfect timing. At that time, I had already done all the research and was ready to go with pretty much a formulation or at least a recommendation.

Our mission at bekome is really is to make mental health care more accessible for everyone, and to really target a full and integrative approach. We’re looking at targeting nutrition, mental health, and also just lowering inflammation. Aside from the nutrition and the supplementation part, our mission is to educate and personalize treatment. We offer consultations and one on ones. I recently ran a webinar. Our goal really is to provide a community where people can feel informed about the choices that they’re making.

So some of the things that I think are really important for us as a company and our personal mission is to also dispel some of the stigma around mental health. I think for so long, our field has separated mental health from physical health, that it’s created this stigma. We are trying to find realignment between them. In my professional experiences working at a clinic, I found that we would get referrals from primary care. There was almost this big split, where there wasn’t as much collaboration, and this is when I really started to feel that I needed to be more informed. Our field of mental health has many specialists. But if we think about primary care or just physical health, we have cardiology or gastroenterology. We have tons of different specialists, but in mental health, there are people that specialize in training. There isn’t really too much crossover between the physical aspects and the science, of anxiety and the mental health. This is where we came in. What we’re trying to do is not only make mental health care more accessible for people, but also really destigmatize it and start viewing it as it could be preventative care. It can be maintenance. It can be a lot of different things and we want to make it a part of our day to day. If we have it along with nutrition, I think that this really magnifies the outcomes that we can potentially get.

Lindsey:

That’s great. So tell me about the ingredients in bekome’s Peace of Mind Daily Packs and how you selected each ingredient.

Camila Smith, LCSW, DHSc:

Yes, so when looking to select them, I brought in some of my clinical knowledge and experience as well as personal. And in the treatment of anxiety disorders, we primarily use SSRIs, sometimes beta blockers and some people use benzodiazepines. These are more fast acting, so we almost have daily medications that help to keep the symptoms at bay and we have the as needed. When I was thinking about the ingredients, I thought it was really important to provide this sort of flexibility with our ingredients, meaning we wanted ingredients that were helpful over time, but also something that provided an immediate effect. That was one of the main parts that we considered when looking at ingredients. The ingredients that we have included are vitamins, amino acids and botanicals. The vitamins that we chose were magnesium and B6. These were specifically chosen because they are necessary for the production or the synthesis of serotonin, which is our mood, food, pain and sleep neurotransmitter. In addition to B6 and magnesium, we also chose l-theanine. L-theanine is an amino acid that’s naturally found in the highest content in green tea. L-theanine has been shown to provide relaxation and increase focus. Studies have actually found that when individuals take l-theanine there is a change in brainwaves. It activates alpha, which is a relaxed state, so we looked for somethingthat when taken in the morning would provide us with energy, calm and focus. And as we transitioned, we also added in passion flower. Passion flower is a calming botanical and it helps to relax the body. There’s flexibility with the pack. We do recommend for some people, for example, that they take the passion flower, and perhaps magnesium at night, to ease into the night in a more relaxed way. The last ingredient is our probiotic. This was because we really wanted to target the gut-brain connection, and probiotics are known to really help balance out that bacteria and decrease inflammation. We chose ingredients that help to synthesize serotonin, induce relaxation, and just promote overall mind body or brain and gut health. 

Lindsey:

Great. So tell me, why did you choose not to include 5-HTP or tryptophan in the formulation?

Camila Smith, LCSW, DHSc:

When we were thinking about creating a supplement, one of the really important parts to us was to make this accessible. What I mean by that is that a majority of people would be able to take it and that it had minimal side effects or risks. We were also very intentional about selecting ingredients that could be used alongside medications, traditional SSRIs or medications for anxiety. There’s great research on 5-HTP. It’s wonderful; however, there are contraindications with SSRIs. Because a lot of individuals with anxiety disorders do take SSRIs, we wanted to keep it as open as possible and really reduce the risk of any side effects. It was primarily because of the contraindications that 5-HTP has.

Lindsey:

Just to spell it out to listeners, SSRIs or selective serotonin reuptake inhibitors, they basically increase the serotonin in the brain and 5-HTP is a precursor to serotonin, as is tryptophan. Either one of those would also increase serotonin and you can have something called serotonin syndrome where you have like a racing heart and such and it can be dangerous, so that’s why it would double operate.

Camila Smith, LCSW, DHSc:

Exactly, absolutely. This is where we added for example, the magnesium and the B6 are necessary for that breakdown from tryptophan to 5-HTP to serotonin. So we did think about adding ingredients, vitamins that would aid and make the process of creating serotonin more flow. We tried to be very mindful of serotonin syndrome.

Lindsey:

Yeah, I have a lot of clients who show up, I mean, pretty much everybody – I wonder if it’s an artifact of the test – on an organic acids test, they show up with low B6, and it often comes alongside these mental health issues like anxiety and depression.

Camila Smith, LCSW, DHSc:

Yeah, B12 has been found to mimic depression and sometimes manic episodes; they’re pretty similar. If you put them side by side, B12 deficiency looks exactly like major depressive disorder. The only real difference that we find is that a B12 deficiency does not tend to cause harmful thoughts, but there are some mirroring side effects or symptoms between them.

Lindsey:

Hmm, interesting. So I know that you offer consults, in addition to the supplements, to potential customers. Are those free and tell me what’s involved in those consults?

Camila Smith, LCSW, DHSc:

Yes, there’s two consults. One is a 15-minute consultation, and other one is a 30-minute consultation. The 15-minute consultation is available to anyone that wants to. Maybe they’re on the fence about the supplements. Perhaps they have questions. That 15 minutes gives us an opportunity to connect one on one. Again, one of our primary goals is to provide personalized care and also to educate. The 15-minute can be booked at any time with no purchase necessary whatsoever. The 30 minute consultation is included with the 28-day or the subscription. Ideally, we would have the 15-minute either at the start of or prior to starting. And then the 30-minute really allows us to do a little bit more of a deep dive. During this consultation, we check in in regards to progress, any barriers that somebody might be having and also offer guidance for individuals. Some individuals might have questions regarding their nutrition or sleep, which I have also worked around. It provides an open format where we can really get down to breaking down the barriers and what we can do as collaboratively to help people feel better.

Lindsey:

And so those are free as part of the service?

Camila Smith, LCSW, DHSc:

Yes, they come included.

Lindsey:

Okay.

Camila Smith, LCSW, DHSc:

The 15-minute is free, and so is the 30-minute but that is with the 28 – a month’s supply, there is that additional 30-minute one that’s included.

Lindsey:

Right. Okay. So tell me about how you selected the strains for the probiotic that’s included in your daily packs.

Camila Smith, LCSW, DHSc:

Again there’s so many probiotics, there’s tons of different bacteria and they all have their own benefits. One of the things that I did similar to the other ingredients was research specifically. It’d be information, the data on the benefits of it with mental health. We particularly focused on anxiety disorders, and really looked at the best ones. I created a list of the top ones that we wanted to include, and ended up selecting a blend that has a multitude of different strains.

Lindsey:

And so what future plans does the company have with regard to the products?

Camila Smith, LCSW, DHSc:

We have a lot of exciting things in store right now. We’re in the early phases of starting to think about adding different packs. For example, when we’re looking at anxiety and sleep: these can be add-ons for somebody that is having trouble with sleep. We would, in addition to the primary pack, there would be additional ingredients to help with sleep. So we’re looking at sleep, mood, focus and a pregnancy pack. That’s one area we’re looking to continue to expand. We’re also considering adding, what we will have to think about as the SOS pack, right. Those are the fast acting things that we can take in the moment if we are feeling really stressed. Hopefully, in the future, we’d like to personalize even more. There’s a lot of different ideas that we have. One is creating an app for every customer to go in and share their symptoms. That gives us a better picture and we would personalize a blend of different ingredients specifically for that person. We’re hoping to in the future even get more and more personalized, even considering adding in different testing so that we can see where people’s levels are, whether it’s organic acid or enzymes. Really just looking at all the different facets that impact mental health.

Lindsey:

So digging a little more into the details, what type of magnesium is in them, and how many milligrams?

Camila Smith, LCSW, DHSc:

We have magnesium glycinate and it’s at 225 right now. The research shows that it really can go anywhere, and even up to 400 milligrams. We wanted to start at a dose that is well tolerated for the majority of people. We chose magnesium glycinate, particularly because of the bio absorption of it. We wanted to be mindful of selecting a kind of magnesium that didn’t leave the body as quickly.

Lindsey:

Right. Because of course the magnesium oxide and the magnesium citrate both will promote bowel movements. And you don’t want to overdo that for people for whom that’s not an issue. What about the B6?

Camila Smith, LCSW, DHSc:

There’s research that shows that a 10:1 ratio, Ten magnesium to one B6, has had really great results. They synergize really well together and when taken at that ratio, it’s known to improve the efficacy of it. So when selecting the dosage, we tried to keep it at that 10:1 to really optimize both ingredients.

Lindsey:

And in your studies, did you look at all at nutritional interventions for mental health issues?

Camila Smith, LCSW, DHSc:

Yeah, when I was, with my dissertation, there were several kind of dietary interventions, nutritional, that we looked at and that I formulated. We have it actually on our website if anybody’s interested on the blog. There is a whole document that’s included on the blog that has all of the recommendations for different foods that are high in magnesium or high in tryptophan. We talked about tryptophan earlier. There’s certain foods that we can eat that are natural mood boosters. We offer that again on the website and it is something that through our consultations, we also check in and see how everyone’s doing in terms of their diet and offer recommendations as needed. We definitely did include that in our approach.

