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Adapted from episode 78 of The Perfect Stool podcast hosted by Lindsey Parsons, EdD and edited for readability with David Minkoff, MD, who founded LifeWorks Wellness Center in Clearwater, Florida in 1997, which is now one of the largest alternative medical clinics in the U.S. He also founded BodyHealth in 2000, a nutrition company offering a unique range of dietary supplements. Dr. Minkoff has a diverse background as a board certified pediatrician, a Fellow in infectious diseases, an ER physician and as the co-director of a neonatal intensive care unit. He recently wrote the bestselling book The Search for the Perfect Protein: The Key to Solving Weight Loss, Depression, Fatigue, Insomnia, and Osteoporosis and writes two online newsletters each week, The Optimum Health Report and the BodyHealth Fitness Newsletter.

Lindsey: 

So why don’t we get started by talking about how gut health issues relate to protein or can be at the root of protein deficiencies. Because I imagine it goes in both directions, a lack of amino acids can cause gut issues and gut issues can cause protein deficiencies.

David Minkoff, MD:

I think more than any time in history, gut problems are pervasive. Every patient I see has gut issues. And I’m seeing people from very high end professional athletes to people with serious cancer, or Lyme disease or autoimmune disease. 100% of them have got gut issues: they have bad bacteria, they have yeast, many of them have parasites, many of them are on medications that also injure their gut. And they don’t have stomach acid, and they don’t have digestive enzymes. And they don’t digest their proteins, assuming they’re eating enough protein. And so they get protein malnourished. And if you measure amino acid levels in fasting blood, virtually everybody has amino acid deficiencies. And that’s because the proteins that they’re eating aren’t being digested and absorbed. And so they end up in kind of a catch 22. Because the gut, you know, the thing that prevents leaky gut, these special proteins, which hold the cells together, are proteins, and all the enzymes needed to digest food are proteins. And the basement membrane, the thing that keeps the gut, the parts of the gut wall in good separation, are proteins. And so if you get protein malnourished, you’re not going to get those things in their normal condition. And then you get this catch 22 of don’t have enough protein, then can’t make enzymes, so can’t digest the protein. And then the gut is leaky. So these foods go into the body undigested. And then you have allergies and autoimmune things happening. And then added to that, many, many people follow the TV ads that say, you know, if you get heartburn from eating XYZ hoagie, just take a drug to block your stomach from making acid, and you won’t have symptoms, and you’ll be fine. So you add that to the mix. That’s why virtually everybody walking around, at least the ones that come into my office, the first thing that we have to restore is  their gut health and their digestion.

Lindsey: 

Yeah, I was on PPIs for probably 10 or 15 years straight.

David Minkoff, MD:

The PDR clearly says that these drugs can be used for emergency purposes, if someone’s got a bleeding ulcer, or they have severe gastritis. And the drugs could be useful for a couple of weeks. But it’s totally ignored. And all the family doctors and the gastroenterologists put people on them for years and decades.

Lindsey: 

I feel like that’s gotten a little bit better. Like now at least on the package it’s super clear only two weeks, although I guess I do remember it being on the package when I ignored it completely years ago.

David Minkoff, MD:

Yeah. And they’re available over the counter now. So you can go to right, you know, you at any pharmacy and you can buy them. And you don’t even have to go through the doctor. I think last time I looked, there was 25 million prescriptions a month of prescribed acid blockers or proton pump inhibitors. But probably the number of people that are buying these drugs over the counter is double or triple or quadruple that. So it’s pervasive.

Lindsey: 

And a lot of them, what I’m finding is, a lot of them have H. Pylori that’s causing the acid reflux and their gastroenterologists are missing it because they’re only doing a biopsy along with an endoscopy and they’re not doing stool antigen testing, or maybe they’re only doing breath testing.

David Minkoff, MD:

Today, in fact, there was a new patient, and they were having gastritis and they got scoped and the guy said gastritis and the person didn’t have – I don’t know what the gastroenterologist decided – but he didn’t have H. Pylori, and he still had symptoms and he was on his proton pump inhibitor. If he ever tried to cut him off, he couldn’t come off. And then in the office, we found H. pylori, and we’ll treat him and he’ll be fine. And his stomach will get better.

Lindsey: 

 Yeah, it’s easy.

David Minkoff, MD:

Yeah. And we don’t use triple antibiotic therapy because I don’t like that; that makes people worse.

Lindsey: 

What do you use?

David Minkoff, MD:

I use a couple of ounces of aloe with a tablespoon of sovereign silver and mastica and some aged garlic sometimes, and DGL. And one of the keys to it is that the H Pylori can be resident in their gum tissue, and in the partner’s gum tissue. So we have them brushed their teeth twice a day with mastica and have their kissing partners brush their teeth. And then you can sort of end the cycle because if the partner is carrying it, and they’re sharing food or drinks, or they’re kissing, you could treat the one person and they can get reinfected by the other person who doesn’t have any symptoms, but the organism’s living in their in their gums.

Lindsey: 

Are they taking a capsule and opening it up and brushing with it?

David Minkoff, MD:

Yeah. They’re doing their regular teeth brushing. And then they just open up a capsule and brush it in and leave it. And it works. I mean, my success rate for H. pylori is near 100%. They do it for six weeks, and it goes away. And sometimes they’ll get reinfected. But it almost always works and their symptoms go away.

Lindsey: 

That’s great. So back to the protein question, do protein deficiencies or a protein-deficient diet ever lead to gut health problems?

David Minkoff, MD:

Well, yeah, because if people are, and we find this most in people who are vegans or vegetarians, that the quality of proteins that they’re eating, or the quantity of proteins that they’re eating, if it’s fruits and vegetables, have almost no usable protein. So our evolution, we were omnivores; we did include animal proteins, and the animal proteins have the highest quality. And people may not be eating enough, you know, a bagel with coffee for breakfast, or a doughnut, and a salad for lunch, and maybe a couple ounces of meat for dinner is not enough protein. And so people can become protein malnourished, their hair breaks easy, their nails are low quality, they’re tired, their thyroid functions low, their bones start to degenerate, they get osteoporosis, they may have mood or sleep issues. Because these things are all made out of proteins. And it could be generated from the diet and you replenish them with protein or you replenish them with amino acids. And their symptoms all go away and they get better.

Lindsey: 

Yeah, so that sounded like a list of symptoms, but are there some chronic illnesses that have protein deficiency as a possible root cause?

David Minkoff, MD:

Well, almost everybody with any disease, if you check them, they’re protein malnourished. Name a disease, and if I do their serum amino acids, they’re protein malnourished. So we give everybody [amino acids]. You can sort of bypass their digestion, and you can bypass their no enzymes, by giving them this. It’s a product called Perfect Amino*. It’s a mixture of eight essential amino acids, and they replenish their amino acids. And within weeks to a couple of months, they will come back with gee whiz, my digestion is better and my energy is better, and I feel better. And I’ve been going to the gym for a long time trying to get stronger. And now it’s actually working, like I’m getting stronger, and muscles are growing.

Lindsey: 

So what tests do you use with your patients to assess their amino acid status?

David Minkoff, MD:

My favorite test is a Genova. It’s called an ION panel. I love it.

Lindsey: 

Yeah, I like that one.

David Minkoff, MD:

They also do a another one, which is NutrEval, which I don’t like. I don’t think the test is any good. But their ION panel is excellent. I order it on every patient, because you get all the amino acids. And you get all their essential fatty acids, and you get a whole bunch of vitamins and minerals. And then you get organic acids so you can see what kind of infections they have in their gut.

Lindsey: 

Right and the heavy metals.

David Minkoff, MD:

And you get heavy metals. And so it’s a great, great test, my favorite test.

Lindsey: 

Yeah, it’s a great full body test for the money that you’re paying. It’s really an amazing all over what’s going wrong in the body kind of test. So I have found with some of my clients that getting them to take their amino acids can be challenging. Typically, I’m recommending powder forms. Some people have seemed to have bad reactions to them. Like maybe they don’t like the powders or they feel weird after they take them. Any tips on how best to take them and what side effects might happen and how to mitigate that.

David Minkoff, MD:

We make four different flavors of powders. And we also make them in tablets, so they can take the tablets where there’s no flavor, or they can take the powder products called Perfect Amino*. There’s strawberry, there’s berry, there’s mocha, there’s lemon lime, and most people can find one that they like or that’s palatable, and I usually have them throw some greens mix in with it, and it just isn’t bad. And then if they want to put it in with a smoothie, throw some blueberries in there, or some MCT oil or you know, you can doctor it up, and we make a meal shake. It’s got it in there too, which has all that stuff in it with vitamins and minerals. And it really tastes, I think it tastes really good. And very few people have problems with digesting it or stomach upset. There’s a few but it’s in my I mean, I’ve given 1000s of people this product, and very few have trouble. Very few.

Lindsey: 

And what dosage do you typically recommend for someone who is just generally amino deficient, not total collapse of mitochondria deficient, but just generally deficient?

David Minkoff, MD:

Two scoops or 10 tablets. 10 grams

Lindsey: 

At one time?

David Minkoff, MD:

At one time; it works better if you do it at one time. Because that bolus comes in, and then it hits the cell. And then proteins are made right away. It’s in the bloodstream in 23 minutes. It does not spike insulin or a glucose response. So people are fasting, or they can take it and it won’t disturb their fasted state, there’s no, there’s virtually no calories in it. So 10 grams is less than one calorie. So they can get the nutrition from the amino acids, without any sort of disturbance of anything else that they’re doing. There’s also no drug interactions known. So if they are on prescription medication, they can take this safely, without worry that it’ll interfere with the drug or mess with the drug.

Lindsey: 

But it is best on an empty stomach or at least not with other protein foods, right?

David Minkoff, MD:

It works both ways. If you want to get the most for your money, take it on an empty stomach, then in 23 minutes, eat whatever you want. No, it does work with, we have people mix it with other things, and it works fine. So I don’t think you have to be strict with that.

Lindsey: 

Okay, so my understanding is when you get 10 grams of amino acids at once it does stimulate mTOR. So is that kind of dosage not recommended for people who have had cancer?

David Minkoff, MD:

No, we don’t know if it stimulates mTOR. It’s never been studied and measuring mTOR is a tall order. We give it to all cancer patients, I have a practice, it’s 50% cancer patients, usually seriously ill cancer patients, they all get perfect amino between 10 and 20 grams a day, because they need it for their nutrition. The whole immune system is made out of proteins, you know, cytokines and white blood cells and immunoglobulins. These are all proteins. And most of these people, if they’ve been sick, or if they’ve been seeing oncologist and they have been getting chemotherapy or radiation, they’re very protein starved and protein deficient. And their serum level of albumin goes down. And they need proteins very badly. And it does not in any way stimulate cancers or induce cancers or allow the cancers to grow faster. It’s perfectly fine to use that.

Lindsey: 

Okay. And how do amino acids relate to autoimmune health?

David Minkoff, MD:

Well, mostly what I see with autoimmune diseases, they’ve got either a gut that’s too permeable. So that could be from the drugs that they’re taking, or the Roundup that’s in all their food, if they’re not eating organic, or they’re gluten sensitive or dairy sensitive, and they’re eating those foods and they’re causing inflammatory reactions. In the gut wall itself. They get the tight junctions between the enterocytes, between the cells that line the gut break down, and then partially digested or undigested proteins get access to the blood supply. And they go into the intestine, not in a simple amino acid form. But in short protein chains. And the immune system, the biggest part of the immune system is around the small intestine. And those immune cells are sort of our guardians to protect us from foreign things coming in. Now, that could be viruses or bacteria, but it also could be partially digested proteins. And those proteins are foreign. They’re not human. They’re from cows or soybeans or chickens or nuts, whatever people are eating, and the immune system sees those foreign proteins as invaders and makes antibodies to those proteins. And sometimes those proteins look very much like our proteins, like the membranes that line our joints, our skin, our thyroid glands can look kind of like the undigested food from animals or plants, and then the immune system starts an attack against the body, which is what autoimmune disease is. Now sometimes the inciter comes in through a tick bite or an insect bite, or it could be a heavy metal where the surface of the cells look abnormal. And the immune system then doesn’t recognize them and makes reactions, but almost all of it’s gut and for most autoimmune diseases, you have to get their gut in good shape, and then you can get the autoimmune process to turn off the antibodies that the body has been making against itself start to go away.

Lindsey: 

So what that what stool tests do you prefer?

David Minkoff, MD:

I like the DiagnosTechs GI FX 2 or FX 3. It’s very simple. It’s two pages. Like the Genova one, and the Vibrant America one and the

Lindsey: 

GI Map?

David Minkoff, MD:

Can’t stand those tests. They’re too complicated, just confusing, way too many bacteria. Nobody has any idea what all that stuff means. And the DiagnosTechs Test is simple. It gives you a relative level of good bacteria, both gram positive and negatives, it gives you levels of chymotrypsin, it gives you an antibody for H. pylori. There’s a salivary part of it, which gives you antibodies to sIgA total levels, and also to about half a dozen parasites, which actually, like I get parasites on the stool, they find them!

Lindsey: 

It’s PCR I assume.

David Minkoff, MD:

It’s a – I love that test. And a patient can understand it, simple. That’s my favorite one.

Lindsey: 

What was it called?

David Minkoff, MD:

DiagnosTechs GI FX, it’s either 2 or 3. It’s a Seattle lab.

Lindsey: 

Okay, it’s good to know, I haven’t ever looked at that one. Yeah. So do you have any favorite individual amino acids are ones that are particularly pertinent to particular issues?

David Minkoff, MD:

Well, yeah, I mean, you can use amino acids as medications. So someone is hypothyroid. And their tyrosine is low. You might give them extra tyrosine, someone who’s got low serotonin and we measure serotonin levels, or GABA levels, you can use targeted amino acids tryptophan or five hydroxytryptophan or taurine. And they can be very helpful. And they’re almost using like a pharmaceutical, and it can help with mood or sleep. Depending on what the what the person’s issue is. Some people for their gut, glutamine* can be very helpful.

Lindsey: 

What kind of dosage?

David Minkoff, MD:

Five grams.

Lindsey: 

Once a day?

David Minkoff, MD:

Yeah, the powder.

Lindsey: 

Okay. Because I’ve heard claims of needing enormous quantities of glutamine for it to be useful, but . . .

David Minkoff, MD:

That’s because the scoop, it’s easy, it’s easy, and glutamine kind of has a pleasant sort of almost sweet taste. Most amino acids are very bitter. Because you could put a scoop of glutamine underneath your tongue and just let it dissolve. It actually is quite pleasant.

Lindsey: 

Yeah, not like L carnitine.

David Minkoff, MD:

Yeah or methionine, you know, some of them taste horrible.

Lindsey: 

Yeah. So I use freeform amino acids with my clients sometimes. Are the amino acids in Perfect Amino free form, or if not, what’s the difference?

David Minkoff, MD:

Well, the amino acids in Perfect Amino – the only utilizable amino acids are L form. So molecules come with a left hand and a right hand configuration. The human body could not utilize amino acids that are in the right hand form. Most amino acids are that are sold are mixtures. And so you only can utilize half, the L side, the left hand side. So if you’re getting a gram, only 50% of it, only 500 milligrams is going to be L form, and the rest of it isn’t usable. So perfect Amino is all l form amino acids. And if they’re pharmaceutical grade, there’s a lot of companies, Chinese companies, that make crappy amino acids that are full of impurities. And they’re not clean, they’re not pure. So Perfect Amino is – these are pure, these are pharmaceutical grade L form amino acids.

Lindsey: 

I was just going to ask is free form the same as the L form? Is that what that means?