Lindsey:

I know that depression in particular is thought of to be in large part a result of inflammation and obviously, a very pro-inflammatory diet with lots of sugar, processed food, omega 6 fatty acids and white carbs is probably pretty detrimental to mental health.

Camila Smith, LCSW, DHSc:

Absolutely. There’s actually 12 different subsets of anxiety. We tend to group it together, but we have generalized anxiety, panic, and social. Another form of anxiety is what we call anxiety secondary to medical conditions. What this means is that somebody might have, let’s say, a cardiac condition, and these changes that the body experiences will then offset a stress response because the body is experiencing these fluctuations. When we’re thinking about the importance of balancing out the body through nutrition and supplementation, it’s really important because anxiety can be triggered by mental stressors and physical stressors; both. Our stress response can also be activated by, for example, changes in our histamine levels, right? If we’re having a reaction to our environment, it can be anxiety. It can be offset by changes in temperature. Pretty much anything that throws our body off, can trigger anxiety.

Lindsey:

Yeah I know. Years ago, I started to have some panic attacks and it always started where I got a little bit short of breath. All of a sudden, I was questioning whether or not I was having a heart attack. And it just started snowballing! One time I actually went to the hospital and got them to test my heart, and then I realized it was panic attacks. I was having health issues and had just moved to a new place. I didn’t have a doctor and I’m a little bit of a hypochondriac, so I thought I had cancer as I have on numerous occasions in my life. Once I got all that sorted out and went through the cycle of the different anti-anxiety medications one could take, ultimately, once I resolved the health issue it was not an issue, but I know what it feels like to be in that panic attack cycle.

Camila Smith, LCSW, DHSc:

Yeah, definitely our body reacts right when there’s any changes or when anything catches us by surprise – even something like a stomachache, or a headache. If we have something for a sustained period of time, our body reacts to that and humans have this incredible ability for metacognition. This means that we have the ability to think about our thoughts. That sounds tricky, but let’s say that I have a stomach ache. I have the ability to think about having a stomachache. I can then come up with a narrative. This is where fear and random anxiety kicks in. There is a huge connection with our body or physical state and anxiety. Anxiety is, after all, an evolutionary response. It’s what’s kept us alive as a species and we will all experience anxiety at some point. Anxiety is natural, and almost like building a relationship with our anxiety, understanding its purpose, and finding ways to soothe and calm our body and establish safety is really important.

Lindsey:

Yeah. So have you yourself taken this this daily pack?

Camila Smith, LCSW, DHSc:

Yes, I do. Actually, I’m currently taking it. So I had recent pretty significant life stressors, life changes, car accident, and it really changed my life. It changed a lot of my day to day in a few months. Around May, I started taking an SSRI, and initially it was helpful, but I started having really, really difficult side effects. I started having nightmares, and the nightmares were scary to the point where I was dreading going to sleep or I would wake up, fall asleep and  go back into these nightmares. I would also experience the withdrawal symptoms rather fast off it, so if I was late with a dose or even missed a day, I wouldstart to get really dizzy and nauseous. The side effects were a bit much, so I started to working with my provider to titrate down and add it in the pack. I have to say that it really made a difference. I don’t have the side effects and I feel good. There were about three weeks where I was coming down, I was titrating down before I started the pack, there was a period in time where I wasn’t taking the supplements. Two weeks into taking them, I felt different. There were also notable changes from an outside perspective. I had someone in my life say, “You seem to be doing really well! You’re in good spirits and you’re focused!” It was really awesome. Sometimes it’s hard to gauge our own progress. It might take a little bit of time to see, but yeah, definitely I take it every day and it has really been a blessing for me.

Lindsey:

Yeah, and I know you’ve got a Facebook community group. Have you got a good conversation going in there with people who’ve been trying it?

Camila Smith, LCSW, DHSc:

We just started with the Facebook group about two-three weeks ago. This was right after I ran a webinar, which is actually available on YouTube. It’s a 30 minute webinar on the overlap between nutrition and mental health. Following the webinar, we created the Facebook community to start having a central place. We also put out content on Instagram, and Tik Tok is, as of right now, some of our primary sources, but we are looking to build our community. We’re in the earlier stages, but it’s also a very exciting time because we’re building.

Lindsey:

Awesome, and where can people find your website and try out the peace of mind daily packs?

Camila Smith, LCSW, DHSc:

Yeah, so one way would be to go on either any of the sources on Instagram or handle is “join bekome” and bekome is with a “k.” It’s the same handle for Facebook if you go on Facebook and type in joinbekome. Our website is also joinbekome.co. Currently we are offering, which is really exciting, so we have the 7-day pack. Initially we only had the 28-day, but we’ve started offering a 7-day trial. We have a 14-day, we have a 28-day and we have a subscription. It’s been really great to see how many people are willing to try it and are returning after the 7-day pack. Again, with the 7-day pack, there is a complimentary 15 minute consultation. Whether somebody decides to take the consultation before they start, or maybe halfway through it, there is wiggle room there. Every customer can choose when they sign up for it.

Lindsey:

I understand that there is a discount for my listeners for 20% off.

Camila Smith, LCSW, DHSc:

Yeah, actually, we’re going to go ahead and update to 30%.

Lindsey:

Wow.

Camila Smith, LCSW, DHSc:

For the 30% off, we will call it Lindsey30.

Lindsey:

Okay, beautiful. So that’s just for my people.

Camila Smith, LCSW, DHSc:

Yes, just for your people.

Lindsey:

How long will that last?

Camila Smith, LCSW, DHSc:

You know, we don’t necessarily have an end. Seeing that people will listen to podcasts at different times. we want to be able to offer it.

Lindsey:

Awesome. Well, I appreciate you doing that for them.

Camila Smith, LCSW, DHSc:

You’re very welcome. We’re very excited to have different people try it. When we put the product out there, we’re also passionate about the bigger picture of this, that it wasn’t our intention was not by any means to just put out a pack. We really want to build connections, to educate and support. However we can get people to feel comfortable, we’re definitely here to do that.

Lindsey:

That’s awesome. I appreciate that mission.

Camila Smith, LCSW, DHSc:

Yeah.

Lindsey:

Any final thoughts before we go?

Camila Smith, LCSW, DHSc:

No, just again, reiterating what an exciting time this is in science, in mental health. At the same time, it can be really overwhelming because we have so many resources available. Sometimes it is hard to know where to go when presented with an overabundance of options and resources. I think this is where having trusted sources [is important]. This might be working with a clinician, taking supplements or working with a doctor. Finding that support can be really, really helpful. I encourage anyone that is on a journey to mental health, to utilize and access whatever resources are available. The more resources we have alongside education means we will be more competent and comfortable in our ability to manage whatever it is that we’re experiencing.

Lindsey:

Well, I did appreciate the fact that you had this topic of your dissertation and that you looked at the scientific evidence and the weight of it for each of these ingredients. I like everything that I recommend to be evidence-based, which is why I was happy to have you sponsor the podcast and come talk about this. I’m glad to share this with my listeners.

Camila Smith, LCSW, DHSc:

Thank you so much. That was so key for me. I think even as a consumer, there’s been many times where I might go on Amazon and there’s so many different supplements. It’s hard to do all of that, that work ourselves right to go in and understand –  and even if we do all the research, we may not fully get it. There’s a little bit of a deeper layer when it comes to the dosages or how ingredients work synergistically together. Which ingredients work with which ones? Which ones do not? Contraindications.  There’s a lot of little or big nuances that also go into formulation. We wanted to take that pressure away and offer something that is evidence-based that works, our results also show. We ran a trial prior to launching and we found that within the first week, there was a 91% improvement, which was really amazing to see. Overall there was a 41% reduction in symptoms. This was measured by a scale. We used current scales and we did a baseline prior to starting the supplements. We did weekly and at the end. We compared the data using the scores and looked across the board to see how individuals were progressing. We measured a variety of different symptoms, including the physical, maybe palpitations, muscle tightness, but we also looked at mood, feelings of hopefulness, sleep and gastrointestinal. We really tried to look at all of the different buckets of anxiety so that we could see firsthand how it was impacting individuals. And you know, we were really happy to see that it was very positive.

If you’re struggling with your mental health, gut health or all over body problems, you’re welcome to set up a free, 30-minute breakthrough session with me (Lindsey). We’ll talk about what you’ve been going through and I’ll tell you about my 5- appointment health coaching program in which I recommend lab tests, educate you on what the results mean and the protocols used by doctors to fix the problems revealed. Or if you’re ready to jump in right away or can just afford one appointment at a time, you can set up an 1-hour consultation with me.

*Product, test and dispensary links are affiliate links for which I’ll receive a commission. Thanks for your support of the podcast and blog by using these links.

Adapted from episode 80 of The Perfect Stool podcast hosted by Lindsey Parsons, EdD and edited for readability.

Combating GERD: Are PPIs the Answer?

So you may have heard the term PPI being thrown around. It stands for Proton Pump Inhibitor, which is one of the most commonly prescribed and taken medications in the US, primarily for acid reflux or GERD (gastroesophageal reflux disease), with 15 million Americans a year using them. Some examples of these are Nexium, Protonix, Aciphex, Omeprazole, Prilosec and Prevacid. They have been available over the counter since the early 2000’s, and as a result, many people think they’re a viable long-term solution for acid reflux, despite having a strong warning on the package to not use them for more than 2 weeks straight.

In addition to their use for GERD, PPIs are also prescribed for ulcers, gastritis and Zollinger-Ellison syndrome (ZES). I’m doing to dig in a little more on each of those conditions, their root causes and the long-term drawbacks of PPI usage, so you can investigate other alternatives.  

What is GERD?

So the most common reason your doctor may prescribe or recommend a PPI is GERD or acid reflux, which affects between 18-28% of Americans and over 20% of people in the Western world. Gastroesophageal reflux occurs when the lower esophageal sphincter (the valve at the bottom of the esophagus) lets acid up into the esophagus. Common GERD symptoms include:

• trouble swallowing;
• heartburn;
• a foul or acrid taste in your mouth;
• regurgitating food (although what I used to get was just little bits of food in my mouth in the morning, indicating it had been coming up during the night);
• upper abdominal chest pain;
• sore throat; and
• vomiting.

While after a big or particularly unhealthy meal anyone may have these types of symptoms, if they’re happening on a regular basis, you may have GERD.

What is LPR?

Then there is another type of GERD, called LPR or laryngopharyngeal reflux, which is the type I had. For me its main manifestation was a chronic cough, usually worst in the 30-60 minutes after I ate, a feeling of warmth and sometimes hunger about an hour after eating in my chest, post-nasal drip, frequent throat clearing, hoarseness, and a lump and mucous in my throat. It can also include persistent irritation of the throat, the vocal cords, respiratory problems and plugged Eustachian tubes, which connect your middle ear to the back of your nose and throat.

So this was the condition I was dealing with when my doctor first suggested PPIs to me. I subsequently took them continuously for about 10-15 years, which may have contributed to my other issues that arose after that. And I’ve since learned that meta-analyses of PPIs for LPR have shown they’re no better than a placebo.

What are the risk factors for GERD and LPR?

Anyone can develop GERD or LPR, but some are more at risk than others. You are most likely to develop GERD if you are:

• Overweight;
• Taking medications that cause acid reflux;
• Pregnant;
• Smoking regularly;
• Drink alcohol regularly;
• Have an autoimmune disease called scleroderma; or
• Have a hiatal hernia (which is when the upper part of the stomach bulges into the diaphragm).

Let unaddressed, GERD is not life threatening on its own, but long-term and untreated GERD could lead to serious health issues, like esophageal cancer, not to mention the discomfort you deal with. So while the kinds of recommendations my doctor made to me about not going to bed until 2 hours after a meal or putting the head of your bed up on blocks to sleep at an angle or even sleeping in a recliner, may have been well-intentioned, they never got at the root cause of my reflux.

Is GERD always caused by high stomach acid?

When doctors recommend PPIs for GERD, their assumption is that you have too much stomach acid. But one of my former podcast guests, professor of naturopathic gastroenterology and author of a textbook on functional gastroenterology, Dr. Steven Sandberg-Lewis, performs the gold standard test for stomach acid with his patients called the Heidelberg test, and over the years has found that 75% of them actually have low stomach acid, or hypochlorhydria, and only 25% of them have excess stomach acid. In addition, some have hidden hypochlorhydria, which means that they have some normal stomach acid on the first challenge, but it runs out after a while, meaning there’s not enough of it to digest a meal.

While most people won’t have access to this test to determine officially whether they have too much or too little stomach acid, there are a couple easy ways to determine what’s likely. One way is by taking one capsule of Betaine HCl halfway through a meal with 6 oz. of animal protein. If you feel burning or warmth in your chest, you probably have adequate stomach acid. But you should check at a few different meals to be sure. You can always neutralize the acid with TUMS or a little baking soda in water if the burning is uncomfortable.

Other clues that you may have low stomach acid can be found on your standard blood tests called the CMP – or comprehensive metabolic panel and CBC – complete blood count. If you have one or more of these signs: chloride levels under 100, high or low serum protein or serum globulin levels, low phosphorous levels, especially with a vitamin D deficiency, high BUN levels of 20 or more, abnormal MCV, MCH, MCHC or below normal Hematocrit or Hemoglobin, indicative of iron deficiency, you may have low stomach acid.

And then there are several common reasons you may be low on stomach acid that you may already know about, including having had gastric surgery, having stomach cancer, and autoimmune gastritis (or an autoimmune attack on the parietal cells in your stomach that produce acid and intrinsic factor, which helps absorb vitamin B12), which causes pernicious anemia, which is a deficiency of B12. I was diagnosed with that issue early on in my gut heath journey, but no one suggested at that point that I may need to support my stomach acid. Since autoimmune diseases tend to occur in groups, if you have another autoimmune disease, it’s possible you have autoimmune gastritis as well and can asked to have your parietal cell and intrinsic factor antibodies tested. Finally, if you have H pylori, or Helicobacter pylori, you may have low stomach acid. I’ll dig into that a little bit more further down. Another sign for me is when clients tell me that when they eat meat, it feels like it just sits in their stomach. Sulfur smelling gas is also a possible sign of undigested protein and low stomach acid.

And of course GERD isn’t always related to stomach acid, but can be the result of upward pressure of gasses from an excess of bacteria in your small intestine, or small intestine bacterial overgrowth (SIBO), and undigested or malabsorbed carbohydrates. In my case, an intolerance to dairy, in particular casein, seemed to be at the root of my acid reflux, as it disappeared almost completely after I eliminated dairy from my diet. I knew I was lactose intolerant and took lactase enzymes when eating dairy and had already made the move to remove gluten, but the completely removal of dairy was key for me personally.

What is the cause of excess stomach acid?

For those people who do actually have excess stomach acid, one possible reason is Zollinger-Ellison syndrome (ZES), which is a rare digestive disorder that causes tumors called gastrinomas in the intestine, pancreas or both. Gastrinomas release the hormone gastrin, which prompts the stomach to produce too much acid. That’s one of the reasons why it is best to start to try to address these types of issues with a gastroenterologist, to make sure it’s not serious. If you get nowhere with that approach, then a functional medicine or naturopathic expert on gut issues may be in order.

Another common cause of excess stomach acid is an H. Pylori bacterial infection. Usually with a new infection, stomach acid increases, but then after the infection continues and increases, the damage to the stomach cells can lead to low stomach acid. 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, causing burping and bad breath that are commonly associated with H. Pylori, and which neutralizes stomach acid.

You can also end up with excess stomach acid after going off of a PPI or H2 blocker. Common H2 blockers are Famotidine (Pepcid AC, Pepcid Oral, Zantac 360), Cimetidine (Tagamet, Tagamet HB) and Nizatidine Capsules (Axid AR, Axid Capsules).

And a couple other less common reasons for high stomach acid include gastric outlet obstruction and chronic kidney failure.

Is it a good idea to take PPIs for an ulcer?

In addition to their use in GERD, PPIs are also often prescribed to both prevent and treat ulcers, which are open sores on the inside of your stomach (aka a gastric ulcer), or an open sore on the inside of the upper portion of your small intestine, or your duodenum, (aka a duodenal ulcer). Together, both are referred to as peptic ulcers.

Symptoms of ulcers include

• Burning stomach pain
• Feeling of fullness, bloating or belching
• Intolerance to fatty foods
• Heartburn
• Nausea

And some more severe but less common symptoms are:

• Vomiting or vomiting blood — which may appear red or black
• Dark blood in stools, or stools that are black or tarry
• Trouble breathing
• Feeling faint
• Unexplained weight loss
• Appetite changes

Because the main causes of ulcers are H. pylori and long-term use of NSAIDs and/or taking other medications along with NSAIDs, such as steroids, anticoagulants, SSRIs (or selective serotonin reuptake inhibitors, which are prescribed for anxiety or depression), or the drugs Fosamax or Actonel, getting off those medications through functional medicine approaches to the issues necessitating them is a necessary first step. And then for H. pylori, getting diagnosed and treating it. However, in the meantime, if you do have an active ulcer, taking PPIs is recommended and can prevent further damage and serious complications.

What is H. pylori and how do I know if I have it?

So, you may not be old enough to remember this, but I do. They used to believe that spicy foods and stress caused ulcers, which we have since learned isn’t exactly true. Drs. Barry J. Marshall and J. Robin Warren, Australian researchers, discovered in 1982 that H. Pylori was in fact the root cause of more than 90% of duodenal ulcers and up to 80% of gastric ulcers, for which they were awarded a Nobel Price for Physiology or Medicine in 2005, after being ridiculed and ignored by the mainstream medical establishment. 

The dilemma with H. Pylori is that doesn’t always cause ulcers and many healthy people have it in their systems with no problem. In fact, in developing countries, H. Pylori is found in over 80% of people, and about 20-50% have it in developed countries, but only 10-15% of people who have H. Pylori will develop peptic ulcers. The way that some strains of H. pylori cause peptic ulcers is by attaching themselves to the protective mucous coating of the stomach and duodenum, and weakening it, allowing acid to reach the sensitive lining beneath it, causing an ulcer to form. Left untreated, ulcers can lead to stomach perforation and bleeding and in extreme and untreated cases, death.

Now you should understand that only some strains of H. Pylori cause ulcers or gastric cancer, but not all, so if you have it, it’s important to find out whether your strain of H. pylori has virulence factors that can cause these complications. To find out, you can take the GI Map Test*, which currently costs $399 and is one of my favorite functional medicine stool tests, or an H. pylori profile, which is the H. pylori test with virulence factors from the GI Map, which is just $139 (reach out to me about accessing this test). You can also diagnose H. pylori, but not the strain, through a stool antigen test, which most doctors will order if you request it, a urea breath test, or a biopsy done with an endoscopy. However, in my experience, those biopsies always come up negative for my clients who then test positive using the GI Map’s PCR, or DNA-based test for H. Pylori. I like the GI Map because while it’s not usually covered by insurance, the information you get on it is worth its weight in gold. You can order it yourself online too, and I usually recommend it for my clients with any chronic GI issues, because it will tell you not only if you have H. Pylori and whether your amount of H. pylori is abnormal, it will also test for all other known gut pathogens, parasites, etc. as well as signs of gut dysfunction originating in your digestive organs.