David Minkoff, MD:

I don’t know what free form means. Free form probably means that they’re all there. It’s just amino acids, but there’s probably half right sided. So it’ll say l-tyrosine. Or l-leucine. That’s L for left. The other thing is, like if you look at something like like branched chain amino acids, so these are amino acids that have a structure that has a 90 degree angle, and they’re called branched chains, leucine, isoleucine, and valine. And people have said, well, branched chain amino acids are good for fitness, and they’re good for muscles. Athletes should use branched chain amino acids. But what happens is, if you take those amino acids, you don’t ever build proteins, because if you don’t have the eight essential amino acids there at the same time, you won’t build protein. So the body takes these amino acids and turns them into just calories;  the body utilizes them as carbohydrates. Now you can get effects from single amino acids, as if you’re using a pharmaceutical, but you’re not building protein. You want to build protein, you got to have eight essential amino acids. And the configuration of Perfect Amino is such that the amino acids have to be in a very specific ratio, or the body can’t utilize. And so if you mix up the ratios, like on the on the ION panel, at the end, they give a suggestion of okay, for the amino acid deficiencies that you have, mix, you know, send the pharmacist or, or whoever mixes up your amino acids, this much of this and this, much of that, and this much of that. And that’s what they should take to replenish them. It won’t work, the body can’t use them that way. The way they have to come in is they have to come in in a very carefully balanced form, which is what Perfect Amino is, and then the body will utilize those to make protein.

Lindsey: 

And does the protein we eat come in that perfectly balanced form?

David Minkoff, MD:

No, it doesn’t. So if you look at different foods, you know, if you’re talking to a dietitian, and they’re calculating, you need a gram of protein per kilogram of body weight, or per pound of body weight, depending on who you talk to. So you weigh 120 pounds, you should have 60 grams a day of protein, let’s say, I think you need a little more. But let’s just say that. And they’ll say, Okay, if you have a yogurt, that’s eight grams of protein, and you have a tuna fish sandwich, and that’s 20 grams of protein, and you have a steak, and that’s another 20. And then you have some whey protein, and that’s 20, you get to your 60. But each one of those is not equal in that the body can’t take those proteins and make its own protein with the same efficiency. So this has been worked out, if you eat only whey protein for a day, and then measure, you can measure what percentage of the amino acids that make up whey protein actually get incorporated into the body’s proteins. Because that’s why you’re eating protein, you want to rebuild your own muscles and tendons and ligaments and bone and hormones and all the rest of stuff that they get made out of. And if you take whey protein, only 16% of whey or dairy proteins are usable, they just come in in the wrong combinations, and the body can’t do it. It’s almost like you want to build a car. And the minimum for a car is let’s say, four wheels, and a frame, and a steering wheel and a motor. That’s your basic car, which let’s call that a protein. And if you have a manufacturing facility, where you have no storage space, so if the suppliers don’t send you the exact right things, you have no place to store the excess. So if you get shipped, let’s say 100 wheels, and 25 frames and 25 steering wheels and two motors, you’re only going to get two cars, but now on your lot, you have nowhere to store this stuff. So you have to dump it all. And it’s the same in the body. There’s no storage depot for amino acids or proteins. There are storage depots for carbs and fats. But there’s no storage depot for proteins. So if you eat a protein, and the amino acid balance or mixture in that protein isn’t what the cells actually need, there’s a whole bunch of excess amino acids leftover and those get turned into calories and nitrogen waste. And that’s why we urinate,  mostly to get rid of the nitrogen.

Lindsey: 

Assuming that somebody’s suggestion is repaired and all that, obviously we’re made to get our protein from our foods. So ideally, once you get past the point of needing to supplement, how much and what types of protein should people be eating to get adequate protein?

David Minkoff, MD:

Well, I think what you can do is, we know that if you took 10 grams of perfect amino three times a day, for your average person that would that would fulfill all their protein requirements that they would ever need. Now, that isn’t very interesting. And people like to eat food. So what you have to do, I mean, ideally what the dietitian would say is okay, meat protein, and fish 33% of those amino acids that are in that protein, your body can use, and eggs are the best food, whole eggs, white plus yolk, 48% of the amino acids, they’re utilized. If you look at soy and whey it’s like 16, or 17%. Collagen is actually zero because collagen’s missing tryptophan and you can’t make proteins without tryptophan. So if you tried to live on collagen and lettuce, you couldn’t do it, it wouldn’t go. So these foods are fine. And as long as you’re getting enough of them to meet your daily requirements, you could be okay. You know, if your gut was good, and your digestion was good, what I find with most people is I say just take another 10 grams of Perfect Amino with it every day to make sure that you’ve got enough. If you’re malnourished or you have osteoporosis, you may need more for a while until you build back up.

Lindsey: 

So other than Perfect Aminos,  are there other supplements that you make that you would like to mention?

David Minkoff, MD:

Yeah, we did a study. So I have a practice where most people are semi-nutritionally conscious. So we did a study, there is a machine available, where you can measure levels of what are called carotenoids, or flavonoids. These are the antioxidant chemicals that are in fruits and vegetables and what give fruits and vegetables their color; there’s 1000s of them. So this machine could measure carotenoid levels in the skin. And they correlated with the carotenoid levels in the blood or in the body. And so for fun for a couple of months, everyone that came in, I put had him put their hand over this little sensor and measure their carotenoid levels, and people who had adequate levels of carotenois, cause these are antioxidants, these are what protect us from radiation and heavy metals, and chemical toxins, which we are all exposed to every day. And if you don’t have enough antioxidants in your system, to sort of buffer or neutralize all these things that are coming in, the body gets injured from this stuff. So injury to inside lining of blood vessels, or inside lining of gut, or in the tissues themselves. And it’s manifest with inflammation and pain. So we measured everybody coming in for a couple of months, and what was their level of carotenoids? And above 50 was considered like your adequate, like you got enough, like then if you measured their carotenoid level in their blood, it would be like, oh, this is a good level. And the average that we found from people coming into the clinic was 18. They were all low. And the children that we saw, the average was 12. So as an experiment, we make a product called Perfect Greens, or another one called Perfect Reds. So one scoop, oh and the people who were above 50, were eating 8 to 10 servings a day of vegetables. So very few people eat that much salad or fruits and vegetables; almost nobody because hardly anybody was above 50. We had a few, but most people, the average was 18. So we make a product which is an organic mixture of fruits and vegetables. It’s organic, dehydrated, one scoop equals 10 servings of fruits and vegetables. So I said okay, for the next month, put one scoop in your smoothie, put one scoop on your cereal, put one scoop on whatever you’re eating every day and come back and we’re going to retest your carotenoid levels, and everyone was above 50. So you know, we’re walking around protein malnourished, but we’re also walking around antioxidant malnourished. And if you take one scoop of this stuff, you can put it in the same jar with the same smoothie or the same glass with Perfect Amino and now you get your amino acids and you get your your 10 servings of fruits and vegetables.

Lindsey: 

So do you need the greens and the reds separately?

David Minkoff, MD:

I just alternate, one day do greens . . .

Lindsey: 

Okay. Because it could get a bit overwhelming with your aminos your greens and your reds in one smoothie.

David Minkoff, MD:

Yeah, I mean my wife puts everything in there but I I just have them sitting on the shelf and one day I do one and one day I do the other. Now the other thing that people are deficient in from this ION Panel is many, many people are deficient in Omega 3 oils, EPA, DHA. They’re deficient, they’re not eating fish, and they’re eating a lot of bad oils and the brain and the nervous system are made out of these Omega 3 oils. They’re really important, and most people aren’t taking them. So okay, throw in a couple of capsules. We call it Omega 3 Health, but it’s a distilled product with cold water, deep fish oils with no chemicals, and no heavy metals and no burp when you take the thing. And so everybody ought to take that.

Lindsey: 

How many grams of EPA and DHA are in one capsule?

David Minkoff, MD:

They’re 1200 milligrams each. So if you take three of them, it’s 3600. And I forgot what the balance is. But it works out to be a decent balance.

Lindsey: 

So 3600 of DHA and EPA combined? So more than 1000 per pill?

David Minkoff, MD:

Yeah, I think they’re 1200. [Correction: they are 1200 in two pills]. Okay, I’m going to look at it the thing, but I think that’s what I remember. So sort of everybody gets Perfect Amino, they get reds or greens, whichever one they like better. And if they like both, alternate, they get fish oil. And then we make a multi, which is the best multi on the market, two tablets twice a day. So it’s 16 Whole Food concentrates plus extra CoQ10, methylfolate, good amounts of selenium. I mean, it’s really a good one. And everybody else’s is 12 capsules, and it’s called Body Health Multi Complete, and it’s got 5000 units of vitamin D in it. You know, everybody needs vitamin D. So this is a way to get a whole lot of stuff in a relatively small package.

Lindsey: 

And how many a day?

David Minkoff, MD:

Two in the morning, two at night.

Lindsey: 

I’m looking at it right now. So you know, you mentioned decent amount amounts of selenium. And one thing that I noticed, well, what happened to me was I was taking a multivitamin that had more than the RDA of selenium. And I think something around the amount that yours has, like 200 micrograms, and I started getting headaches, and I started pulling out all the 16 different supplements I was taking till I was down to the multivitamin. And I was like, That’s it. I’ve got too much selenium and I looked up every single side effect for everything that was in it. And finally, that was the one. So I’ve stayed away from higher dose selenium supplements. Am I unusual, or have you heard about this from somebody else?

David Minkoff, MD:

Super rare. In my experience, like most people don’t have enough selenium. Selenium is protective against metal toxicity. And it’s required for making thyroid hormone, it’s required for antiviral activity. So it’s super important. And most people don’t get much. Very few people react to these things. It’s a tablet, and it’s a little bit, I wish we could make it a little bit smaller, but that’s what the complaints are from, the product is maybe a little bit too big. But boy, it’s very rich in B’s, and it’s got you know, methylfolate and 5000 D.

Lindsey: 

Right, and you’ve got the methylated B’s in there.

David Minkoff, MD:

You get the methylated B’s in there, and it’s with P5P. I mean, it’s really a great product, and it’s cheap. If you buy all those things individually, it’ll cost you 130 $140. And so this is a really good mixture. The other thing everybody needs,  magnesium, you know, 80% of the people we do the ION panel on have low RBC, magnesium. So I stick up them on a magnesium. We make a product, which is called Calm. It’s mag citrate. I take a scoop, which is 400 milligrams of magnesium before I go to bed at night, it’s relaxing, helps you sleep. It’s a great laxative. So anybody who’s got slow bowels or they’re constipated, usually there’s a dose that you can work out which is just the right amount so that they have a nice easy bowel movement every day. So that’s on my list. The other one on my list, which I find very frequently deficient is iodine. You know, if they’re eating seaweed or nori a couple times a week, they’re probably okay. But almost nobody or not enough people are and many people are iodine deficient. And that might manifest as low thyroid or cystic breast disease. And so I put everybody on a little bit of iodine.

Lindsey: 

Like 150 milligrams?

David Minkoff, MD:

Usually six milligrams. It’s not a little bit, it’s a good dose. But it’s it’s half of what Japanese people take every day with just their diets. So it’s a product called Ioderal, we don’t make it, it’s half iodine and half iodide. It’s a 12.5 milligram pill, it’s tiny. And I say just take half every day or one every other day. Because I measured  over 500 people for iodine sufficiency. And like 80% of them were iodide deficient. So we’re trying to sort of hit broadly the stuff that really is needed. Those are the things on the list, which I originally give to everybody like these, I just tell people you’re going to take these for the rest of your life.

Lindsey: 

So no, I just I thought 150 stuck in my head. It’s 150 micrograms is the RDA. . . 

David Minkoff, MD:

is the RDA, but it’s way too low.

Lindsey: 

But my understanding, because I have Hashimoto’s, is that too much is also – that it’s a very Goldilocks kind of supplement – that too much is too much as well. It can be can be harmful as well.

David Minkoff, MD:

It can be. If you read any of David Brownstein’s books on iodine. He’s a practitioner in Michigan. His name is David Brownstein. He’s written some incredible books on iodine and what it does and how much you need. And they’re just really excellent. Now there are some people with Hashimoto’s, which you have to watch the iodine. And if they’ve got Hashimotos, I may not put them on any iodine to start. Yes, because sometimes they’ll flare, that is true.

Lindsey: 

And what’s the best way to test iodine?

David Minkoff, MD:

The best way is the urine challenge. So you give somebody iodine, and then you collect their urine and see how much comes out. And if they’ve got enough iodine, they’ll dump it all. If they don’t have enough iodine, most of it won’t come out. I haven’t done that test in a long time. I did about 500 of them over a few years. And virtually everyone needed iodine. I just stopped doing the test because it was a waste of money.

Lindsey: 

And is this because everybody’s moved to sea salt as opposed to iodized salt?

David Minkoff, MD:

Everybody goes, I don’t do iodized salt. I do sea salt.

Lindsey: 

So yeah. Okay. Well, this was all very interesting. Any final thoughts about gut health and any of this?

David Minkoff, MD:

I think you know, the central core of your body is your gut. And if you want to have a good brain, and you want to have good joints, and you want to have good energy, it only can happen if your gut is good. If you are able to, you know you have a functioning gut where you can digest your food, and where you have a mix of bacteria inside which are the right mix for you so that they help you detoxify, they make things that you need. Virtually anyone who isn’t really being careful about their food and eating organic, and supplementing, that a gut test is a sure 500 bucks well spent. And then analysis by someone like yourself or me who’s who’s experienced with this, who can then help the person get their gut fixed is just like, if you want good health, it’s a mandatory thing.

Lindsey: 

Totally agree. Well, I’m going to put a link to your Perfect Aminos and other products you mentioned in the show notes so that people can support the show as they as they look at your products. I really appreciate your time and coming on and sharing with us about this.

David Minkoff, MD:

Yeah, you’re welcome. And the book is called the Search for the Perfect Protein. It describes the whole thing. It was an Amazon bestseller. If they go to our website, which is bodyhealth.com, if they want to download a free PDF copy of it, they can. It’s written for people to give them an understanding about overall body health,  amino acids, and there’s a whole bunch in there about gut health. I’ve just had gazillions of compliments on it because it helps people understand what’s going on.

If you are struggling with gut issues and/or mental health 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.

Adapted from episode 77 of The Perfect Stool podcast with your host and gut health coach, Lindsey Parsons, EdD.

This is my second blog post on interpreting Organic Acids tests, a test that I use with a lot of my clients that can tell you about your gut health, in particular with regard to candida and mold, bacterial overgrowths, and overgrowths of clostridia, oxalate levels, your production of energy from carbs, fatty acids and protein, your neurotransmitter levels, nutrient levels of B vitamins, vitamin C, CoQ10 and NAC and detoxification markers. In the last post, I focused on the gut stuff, oxalates and neurotransmitters. In this post, I’ll be focusing on energy production, nutrient levels and detoxification markers.

So I’m going to jump right back into the test, noting briefly that this is the Great Plains Organic Acids Test and there is another from Genova called the Organix that some practitioners use. One some of these sections, the Organix does have one or two advantages over the Great Plains OAT, one of which is that it lists the nutrients at the top of each section that are involved, such that if there’s an issue, you know what to supplement with, although dosages, timing, etc. aren’t given. So I’ll mention those nutrients as we go along.

And I do want to forewarn you that I’m going to be using a lot of big, science-y words and not to get intimidated. Just have the sample test open and glean what you can from what I’m sharing. If at some point you take the OAT or already have one of your own, you can key in on the markers you have elevated or low and dig in further.

Glycolytic Cycle Metabolites

So we’re jumping first to p. 3 and markers 22 and 23 lactic and pyruvic, under Glycolytic Cycle Metabolites. The glycolytic cycle, also known as glycolysis, is the metabolic process that converts glucose (which you get primarily from eating carbohydrates) into pyruvic acid, which is turned into acetyl-coA, which then enters into the Krebs cycle to produce energy. This process is a sequence of ten reactions that are catalyzed by enzymes, and those enzymes require co-factors, which are nutrients, like B vitamins for example, that are necessary for those reactions to take place.

Now when pyruvic is high, as it is in this test, it means that the pyruvic acid isn’t converting into acetyl-coA, which when it gets bad enough, indicates insulin resistance. So this is an early sign of a diet that’s likely too high in sugar and refined carbohydrates. Interventions at this point are usually dietary, like eliminating all added sugars and white carbs. And then in terms of supplement support, you’re looking at alpha lipoic acid, which helps stabilize blood sugar and the B vitamins, in particular B1 or thiamin, B2 or riboflavin, B3 or niacin and B5 or pantothenic acid. But it’s best to take a B complex whenever you’re taking B vitamins, because they work together synergistically. Chromium can also be useful if you’re dealing with blood sugar dysregulation, both on the hypoglycemic side, meaning low blood sugar, a sign of which is dizzy spells and shaking when your blood sugar drops, and the hyperglycemic side, which means high blood sugar and is typical of type 2 diabetes, and also characterized by blood sugar highs and then crashes in which you feel exhausted.