Once you diagnose H. pylori, you can treat it either with the recommended regime of 2 antibiotics for a week plus a proton pump inhibitor (one of the rare uses for which I think a PPI is justified) or a course of herbal antimicrobials targeting H. pylori specifically. There’s also a new probiotic that helps treat H. pylori called Pyloguard, which you can find in my Fullscript Dispensary*.  

Are PPIs a good treatment for gastritis?

Gastritis is inflammation, erosion or irritation of the lining of the stomach which will often lead to a recommendation of a course of PPIs. It can be asymptomatic or can have symptoms such as

• Indigestion
• Nausea or recurrent upset stomach
• Bloating, pain, vomiting, including vomiting of blood or material that looks like coffee grounds
• Burning or gnawing feeling in the stomach between meals or at night
• Hiccups
• A low appetite
• Black, tarry stools, indicative of blood in your stool

You can have an acute or sudden case of gastritis, or it can come on gradually and last a while, which would be considered chronic. But either way, if you catch it early, gastritis can be dealt with easily. However, left untreated, it can lead to a severe loss of blood and may increase your risk of stomach cancer. If you have evidence of blood in your stools like the black, tarry stools I mentioned, you should ask your doctor to do a fecal occult blood stool test.

Common causes of gastritis are alcohol abuse, H. pylori, other bacterial gut infections, viral infections, and bile reflux, or when bile backflows into the stomach from the bile tract that connects to the liver and gallbladder. It is also commonly caused by aspirin and NSAID use. When I was going through terrible sciatica, I ended up taking ibuprofen at the maximum recommended dose pretty much all day long, which ended in me having either gastritis or the beginnings of an ulcer. That was one scenario where I did take a PPI for a short time in order to reduce my stomach acid and give my stomach some time to heal, as I tried to find other solutions for my chronic pain. One product I can recommend if you have some type of physical pain like that that necessitates ongoing pain relief, is called Acute Pain Relief (find it in my Fullscript Dispensary*). It’s a Euromedica product with Curcumin and Boswellia that will help your acute pain by naturally decreasing inflammation.

Is it dangerous to take PPIs?

While a short course of PPIs is generally considered safe, long-term PPI use is very problematic. Because PPIs reduce your stomach acid by up to 99%, the result of that can be the development of even worse gut bugs like C. difficile, maldigestion of protein, B12 anemia (which I had) and other vitamin and mineral deficiencies, increased risk of fractures and osteoporosis and pneumonia.  A 2021 study by Arun Koyyada concluded: “. . . the use of long-term PPIs may lead to significant vitamin (B12 and C) and mineral (iron, calcium and magnesium) deficiencies which need gastric acid for their absorption and bioavailability.”

So if you think of each one of those nutrients, if you’re B12 deficient, you’ll see signs such as fatigue or numbness in your extremities that can lead to permanent nerve damage, a sore and red tongue, mouth ulcers, disturbed vision, irritability and depression. If you’re low on calcium, this can cause muscle spasms and impair bone growth and repair and lead to osteoporosis. If you’re deficient in magnesium, it can lead to heart arrhythmias, loss of appetite, fatigue, shaking, pins and needles, muscle spasms, hyperexcitability and sleepiness. If you’re deficient in iron, it can lead to extreme fatigue, weakness, pale skin, chest pain, fast heartbeat, shortness of breath, headaches, dizziness, lightheadedness, cold hands and feet, inflammation or soreness of your tongue and brittle nails.  

Because PPIs block the production of stomach acid, which helps break proteins down into aminos acids, when it is not present it stresses the enzymatic system of the pancreas and other digestive organs which are prompted to secrete enzymes in response to stomach acid levels and ultimately causes a decrease in the absorption of proteins. Because proteins and the amino acids that make them up are necessary for building the gut lining and pretty much any other type of cell, enzyme, hormone or neurotransmitter in the body, protein deficiencies can lead to  numerous, cascading and complex medical issues and the failure to rebuild the system that is used to digest protein. These issues can include mental health issues, immune suppression and imbalanced hormones.

A 2017 study, Adverse Events of Proton Pump Inhibitors: Potential Mechanisms, concluded: “Current evidence suggests that use of PPIs may be associated with negative outcomes by eliciting several different pathophysiologic mechanisms. While short-term PPIs could be considered effective and safe in adult patients with acid-related disorders, their long-term and often inappropriate use in patients carrying vulnerability to adverse events and/or high risk of drug-interactions should be avoided.”

And that hits the root of the problem, the indiscriminate prescription of PPIs when they aren’t indicated medically at all, which happens in 33% of cases, or outside of the current guidelines, in 54% of cases. This isn’t much different from the antibiotics problem, where they are prescribed indiscriminately because people go to the doctor with a problem that conventional, Western medicine doesn’t know how to solve and the doctor feels obliged to do something and so just prescribes an antibiotic.

Other serious side effects that have been linked to PPIs include dementia, kidney disease, myocardial infarction, pneumonia and stroke. A study with US veterans found 45.2 excess deaths per 1000 patients amongst those taking PPIs due to cardiovascular disease, kidney disease and gastrointestinal cancer. They also found a greater number of infections, parasitic diseases, neoplasms or new and abnormal growth of tissue in some part of the body, and genitourinary disease associated with PPI use. For kidney disease, studies consistently suggest that the use of PPIs may be associated with an increased risk of adverse kidney events, especially in the elderly (with long-term PPI use and pre-existing kidney disease). Another additional question being studied is whether chronic PPI use can lead to the onset of gastric cancer. The abrupt discontinuation of PPIs is also related to increased gastric acid production above pre-PPI treatment levels, a phenomenon called acid rebound.

So my advice is, if you need something to give you immediate relief, try a simple acid reducing medication like TUMS, or baking soda in water, an H2 blocker, or if you must take a PPI, my recommendation is to follow diligently the instructions on the package that says not to take them for more than 14 days. If your problem doesn’t resolve in those 14 days, you may need to look harder for your root cause.

If you have follow up questions, a great place to ask them is in my Facebook group called Gut Healing.  And if you’re struggling with gut and/or other health issues and need some help, I offer a free, 30-minute breakthrough session to talk about your issues and to see if health coaching might help you resolve them.

*Product, test and dispensary links are affiliate links for which I’ll receive a commission. Thanks for your support of the podcast and blog by using these links.

Adapted from episode 79 of The Perfect Stool podcast hosted by Lindsey Parsons, EdD and edited for readability with with Stasha Gominak, MD, neurologist and sleep coach. Dr. Gominak attended medical school at Baylor College of Medicine, completed her neurology residency at the Harvard-affiliated Massachusetts General Hospital in Boston, and practiced neurology in the San Francisco Bay area until 2004, when she moved to Texas and began focusing her practice on sleep disorders.  In 2012 and 2016 she published two pivotal articles about the global struggle with worsening sleep and the possible causes and solutions related to vitamin D deficiency and the intestinal microbiome, which we will be discussing today. Today she currently divides her time between RightSleep® coaching sessions for private individuals and teaching other clinicians the RightSleep® method of sleep repair.  

Lindsey:

So let me just jump right in and ask you how you stumbled onto the connection between vitamin D and the gut microbiome?

Stasha Gominak, MD:

Thank you for asking that question. Lindsey. It is really interesting. So I started with an interest in sleep. I’m a neurologist, I was noticing that most of my neurology patients, regardless of the reason why they were referred, if we would do a sleep study, they didn’t necessarily have sleep apnea, but they didn’t also have normal sleep. Then by a series of odd accidents, I found out that they all had low vitamin D. And I found a substantial literature about vitamin D affecting sleep. And that literature was written primarily by a guy named Walter Stumpf, who had already put together a conceptual framework that said, Vitamin D is not a vitamin, it is a hormone that we make on our skin from the sun. And it is meant to allow us to change three important things in relation to the season: one, our metabolism, two, our sleep, and three, our fertility. So that allows us to not have babies in the middle of winter when there’s no food, allows us to sleep, and slows our metabolism. So in essence, we hibernate.

So this was the framework that he had built, after doing lots of scientific studies of many different kinds of animals, insects, fish, birds, etc. It was his article that suggested that the D receptors throughout the GI tract were very important in things that happened to us, like there are vitamin D receptors in the islet cells of the pancreas where insulin is secreted. And it was his hypothesis that it was affecting our GI tract. Because of those articles, I just assumed that the vitamin D that I was going to give for our sleep would help get the right microbiome back. And at the time that Walter Stumpf was writing his articles, we didn’t have an epidemic of the wrong microbiome, the GI people hadn’t been writing about the microbiome, it didn’t even exist as a concept in the 1980s. So by the time I’m giving back vitamin D, many of my patients have irritable bowel syndrome, and the whole concept that you really have to know that your microbiome is normal has started to show up in the GI literature. I thought that the vitamin D was going to just fix it. Because I thought that it made sense that perhaps we change our metabolism through changing the microbiome, therefore, vitamin D should be a trophic factor to the bugs that live in the belly.

Lindsey:

Could you define trophic factor?