High lactic, number 22, can be from vigorous exercise, because when oxygen is in short supply, pyruvic acid is converted to lactic acid through an anaerobic process, leading to sore muscles, like after you’ve lifted too many weights or done something new to your muscles. Lactic can also be elevated from bacterial overgrowths in the GI tract, B-vitamin deficiencies like I described before, which can lead to blood sugar dysregulation, mitochondrial dysfunction or damage and anemia, among others. There can also be genetic reasons, but the numbers are generally much higher (above 300 mmol/mol creatinine) when you start suspecting that. Pyruvic can be elevated for the same reasons as well, with possible genetic causes over 100 mmol/mol creatinine. If you have enzyme issues that are genetic, you can see neurological problems and seizures.

If lactic is high but pyruvic isn’t, it is more likely to point to anemia, zinc deficiency, but also excess alcohol or toxic metal exposure. If either is high, because there is a lack of energy production, CoQ10 is also a helpful supplement to help with energy.

Mitochondrial Markers – Krebs Cycle Metabolites

The next section, Mitochondrial Markers – Krebs Cycle Metabolites, markers 24-29, are markers of the metabolites of the Krebs cycle, also known as the citric acid cycle, or TCA (tricarboxylic acid cycle), which is the intermediate step in the creation of energy from food, which takes place inside our mitochondria (which are in all of our cells).

So as I mentioned above, glucose from carbs converts to pyruvic acid then to Acetyl-coA. Acetyl-coA enters into the Krebs cycle and then there are all these chemical reactions that happen, so Acetyl-coA is converted into citrate (which is the oxidized form of citric acid, when it loses its hydrogen). By the way, these markers on the Genova Organix form of the test are all listed in the –ate form like citrate whereas on the Great Plains OAT they’re all listed in the –ic form or acid form like citric. So then citrate is converted into cis-aconitate (and the corresponding marker on the Great Plains OAT is aconitic), which is converted to isocitrate (which is on the Organix but not on the Great Plains OAT), then alpha ketoglutarate (which is the same as 2-oxoglutaric acid on the Great Plains OAT), which is converted to succinate, then fumarate, then malate (and there are a few steps in between that I didn’t mention). One of the byproducts of the citric acid cycle is NADH, which then is fed into the electron transport chain through a process called oxidative phosphorylation, which is the final step in the creation of energy or ATP – adenosine triphosphate. Now forgive me if I have anything not quite right in this description, I was a French literature major in college, so I’ve had to do a lot of catch up in my chemistry and biology to understand this stuff, but the long and short of it is, each of these markers on the OAT can indicate if there’s a break in the process of the creation of energy or a problem with it entirely, like there’s not much of it going on, because your mitochondria have collapsed and been destroyed by oxidative stress, like toxins and not enough antioxidants, like vitamins C and E.

And if you see one of these markers elevated, it can be because of a missing co-factor or nutrient in the process. So for example, to convert isocitrate to alpha ketoglutarate, you need B3 or niacin, Magnesium and Manganese, so if one of those is missing, you’ll have excess isocitrate because the conversion isn’t taking place. Or to convert succinate to fumarate you need B2, also known as riboflavin, so if you’re short on that you’ll see succinate elevated because the conversion isn’t taking place. That’s the general background. And a deficiency of CoQ10 or its active form ubiquinol, is also a common problem when there are breaks in the citric acid cycle.

So specifically, high succinic can be from a deficiency of B2, CoQ10, bacterial degradation of unabsorbed glutamine supplementation, or from heavy metal or other toxic exposures and mitochondrial dysfunction.  It’s also possible to have a genetic issue with an enzyme. Low levels indicate a need for supplementation of the amino acids leucine or isoleucine.

Elevated fumaric can be from a defect in the enzyme fumarase that catalyzes the conversion to malate, a defect in mitochondrial function or impaired Krebs cycle function. Symptoms will be fatigue and weakness. You can support it with the addition of CoQ10, NAD+ (which is a derivative of niacin or vitamin B3 called nicotinamide adenine dinucleotide), nicotinamide, another form of B3, the amino acid l-carnitine, riboflavin or B2, biotin or B7 and vitamin E.

Elevated malic can point to a need for more niacin or CoQ10 or hyperinsulinism, which impedes weight loss, and again this represents a break in the citric acid cycle, so you’ll again see fatigue and weakness.

When 2-oxoglutaric (also known as alpha ketoglutarate) is elevated, if it’s not from supplementation, it can be due to vitamin deficiencies, such as B5 (also known as pantothenic acid or FAD (flavin adenine dinucleotide) derived from riboflavin and thiamine, or from undereating. Symptoms of this would be fatigue or reduced stamina.

Now if you see citric, fumaric, and 2-oxoglutaric acids simultaneously elevated, it strongly suggests mitochondrial dysfunction.

Then when aconitic is elevated, it could be a mitochondrial disorder or the need for additional reduced glutathione, which is your master antioxidant. Low levels aren’t significant or problematic unless you see multiple Krebs cycle metabolites low. Now if you see all or most of these markers very low, this indicates mitochondrial collapse, which means that there are not that many mitochondria. In this case, you’ll want to give free form amino acids or protein powder to stimulate the growth of new mitochondria, which is done at a particularly high dosage at one time to stimulate something called mTOR, but this is a complex topic that would probably require an entire blog post on it alone.

Then citric can be elevated from intake of citric acid containing foods, intestinal yeast that produces citric acid, amino acid deficiencies of taurine and methionine, problems with the citric acid cycle, ammonia toxicity (which can be from H pylori or other bacterial overgrowth as well as poor protein absorption), or a lack of glutathione, our master antioxidant. You may also see pyroglutamic values low along with this, which is in the detoxification section, marker 58, in which case you know you should supplement with either NAC (N-acetyl cysteine), an antioxidant that increases the glutathione reserves in the body, or glutathione itself, preferably in some format like liposomal or trisomal (available in my Fullscript Dispensary*), which is more absorbable, but at minimum in the reduced glutathione* format.

But in general, when there multiple high markers in the Krebs cycle, you’re looking at supplementing with CoQ10, Magnesium, amino acids and the B vitamins. And then you should be figuring out if there is an underlying cause for the dysfunction, like gut health issues or toxins like heavy metals, environmental chemicals or mold.

Mitochondrial Markers of Amino Acid Metabolites

The next section, markers 30-32, are Mitochondrial Markers of Amino Acid Metabolites. Markers 30 and 32 will be increased if there’s a reduced ability to metabolize the amino acid leucine, which can be genetic, or a mitochondrial disorder. In any case, supplementing with CoQ10, niacin, l-carnitine, the B vitamins and vitamin E may be helpful. So in these cases I usually look at a multivitamin with high B vitamins like my favorite multi, Perque Life Guard (which you can find in my Fullscript Dispensary*), plus a CoQ10 or ubiquinol supplement. Slight elevations in marker 31, 3-Hydroxyglutaric may indicate mitochondrial dysfunction, while high elevations are usually from genetic issues.

Pyrimidine Metabolites – Folate Metabolism

The next section, 33-40, the neurotransmitters, I covered in my previous post, so I’m jumping to 41 and 42, the Pyrimidine Metabolites – Folate Metabolism. The Pyrimidines are one of two chemical compounds that cells use to make the building blocks of DNA and RNA. Elevated uracil, or marker 41, may indicate a defect in folic acid metabolism, which is present in about 10% of children with autism, or a folate deficiency. If it’s elevated for a client, I just make sure they’re getting a good quality multivitamin or B complex with the active form of folate, not folic acid or folinic acid, which many people have genetic issues metabolizing. So I look for the active forms of folate, which might be listed as methylfolate, l-methylfolate,5-methyl-THF, L-5-MTHF or 5-MTHF.

Slightly elevated thymine isn’t significant, but very high values on thymine have been associated with inflammatory diseases and cancer. And elevated thymine along with elevated pyrimidines has been associated with a genetic disease that’s associated with seizures and autism.

Ketone and Fatty Acid Oxidation

Then the next section, Ketone and Fatty Acid Oxidation, markers 43-49, is one of my favorites. I like this section because if there are issues here with elevated markers, it’s one of the quickest and easiest fixes that usually has a dramatic effect on how people are feeling. So fatty acids, like carbs, must be converted into Acetyl-coA to be brought into the Krebs cycle to create energy. This process is called beta oxidation. Now to do this you need two things, the amino acid l-carnitine, and vitamin B2 or riboflavin. This is where I often see issues in vegetarians, vegans or people who only eat chicken and fish or just seafood. Carnitine is most plentiful in red meats like beef and lamb. For example, 4 ounces of ground beef has 87–99 mg of carnitine, four ounces of steak, 56–162, but four ounces of chicken breast, only 3-5. Four ounces of codfish, 4-7, a glass of milk 8. Pork is sort of moderate with 31 mg per 4 ounces. And lamb is the highest with 180 grams in 4 ounces of lamb filet. So over time on a restricted diet, carnitine will become depleted, then you aren’t bringing fats into the Krebs cycle to be burned for energy; instead they’re getting stored as fat. So this leads to weight gain and low energy, muscle aches, weakness, recurrent infections, migraines, age-related cognitive decline and in extreme cases, dementia. And because you don’t have fats to supply energy when carbs are quickly digested (which usually happens in about 2 hours) you’ll have blood sugar highs and lows. So you’ll usually see blood sugar high followed by a crash and symptoms like nausea, confusion or hypoglycemia.

Of course all this can happen to a meat eater with a deficiency of B vitamins as well, which can be dietary if not enough is consumed, there’s malabsorption, like with certain gut issues like Crohn’s disease, ulcerative colitis or celiac, low stomach acid so proteins aren’t getting broken down properly into amino acids, or it can be from excessive exercise, like when training for endurance sports, or alcohol abuse.

But since B2 is most plentiful in dairy foods, fortified foods like oats and breakfast cereals, meats and nuts, if you’re on a gluten-free, vegan diet and eating no processed foods, you could end up deficient in both carnitine and B2.

So issues in this area are relatively easy to fix with the addition of l-carnitine* or its active form acetyl-l-carnitine*. I usually use the former when there are physical issues like fatigue or weight loss resistance, and add the latter if there are brain issues like memory issues, age-related cognitive decline or brain fog.

All that I was just talking about applies specifically to markers 45, 46, 48 and 49. They can also be elevated because of fasting or high intake of coconut or MCT oil.

Some of the other markers like 3-hydroxybutyric and acetoacetic acids can also be elevated because of a ketogenic or very high fat diet, so it’s important to ask about diet before jumping to the conclusion that someone has a defect in their fatty acid oxidation. Those two can also be elevated because of prolonged fasting, protein malnutrition, a B12 deficiency, pulmonary infections and a severe candida overgrowth in the GI tract.

But overall, generally the more markers high in this section, the higher I think of raising carnitine dosing. I try to find the 1000 mg pills* to reduce the quantity people have to take. 3000 mg a day in 3 doses is ideal, best on an empty stomach like all amino acids. It smells and tastes gross, so it’s best to do in pill format rather than in a powder. And you can go up to 5000 mg/day if you’re not getting results at lower doses. Or add in up to 2000 mg a day of acetyl-l-carnitine* if you have the brain symptoms too, as it easily crosses the blood brain barrier and helps increase acetylcholine, which is an important neurotransmitter for learning, memory and general cognition, which can help with Alzheimer’s, as a severe depletion of acetylcholine is associated with Alzheimer’s.

Of course as with any markers, very high levels can indicate a genetic issue, and for adipic in particular, gelatin and other junk foods may have adipic acid as an additive, causing an elevation.

Nutritional Markers

The next section, Nutritional Markers, 50-57, indicate deficiencies in different B vitamins, which are listed by each one, vitamin C, CoQ10 and NAC. This is pretty intuitive, with low markers for most of them indicating deficiencies, generally flagged if below the mean, except that some of them are inverse markers and have an asterisk, which means that a high value indicates a deficiency. This is the case for B12, methylmalonic, which is much more sensitive and will show up earlier than a blood test for B12, B2(glutaric), CoQ10 (3-hydroxy-3-methylglutaric), and Biotin (methylcitric).

Deficiencies of different vitamins can have a variety of causes, but for B12 for example, a vegan diet, pernicious anemia, and gut issues are common causes. For B6, low values are associated with high oxalates and low neurotransmitters but those are not causes per se and are more likely the result of having low B6.

I often see marker 52, pantothenic, elevated, which is a marker of B5. It can be from recent supplementation but isn’t of concern if high or indicate a need to reduce, but if values are more than 20 times the upper limit of normal, there could be a genetic issue with conversion of B5 in a disease called pantothenate kinase-associated neurodegeneration. In mild variants of this disease, psychiatric illnesses such as schizoaffective disorder, hallucinations, obsessive compulsive disorder, speech defects, and depression are common. Generally, I assume that more severe manifestations of these types of genetic disorders are uncovered with regular doctors because of the early onset of severe symptoms.

Also, high glutaric acid for B2 (which is one of the inverse markers, so high means low) besides meaning low B2 can also be because of a lack of carnitine, so the B2 isn’t getting used as it should, or because of celiac disease. Supplementing both with riboflavin and CoQ10 is helpful when this is elevated. 

Next is ascorbic acid or vitamin C, which when elevated usually isn’t a concern, as that usually means you’re supplementing with it. Low levels are pretty typical if supplementation is stopped prior to testing and dietary intakes are inadequate, which is the case for most people, given the nutrient levels in our foods have decreased so markedly with the advent of modern agriculture and transport practices. So if you get a low level, it’s good to supplement with vitamin C. The only concern would be with someone with high oxalates or a history of kidney stones, as ascorbic acid or vitamin C could convert to oxalic acid, increasing the risk of kidney stones and other symptoms of high oxalates, which I discussed in my previous post. With normal levels of oxalic acid, vitamin C supplementation shouldn’t be an issue.

I’ve virtually never seen the marker for CoQ10, 3-Hydroxy-3-methylglutaric Acid (or HMG), to be high, and again this in an inverse marker, so high means low levels of CoQ10. But one reason that it may be high is use of statins, which decrease HMG and CoQ10. If you’re on a statin, you should be taking CoQ10 preventatively. Very high levels would point to a genetic disorder.

Biotin deficiency marked by high methylcitric acid I’ve also never seen. But causes could be dietary deficiencies, dysbiosis, or excessive intakes of raw egg whites. And again very high levels could be from genetic causes.

I’ll also note that I think I’ve only seen one OAT in which someone didn’t show up as deficient in B6. So not sure if there’s test error there or all people with gut issues have low B6 (which is not unlikely because gut issues can inhibit absorption) or there’s a population level deficiency issue, but just to let you know I’ve observed that, as have other mentors of mine in the functional medicine community. But I tend to recommend B vitamins to almost everyone I work with in any case, so I typically suggest one with high B6 for a time. Now it is possible to overdo B6 and symptoms of that are a lack of muscle control or coordination, skin lesions, heartburn, nausea, photosensitivity, numbness and reduced ability to sense pain or extreme temperatures. So I don’t recommend super high B6 supplements indefinitely (and when I say super high I’m talking 100-200 mg/day). But usually 6 months then retesting is ideal or move to a more reasonable dose like 25-50 mg/day.

And finally, I just want to say that I’ve never seen N-acetylcysteine Acid or NAC not in range, so it’s not a terribly useful marker. The next section on detoxification usually alerts us to the need for NAC supplementation. So let’s jump there.

Indicators of Detoxification

So this section, Indicators of Detoxification, markers 58-61, helps you understand how well your liver is clearing toxins from your body. The first marker, 58, pyroglutamic, is a metabolite of glutathione, which is our body’s master antioxidant, and one of its roles is to bind to toxic compounds in the liver. High levels, meaning a lack of glutathione as it’s an inverse marker, are usually due to toxic exposures like acetaminophen toxicity, or other toxins, genetic disorders, the metabolic effects of certain antibiotics, or the path to mitochondrial failure from oxidative stress. You can supplement with NAC or N-acetyl-cysteine* to support phase 2 detoxification, increase glutathione and bring this into the normal range. Sometimes other components of glutathione are missing, like glycine or glutamine, or you need other sulfur amino acids to support phase 2 detoxification, like taurine, methionine and cystine, so you may need to add those as well, or just take free form amino acids that contain them all, or just supplement with liposomal glutathione, which is the preferred form.

If glutathione is low, you should usually also supplement with magnesium (I prefer Magnesium glycinate form if you’re not constipated and citrate if you are). If you’re just going off the OAT results, check the Krebs cycle markers, and if they’re all low, meaning mitochondria have collapsed and given up and you’re feeling tired, depressed or have chronic fatigue, you’ll need both magnesium and glutathione or its precursors.

This is also an issue if this maker is very low, which means your body is working really hard to get rid of toxins, so you should also supplement with NAC or glutathione in this case.

The next marker, 2-hydroxybutyric, is also an inverse marker and high values indicate either methylation defects or toxic exposures. Again this points to the need for glutathione or NAC supplementation. It can also be elevated due to genetic SNPs in the methylation pathway or deficiencies of methyl tetrhydrofolate, the active form of folate, Methyl B12, the active form of vitamin B12 or betaine, or could be elevated due to the onset of diabetes, or from excessive alcohol use. Again sometimes genetic issues show up here but this is less common.

The next marker, orotic, is another one I really like because it’s usually an easy fix. It gets elevated when ammonia levels are high from either drug toxicity to the liver, bacterial overgrowth, particularly H pylori, GI bleeding, or inborn errors of the urea cycle, which is our process for ammonia metabolism, like a CBS mutation. So when you eat protein, you need to get rid of the nitrogen, but if you have a problem with your urea cycle and you can’t do that efficiently, you end up with buildup of ammonia, which can be because of faulty enzymes due to very common genetic issues. Symptoms of hyperammonenia are headache, fatigue, confusion, poor concentration, loss of muscle control and food intolerances. To help the urea cycle function, you take high doses of l-arginine, which pushes the cycle and helps clear out the ammonia.

The next to last marker I’ll mention is 2-hydroxyhippuric, which is elevated from aspartame consumption, high salicylates, like in aspirin and also an additive to personal care products and naturally occurring in many fruits and vegetables. Some people have a sensitivity to salicylates, so if you’ve tried everything else diet wise and this is high, it could be a salicylate sensitivity. It can also be elevated from overgrowths of certain bacteria in the gut that convert the amino acids tyrosine or phenylalanine into salicylic acid.

Amino Acid Metabolites and Mineral Metabolites

The remaining markers under Amino Acid Metabolites are rarely elevated and mostly point to genetic issues so I’m not going to discuss them much here. And finally, under Mineral Metabolites, phosphoric acid is also rarely off because phosphates are in processed foods, but if it is low, it could point to a vitamin D deficiency.

If you have an OAT test you need help interpreting or would like to order one and work with me on it, or if you’re dealing with either gut issues or mental health issues or chronic all over body problems, the good news is that this stuff is quite fixable, and the Organic Acids Test is often a great way to start to uncover what’s going on underneath. I work with clients using this test to reveal these issues and their root causes and educate you on how to fix them. 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.

Adapted from episode 76 of The Perfect Stool podcast with Ari Whitten and edited for readability. Ari is the Founder of The Energy Blueprint*, an energy and fatigue specialist and best-selling author. He has been studying nutrition and holistic health for more than 2 decades and has a Bachelor of Science from San Diego State University in Kinesiology (with specialization in fitness, nutrition, and health). In addition, he recently completed the 3 years of coursework for his Ph.D. in Clinical Psychology. Ari is a tireless researcher who has obsessively devoted the last 20 years of his life to the pursuit of being on the cutting edge of the science on health and energy enhancement.

Lindsey: 

So you first caught my eye when I saw a conference presentation where you were debunking the concept of adrenal fatigue after an extensive study of the literature. And we can get back to talking about that at the end. But first, since you’re the energy and mitochondria expert, why don’t we start by talking about what the mitochondria are and how they relate to gut health?

Ari Whitten: 

Sure, okay. So, where to begin? It’s a big question. So a lot of my work centers around mitochondrial health and that relates, to some extent, to the thing you just mentioned about adrenal fatigue, in the sense that I spent many years indoctrinated into the adrenal fatigue paradigm, and was a big proponent of it, and was totally convinced that that was true. And eventually, through looking at the literature on that, and we can talk about this in depth at some point, if you if you’d like, came to an understanding that adrenal fatigue is actually not a thing. And it’s certainly not the central thing in the case of chronic fatigue. And I’m happy to again, talk specifics of why I make those claims.

They might seem like bold claims to some people listening, given that there are so many people who are promoting the idea that it is adrenal fatigue, and that adrenal fatigue is real, and that it is the central thing in chronic fatigue and sort of stress-related fatigue and burnout. And then after realizing that, I myself was quite confused, because that was, in my mind too, the central thing to chronic fatigue. So if it’s not, if the science doesn’t support adrenal fatigue as the central driver of chronic fatigue, then what the heck is? And it was largely due to the work of Robert Navio, who is an MD PhD, who runs a lab for mitochondrial medicine at the University of California, San Diego, that I started to develop a new paradigm, a new understanding of what is really the thing in our body that is the most upstream that is actually regulating and controlling human energy levels, in the sense of this deciding whether we have low energy, and we’re chronically fatigued, or whether we have abundant energy, like we do as children. And the main finding, which is a pretty revolutionary, I think biology shaking, new paradigm around mitochondria, is that mitochondria have a second role beyond their role in energy production.

And for over 100 years, we’ve known about mitochondria, we all learned about them in high school and college biology classes as the powerhouse of the cell. And these are where the majority of our cellular energy comes from. And all of that is true. But what is not true is they’re kind of talked about in biology courses as these sort of mindless energy generators that just take in carbs and fats, and pump out energy in the form of ATP (adenosine triphosphate). And they are in fact energy generators, but they’re far from mindless. It turns out that mitochondria are, in the words of Dr. Robert Navio, the central hub of the wheel of metabolism. They are basically like the canaries in the coal mine in our body. They are the most upstream, most sensitive organ in our body that is responsible for sensing signals from the environment about what’s going on in the environment, what’s going on in the body, and responding to those signals by coordinating metabolic and immune responses and energy responses to that. And basically deciding whether or not the mitochondria are going to operate in energy mode, or defense mode, or as Dr. Robert Navio calls it, peacetime metabolism or wartime metabolism. And basically what this means to simplify all of this is that to the extent that your mitochondria are picking up on threats, on signals that are danger signals that something is wrong in the body, and they have the ability to sense virtually every type of stressor imaginable, from pathogens like viral infections, to psychological stress, to poor nutrition, to signals from the gut, to environmental toxicants, to sleep deprivation, to every type of stressor that you can imagine, they can pick up on those danger signals. And to the extent that they’re picking up on the presence of danger signals, they turn down the dial on energy production and shift resources towards cellular defense.

So mitochondria are not just mindless energy generators that take in carbs and fats and pump out energy. They are exquisitely sensitive environmental sensors that are actually regulating human energy levels and deciding whether or not we should produce abundant energy or very little energy and shift resources towards cellular defense. And that is fundamentally the central thing. While there are many processes that in one way or another relate to energy levels, there are brain processes, there are neurotransmitters or hormones, there are all kinds of biochemical processes that indirectly one way or another impact on energy, the central most important thing is that our mitochondria are fundamentally regulating whether we have abundant energy or very little energy as a direct reflection of the degree to which they’re sensing danger being present in the body.

Lindsey: 

Interesting. Okay, so tell me a story of how someone starts with a gut infection and this then impacts the mitochondria. What’s the cascade of events?

Ari Whitten: 

Yeah, so there could be a number of potential events as far as how this plays out. But let’s frame it this way. There are three central findings that are very common in people with chronic fatigue, especially chronic fatigue syndrome, as it relates to gut health. There’s low microbial diversity in the gut, there’s high endotoxin levels; endotoxin producing or containing bacterial species. And there’s very low production of short chain fatty acids and urolithins. So the bacterial species that are responsible for that are in short supply. So there is, in other words, a disturbance in the gut microbiome. Now that gut microbiome shift to, you could say, although these terms are kind of antiquated now, you could say a bad or nonoptimal microbial balance in the gut microbiome can occur for a variety of reasons that I’m sure you’ve talked about extensively on this podcast, of course, poor nutrition, psychological stress, circadian rhythm and sleep disruption, environmental toxins, antibiotic use, and other drugs can all affect the microbiome diversity and balance, or nutrition is, of course, a major one, for a huge portion of the population that’s eating a standard American diet or a standard Western diet. So these kinds of microbial disturbances are widespread. And as a result of an imbalance in the gut microbiome, you can get a degradation of the mucous lining, and you can get an increase in gut permeability. Once you have an increase in gut permeability, you then necessarily are going to experience a variety of problems. You’re going to have undigested food particles that are now entering bloodstream. You’re going to have higher levels of endotoxin from those endotoxin containing bacteria in the gut leaking into the bloodstream. And the result of those things leads to a chronic low level immune activation and low grade inflammation response.

Now that response then ties back into what I was telling you about mitochondria before, which is, the very presence of elevated levels of inflammatory cytokines is actually a danger signal; it is interpreted by mitochondria. It is one of the key signals that mitochondria interpret as, oh, there’s danger present, we better shift out of peacetime metabolism into wartime metabolism. And that leads to mitochondria turning down the dial on energy production. So there’s a very direct link between higher levels of inflammation, inflammatory cytokines, and low energy levels. And of course, anything that goes on in the gut that leads to low grade inflammation, whether it’s poor nutrition, or antibiotic use, or whatever the source was that led to poor microbiome balance, gut permeability, that is now being translated directly into poor mitochondrial function and mitochondrial shutdown and fatigue, as a result, basically being mediated by inflammation primarily.

Ari Whitten: 

So you’re talking about endotoxins, and low butyrate, and essentially leaky gut. So I’m thinking about Proteobacteria overgrowth and gram negative bacteria and LPS. So can you talk a little bit about that?

Ari Whitten: 

You know, the specific species of bacteria that have been seen in the context of chronic chronic fatigue syndrome, there’s a few things that have been known. There’s not a huge abundance of scientific literature. We know that they have low levels of bifidobacteria and low levels of lactobacilli in the gut. Yes, we know that they have higher levels of Bacteroides and Proteobacteria. We also know, there’s actually some studies that have shown that people with chronic fatigue syndrome have very exaggerated immune responses to endotoxins in the blood, which is indicative of them being exposed to high levels of endotoxin chronically as a result of this combination of factors. Beyond that, I’m not aware of any other specific research linking very specific species of bacteria to chronic fatigue in particular.

Lindsey: 

But when you talk about endotoxins, that’s coming exclusively from gram negative bacteria that produce lipopolysaccharides (LPS). Right?

Ari Whitten: 

Right.

Lindsey: 

Okay. So how do lipopolysaccharides impact us?

Ari Whitten: 

So lipopolysaccharides do a couple of things. One is we know that what’s called endotoxemia, which is basically high levels of LPS entering the bloodstream as a result of gut permeability, are linked with all kinds of metabolic dysfunction. This has been linked with neurological disease, cardiovascular disease, obesity, diabetes, fatty liver, and it’s been linked with mitochondrial dysfunction directly. So the LPS does two things, it creates an immune and inflammatory response, which, again, those signals are sensed by mitochondria and result in mitochondrial shutdown. And LPS is also directly toxic to mitochondria, and actually will damage mitochondria and cause mitochondrial dysfunction. So there’s a couple of different mechanisms by which that takes place.

Lindsey: 

So I know you can see on certain lab tests that I use, you can see when the mitochondria aren’t working in producing very much energy, but then you can also see when they’ve completely collapsed. So can you talk about the difference between those?

Ari Whitten: 

You know, mitochondrial testing is challenging, there’s a few different ways that we can test for mitochondria and mitochondrial function. We can do an Organic Acids Test, there’s a test called the Mito Swab Test, in research settings, they can do certain kinds of tests that are not widely available at the consumer level, or even  available to doctors to test their patients. You can test for nutrient deficiencies, for example, carnitine deficiencies, and COQ10 deficiencies have been linked with chronic fatigue. And there’s research where they’ve actually been able to identify those deficiencies; you can do that indirectly with organic acid testing. And so that can give some insight into that as well.

But that kind of testing is limited in the sense that one, it picks up more on mitochondrial dysfunction, which is more like physical damage to the mitochondria and dysfunctioning mitochondria, more so than it does mitochondrial shutdown. And to give you a clear distinction of the difference between those two things, if I am healthy today, as I am, but next week, I have COVID, or I have a flu or some kind of viral respiratory infection, I may have severe fatigue for a few days. And as I recently had COVID, a couple of weeks ago, and in the context of that severe fatigue. That happens as a result of that acute viral infection. I don’t have widespread mitochondrial dysfunction and damage throughout my body. But I do have mitochondrial shutdown. So there’s a distinction between those two things. And I would argue that many of the tests are much better at picking up mitochondrial dysfunction than shut down.

Now there’s one more critical aspect of this. One of the types of testing that is done in certain research settings, but it’s not widely available to consumers, but I would argue is really important, is actually muscle biopsies. They stick a big hollow needle into your muscle, usually your quadriceps muscle, they pull out a chunk of tissue, and they look at it under a microscope. And we know from that kind of research, when they pull out those muscle biopsies from 20 year olds, 30 year olds, 40 year olds, 60 year olds and 70 year olds, there are massive differences in the number of mitochondria per cell. So we know that on average, the typical 70 year old has about half of the number of mitochondria per cell that a young adult does. And the mitochondria that are present only have about 50% of the energy producing capacity of a young person. So those are things that won’t be picked up on things like the Mito Swab Test, or the Organic Acids Test.

Or, you know, there’s also another test out from some chronic fatigue researchers out of the UK called the ATP profile test. You’re not going to find those kinds of results without doing a muscle biopsy. Now, I should mention also that for people maybe who heard what I just said, they might think, “Oh, my gosh, this is terrible news that we lose so much of our mitochondria as a result of aging, basically.” But we also know that when we look at 70 year olds who are lifelong exercisers and athletes, that they actually have the same mitochondrial capacity as a young person. So the loss of mitochondrial capacity is actually not a normal product of the aging process, per se. It is actually the result of loss of hormetic stress in the modern lifestyle, lack of metabolic stress, exercise and other types of hormetic stressors, which is a whole topic we could go into if you want. But anyway, to get back to answering your question, mitochondrial tests, like Organic Acids, Mito Swab Tests are fine, they’re useful, but they definitely don’t tell the full picture of mitochondrial health.

Lindsey: 

Okay. And so the hormetic stressors, did you do a long video about hormetic stressors?

Ari Whitten: 

Oh, yeah, many.

Lindsey: 

Okay, maybe it was yours. I can’t even remember because it was one of these videos that I saw way before I got into this stuff professionally. But I remember pretty distinctly about all the different hormetic stressors that can help develop your mitochondria and increase your mitochondria. So let’s talk a little bit about that.

Ari Whitten: 

Yeah, that sounds like me. I remember 10 years ago, when I used to say the word hormesis or hormetic stress to a lot of my friends who were functional medicine doctors, they used to give me a funny look. They’d never heard of the word and they didn’t know what the hell I was talking about and thought I was crazy. And now everybody’s aware of hormetic stress, which I’m both happy about and not happy about. Happy about it in the sense that it’s important and people should know it. And at the same time, I kind of enjoyed it being my unique shtick that no one else was talking about.

But yeah, so the importance of this to mitochondria basically is what I was just explaining, why it’s important to understand that our mitochondria, the health of our mitochondria, and the physical size of our mitochondria, and the number of mitochondria that we have per cell are all critically dependent on the degree to which we are engaging in hormetic stress in our lifestyle, where hormetic stress is transient metabolic stress that stimulates adaptations in the body that confer greater resistance to a broad range of other stressors. And ultimately, that translates into a number of beneficial adaptations that help lower our risk of numerous different diseases, all the major killers like cardiovascular disease and cancer and neurological disease and many others, and also make us more resilient in the face of stress. And by virtue of the adaptations that they’re stimulating at the mitochondrial level, which is really the central thing going on in hormetic stress, we build our cellular engine, we build our energy producing capacity at the cellular level. And this is the difference between somebody who has a big, strong, healthy cellular engine or a very weak one. Do you have a moped engine in your cells? Or do you have a Ferrari, and that is entirely dependent on the degree to which you are regularly engaging in hormetic stress.