Stasha Gominak, MD:

A trophic factor means a factor that helps things grow. Trophic means growing. So I thought it was going to be obvious that just like other bacterial growth factors that we’re going to talk about in a bit, D was going to be something that encouraged the growth of the normal bacteria. It turns out that at that time that I was thinking that there were no articles supporting that however, the first article supporting that in humans was in 2020. So around the time that COVID starts to appear, and doctors start to give vitamin D, they actually do a study where they give vitamin D at various different doses and actually follow the blood levels, which is an important issue and document that if you can get the blood level to go up, you’re not only feeding the bugs, but your body’s absorbing it. If you can give a bigger dose, you can change which bacteria live inside you. And they show that pathologic bacteria that hurt us or less common and help healthy, helpful bacteria were more common if you’ve got your vitamin D level up. So we have some proof that vitamin D is actually a bacterial growth factor. There are lots of other things in the history of vitamin D that I can refer to also if you’re interested in that.

Lindsey:

Okay, well first, let me ask you, if you can just bring it together a little bit better that connection between vitamin D and the B vitamins?

Stasha Gominak, MD:

Yes. Okay. So I’m going to go into the history a little bit. So here’s what happened next. So I’m giving vitamin D because I want to get their sleep better and the sleep gets better. But then it starts to fail. So after two years of using vitamin D, the beneficial effects on the sleep start to fade and lots of other things start to show up and they’re kind of scary things like, I have pain all over, I have burning in my hands and feet. I personally developed weird buttock pain. So now our sleep is failing, the D level is still 65. So the important thing to know about D is you have to measure the blood level, you can’t just go by a dose. It is a hormone, it’s not a vitamin, it’s really not in the food. That means if you have a stable vitamin D level, and you’ve gotten better, now you get worse again, I began to suspect that something else that the brain wanted to sleep better was not being supplied.

So one of my patients brought me a book about a vitamin called pantothenic acid that no one’s talking about, B5. He brought me a book about it. And it was a book written in the 1990s by a layperson about rheumatoid arthritis, joint pain, and pantothenic acid, and she’s giving pantothenic acid in very big doses, 400 milligrams, that’s considered the normal dose at the time she’s writing this, to lay people and saying that their pain got better and their sleep got better. So I personally was not knowledgeable or that interested in vitamins. But I was desperate. And I really didn’t know why everybody was failing. And I went to the references that were in this particular book. And the references were of laboratories in the 1950s, that blocked pantothenic acid using a specific chemical blocker. And within two weeks, they showed that the people in whom they blocked them had burning in their hands and feet, inability to sleep, belly pain and a funny gait.

So there was scientific evidence suggesting maybe this vitamin D that I’m giving is somehow making these other B vitamins go bad. Now, the thing that’s weird about that concept is, this didn’t show up until two years of vitamin D, which is strange. The second thing is, these people have no change in their diet, we have been told, and the only thing I knew was that the vitamins B, of which there are eight, come from the food. So if they haven’t had a change in diet, if the only thing these people have done over the last two years is to take vitamin D, why on earth would they now be showing up with B vitamin deficiencies if that’s what’s going on? Now I start to read about the B vitamins. And most of the articles that are reviewing water-soluble vitamins, including B vitamins, are saying thiamin, which is B1 has a colonic bacterial source and a food source. Riboflavin has a colonic bacterial source and a food source. They go through all eight of these and say, oh, they come from the poop bacteria, and they come from the food. Well, if my patients have started to have burning in their hands and feet, and keep in mind, I’m a neurologist, neuropathy is my subspecialty. So I’ve been doing this for 30 years. Burning in the hands and feet is not common. Burning in the feet is pretty common, but in the hands and feet in two young women already on B12, which is one of the things that can affect that, come in within a month of each other. That’s really creepy. That sort of suggests that in my effort to make them sleep better and repair, I may have used up their B vitamins.

The B vitamins are really the building blocks of the things we do, all sorts of things we do. So maybe I’ve made them deficient. Why would that happen? What if the real source is really from the bugs? What if the fact that they have irritable bowel syndrome really means they have the wrong microbiome? Because their D was not high enough to bring the healthy happy ones back. And they have become B deficient because their bugs are off. Now the weird part about that is I’ve been given them D for two years. Why didn’t the healthy bugs come back? So the first question was, well, if I think they’re coming from the bugs, how can we get them back? What do those little guys want that they haven’t been receiving? Okay. In the background, I’m reading all these other articles about the fact that there are historical articles that suggest that the four healthy phyla that we have of bacteria actually trade B vitamins among themselves. So there are lots of articles from the 1930s/40s that say this particular species makes riboflavin, this species makes thiamin. So there’s actually a whole body of literature that says, we first described the B vitamins, as bacterial growth factors in the 20s and 30s. What they were doing is growing bacteria in a little petri dish. They’re following Pasteur. They’re pouring this interesting yeast and water mixture together. I’ll tell you about that in a minute. So they’re pouring this stuff into a Petri dish. And then they’re watching the bacteria that grow. And then they realize over time that there are things called growth factors that are chemicals that are in there and the bacteria are actually making them.

So there’s a literature already that suggests these four specific phyla hang out In our GI tract, because they trade eight chemicals called the B vitamins, if you’ve never thought of it before, why do we have A? And then we have eight things called B. And then we have C. And that’s kind of weird. Like, why are they all grouped together? It’s because they were discovered together in this liquid that they actually use that was already sitting on the counter. So picture they’re way back in their little microscopic world doing these bacterial growth studies. And they borrowed their wife’s yeast solution that she’s got sitting on the counter that she put brewers yeast in, because she was going to make beer. And what you do with that stuff is you let it sit on the counter at the right temperature, you can’t boil it, and you can’t let it go too low. And what you’re really doing is you’re choosing a middle temperature that promotes the growth of bacteria that are naturally in water, in the air. And you let those grow for a specific period of time, depending on whether you want to make bread and what kind, and you may add certain cultures, and that’s how you make sourdough bread. So the same yeast-bacterial mixture that is used to make beer and bread turns out to be the source of what we call nutritional yeast. Nutritional yeast actually has B vitamins in it. So backing up for a moment, that means the yeast makes D2. D2 is a much, much older chemical. And it’s actually made in yeast from exposure to the sun, just like our D3 is made from exposure from the sun, but it’s a different chemical. And the bacteria that grow in that water with the yeast in it are selected for by being four different groups that want D. So in actual fact that liquid would trade D from the yeast, with the bacterial growth factors that helped the yeast, so they would help each other. They run in a symbiotic relationship, then they use that same liquid that they stole from their wife’s kitchen cabinet, poured it in a petri dish and started to study the bacteria. And soon they found that some of the Bs were heat sensitive. So if they boiled the liquid, they couldn’t get certain ones to grow.

And then they saw other interesting things like, here’s a little lump of white stuff with little black tips on it. And that’s a particular kind of bacteria. And it has a clear zone around it. And somebody said, Well, does this mean that these bacteria are secreting a chemical that prevents this little yellow slimy one from growing into its territory? And the answer was yes. And penicillin is born. Penicillin is an anti-bacterial agent, it’s made by bacteria. Well, why would they do that? Well, they do that to kill off their competitors. So in the background is a lot of history. You have to start thinking that somebody way back in the 1930s, when we went from bacterial growth factors to vitamins, kind of knew that these eight chemicals were coming as an eight pack. And in actual fact, when I was in medical school in the late 70s, I was told if you give one B, you should give all of them. Now, in the last four years, that dogma has changed a bit in medicine. Some people in the supplement industry have not changed that dogma. But medicine has started to do single Bs by themselves, which I think is a bad idea. Ultimately, then as I’m going in to try to fix this burning in the hands and feet, and I buy pantothenic acid, I don’t know much. And so I think well, if they said, if you give one you should give all, I pick up this stuff called B100. That it’s actually a big dose B complex, and it’s specific doses of all of them. It’s not that I knew what I was doing, it’s that I wanted to make sure it was consistent among the people I was recommending it to (so I don’t brand my own vitamins). So I give this B100 stuff. And I read the articles I described to you and I thought, you know, the one thing, if the happy healthy guys are still down in the belly, my belly, and my patients bellies, I bet there was too much bad bacteria in between them. So there’s piles of poop in between these healthy guys. And maybe they’re too far apart for them to trade the thiamin and riboflavin the way they used to. But I’ve just flooded the GI tract. I’ve made this B vitamin soup.

Now I’m giving them a B vitamin soup, all a big dose, and D, theoretically it should bring the bugs back. And in actual fact it did, but because I’m following sleep and pain as a measure of whether or not they’re back to the way they were, that’s a long discussion. But ultimately, within three months of taking B100 and D, all the symptoms get better and go away an d the belly IBS symptoms go away. So there’s sort of a second idea in the background. D by itself, and this is really an important piece, because now everybody’s interested in D, COVID has hit the front page, everybody’s taking D. But anybody who has a D that’s low, you can pretty much assume that their microbiome has gone bad. And I didn’t actually have IBS symptoms; I just couldn’t eat garlic. But if you do D, and you do not bring back the supportive natural microbiome, and my method is not the only way to do that, you’re the pro in that, and we can talk about that further. But, bringing back the microbiome then means, as I use D to sleep better, make repairs on my immune system, I now have the eight building blocks that are needed to make those repairs so that the better health is actually achieved by not only taking D but converting the microbiome back to the four healthy, happy phyla.

Lindsey:

Wow, that is fascinating stuff. And I sort of knew about the fact that the Bs were discovered together, but I had no idea about the logistics of it. So that’s amazing. So just backing up a little bit to the real basics, what do you consider optimum levels of vitamin D, and what’s the best way to get it?