And hormetic stressors, to be specific, I mentioned exercise except, there’s many different subtypes of exercise, so resistance exercise, steady state endurance exercise, and then high intensity interval training and sprint interval training. And all of these really are distinct categories that have their own unique sort of fingerprint of adaptations that they’re stimulating that are different from one another. Other types of hormetic stressors are heat, and cold, fasting, hypoxia, low oxygen state, so breath holding practices, there’s different types of chemical hormetic stressors. There are things like methylene blue, for example. And then there’s different kinds of light therapy like red and near infrared light, as well as ultraviolet lights are hormetic stressors.

And there’s xenohormetic stressors, or xenohormetins, which are phytochemicals, sometimes referred to as exercise medics because they stimulate some of the same hormetic pathways as exercise does. And certain phytochemicals like sulforaphane, and curcumin, and resveratrol, and pterostilbene, and many others act as hormetic stressors as well. So all of these right, regularly engaging in some variety of the hormetic stressors that I just mentioned, is not just optimal for mitochondrial health, it is actually necessary to maintain mitochondria, in the same way that if you break a bone, you break an arm or a leg and you get a cast on that on that arm or the leg. And then eight weeks later, you get the cast off, you look down at your arm or your leg. And then you’ll know this if this has ever happened to you or if it’s happened to a child or a friend of yours. You look down at your arm or your leg, it’s half the size of the other one. And that atrophy, that loss of that muscle tissue happens because the body is ruthless with getting rid of any tissue, especially energetically costly tissue, that is not needed for survival. So as soon as your muscle is immobilized and cast, the body goes oh, I guess we don’t need that for survival anymore, let’s get rid of it. And that cutting down of that muscle tissue to half the size as the other limb happens literally in the span of two months.

Now that same exact process, that same exact principle is happening internally at the cellular level at the mitochondria level, where if you are not using your mitochondria, if you’re not challenging them and stimulating them through hormetic stress, they atrophy, they literally shrink and shrivel and die off and you lose your mitochondria as a result of the body basically sensing that they’re not needed, because you live a typical modern lifestyle that is largely devoid of hormetic stress. So this aspect of loss of mitochondria, is in my mind, one of the biggest contributors to the modern disease epidemic. And it’s something that in my opinion, hugely, is little known and hugely under appreciated within the natural health and functional medicine communities that are just not talking about the difference between a body that is full of big, strong, robust mitochondria, or a body that’s lost 50 or 75% of its energy producing capacity; there’s a massive difference. This is a central driver of chronic disease, and especially chronic fatigue.

Lindsey: 

So if someone is suffering from chronic fatigue or fatigue of any type, would you first start with some gut testing to see if that was a factor, like what’s the first step in reversing it?

Ari Whitten: 

Not everybody with chronic fatigue has gut issues. But it is certainly the case that a subset of people with chronic fatigue have gut issues. And it’s certainly the case that a certain subset of people with chronic fatigue, their primary number one causal issue is a gut problem that then causes that fatigue. And you can say that’s the primary cause of their issue. But it’s certainly the case that there are lots of people running around with low energy levels. Well not running around, I should say, walking around, or laying around . . .

Lindsey: 

Or lying in bed.

Ari Whitten: 

Yeah, exactly . . . who have really no significant gut problems at all. And I shouldn’t maybe go quite that extreme because as soon as other systems of the body dysfunction, you’re likely to have at least some degree of gut dysfunction. But I would only start with a gut specific intervention in the case of someone who is really has very clear gut-related symptoms, they’re complaining of abdominal, GI distress, abdominal pain, bloating, digestive difficulties or fatigue after meals. Specifically, in cases like that, I would certainly start with with trying to address gut health.

Lindsey: 

Okay, and then after you’ve addressed, so assuming gut health, probably the same root causes as everything else in functional medicine, right, your toxins, your molds, these types of things are root cause issues? Others that I’m not thinking about?

Ari Whitten: 

Yeah, certainly poor nutrition is a major cause, circadian rhythm disruption and sleep disruption. I would say that and poor nutrition and psychological stress are probably the three most common contributors to chronic fatigue, when you’re talking chronic fatigue syndrome specifically, which is differentiated from sort of a more general state of chronic fatigue, basically, just by severity. And there are no blood tests or any other tests that can tell you if you have chronic fatigue syndrome. It’s based on symptoms, and specifically the presence of severe fatigue lasting six months or longer and the presence of something called post exertional malaise, which is a symptom that after any sort of physical exertion, people might be really exhausted for two or three days following that. And so if you’re in that state, you can say you have chronic fatigue syndrome. But in more general states that are way more common, that affect 50 to 100 times more people than chronic fatigue syndrome, you’re looking at more things like poor nutrition, circadian rhythm disruption and sleep deprivation. Low level sleep deprivation and psychological stress and lack of hormetic stress are the biggest contributors to that.

Lindsey: 

Yeah, one of my basic questions when I am interviewing new clients is how do you feel after you exercise? And if they say I feel energized, I’m like, okay, good. So is there any distinction between the types of gut dysbiosis and how they most impact energy like Candida versus parasites or H Pylori, or just general bacterial dysbiosis? Or SIBO?

Ari Whitten: 

You know, we just don’t have the research to make those kinds of determinations. So where somebody has got specific issues, you know, they need to work with a gut specialist like yourself to resolve that. But as far as an established body of research, with that level of specificity, linking specific kinds of gut issues with chronic fatigue, that research just doesn’t exist as of right now.

Lindsey: 

Okay, fair enough. So let’s get back to the whole adrenal fatigue question and tell me a little bit more about what they used to think that was, and what you found in your research?

Ari Whitten: 

Yeah. Okay. So just a general overview of what adrenal fatigue what the adrenal fatigue hypothesis is. Basically, the idea is that our adrenal glands are glands that are involved in the stress response. And they produce a hormone called cortisol, which is produced in response to stress, and has a variety of functions but is involved in, for example, the release of blood sugar from the liver and from the muscles to help regulate blood sugar levels in response to stress. It has other roles, like anti-inflammatory effects, and various other things. And that gets very complex when we talk about it in the chronic picture. But the gist of it is, it’s a hormone that is important in the stress response. And the idea was that with adrenal fatigue, that system is meant for acute stress. And with chronic stress, it eventually taxes the adrenal glands and taxes them and taxes them and taxes them over a very long period of time chronically. And as a result of that, they get worn out, and they stop producing enough cortisol to meet the body’s demands.

There are several versions of this. Some people say there’s eight phases, or seven phases, some people say there’s three phases. There’s various models that have been put out there, I should mention, none of which have been scientifically validated, but they are impressive looking. When you look at these fancy models, they seem very science-y. And the idea is that there’s an acute phase where stress sort of taxes the adrenals excessively, then you have high cortisol levels, then you go back down, you start to go down, and then maybe at some point, you’re in a middle phase where your cortisol levels are technically within a normal range, and then but that’s just a phase. That’s like phase two adrenal fatigue, and then you’re headed further down into phase three, adrenal burnout, at which point you have low cortisol levels. All of this sounds reasonably logical and plausible. The problem with it is that it’s completely unsupported by the scientific literature. And what I’m saying is actually not a radical position, it only is perceived to be a radical position in some alternative health circles. And I should mention, I’m aligned with the natural health and functional medicine movements. But this is one area where I feel they’ve gotten things wrong historically. If you look at, within conventional medicine among endocrinologists, there’s a huge body that represents 14,000, endocrinologists. And these are hormone specialists. And they came out many years ago and said, I’m going off the top of my head, but it’s almost a direct quote, “There is no evidence to support the idea that the adrenal glands get worn out as a result of chronic stress of any type, resulting in low cortisol levels and resulting in many common symptoms like fatigue.” They literally said, there is no evidence to support this theory.

And ironically, I got interested in exploring the research on this, because I was so pissed off by conventional medicine brushing off adrenal fatigue.  I was absolutely convinced that adrenal fatigue was a real thing. And I wanted to stick it to them. And my plan was basically to go into the scientific literature, and then compile all the research showing that it is legitimate and science based. And then I was going to write a book, basically, on the scientific basis of adrenal fatigue. And what I found when I started to explore that issue, the research on that topic, was something that shocked me. Because I had read thousands of articles and books written by people I really respected talking about adrenal fatigue. So of course, I was absolutely convinced it was totally real. But the first big red flag was that I went on PubMed and typed in adrenal fatigue, to find any research that has been done on that medical condition. Because if you do that, with any medical condition, even the most obscure, random medical condition, you can find, like some rare genetic disorder, something that affects two out of every 100 million people, if you type that in, you’re going to find at least dozens, if not hundreds, or thousands of studies. You type in adrenal fatigue, you find almost nothing. So that first was was quite confusing, quite shocking to me. Why, why? Why is there no research on this medical condition whatsoever?

So then it took me a while to even figure out how to find any research that would be relevant to evaluating the adrenal fatigue hypothesis. And eventually, and I’m condensing about a year of my life that I dedicated to this topic into a five-minute segment here. But eventually, after several weeks of kind of digging around, I started to find bodies of research that did exist that were relevant to this. So there are several other fatigue syndromes that are largely synonymous with the basic idea of adrenal fatigue, only without positing that it’s specifically the adrenals and cortisol that are causing it, that do exist that are accepted medical conditions. So one is called Clinical Burnout. One is called Burnout Syndrome. One is called Vital Exhaustion. One is called stress related exhaustion disorder. And there’s also of course, chronic fatigue syndrome that’s in this mix as well.

And when I started to look up those terms, and HPA axis or cortisol, then I started to find bodies of literature. And in fact, there’s there’s been dozens of studies that have tested adrenal function, cortisol levels and HPA Axis function, more broadly, hypothalamus pituitary adrenal axis function in people with these accepted kinds of fatigue syndromes. And the majority of those studies, and they’ve been done for over 25 years all over the world, so the majority of those studies basically, I would say 90% of them, basically just take people with that fatigue syndrome, whether it’s chronic fatigue syndrome or stress-related exhaustion disorder, burnout syndrome or whatever and they analyze their cortisol levels and adrenal function or do other tests like Dexamethadone Suppression Test to assess HPA Axis function more broadly in the people with the fatigue syndrome and they compare it to demographic matched people without fatigue, you know, same age and sex and gender and controlling for smoking and exercise habits and all these other kinds of things.

So the vast majority of the tests basically do that. And over the last 25 years, there have been 59 individual studies by researchers all over the world that have done these kinds of tests. There’s another 20 literature reviews, systematic reviews, which is considered the highest level of scientific evidence, that has been done on a lot of these specific subcategories that I mentioned. So for example, researchers will do a systematic review on all the studies looking at cortisol levels in people specifically with chronic fatigue syndrome, or specifically with burnout syndrome, or specifically with stress-related exhaustion disorder. So there’s 20 of those but of the 59 individual studies, here’s how they break down: 15 of them gave evidence for lower morning cortisol levels in the group with fatigue compared to those without fatigue. And this isn’t even abnormal cortisol levels; they were still within the range of normal on average, but it’s slightly lower than the group that was helpful. Another 11 of those 59 studies found the opposite findings, slightly higher cortisol levels associated with the fatigue syndrome, and 33 of the 59 studies found no detectable difference whatsoever in cortisol levels between the group with fatigue and those without.

So of this body of evidence, this is what I was left with after I spent a year of my life digging into the research and analyzing all these studies. I was left with a body of evidence where the bulk of the research clearly is indicating there is no discernible HPA Axis function or cortisol abnormality that is even present in people with chronic fatigue, let alone let alone any sort of scientific case that is compelling to believe that that is the central cause of those symptoms.

Lindsey: 

But isn’t it possible that some people’s chronic fatigue or fatigue could be caused by adrenal related issues and some people’s not and therefore, it comes out in the wash in a study because some might be mitochondria related?

Ari Whitten: 

Sure. So for example, you can have Addison’s disease. And in the context of Addison’s disease, one of the symptoms will be fatigue. So, there are there are many different conditions that one could have that will cause fatigue. And there is a very small portion of people who have Addison’s disease, and that is the central cause of their chronic fatigue. It is also possible to have HPA Axis dysfunction. That is a real thing, like HPA Axis dysfunction does exist. And it is possible to have totally dysregulated cortisol levels or even chronically low cortisol levels. If it’s very low cortisol levels, it’s probably Addison’s disease. But it is absolutely possible to have that. It is also the case that this is present, based on 25 years of studies from all over the world, that it is present to such a small degree in such a small subset of the bulk of the people who have chronic fatigue, that it is clearly not any kind of central feature of chronic fatigue. But it is the case that it can be a contributor to fatigue in a small subset of people.

Lindsey: 

Okay, so that’s good to know that it could be playing a role for some people because I do sometimes test people’s adrenals personally, just because, you know, if they tell me, they’re drinking tons of coffee, or they’re having trouble sleeping, or they wake up and they feel like they’re still asleep for a couple hours, that’s when I think, okay, there may be some dysregulation here. So, you know, what could you or would you do in cases like that?

Ari Whitten: 

So I would say that it’s really important to still understand paradigmatically what is going on here? Because what you don’t want to do is, is say, well, because HPA axis is a thing, I still believe in adrenal fatigue and yes, this adrenal fatigue thing still is going on in some subset of people. So one other aspect of research that I spend a lot of time analyzing, is the question of, does chronic stress result in low cortisol levels? So if we look at people under various kinds of extreme chronic stress, for very long periods of time, do they have low cortisol levels? Now, on average, if you were to compare people who have years- or decades-long, chronic psychological stress, for example, and compare them to people with less psychological stress, what you would expect to find if the adrenal fatigue hypothesis had any legitimacy whatsoever is that on average, the people under chronic years or decades long stress should have at the very least slightly lower cortisol levels, on average, based on the fact that at least some subset of those people will have adrenal fatigue or adrenal burnout, right? This is this is basically science 101.

Now those studies exist, there are huge bodies of literature that have examined the relationship of chronic stressors of all kinds of types from numerous different kinds of psychological stress, relationship stress, financial stress, job stress, they’ve looked at physical stressors like physical overexercise, overtraining syndrome. In athletes, they’ve looked at metabolic stressors, chronic cigarette smoking, chronic alcoholism, they’ve looked at all kinds of, even you could say, in many natural health, functional medicine models to look at allostatic load, they’ll even consider a disease state to be a chronic stressor, like somebody who has obesity and diabetes, that is a metabolic stressor. Clearly, the high blood sugar levels, chronic hyperglycemia, and high blood lipids. And metabolic syndrome is itself a type of metabolic stress that we know causes lots of cell damage. So we can look at any type of stressor that you can think of. And we can analyze the people with the most chronic, most severe version of that they’ve even broken it down into. Are you a heavy cigarette smoker or a light cigarette smoker? Are you a heavy drinker? Or are you a light drinker versus a non drinker? Right, those studies exist. And what those studies find, pretty much without exception, every type of stressor that you can think up, the people with the chronic stress actually have, on average, slightly higher cortisol levels, that body of evidence, and it’s a huge body of evidence, gives no support whatsoever to the idea that adrenal fatigue is a real thing to the idea that there is ever a point where chronic stress is wearing out the adrenals capacity to produce cortisol.

Now, so given that, we then need to ask, well, then why is there a subset of people who do seem to have low cortisol levels, or at least low morning cortisol levels? And I’ll tell you one thing that is that is very strongly supported in the literature as far as a major cause of that. And it’s simply two things: one, circadian rhythm and sleep disruption, and two, being a night owl chronotype. There are studies where they’ve simply looked at normal healthy people, not even people with any disease state or fatigue or anything like that, just normal healthy people. You’re either a morning person, or a morning chronotype, I should say, or a night owl chronotype. And when they look at cortisol levels in those two different chronotypes, they find that typically the night owls have about half of the morning cortisol levels of a morning person. And this is no small effect. This is a massive effect. And again, these are people without fatigue, without any symptoms.

But if that night owl walked into the office of somebody who was an adrenal fatigue proponent, they would walk out with a diagnosis of adrenal fatigue. And they would be told the whole narrative about how chronic stress has worn out their adrenals’ capacity to produce enough cortisol, and that whole narrative is completely unsupportable by the scientific evidence. But we do know that things like circadian rhythm and sleep deprivation and being simply being a night owl do have a massive impact on your levels of cortisol. And there are a number of other potential causes of that as well, certain prescription drugs can lower cortisol levels, or toxins can lower it. But yeah, anyway, that’s a bit of a digression.

Lindsey: 

Okay, no, that was really interesting and amazingly detailed and articulate. So thank you. So what about secretory IgA, any relationship between that and the adrenals?

Ari Whitten: 

I would say that’s outside of the literature that I looked at. So I can’t speak to that.

Lindsey: 

Because I do certainly hear from some of my mentors the idea that high stress can lead to a decrease in secretory IgA, which is your gut mucosal immune system, and therefore lead to gut infections.

Ari Whitten: 

Yeah, that’s true. Yeah, yeah. I’m not aware of a link with adrenal function specifically, but I do you know that chronic stress considerably lowers secretory IgA.

Lindsey: 

So the adrenals may not be the mediating factor, but either way, stress can lead to that.

Ari Whitten: 

Yeah. I mean, yeah, I don’t know about how those things relate. I mean, it’s possible that chronically elevated cortisol levels, which which does occur with chronic stress, that could certainly impact on secretory IgA. It impacts on a number of things. I mean, chronically elevated cortisol levels are not good for a big variety of reasons:  immune function and gut permeability,

Lindsey: 

Right, right, blood sugar . . .

Ari Whitten: 

. . . and there’s neurological function, there’s a lot of negative effects from that. 

Lindsey: 

Right, right. Okay. So I know that you sell some supplements that are designed to help people bring up their energy or increase their mitochondria, as well as for immune and brain support. So can you tell me a little bit about those?

Ari Whitten: 

Sure. So I have three flagship formulas, I would say. One is a mitochondrial specific formula, and it’s called Energenesis. One is a brain-specific formula. It’s meant largely for mood support and cognitive support and long term brain health, as distinct from like, a short-acting nootropic that’s full of lots of stimulants that you might get a short term boost from, but it’s actually hurting you in the long run. And then I have a comprehensive multivitamin and multimineral supplement with actually real clinically-effective dosages of those vitamins and minerals in the optimal form, for example, methylated B vitamins extracted from whole foods, along with a number of superfoods like spirulina and chlorella and things like that. So the mitochondrial formula has lots of good ingredients. It has all the classic mitochondrial support ingredients that you might find recommended by a functional medicine practitioner, things like acetyl-l-carnitine and creatine and alpha lipoic acid and CoQ10, and things like that, and magnesium.

And it also has a variety of other really great compounds that are not typically recommended. So things like astaxanthin, which is a carotenoid pigment that comes from algae. That is actually what gets salmon its pink color. Also, it gives flamingos their pink color. This is a carotenoid that has a unique chemical structure to it. And it actually embeds itself in mitochondrial membranes, where it stabilizes them and protects them from damage, and actually embeds itself across mitochondrial membranes so that both the outer and inner membrane, so really neat, hugely beneficial compounds supported by lots of research. And another compound I’ll mention is shoden ashwagandha. And shoden ashwagandha has a whole bunch of research showing that it improves sleep quality, improves resilience to stress and reduces anxiety levels and increases energy levels in people with chronic fatigue. It’s the most potent ashwagandha extract in terms of what’s analyzed.

Another compound that’s in there is ellagic acid*. And this is an interesting one that relates to gut health and the gut-mitochondria access, in the sense that ellagic acid is this compound that’s found in significant quantities only in a few foods. It’s found in really minute quantities in a lot of different berries and things like that. But it’s rich especially in pomegranate and chestnuts. And this ellagic acid is metabolized by certain bacteria in the gut into a compound called a urolithin A. And urolithin A, it turns out, is pretty much the most powerful promoter of mitophagy ever discovered. Mitophagy is basically like a quality control process of our mitochondria, where the body identifies dysfunctional mitochondria and targets them for breakdown, so that only the healthy mitochondria are reproducing and cloning themselves and you’re only rebuilding healthy mitochondria and getting rid of the bad ones. Super important process, especially for preventing cancer and also of course chronic fatigue. So this urolithin A that comes from ellagic acid is critically important for doing that.

Lindsey: 

Just a second, because I was actually looking at a urolithin A supplement yesterday, because I was reading an article that linked to it, and I noticed it’s not cheap. I think there’s only one out there and it was like $200 for a bottle.

Ari Whitten: 

Exactly. Yeah. I’ve actually been trying to get it in one of my formulas. For a long time now, it’s been unavailable. But I think just a couple of weeks ago, my supplier let me know that they found a source for it. So it’s just now becoming available. I think previously it was patented and only held by one company and they weren’t releasing it to other supplement formulators. But it’s interesting in the sense that there is research on supplementing directly with your urolithin A and it’s pretty impressive research. The distinction between that and ellagic acid is not totally clear as of right now, in the sense that it is possible that – well let me put it this way – I looked into research to figure out what specific bacterial species are is responsible for converting ellagic acid into urolithin A, and there’s actually a study that I was able to find where they identified the specific bacterial species. And it was a really obscure species. I don’t even remember what the name of it was because it’s so uncommon. I’ve never heard of this species anywhere else. Now, having said that, so that brings up the question of, well, maybe some people don’t have that bacterial species and therefore can’t convert ellagic acid into urolithin A. Nevertheless, I asked Kieran Krishnan, who’s a friend of mine, who’s a world-renowned gut expert

Lindsey: 

Microbiome Labs?

Ari Whitten: 

Yes. I asked him his thoughts on that. And he kind of brushed it off and said, you know, the gut is pretty redundant. It’s probably not just one species that does this. And there’s probably many species that do this. He didn’t seem to be particularly worried about the idea that someone might not have the capability to produce urolithin A. So yeah, it’s not totally clear if there would be a unique benefit of supplementing urolithin A over ellagic acid. I guess, if it is the case that some people, some subset of people, don’t convert ellagic acid into urolithin A well, then they would benefit more from direct urolithin A supplementation.

So yeah, there’s  a few compounds in Energenesis. And then I’ll mention one more, which is a patented phospholipid extract called NTFactor* phospholipid. And this has a ton of amazing research on it. I think this has got to be the most underrated and little known supplement within the functional medicine community that has a ton of amazing research on it that people just don’t even know about. And there’s a great paper by a researcher named Garth Nicholson called Lipid Replacement Therapy, where they have studied this NTFactor phospholipid compound in the context of numerous different kinds of chronic fatigue, chronic fatigue syndrome, there are several studies for obesity-related chronic fatigue, aging-associated chronic fatigue, just you know, people who have fatigue and old age and other types of chronic fatigue, like Gulf War illness and things like that. And across the board, every study that’s been done on this has shown at least 25, if not closer to 45% increases in energy levels between four to 12 weeks of just using this one compound. So it’s a pretty amazing compound. It’s been shown also in people in older age to restore their mitochondrial health, mitochondrial function to that of healthy 29 year olds.

So that’s an amazing compound that in the literature review from Garth Nicholson is called lipid replacement therapy. Basically, our cell membranes and mitochondrial membranes are made of phospholipids. And these phospholipids have the ability to get across the gut intact and actually get transported into the cells and into the mitochondria where they are into the membranes and mitochondria, where they replace damaged phospholipids in membranes and mitochondria, helping basically to repair damage to those membranes and helping the mitochondria to function better. So yeah, anyway, that’s a sort of small sampling of some of the compounds in my formulas.

Lindsey: 

Cool. Well, we’re running out of time. So give me quickly what the other supplements are that you have?

Ari Whitten: 

Okay, so Ultrabrain is a brain-specific formula, again, mood support, anti-depression, anti-anxiety, as well as cognitive support and long-term brain health. It’s stimulant-free, Energenesis and Mitochondrial Formulas, also stimulant-free. And it has a number of great compounds in it supported by scientific research. So rhodiola rosea* is one that most people will have heard of, of course, but I think most people don’t necessarily know how impressive the research is on rhodiola rosea. There’s research in the context of people with stress-related burnout and chronic fatigue, that just that one compound alone can cut levels of fatigue in half. In some studies, they’ve shown it in as little as seven minutes, which is, I mean, so impressive that it actually makes me skeptical, but there’s several studies where they’ve shown that.

There’s Lion’s Mane extra, dual extract of alcohol and water extract. So it’s got basically a broad spectrum of activity. All the different active components of Lion’s Mane are in there. Lion’s Mane, of course has many different brain boosting effects. It boosts levels of BDNF (brain derived neurotrophic factor) in the brain. It’s been shown to reduce levels of anxiety and depression by about 30 to 40% in the span of eight weeks, in people with anxiety disorders, in people with major depression. There’s a number of herbs in there that have been shown to support long-term brain health, things like ginkgo biloba, and Bacopa Monnieri. It’s got acetyl-l-carnitine. It’s got saffron. Saffron is another hugely underrated compound.

Lindsey: 

I’m gonna have to stop you because I do have to wrap it up in a minute or so. But I’m sure that you’ve got all of the information on all of the ingredients on your website, right?

Ari Whitten: 

Yes, of course. Yeah. So the website is theenergyblueprint.com*.

Lindsey: 

And then what is the name of the third formula, the immune formula?

Ari Whitten: 

Yeah, I have another immune formula called Immune Genesis.

Lindsey: 

Yeah, great. People can go on the website and and investigate them all. So this was super interesting and detailed, and I loved it. So thank you so much for coming on and sharing about all your research with us.

Ari Whitten: 

Yeah. Thanks so much for having me, Lindsey. It was a pleasure.

So if you’re dealing with energy issues stemming from gut issues, I work with clients to uncover the root causes of these issues and educate you on how to fix them. If you want to talk to me about what you’ve been dealing with and see if I think I can help, you can set up a free, 30-minute breakthrough session with me. I’ll ask you about what you’ve been going through and I can let you know if I think I can help you. I’ll tell you about my 5-appointment gut or autoimmune healing program and you can decide it that seems like a good fit for you. Or if you’re ready to jump in right away or can just afford one appointment at a time, you can set up an 1-hour consultation with me.

Adapted from episode 74 of The Perfect Stool podcast and edited for readability.

Today I’m going to be introducing you to a test that I use with a lot of my clients called the Organic Acids Test and explaining the markers on the test that can tell you about your gut health, excess oxalates and your mental health and give you some insight into how to interpret this test. And then in a future post, I’ll finish it off to discuss the other markers on the test that address your detoxification status, energy production and more.

So the Organic Acids Test is a test I use with most of my clients because in addition to giving insight into gut health issues and having the only reliable marker of invasive candidiasis, it also offers insight into bacterial overgrowths in the gut, other fungi, markers of mitochondrial health and energy production from all the macronutrients (carbs, fat and protein), detoxification markers, markers of excess oxalates, B vitamins, vitamin C and CoQ10 status and the state of your neurotransmitters (serotonin, dopamine, epinephrine or adrenaline, norepinephrine or noradrenaline and more). So it’s an amazing test to get a read on what’s going on in someone’s body and where problems could be arising. It’s also a urine test that can be done at home and can be ordered in most states without a doctor’s order, so that makes it easy and accessible. As far as I know, it is primarily offered by two labs – Great Plains and Genova. The Genova one is called the Organix with an x. But the markers on each are a little bit different. I generally prefer the Great Plains one because it includes oxalates, which aren’t on the Organix, and it has many more markers for fungi, including environmental molds.

So a little history on this test first as I understand it. One of my mentors on this test, Dr. Daniel Kalish, shares this history in most of his videos. He’s been working with Richard Lord, PhD for years to learn about this test and others and how to interpret them and to pass on Dr. Lord’s complex understanding of the body, and I’ve taken a course with videos and webinars from both of them on amino acids and B vitamins. But basically Richard Lord, in addition to developing the GI Effects test, was the first person to think of taking these organic acids tests normally given to infants to make sure they don’t die in the first few days or weeks of life due to certain genetic SNPs or single nucleotide polymorphisms, aka gene mutations, and apply them to adults. So while an infant with a homozygous form of a certain gene (meaning two copies of a mutation) might have extreme effects ranging from severe disabilities to death, adults who are heterozygous (meaning just one copy of a mutation) or only have one polymorphism impacting a given condition (as multiple genes can impact things), may have much more mild effects that only come to light when there are environmental factors at play like a poor diet, lifestyle or just the effects of aging. So the organic acids are metabolic byproducts in urine, meaning the end products of digestion by you or your microbes. And the markers point to the ways in which gut health or other root cause issues are causing dysfunction in the body and at the cellular level. I generally recommend this test to clients also struggling with complex issues like autoimmunity, fatigue, brain fog or mental health problems or who show symptoms of systemic candida infections like sugar cravings, a white coating on their tongue or recurrent yeast infections.

I’m going to be discussing markers on a sample Organic Acids Test, so you’ll want this open as you continue to read. So the first set of markers, 1-9 are yeast and fungal markers. The primary one to determine if someone has invasive candidiasis is number 7, Arabinose, which is the only fungal marker on the Organix. I will generally recommend taking action on that if someone is symptomatic and it’s above the yellow and orange bars, which represent one standard deviation around the mean, which is the black line in the middle. If someone isn’t symptomatic but has a number near the top of the range, like in this example, I will let it go. But if someone had bacterial dysbiosis/SIBO and had a high marker on Arabinose, like this, I would make sure I educated them on antimicrobial products that covered both bacteria and yeast, like most herbals do.

Another set of markers that are different from the candida markers are the furans – 2, 4 and 5. These three are markers of aspergillus, which is typically an environmental mold. When I see those elevated, I recommend mold testing in someone’s house. Number 6 can point to candida or aspergillus.

Then number 9, tricarballylic is associated in particular with a fumonisins, which are a toxin produced by the fungus F. verticillioides (vertasiliodees), which come from corn products contaminated with this omnipresent toxin. So generally when I see that elevated, I suggest people reduce corn-based products other than fresh corn. In this case, eating organic probably doesn’t matter, as it’s an equal opportunity toxin.

Then I’ll go briefly over the remaining markers. So number 1, citramalic, can point to elevated Saccharomyces species or Propionibacteria overgrowth. Although one of the most common probiotics and one I use a lot is called Saccharomyces Cervisiaie subspecies Boulardii (S boulardii for short), some people can have an immune reaction to this strain.

And then number 3, 3-Oxoglutaric, is also a marker of yeast overgrowth. That’s one I commonly see elevated. And 8, Carboxycitric is a general yeast/fungal marker.

Then the next section is the bacterial markers. So the first four (10-13) when elevated, point to bacterial overgrowths characteristic of SIBO or small intestine bacterial overgrowth. In combination with SIBO symptoms like bloating, constipation, diarrhea or soft stool, elevated markers here are a good indication of SIBO, since I generally don’t put much stock in breath testing. But of course when you see that, it’s best to get a stool test so you know if there are other things at play like parasites, or specific pathogenic bacteria like Enteroinvasive E Coli or H pylori, for example. Just treating with antimicrobials when you choose the wrong ones can leave someone with an overgrowth of something even more dangerous.

The other thing about these first four bacterial markers is that they are also metabolites of fruits and veggies and their polyphenols in the urine. So if they’re really low, that’s also not great, because it means that someone isn’t eating the proverbial rainbow as they should be. Polyphenols feed the good gut bacteria, so you want some moderate to higher level of them within normal. And then the last marker DHPPA is a marker of Lactobacilli, Bifidobacteria, and beneficial strains of E. coli, so elevations here are not generally concerning.