Stasha Gominak, MD:

And I want to circle around and give you one other way to test this concept that the B’s come from the bugs, okay, because there’s another approach to that. But we can come back to that at the end. Vitamin D is extremely controversial at the moment, there are emotion laden fights going on between people in medicine, people in supplements. It really is one of the fascinating parts of medicine. So one, anybody who’s taking vitamin D should spend some time and learn about it. Two, you’ll find very divergent opinions. Okay. In the background, my view is, I entered this as a completely naive neurologist. I’m not an endocrinologist, I didn’t study hormones, I would never have gone down this path if I understood just how complex this is. However, I did stumble into something that is very important to all of us.

And in short, I had one simple question. I’m interested in sleep, not hormones, I’m interested in sleep. What’s wrong with my patients? I now have hundreds of sleep studies in young, healthy females who have daily headaches; that’s the group I’m studying. They don’t make enough rapid eye movement sleep, they just don’t have any. Okay, that can’t be because they don’t breathe, right? That’s something in the brain, then I stumbled into the fact that they all have low vitamin Ds. And then I find that there are scientific articles that show that there are vitamin D receptors in the actual cells in the lowest part of the brain that do sleep. That means D is designed to run your sleep. Now, the next question was, if it’s all low, is there a vitamin D blood level, not a dose, but a blood level that will make my patients come back and say, hey, you know what, my sleep is better? Like I had a very simple question. If we increase the D blood level, and we keep measuring it, so there is a very specific blood level of 60 to 80 nanograms per mL that promotes better sleep in someone who’s had a sleep disorder. Okay. In the background, you have to be D deficient for a long time before you develop a sleep disorder. So one, it’s not really a study that answers what’s the ideal D level for a human being who’s been living outdoors their whole life. Remember, we’re animals. Every animal that hunts during the day, lives outside except us and our pets. That means we’ve just done something that really goofed up our biology, because the dermatologists in the 80s began to tell us being in the sun is bad for you. And we moved indoors, we got air conditioning, computers, now COVID. We are the only animals on the planet who had a biology that meant we lived outdoors from the moment the sun came up until it went down who have moved indoors over a 40 year span. And that has profoundly affected our D levels.

Now, if you go to hunter gatherers in Africa, and you say these people don’t even have a hut, they just live outside all the time. You will see that their D levels are in the 40s and 50s. I think that’s a different question. What if I’ve never gotten D deficient because I live outside and I don’t actually have to push it to a place to feed a deficiency state. Okay, so the 60 to 80 range is argued about because every clinician who uses D a lot, has a different range that they believe in. Mine was based on watching people sleep. And I really just said, “Well, how’s your sleep now?” And when they came in and said, My sleep is better, I go, “Oh, this is awesome. Let’s go down and see what your D level is.” That has now been consistent since 2010. So it’s been 12 years. All right. So in the midst of this, there are multiple questions about it. There is a question about most people who want to look at supplements and want to know, what’s the ideal? What’s the ideal level for humans? That’s really a different question. And we don’t know that answer. So every single person who writes about D enters it from a different viewpoint. There’s one guy entering it from a dermatology standpoint, who’s showing all these amazing kinds of D that are made on the skin. Other scientists are entering it from some other standpoint. So it depends on how you ask the question, what is the best level for sleep? 60-80 nanograms per mililiter.

Lindsey:

Okay, yeah, and I’ve definitely heard the numbers 50 to 80, and 60 to 80. And I find that my clients, to get to that level, usually you start them at 5000 IU of D and I always do D and K together. And then usually at some point, they hit the optimal levels, and then you can maybe reduce it to a little less or less frequently.

Stasha Gominak, MD:

Let me comment on when you’re trying to manipulate your sleep. If you see sleep as the final way that we heal our body. Okay, you and I are intervening. We’re biohacking by giving things that we presume the body needs. But the actual healing is extremely complex. And the sleep is the intelligent fixer of that. What that means is when I’m trying to get somebody to do D, I’m not really focusing on their bones. When you’re doing bones with D, you may get a D level once a year. When you’re trying to get your sleep perfect, so that you don’t ever develop medical problems or that you heal your medical problems, then watching what your D level is at least four times a year, so that you’re aware of what’s my summer maintenance dose with sun as a second source? What’s my winter maintenance dose? And more importantly, are there physical signs that I get when my D drops below 60? Are there physical signs I get when my D goes above 80? Those things have not been recognized by medicine yet. They are there in every single person, but they’re a little variable from person to person as to what they manifest when their things aren’t right. Sometimes it’s sleep, sometimes it’s pain, sometimes it’s anxiety. So there’s an odd history that with thyroid hormone, even lay people know if you go too high, you get weird if you go too low, you get weird. Same thing with cortisol. Same thing with testosterone. Same thing with estrogen. When you go in and you’re taking supplements from your doctor, the doctor is focused on what your symptoms are. Because they know that’s a reflection of do I have the estrogen level, right? Do I have the testosterone? They haven’t done that for D, but D is exactly the same. If you keep it at a nice homeostatic middle, which I usually want to have it in the 60s. For most people, when you get physical symptoms that suggest is too high or too low, then you adjust it and you run and you get a level. We haven’t moved to that yet in medicine, which is a shame because it’s there for us, we just have to learn about it.

Lindsey:

So what kind of symptoms do people manifest when it’s too high?

Stasha Gominak, MD:

The problem with that is it’s a little different in each person. Okay, so really, the way you should look at this is if someone’s coming to me with problems, and we say most of us in this world around the globe now are D low and our microbiome is screwed up. Some of the symptoms you’ve had leading up to finding me will be either related to the D being low to your sleeping bad, or your microbiome being goofed up, okay. And then over time, as you get more D and some of those symptoms go away, they’ll usually be signs of what happens to you when your D goes low. Now, that is particularly difficult, because those are all things like oh, I wake up at 3 a.m. and I can’t go back to sleep. Oh, I have foot pain. I was told I have plantar fasciitis. Oh, I’ve been told I have ulcerative colitis. They’re all things that we’ve applied names and legends to. Okay, so I have these things because blah, blah, blah. And we weren’t told it was because we had low D. Then when those things go away as you’re taking the vitamin D, as they go away, then you realize, oh, my D is better my sleep lupus better, I all sort of colitis is gone. And oh, by the way, my eczema is better, then you start to list the things that are responding. And then over a period of many months, as long as a year, you can actually show that when my D is in that 60-80 range, I don’t have the following things. But it’s variable from person to person. Many of the things that show up are actually related to another thing called acetylcholine, which is a neurotransmitter. That’s a very complex set of things. It’s related to a lot of the mental issues that come with having a low D and a low microbiome, especially anxiety, agitation, high heart rates, etc. I wish I could give you a specific, easy answer, but it really varies from person to person. I have a whole website dedicated to informing you about what will likely show up when you’re learning about how your body tells you your D isn’t good.

Lindsey:

Let me ask you this, though, is it more important to get certain amounts of D or some of the D at least, from the sun? What do you recommend in terms of sun exposure? I jumped on the whole functional medicine world of get your X number of minutes of sun a day and went and got a basal cell carcinoma right on my forehead. Now I do still get some sun, but I don’t expose my face ever. I always protect my face.

Stasha Gominak, MD:

Okay, that’s a perfect setting in which to talk about this. I got a basal cell carcinoma after I started to take D. When I told you that D was a pro growth hormone, one of my fears was this: We have to understand that when you and I have been living our lives with a low D, and D, by the way, in its primary use can actually go into the cell and correct a squamous cell carcinoma. So you, grow a squamous cell carcinoma in a petri dish, you pour in D, it corrects itself and it actually changes the DNA. I’m not seeing articles about basal cell doing the same, but there are many things that D does on our skin that were originally designed to protect us from the side effects of UVB light and UVA and the damage to our DNA. Now, having said that, we’ve just walked around on the planet, (for me) around 40 years without that protection. That means if I already have a cell that’s gone rogue, and it’s decided it’s just going to grow the way it wants, giving D could potentially increase that growth.

Now, I want to say to each person, you have to do what you’re going to to deal with the sun exposure based on your own personal history. So your decision not to expose your face, I think, is a smart one. And any of us who’ve had a basal cell carcinoma, one, should be examined all the time by the dermatologist, and two, should be pretty careful about sunscreen. Now, I want to circle back to your original question. More and more research is showing that being outdoors is one of the most important things for your health. Even if you’re not in the direct sun, there’s a whole bunch of literature about infrared light that we can get indirectly, not even when we’re outside, but from incandescent lights. So there’s now a literature that suggests we changed from incandescent lights to halogen and LED, we screwed ourselves even further. Because there was actually infrared light coming from those lighting sources that would penetrate our body to two or three inches, these very unusual energy types that do things to our mitochondria deeply in our body that help our health.

Okay, so then I want to back up to say, I still support your idea that being outside is the best thing you can do for yourself. Now, we actually have an advantage in having sunscreen. That means you can actually modulate what you do. You can be outside a lot, put on sunscreen, and still try to move your D level around with oral D. There are in fact a rainbow of types of Ds that are made on the skin when we’re exposed to UVB light, not just the one we take. We take one type, we take a D325OH. Well, it turns out, there are many other OH types. There’s 3OH, there’s 17OH, there’s 23OH, there’s a whole array, so that is very complicated. What I want to tell you about it is we humans know, one 1,000,000th of what we should know about this chemical.

That means when we want to biohack, we should really just go back to what is the evolutionary model that we’re following. All other animals live outdoors. All other animals have fur, feathers, scales, so we are kind of unique. We and pigs are really some of the only bald animals on the planet. That may, to some extent, have given us an advantage, because most animals get their D from licking their fur. They make the D in their fur, but it’s not 100% absorbed directly. That could mean that we actually made more D than the Neanderthall, who were furrier. We actually slept better, reproduced better and got smarter. We have a kind of a unique situation. Now, if you look at it through that lens, it’s still much better for you to be outside.