The final section on microbes is specific to species of Clostridia that can be pathogenic. Now there is a whole range of Clostridia, many of which are not just beneficial but essential to healthy gut function. So there’s the class of bacteria, Clostridia, which consists of many known butyrate-producers, including the genuses Eubacterium, Roseburia, Butyrivibrio, Coprococcus, Ruminococcus and Clostridium. So you see there’s the genus Clostridia or clostridium in the singular and the class clostridia. Butyrate producers like clostridia are essential to healthy barrier function in the colon, for keeping it anaerobic and feeding the colonocytes, or cells lining the colon. But there are pathogenic clostridia as well under the genus clostridium, like C. difficile, which is responsible for almost 500,000 cases of acute, chronic diarrhea and almost 30,000 deaths a year in the US.

Marker 17, 4-cresol is a marker specific to overgrowth of C. difficile (but also another clostridium called C. scatologenes). However, if you don’t have symptoms like diarrhea, your C. diff is likely still being kept in check by other bacteria, but it’s an important consideration in picking antimicrobials, because you don’t want to start killing off the other bacteria that are keeping it in check before reducing it. But when this marker is elevated, it impacts an enzyme called dopamine-beta-hydroxylase, or DBH in the brain, which converts dopamine to norepinephrine, which will show up later in the test as elevated homovanillic acid or HVA. High urine values of 4-cresol are associated with the most severe clinical symptoms in autism, multiple sclerosis, neurotoxicity, hallucinations, and other neurological and psychiatric disorders, but at lower levels can show up as symptoms of low norepinephrine, like anxiety, depression, ADHD, memory problems, headaches, sleeping problems, low blood pressure and low blood sugar.

Then marker 15, 4-hydroxyphenylacetic acid, can be a marker of various types of Clostridia overgrowth as in SIBO, but also a marker of any type of small bowel disease or possibly elevated because of celiac disease.

Then marker 16, HPHPA, is indicative of another group of clostridia overgrowing, which can cause a derangement in neurotransmitter balance, so I often see issues with neurotransmitters like dopamine and serotonin off when this marker is high. The same is true for 4-cresol as well.

Finally, marker 18, 3-indoleacetic Acid, is elevated when another group of clostridia is overgrown, and very high amounts of this metabolite, which is derived from tryptophan, can indicate that there is a depletion of tryptophan needed for other physiological functions. And tryptophan is the precursor to serotonin, our feel good hormone, which when too low leads to anxiety, depression and problems sleeping, because serotonin is the precursor to melatonin.

So you can see how the bacteria and yeast can start to impact your mental health, and this test really shows you the connection between them.

So the next page of the test shows the Krebs cycle or citric acid cycle, which is the cycle by which your body produces energy. So it’s showing you all the conversions between different organic acids that are on this test. When you have high levels of these organic acids, what you’re seeing are breaks in that cycle, and hence, in the production of energy.

Then below that is a model of the amino acids being turned into the catecholamine neurotransmitters, which are dopamine, epinephrine and norepinephrine – so you see how phenylalanine, an essential amino acid, meaning you have to get it from food, is converted to tyrosine, which converts to DOPA, then dopamine. That then converts to norepinephrine and epinephrine, and you see to the side of the arrow going to norepinephrine the enzyme that catalyzes the conversion, dopamine beta hydroxylase and the nutrients necessary for that conversion, copper and vitamin C. And then the metabolite of norepinephrine and epinephrine is vanillylmandelic acid, or VMA, and the metabolite of dopamine is Homovanillic acid, or HVA. We’ll look more closely at all this when we get to the neurotransmitter section.

So the next page, page 3, starts with the oxalates. And you can see on this example test that there are two oxalate markers that are officially high, and I just want to point out that once you see the orange/yellow bar reduced in size to the left like that and the scale ending, you know the levels are so high that they’re off the chart. Then you should look at the scale and the number you got on the test to get a sense of how high. Oxalic acid or oxalates are a naturally-occurring compound in plants, and they’re especially high in berries, nuts, legumes and dark green leafy vegetables like spinach. So when I see someone put down on their intake form that they eat a green smoothie each morning, I’m always thinking yikes, there could be an oxalate issue. Oxalates are also produced as waste by our bodies, as well as coming from our diet. If the oxalates bind to calcium in our digestive tract, it will be pooped out and won’t cause an issue. But often as people try to eat healthier, they often fill up on high oxalate foods and eliminate dairy, and then they start to get these issues like urinary tract infections or UTIs, because oxalates are little crystals that can make cuts in your urinary tract. They can also deposit crystals in your joints causing joint pain, be deposited in your bone and cause osteoporosis, be deposited in the kidney and form kidney stones, be deposited in the eyes and cause cuts and pain and in the muscles, blood vessels, brain and heart and cause problems in all those places. They can contribute to muscle pain in fibromyalgia, and oxalate deposits in the breast tissue have also been associated with breast cancer. Another source of high oxalates can be a bile acid deficiency. Bile is what helps break down fats, so when it’s deficient, the excessive undigested fatty acids in the diet will be poorly absorbed and they will bind to calcium, preventing it from binding to oxalate and eliminating it. High oxalates in the GI tract can also reduce absorption of calcium, magnesium, zinc and other essential minerals.

So oxalic, marker number 21, is the primary marker of excess oxalates in the diet, but can also be elevated due to dysbiosis from aspergillus, penicillium and possibly candida, or from high doses of vitamin C. However, my favorite oxalate expert, Susan Owens, believes that it’s the other way around: high oxalates can cause elevations in candida and bacteria. There can also be genetic causes of high oxalates. The other two markers, gycolic and glyceric, if low, rule out genetic causes for high oxalates. While oxalates are best known for causing kidney stones, I see lots of clients who have what I believe to be oxalate-related problems who have never had a kidney stone. Some of the most common manifestations I see in my practice are UTIs, joint pain and interstitial cystitis, or frequency or urgency with urination.

High glyceric acid, number 19, may be due to microbial sources such as yeast (aspergillus, penicillium, candida) or due to dietary sources containing glycerol/glycerine, or due to genetic factors.

High glycolic acid, number 20, can also be from overgrowths of fungi and yeast in the GI tract, including aspergillus, penicillium and candida, from dietary sources of glycerol or glycerine, and from a wide variety of bacteria. And glycolic acid can also come from fruits and veggies. According to Susan Owens,  when glycolic is elevated, you should look for a B6 deficiency due to ongoing infections, like gut infections, because your body will create endogenous or internal oxalates if you have a lack of B6.

If you’re concerned about oxalates and how to lower them correctly (and mind you stopping all high oxalate foods suddenly is not the way unless you suddenly want have an oxalate dumping event where oxalate crystals start coming out of your body everywhere), you can check out Susan Owens’ web site lowoxalate.info. There’s also a Facebook group called Trying Low Oxalates.

For now I’m going to skip to the neurotransmitters and save the energy production markers for the next post. So skip to the bottom of page three and maker 33, HVA. This is your marker of dopamine. When this marker is very high, it means you’re going through some type of high emotional or internal stress and using lots of your neurotransmitters. When it’s below the mean, it indicates your dopamine production is low. This will happen with long-term antidepressant usage if it’s an SSRI or selective serotonin reuptake inhibitor, because serotonin and dopamine compete for resources in the body and SSRIs increase serotonin. It can also happen when you’re protein deficient, because you need phenylalanine, which converts to tyrosine, to make dopamine. So long-term vegan or vegetarian diets can lead to a dopamine deficiency. You can also have issues with missing co-factors like vitamin B6 that are necessary for dopamine production. Chronic stress can lead to this, but it can also be genetic. When dopamine is very low, you’ll see profound fatigue or physical exhaustion, difficulty concentrating, compulsive behaviors, loss of satisfaction, addictions, cravings, sensation-seeking behaviors including pain-inducing behaviors like cutting, or drugs, sex addictions, or food compulsions, like sugar cravings, because eating sugar temporarily causes a dopamine rush). Low dopamine has also been linked to Parkinson’s, restless leg syndrome and ADHD.

The next marker, VMA, is indicative of low levels of epinephrine and norepinephrine. Because they are converted from dopamine, there are similar root causes and symptoms of low levels, with the addition of a lack of Sam-e or S-adenosylmethionine, a well-known supplement used for depression, which is needed for the conversation of epinephrine and norepinephrine to VMA. Common genetic polymorphisms in the MAO and COMT genes can also cause a reduction in VMA. VMA values that are below the mean but which are much lower than HVA values are usually due to issues with an enzyme called dopamine beta hydroxylase or DBH due to the Clostridia metabolites HPHPA, 4-cresol, or 4-hydroxyphenylacetic acid, which we saw on the first section, or the mold metabolite fusaric acid (the one that comes from moldy corn). So again you see how the bacteria and fungi interact with the neurotransmitters and can cause mental health issues. There are also certain pharmaceutical drugs that can lead to low HVA values, as well as consuming aspartame, or deficiencies of the cofactors vitamin C and copper. If you have low VMA due to Clostridia metabolites or a genetic DBH deficiency, you should not take supplemental l-phenylalanine, l-tyrosine, or L-DOPA.

The next marker, 35, represents that ratio of the two above, so if it’s high, you can see there are conversion issues from dopamine to norepinephrine and epinephrine. Again, this points to a lack of cofactors like vitamin C or copper or the other causes I mentioned above.

The next marker, 36, DOPAC, is an intermediate in the metabolism of dopamine and when elevated, it can be from supplementing with l-phenylalanine, -l-tyrosine or L-DOPA, or because of factors that inhibit the DBH enzyme as I mentioned above. Because if you go back to the image on the bottom of page two, you’ll see that the DBH enzyme is helping convert dopamine to norepinephrine and epinephrine, and if it’s sluggish, then the dopamine will be shunted off to DOPAC, which converts to HVA. So that’s one way to see if DBH is likely an issue.

Then 37, the HVA/DOPAC ratio, will tell you if that final conversion is off, which can point to a lack of Sam-e, needed for the conversion, or a sluggish COMT enzyme, which catalyzes the conversion.

Then markers 38-40 are all about tryptophan metabolism. Tryptophan is an essential amino acid that is the precursor to serotonin. So when you see marker 38, 5-Hydroxyindoleacetic acid or 5-HIAA high, it means you’re using up a lot of serotonin, which can deplete tryptophan, which is needed for the formation of all proteins in the body except collagen, and can be caused by stress or SSRI usage. Levels below the mean may indicate low serotonin production related to long-term tyrosine usage or usage of ADHD medications, antidepressant usage, recreational drugs, a deficiency of tryptophan from a long-term vegan or vegetarian diet, poor absorption, and/or missing co-factors or an inherited deficiency. When you’re low on this marker, you’ll see anxiety, panic attacks, insomnia, chronic pain and digestive imbalances and constipation (because serotonin is involved in moving the intestines, assimilation and absorption, particle transport and fluid discharge in the GI tract). Also, serotonin is released as you eat and is nature’s natural appetite suppressant. So low levels will increase food cravings and lead to overeating and weight gain.

Then marker 39, quinolinic, points to faulty tryptophan metabolism, where tryptophan is being diverted into the kynuerate pathway because of stress or infections, and it eventually turn into quinolinic acid, which is neurotoxic. This will lead to decreased serotonin and its symptoms. The most common source of infections are viral, parasitic, fungal or bacterial infections in the gut or body in general, and the second most common sources of inflammation are chemicals and heavy metals impacting the liver as well as autoimmune disorders. There’s a diagram of this on the top of p. 7. High levels of quinolinic have been implicated in Alzheimer’s, autism, Huntington’s disease, stroke, dementia, depression and schizophrenia, and high levels are also highly correlated with the degree of arthritis impairment. 

Marker 40, kynurenic, will be elevated if you’re inflamed, are defending against a pathogen or are deficient in B6 and the result will be a decrease in serotonin. Kynurenic is also produced in the liver, so if it’s low from the liver, that points to a B6 deficiency, but if it’s low because of the brain and stress, it points to neuroinflammation. If you see both kyurenic and quinolinic high, you know there’s inflammation impacting the brain. Then you need to find the source of the inflammation. However, if you see low B6 on marker 51 and high kyurenate but low quinolinate, it’s likely a low B6 problem, not neuroinflammation.

So I’m going to finish the remaining OAT markers in a future blog post, but that gives you a great insight into how the OAT can show you how bacterial and fungal infections in the gut or dietary issues, which can lead to mental health and physical health issues.

So if you’re dealing with either gut issues or mental health issues or chronic all over body problems, the good news is that this stuff is quite fixable. I work with clients using this test to reveal these issues and their root causes and educate you on how to fix them. If you want to talk to me about what you’ve been dealing with and see if I think I can help, you can set up a free, 30-minute breakthrough session with me. I’ll ask you about what you’ve been going through and I can let you know if I think I can help you. I’ll tell you about my 5-appointment gut or autoimmune healing program and you can decide it that seems like a good fit for you. Or if you’re ready to jump in right away or can just afford one appointment at a time, you can set up an 1-hour consultation with me.

Adapted from episode 73 of The Perfect Stool podcast and edited for readability.

Dr. Corey Deacon is the co-founder and Medical Director of Neurvana Health in Calgary, Alberta, Canada. He has a Masters in neuroscience, a Doctorate in Natural Medicine and is a Certified Functional Medicine Practitioner. He also holds board certifications in Neurofeedback, Holistic Health and Alternative Medicine. Dr. Deacon’s work with traumatic brain injuries led him to working with the gut.

Lindsey: 

Let me start by just asking you what the connection is between traumatic head injuries or concussions and the gut?

Dr. Deacon:  

Great question. There’s multiple connections between the brain and gut. There are very fast connections, which are essentially a physical connection between the brain and the gut in terms of nerve fibers. We have a nerve fiber that runs from the back of the neck, down the left side of the neck, underneath our diaphragm and down into our gut. And it innervates actually on a lot of our other organs, but specifically, we’re going to talk about the gut. It’s called the vagal nerve, or the vagus nerve. There’s two divisions of the vagus nerve: the dorsal and the ventral. It actually regulates gut motility. It regulates what is secreted in the gut in terms of enzymes, in terms of our bile acids, stomach acid or everything we need to break down things in the gut so that they can be absorbed. The vagus nerve also plays a role in regulating the immune system. This is a very fast connection, because it’s electrical. This vagus nerve runs in an electrical fashion.

Then, we have a slower connection, that is a neuropeptide connection and this is basically a fancy term for really small hormones that come from the brain and feed down to the gut. Actually two of these are my two favorite hormones in the entire body. One is called VIP; I call it very important peptide. It actually stands for vasoactive intestinal polypeptide. It actually seals the gut up. So we’ve all heard of this phenomenon called leaky gut or if you look at the research, it’s called gut permeability. It’s basically when the cells of the gut open themselves up and this is typically for the immune system to come in and deal with a problem within the gut. The gut is only one cell thick; it’s very easy for components to move from the gut into the bloodstream and into the immune system. This VIP is actually responsible for keeping those tight junctions sealed. Typically, what you’ll see and you’re seeing a lot of research published now on this phenomenon of leaky gut triggered by a brain injury. This happens because these peptide hormones get thrown off and so all of a sudden, you’re going to see the levels in blood of a VIP dropped very low and now the gut can’t seal up properly. This is a big problem.

The other hormone that’s really big, there’s a handful, but I’m going to just focus on these two. The other one is MSH. MSH stands for melanocyte stimulating hormone. It’s a hormone that gets released when we have sun exposure and UV exposure penetrates the arterioles in the skin. MSH is incredibly important for regulating the mucosal immune system. All the mucus layers in our body within our sinus cavity, our oral cavity, our entire gut tract, vaginal tract and urinary tracts are all coated by the mucosal immune system, typically it’s driven by an antibody called IgA or immunoglobulin A. This can be measured in saliva and in stool as Secretory IgA. This MSH, when it drops low from a head injury will now typically cause a low response of the secretory IgA. Now, we run the risk of overgrowing microbes that shouldn’t be there; dysbiotic microbes that we don’t want to be growing. Long story short, there are two connections between the brain and the gut. One is electrical and one is chemical. This is how head injuries can drive problems within the gut.

Lindsey: 

Okay, so all this sunscreen… is that hurting our gut lining?