And frankly, I suspect that we’re going to see more and more and more literature about the actual science of what happens to us when we’re outside. You and I have been, as everyone else has, been fed, the idea that we live in a toxic environment. That’s not wrong. And I’m glad there are people out there trying to do something about it, but I personally may not be able to do anything about my neighbor using Roundup. We’ve used that explanation because we don’t have a good answer for why do I feel so shitty all the time? Why can’t I sleep? Why am I infertile? We supply these answers. But what if they aren’t the whole answer? We should still be curious, are there other things that I might be able to do that would be able to add to my health just like what you’re doing, and then modulate it. What I like is being able to say, we can actually hold two or three belief systems all at the same time. We can use Lindsey’s belief system, about toxic environment, functional medicine, detox, the GI tract is the center. We can use Stasha’s if it’s about sleep; we can use routine medicine also. We can take from all of them the things that are valuable to us.

Lindsey:

So I guess to sum it up, go outside, use sunscreen to keep from getting burnt, and get some of your D from supplements as well.

Stasha Gominak, MD:

I think that’s a good summary statement that each individual person has to use their judgment to which one they’re going to do and that they should still observe what’s best for them.

Lindsey:

Yeah, and might it be a good idea to increase your D levels with supplements before launching into your “I’m going to go get regular sun every day without sunscreen” project?

Stasha Gominak, MD:

Actually, that is a great idea. My view is some people really can’t tolerate that this is the temperature that’s outside in Texas right now.

Lindsey:

I mean, in Arizona, so similar.

Stasha Gominak, MD:

Yeah! It’s very difficult to tolerate 100 to 110. Now, one of the fascinating parts about that is our autonomic nervous system, the nervous system that keeps our belly pooping on the right timeframe – that we poop every morning. It really has a time clock. And we sleep at a certain time. That autonomic nervous system that runs all of that is actually tied tightly to vitamin D and the Bs from the microbiome. So our ability to manage our internal temperature is directly related to that. That means humans have actually lived in Arizona, like I was recently down to near Big Bend. It was 110. I was like, “How did these people live here 100 years ago, without even a tree? How did they make it?” They did make it! And that means that their ability to defuse the temperature and find a way to make their internal temperature normal in 110 degrees was actually normal. Many of us have lost that control. When we lost our D in our microbiome. That means your question is, what should I do to get out there first, if you go out in the sun and you feel like you’re going to pass out, you don’t do that right off the bat. You start to work with exactly what you said. I supplement first. I get my sleep better. I get my nervous system better. That’s when I start to go out and I do things according to what my body says it can tolerate.

Lindsey:

Okay, sounds like a good plan. So can you talk a little bit about how vitamin D is important in autoimmune disease?

Stasha Gominak, MD:

Yes, the first thing I would like to list under that is… All we’ve seen about the articles hitting the front page about COVID are not about the virus, but how my unique immune system reacts to it. So now we have information that says, they really die of an autoimmune storm that affects the ability of the lung to tolerate what my own immune system is doing. Okay, and then we get into the science of it. But ultimately COVID is not just about the virus, it is about the virus and the host. We were never designed to attack our own body. Our immune system is extraordinarily well developed to never attack our own body. Also, parenthetically, that bit that I said about this bacteria makes an antibiotic. We’ve been taught that the reason why we lost our microbiome was the use of antibiotics, but there are actually two or three generations of humans between the early 40s (1940’s) and the mid 80’s, who took a lot of antibiotics. I was alive then. We took antibiotics for strep throat, and we did not develop IBS.

Lindsey:

But were they as broad spectrum?

Stasha Gominak, MD:

Yes, I’m simplifying it. On the first, it’s not that antibiotics are not to blame, because they absolutely do change the microbiome. But there is a suggestion that it wasn’t just the antibiotics – that something started to happen in the middle 80s. That is when IBS started to show up and that’s when D’s started to go low. In the background, I want to make the point that when we get our normal microbiome back in the belly, the bacteria that are supposed to be on us are not just inside, they’re in our sinus cavities. They’re inside our nose, they’re on our scalp, they’re in our pits, they’re in our perineal area. They have very specific bacteria that are supposed to grow there. And all of the bacteria and viruses and fungus that naturally grow on us when we live outdoors and have a good D level, actually make antibiotics. They make antivirals. They make antifungal agents. That means if you picture those Africans wandering around without even a hut, and it turns out if we use COVID, as an example, the people who still live outside even though they’re poor – like in India, the garbage dump, the guys that are in collecting garbage, actually made it through COVID better than the software engineers, because they still have an outdoor life, which implies that our natural microbiome plays a huge role in protecting us from infection. That means as we get this infection with COVID, if we don’t have a normal microbiome, we don’t have our own immune system helping us.

So step one, the question is: one, what’s happened to the immune system, and what showed up at the same time is higher incidence of autoimmune disease and a higher incidence of I can’t protect myself from this simple virus. So if you look at what we put on the front page, it’s if you’re obese, you have a higher likelihood of a bad outcome. If you have dark skin, same thing, if you have other underlying diseases. Those are all things that really point to I have a sleep disorder and actually my microbiome isn’t right and D is low. So in the background, it describes a population that is 60%, not having a normal immune system, and has a higher incidence of autoimmune disease because of these changes with D and the microbiome.

Now, stepping back a little bit. The next question would be if I have an autoimmune disease, how do I use this knowledge? You’re telling me about how do I use this knowledge about D and the microbiome to make it better, because that’s really what I would want as an individual. So it’s nice to know that these things are linked scientifically. Now, it is my belief that what I saw in my patients, which was I spent five years with CPAP devices and sleeping pills, okay, I saw autoimmune disease and my patients getting better and it wasn’t with any drugs. It wasn’t with D. I personally believe that the vitamins are tools. They’re bricks. They’re things that our body was missing. But in order to have a coordinated healing of a complicated system, the immune system is extraordinarily complicated. You have to be sleeping, right, you have to be sleeping a lot; you have to be sleeping a normal amount. It’s really not as simple as take these vitamins, get your microbiome back, and then your immune system will be okay. That’s not what I saw. What I saw was when I get into the vitamins side of this, if the person still needs a CPAP device, they will get better faster with my vitamin regimen, if they have CPAP. If they have an autoimmune disease, and I never really get them sleeping, they don’t get better. So I still think that the core of healing our autoimmune disease is about normal sleep. And the way we get to normal sleep is multiple paths. Do I have a GI [issue]? Do I have something wrong with my oral airway that my dentist should work on? Do I have sleep apnea? Do I have a vitamin D deficiency and the wrong microbiome? These are all different paths to if I consistently work towards getting the best sleep I possibly can, I can actually repair some of these problems.

So I don’t see it as a simple recipe. I’ve seen dramatic improvement in autoimmune diseases by using these vitamins. But there’s still several things about it. Let me give you an example. One of the people that joined my program had ulcerative colitis that was cured with the medications his doctor was giving him. So he didn’t have GI tract issues anymore, but he had bad eczema since he was three. So I’ve sold him my program, which is called the Right Sleep Program, of these vitamins and getting sleep better. He really has an intention to get his eczema better. And it didn’t fully work, it got better and then worse again, and then better and worse again.  It was linked to the vitamins, but he also had a sleep disorder where he couldn’t fall asleep until 4am. His sleep schedule would be 4:00 am until about 2:00 in the afternoon. I finally said, “Look, you know what, I think that the D we’re using orally”, he lives in Great Britain. So he lives outside of London. So he has, you know, poor sun exposure. He decides because he is financially able to take a six month vacation and go every single place where he can be in the beach the whole time. And like other people who describe this about sleep, his falling asleep time moves forward. It’s really linked to being out in the sun, not only driving with the eyes being exposed to sunlight and being fixed to the 24 hour cycle, but his eczema got remarkably better as well. And I suspect that I’ve seen multiple other people with eczema that goes completely away. But there are going to be some subtypes where you have to have this array of these different kinds of D that are really only made from the sun. So I think it’s more complicated, but it’s a path that you can start learning about to arrive at where we like to be.

Lindsey:

Interesting. Yeah, no, that’s great information, because I do have a number of clients with eczema. I’ll be thinking about that. So in terms of supplementing with the B vitamins, I know there are some such as B6, for example, that can accumulate in the muscles, I believe and cause toxicity. What are the signs that you’re taking too many B vitamins or what are the dosages that one should reasonably take over an extended period of time or should we be testing, etc.?

Stasha Gominak, MD:

Excellent question. This is a really complicated question. So the first question would be, do we really have stores of B’s, because what we were told was that you don’t have to worry about getting extra B’s because we pee out the excess. Okay. And when you get it as a B complex, thiamin is bright yellow, it almost fluoresces. And as soon as you take a big enough dose your pea is yellow, so it’s really easy to support the idea that we pee out the excess. And when you hang it in a bag in the hospital, it’s yellow also. Now, having said that, we are told that we pee out the excess.

My first foray into B vitamins was using this B5. I’m going to answer your B6 question ultimately, but I want to give you how complicated it is in the background. So I go out and I buy 400 milligrams of B5 and B100 and I start taking it myself. And I recommend for one week to any of my patients who’ve been with me for two years, taking D for two years and now have these new pain complaints and sleep complaints, that they should take 400 milligrams of pantothenic acid and B100. Around day five, I realized that my restless leg syndrome, which is my sleep disorder which makes me very sympathetic to other people who have sleep problems, is terrible now, and it’s gotten infinitely worse since I started this now 500 milligrams of B5. So immediately, I think, uh oh, this is like vitamin D, where they tell you to take 400 milligrams, but they really don’t know what they’re talking about. And I just overdosed. I went down from 400 milligrams, took away the 400, took B100 just by itself, and it was immediately so much better in a day, which is really weird. Then my patients who I recommended it to about 30 out of 40 started to trickle back in and said, “this stuff, this 400 milligrams, this nearly killed me. It made me so agitated, I couldn’t sleep at all and only took it for two days.” This is sitting there innocently in the health food store, 400 milligrams, and that is the recommended dose of pantothenic acid. That means one, you can’t really believe every article you read. Two, each individual has a different background on which this chemical is falling.

It turns out that D makes an enzyme that makes acetylcholine. That acetylcholine can either make you sleep like a baby, or if it’s too high or too low, it makes you unable to sleep. And it can cause anxiety when it’s too high and too low. It acts kind of like this hormone type thing. Too much and too little both affect you. That means it took me several years to piece together that there’s a synergy between B5 and D. Now what does that mean? It meant that I was right, that I’d actually use this D to make their sleep better and I had actually sucked up all their B5 stores. And it took them two years to manifest a B5 deficiency state. That kind of undermines the whole concept that we don’t have stores. And in actual fact, there’s scientific articles that show we have stores of B5, B6, B1 and vitamin C. Okay. And there’s some logic to that. Now, the problem is they aren’t just sitting around in a lump under your skin. We don’t have any idea where the stores are. So in the background, there are also articles about if you take grams of B6, so I’m coming back to your original question. So as a neurologist, I’m trained, somebody comes in with burning in their feet, look for them to be taking too much B6. We’ve been told that B6 overdose produces burning in the feet. But what if, and this is just a what if, what if huge doses of one B means that all the little B packs that are supposed to be actually eight chemicals coming in, the ratio gets screwed up? So if I overdose on B6, it actually means it has an effect on the amount of B5 I’m using. The person who took B6, by itself anyway had a reason why they were taking it, so it’s still possible that what we’re seeing is one, I was able to treat burning by giving B12. But the two gals that walked into my office with burning in their hands and feet were already on B12. Now, that’s the only reason why I would up with B5. What that means to me is these eight chemicals are so tightly intertwined in our biology, that you really are taking a bit of a risk giving individual ones.

Okay, now there’s a second portion of this, which is there’s a whole body of literature suggesting that if I’m not taking B6 supplements, in fact, I’m not taking B vitamins at all, why would I have a B6 blood level that’s too high? And there are a whole bunch of symptoms that are listed with that. There’s a minority opinion, which says, the reason why the B6 is high in your blood is because it’s not going into the cells that are being used. It does not have the complement of the other Bs that it needs and all of these other responsibilities that the Bs have. So it’s not being used in the cell correctly. Having said that, this is really hard. Because if you can’t use the blood level, and it’s been my experience, that for the Bs, the only one you can really use the B1, the B12 blood level. Even that is a little suspect, because there were similar readings about oh, my level is over 2000 and I’m not supplementing, what does it mean?

Stepping back, there is still I think a problem with not having a way to measure what are my B vitamin stores in my body. We don’t really even have a good idea about that. And to be truthful, I feel like I’m out on the frontier, kind of like you are you’re acquiring information, clinical information, from your experience with clients. And when something gets a little bit weird, you then go to the literature and you read a bunch. And then you’re seeing some other human being’s experience, then you’re seeing certain biochemical pathways in rats, and they were trying to put them together. It’s difficult. And my final answer is, you have to have a client who’s willing to listen to their own body. And you have to have a relationship that says, I’m giving you suggestions, but you’re a unique individual with your own unique history. And when you do this suggestion, if it makes you feel worse, we immediately back off, and we do something else. I don’t think there’s a good answer. I wish it were simpler, but I’ve seen people who have B6 that’s elevated. And they have a lot of symptoms that are the same ones that someone uses my program for, and they still get better. There were also people who have other mutations and other places in their biochemistry that I’m suspecting will wind up with B6 being high, because they’re not using that chemical properly because of these other mutations. So what you and I are doing is infinitely complex, truthfully.

Lindsey:

Yeah. So are at this point, are you still giving that B100 as the starting dose and then going from there, or have you changed what you do?

Stasha Gominak, MD:

Excellent question. So what happened next was, I tried to get B100. So I’m doing D for two years and I’m getting really good with where’s the level and now when the patient walks in, I’m giving three things: I’m giving a multivitamin, and we can talk more about, that with very small doses of B’s. I learned that over time, I’m giving B100 and within the first couple of months, a couple of people said, “You know that B100 you gave me made me ache all over. Made me feel like I was 100 years old. I got out of bed and I couldn’t move.” That is one of the symptoms that comes when the B5 dose is too high and it really is about the B5. So what you and I both do is what are the clinical characteristics of this person, because we’d like to get it right the first time instead of making it worse. So if the person walks in the door with daily headache, depression, fibromyalgia, endometriosis, three miscarriages, and recently told they have lupus, that person has a very long, clinically profound case of one, they were D deficient, and they lost the microbiome. Now they have multiple B deficiencies, and they’re a mess. That person is likely to do well with B100. But what I learned next was, if you walk in the door, just daily headache, and you don’t have anything else, how sick are they? Then I started to use B50. Almost everybody did fine with B50. It’s not everyone, but almost everyone does fine with B50. They don’t feel anything, their sleep doesn’t get better right away and their pain doesn’t magically go away. I think what that means is, when we did D for two years, we actually sucked up our B’s stores. We actually did better on B100, because we forced this deficiency state on ourselves. That’s important, because there are literally going to be millions of people who have B vitamin deficiency states, because they started on D and COVID and four years later, they have burning in their feet or they’re just diagnosed with lupus, they start to have joint pain. It happens for years after you started D. And you will never hear anyone tell you that it was related to the fact that they started D started to grow, get better, repair sleep better and they sucked up their B vitamins stores, because they didn’t fix their gut bacteria at the same time.

Lindsey:

Interesting. So we are running out of time, I want to ask maybe one more question about prebiotics and probiotics to help recover the gut microbiome or are you just doing the vitamins?

Stasha Gominak, MD:

I love that question. I was using a lot of probiotics myself, I was trading recipes for probiotics, I was spending 60 bucks a month. I don’t think that dumping the bugs down there is the answer. I think the bugs have to have their raw materials that they require. And they’re constantly duplicating themselves. So you have to picture our microbiome is like a river, they start up at the duodenum. And they’re constantly reproducing them, you know, within 10 minutes, it’s the daughter bacteria of the guys that are here. Now, they’re being replaced, and we’re pooping them out. That means they have some raw materials that they absolutely need minute to minute. And the cool thing is, all this stuff was happening way before humans ever came. That means these four phyla have been self-establishing in the baby from the dirt and mom’s breast before we ever figured any of this out. If the D is strong enough, you will establish these four phyla, bacteria and they will be self sustaining. The amount of B’s that they make are perfect for human biology, and they’re perfect for the squirrels and the raccoons and everybody else out there. Dumping bacteria down is not the answer. I don’t think they help; however, prebiotics is a really important idea. Ultimately, we feed the bacteria and then the bacteria feed us. Okay, so you can do prebiotics when you have the wrong phyla, and not get the sort of outcome you’d like. So it’d be nice to get the four healthy phyla back. You can fine tune who lives inside you and more and more information is going to come. At the moment, I have no idea which species makes this B5 stuff or what part of the GI tract. Whey’re just starting to study those things, but I think prebiotics and the idea behind it, that we can change our biology by changing what we feed them is profound and important.

Lindsey:

So do you believe in supplementing with prebiotics or simply changing the diet to get it from your food?

Stasha Gominak, MD:

I am not knowledgeable in either. What I say is I’m going to give you this wedge of the pie that I know about and then you’ll get better outcomes from the things that you want to pursue to fine tune this than you have so far and we still need Lindsey and we still need the naturopath and we still need all these people who are really knowledgeable in that area.

Lindsey:

Okay, fair enough. Well, this has been a fascinating discussion and I think I could easily have you back on to go into a whole other level of discussions.

Stasha Gominak, MD:

I would love to do that and about children and early development?

Lindsey:

Yes, yes. We’ll definitely have to set that up, but we’re going to wrap it up for today. Thank you so much for coming on and sharing all your knowledge with us.

Stasha Gominak, MD:

My pleasure, Lindsey, I’m thrilled that you’re interested in this.

Lindsey:

Where can people find you?

Stasha Gominak, MD:

My, my website is Drgominak.com. And if you just put in gomaflagy or something like that, something that sounds similar and vitamin D, my website will pop up. And I have a whole workbook that’s designed. This is a pretty complicated system. And it’s not just about vitamins. It’s really about recognizing things about your body and how it talks to you. So there’s a workbook that takes you through a whole year, gives you a journal of writing the things down that you need to observe about yourself.

Lindsey:

This is the Right Sleep program.

Stasha Gominak, MD:

Yes.

If you are struggling with gut issues, fatigue or other or chronic health problems, I work with clients to uncover the root causes of these issues educate you on how to fix them naturally. So if you want to talk to me about what you’ve been dealing with and see if I think I can help, you can set up a free, 30-minute breakthrough session with me. I can let you know if I think I can help you and tell you about my 5-appointment gut or autoimmune healing program and you can decide it that seems like a good fit for you. Or you can just sign up for a single appointment.