Dr. Deacon:  

Sunscreen is hurting our gut lining. Not just because the chemicals that are found within the sunscreen, but even just on a level of light, because we’re not letting light penetrate our skin. UVA light is now found to activate insulin. Right? So what happens if our insulin is not activated? Well, now it can’t join into the receptor properly and we get blood sugar regulation issues. Now we create stress on the pancreas. Now we can’t break down things in the gut because our exocrine activity from the pancreas is low. So yeah, there’s a big connection. And you’re blocking ability to produce vitamin D, which regulates our mucosal immune system as well as this MSH. So yeah, typically what I tell people is: it’s not necessarily the UV light that’s bad. It’s how we approach the sun. We’re not out in the sun when it rises and getting this whole preparation process. We just jumped out there at 11 or 12, when the sun’s at the highest, and you’re going to get burned, right? You want to spend time in the sun around the times when the sun isn’t the highest. Now, typically, we don’t have that problem. I’m up in Canada right now. We do not have a sun exposure problem right now, in terms of sunburn. We need that proper sun exposure. It’s really interesting. You look at the use of sunscreen and when you actually dig into the literature, you’re not even seeing a reduction in skin cancer.

Lindsey: 

Not of any type?

Dr. Deacon:  

Of melanoma.

Lindsey: 

I see my father. He’s got his arms are covered with scars from basal cell carcinomas being burnt off and I’m conscious of what’s going on in the alternative health world saying get your sun. At the same time, I’m thinking I’ve got his genes, and I’m going to end up with arms covered with skin cancers if I don’t watch it.

Dr. Deacon:  

You have to be responsible with your exposure for sure. Yeah, for sure. So there is a guy who I love. A lot of his translational research, Dr. Jack Kruse, he’s a neurosurgeon. He talks a lot about this light exposure, and really the biophysics of how that works. I know that’s not really our topic for today but there’s a lot of a lot of complicated biophysics going on, where we do have to be aware and conscious of our light exposure. Yes, we need sun. We don’t want to burn so we want to do it responsibly. So yeah, in terms of the timing of the day that you’re spending in the sun is very important. If you’re prone to burning and you’re consistently burning, it’s a big problem,

Lindsey: 

Okay so go out. Get a light tan, but don’t let yourself burn.

Dr. Deacon:  

You got it because it’s also a big problem not getting in the sun and that’s actually a risk factor for melanoma. I know a guy, one of my patients, who ended up getting melanoma on his chest. Ever since he was a kid, he always wore a shirt in the sun because his mom was terrified that he would get cancer. He was always lathered in sunscreen and he always wore a shirt. His chest never saw the sun, yet he developed melanoma on his chest. So yeah, it’s important to be spending some time in that sunlight. If you look at the properties of MSH and what it does in the body, how it regulates cortisol, it regulates our sex hormones. It regulates our dopamine and our serotonin, our mucosal gut immune system. It’s really important and you start linng up and seeing, okay, this is why a lack of sun exposure can cause all the problems that it causes including cancer.

Lindsey: 

Interesting. Okay, so back to the topic related to the brain and gut. So tell me about electrogastrograms or EGGs?

Dr. Deacon:  

Yeah, so this is something that I’m incredibly excited about. Electrogastrogram is a way to actually look at the function, the electrical function of the gut. I’m certified in functional medicine. We’re very adept at looking at stool testing, breath testing, certain urine tests and saliva tests to look at the microbiome and look at the chemical/biochemical makeup, the microbial makeup of what’s going on in the gut. What we don’t look at is the electrical activity and the gut, the brain, and actually every cell in our body is electrochemical, which means without an electrical current or voltage, it doesn’t function. We got this chemical side kind of locked down. Then what we’re missing is this electrical side. I see the same thing with people dealing with brain issues and nobody’s looking at the electrical function of the brain. We’re getting MRIs, ETs, questionnaires and neurotransmitter testing, but I’m not seeing a big component of the electrical analysis. What the electrogastrogram is, it’s similar to an ECG or an EKG that you would get on your heart, where you’re looking at how your heart’s beating or how that electrical function is working. You’ll do this see the same thing with an EEG where you look at the electrical function of the brain. The EGG, or the electrogastrogram is electrical function in the gut. What you can do is put this electrical array overtop of your gut. You can run it through an app on your phone and you can collect the data over a 24 hour period of time: marking down when you eat, what you’re eating and when you have a bowel movement. From that we can actually look at: how is this you know, how is this gut functioning and how is it moving things through the gut. You’ll start seeing interesting things in people that have IBS, that have inflammatory bowel disease. They may have gastritis, GERD or reflux, they may have small intestinal bacterial overgrowth, chronic parasites or fungal problems. What you’ll notice is their EGG isn’t smooth, it’s not moving things in the proper rhythm. The proper motor rhythm is about .05 hertz. It’s a very slow frequency and it’s just slowly moving things through the gut. What you’ll find is a lot of people, it’s actually moving too slowly throughout the entire tract. We tend to call this dysmotility or slowed gut motility.

Lindsey: 

Are we talking about the speed of the villi moving things through the gut?

Dr. Deacon:  

You got it. It’s called the migratory motor complex. It’s the motor flexes essentially that are happening. It’s like the muscle flexing that happens through that gut tract to move things along the cilia, because of course, different parts of the intestine are made for different things, right? Whether it’s breaking things down, absorbing things, absorbing water; the large intestine’s main job is to absorb water and then of course, to make all sorts of our B vitamins and other things like that via the microbiome. When the movement gets disrupted, you get into trouble. You will sometimes see where there’s just little areas that are firing improperly. Sometimes you’ll even see them firing in the wrong direction. We all for the most part have heard of acid reflux, where we get heartburn, right? A lot of times this is acid coming back up the esophagus. This is actually able to happen all through the entire rest of the gut. It’s just very hard to tell that it’s happening because you don’t get this very obvious symptom of burning in the chest, in the throat. You’ll sometimes get this backwards movement and then you’re always prone to inflammation in that area because you get an overgrowth of dysbiotic organisms that drive inflammation and bacteria releasing lipopolysaccharides, aggravating that immune system and actually even affecting our detoxification.

Lindsey: 

So with the EGG, can you then tell the difference between somebody who has low stomach acid versus high stomach acid because I know in the functional medicine world, everybody seems to have low stomach acid, but in reality I’m not sure that’s actually true.

Dr. Deacon:  

Yeah, in terms of in terms of pH levels, you can’t get an idea of whether there’s a low or high pH, because that is really determined based on your chemical composition. Acid composition. For us, we typically do a stomach acid challenge. It’s not the best because the gold standard is not to just take HCl and see if you get heartburn, because there’s other factors involved if your mucosal immunity is low. You’re going to feel that that burning very easily and your acid may still be low. What I describe to people as it’s similar to pulling a hot pan out of the oven with really thick, nice oven mitts. You pull that pan out. You can hold it for minutes without even hardly feeling the heat. Now take that same pan and pull it out with rubber gloves. The pan isn’t any hotter, but it sure feels that way. What happens when our mucous layer breaks down in our gut is now we feel the acid. I know you’re very up to date on this research that a lot of people that have this heartburn problem, it actually isn’t even a high stomach acid problem. High stomach acid is very rare. It only happens usually with high gastrin levels, which is the hormone that tells acid to be released. It’s generally a low stomach acid problem allowing overgrowth of microbes.

Lindsey: 

So if you actually have Barrett’s Esophagus, that would be indicative of the fact that you have high stomach acid, right?

Dr. Deacon:  

Well, that’s indicative of a reflux problem, which is a phase reversal electrical problem up into the esophagus because the valve isn’t closing properly. There’s the esophageal sphincter isn’t closing up properly; it’s not getting the information to tell it to close. Which is a muscle, an EMG, an electrical function. Then on top of that you likely have low mucosal immunity as well. There’s a very high correlation between decreased mucous secretions and Barrett’s esophagus. Because the mucus is what protects us, right? It’s what protects us from that breakdown.

Lindsey: 

How can we help that mucus?

Dr. Deacon:  

There’s lots of different supplements that can be taken if appropriate. Colostrum, glutamine helps produce Secretory IgA, vitamin A… but typically when I’m seeing something like that, I’m looking at infections. I’m looking at SIBO, H. Pylori and then I’m looking at how are the brain and the gut are communicating on an electrical level because a lot of times you’re going to get this, what’s called a phase reversal, where all of a sudden things are traveling backwards and muscle sphincters aren’t as tight as they should be.

Lindsey: 

Yeah. Well, let me back up just a second and ask you about the HCL challenge test because some people may not know what we’re talking about. I have done one, so I know but…

Dr. Deacon:  

With betaine HCL, it’s a supplement that is essentially stomach acid. You take a capsule before each meal in a day, and if you don’t get any reactions, the next day, you take two before each meal and then three, four, etc. I tell people to go until they get a reaction or until they hit five capsules, which if you’re at 500 milligrams a capsule, you’re around 2500 milligrams. If you’re still not getting a reaction, it’s pretty obvious you have low stomach acid and you should keep it at dose until you start getting reaction in the form of an acid or burning sensation. What I’ll find, it may take less than the morning, more at lunch and more at dinner. Other people need to take more in the morning, less at lunch and more at dinner and it’s just going to fluctuate. Some people will find they need to take two in the morning, or three at lunch and two in the evening with dinner. That’s the stomach acid challenge. If you have to take more than one or two, you typically have low stomach acid and you’re going to want to be replacing that stomach acid when you eat. If you don’t, you’re not going to break down your proteins properly, which causes them to inflame your gut. You’re going to get malabsorption issues of your proteins and you run the risk of having microbe, bacterial, fungal overgrowth in the small intestine, which causes all sorts of problems. I just had a patient today who came in who had small intestinal bacterial overgrowth that was contributing to her migraines. And so when we just worked with that, getting her gut under control, her migraines went away. It can have a profound effect on the body.

Lindsey: 

Okay, so you were talking about the EGG and how it could turn up, in the case of reflux, it would turn up something showing the electrical signal going the wrong direction.

Dr. Deacon:  

You got it.

Lindsey: 

So what can you do about that?

Dr. Deacon:  

There’s a few things. You can actually do neuro and biofeedback techniques to train the nervous system to reorganize that signal. So neurofeedback, this is something that’s really interesting that I got involved with back in 2013. It’s a process of retraining the brain through operant conditioning, which is essentially audio and visual feedback. It allows us to look at functional disruptions in brainwave activity that can contribute to problems with anxiety, depression, epilepsy, sleep problems, pain, fibromyalgia, ADD and ADHD. It’s really come a long ways. It was actually developed in the 70s for epilepsy. What they were actually doing in the 70s was inducing epilepsy in cats. Then they were training this rhythm called the sensory motor rhythm, we call it the SMR rhythm, that is kind of in the central part of you. If you draw a line from your right ear over top of your head to your left ear, that’s your central somatic sensory motor cortex and that’s where this rhythm comes out of. It actually goes and talks down to the top of the brain stem and the cerebellum to elicit motor movements. This is also includes motor movements within the gut. They were actually training this rhythm and it was it was completely reversing epilepsy in cats. It was then taken and transferred into neurofeedback and now it’s blown up into this whole world of assessment and training. You can do the same thing with the gut; you can actually isolate the dysfunctional signal and train it to function better through operant conditioning. Then you can do SMR techniques at the brain if the brain is what’s affecting the gut. What’s really fascinating is when you combine an EEG with an EGG, so the electrical activity of the brain compared to the electrical activity of the gut, you can actually figure out which one is affecting the other. What you’ll sometimes see, and I think the best example is an eating disorder, is actually 70% of people with eating disorders, actually, that the electrical activity in the gut is affecting the brain. This is something that we have thought for years is a psychiatric condition. Now we’re starting to see it’s actually a functional digestive condition,

Lindsey: 

Is it possible that it starts as a psychiatric condition, then changes are induced in the gut based on the behaviors like vomiting after eating and that sort of thing, that then cause the problem go in that direction?

Dr. Deacon:  

Yes, 30% of the time but 70% of the time, what we’re seeing, because you can actually see what is having an effect on the other. With the brain and the gut, it’s kind of like a healthy marriage. It’s this give and take relationship that needs to happen. As soon as one starts taking control over the other, there’s a problem. You can actually see when the gut is taking control over the brain or when the brain is trying to take too much control over the gut. Actually in more instances than not, it’s the gut taking control of the brain and causing the brain to dysfunction to the point that then the behaviors of eating disorders continue.

You’ll see this with fungal overgrowth sometimes. I don’t know if you ever run into this problem. I do quite quite frequently, where somebody has a fungal overgrowth and they’re just craving sugar, like crazy. It’s the last thing that they should be eating but it’s making their brain feel good. It turns out that aldehyde molecules that come as fungal metabolites (after fungal fermentation happens, they release aldehydes) they make their way up to the brain and they stimulate dopamine release. These aldehydes actually make us feel good at the level of the brain, so it drives our behavior to eat more. This is an example of the fungal pathogens influencing our brain and behavior, to give them a more suitable environment to continue living.

It’s interesting because you’re going to see the same thing happen with gut motility problems because of the dysbiotic organisms that build up in these areas where the motor complex isn’t working properly. And so you will find in this in eating disorders as an example, that now all of a sudden, the brain has been influenced by the gut and the behavior continues. The reason why we actually came across this is we had a couple of people with eating disorders. Typically, we’ve always had good success with them. We had a handful of people we just couldn’t seem to get effect with. We’re looking at copper and zinc problems. We’re looking at the gut and the neurotransmitters. We’re working with neurofeedback and typically, there’s a lot of trauma and emotional regulation problems as well. We’re working with everything, doing all the right things and we weren’t getting anywhere. All of a sudden, we come across the research on EGG and we went, “Okay, you know, let’s take a look at this.” It turns out that the problems were being influenced and it’s actually the gut influencing the brain at too high of a degree. When we actually went and focused on biofeedback and retraining the gut rhythm, all of a sudden, then we started seeing the shift. It was quite fascinating. This was something that gastroenterologists back in the 80s were looking at using, but they couldn’t smooth the signal out; they couldn’t filter out the motor complex from the intestinal reflex through the abdominal muscles. We’re at the point now where we can actually filter it out with technology that we have now. We can filter out the abdominal muscles and see directly what’s coming in from the gut.

Lindsey: 

When you’re talking about the biofeedback and retraining the gut and such, what does that actually look like? What is the process?

Dr. Deacon:  

Yeah, so what you do is you hook up sensors onto the gut or under the brain, wherever you need to intervene. You will play either a game, a movie, music, or you might just have a little animation that plays when your gut or your brain is facilitating the rhythm that we want to see. One thing that happens with the gut and the brain is it’s always fluctuating. Okay, if our electrical activity wasn’t always fluctuating, we wouldn’t be living; we wouldn’t be able to function. There’s what’s called a normative database. We have these databases of people that don’t have any health issues or any major health issues. We can compare the assessments to these normative databases and then we can look at how far out of that normal range somebody might be. Then what we can do is we can train them back towards that range, so when they’re showing brainwaves that are going back into that normal range or gut rhythm waves, they’ll get feedback in the form of music, in the form of a video or game, that they’ll perform better when they’re playing a game. You can even do cool things like dim a screen when a child’s playing a video game, so you can make it really interesting.

But there’s these couple of regions in the brain called the superior and the inferior colliculi. We don’t call it superior because it’s better than the other, it’s just higher up in the brain. They respond to the audio and visual information. They will then send it to the limbic system, which sends it to the reward system in the frontal lobe or the punishment system in the right frontal lobe. It turns out that the limbic system, which is our system that brings in about a terabyte of information every second to try to make decisions about survival, it turns out that it likes stimulus. Who would have thunk, right? Tech companies have known this for years; our brain always wants more stimulus and this is an area called the amygdala that’s typically in charge of this. When we give the brain stimulus, it’s happy, whether it’s bad or good stimulus. We know this because we see bad news, bad media and these bad things that happen yet, we still want more of that, we want to have more of that feedback. When we remove the stimulus, the brain doesn’t like that. It actually figures out how it needs to adjust itself to get more feedback and it turns out that the only way we’re going to give it feedback is when it’s behaving itself better. When the brain and gut come more into sync and are on a more even relationship instead of one trying to control the other, this is something we call brain-computer interface. The brain learns how to drive the machine; it learns the algorithm and the code that you’re giving it. It learns what it needs to do to elicit that and because of neuroplasticity in our brain’s ability to change itself: what fires together wires together and what no longer fires together, no longer wires together. This is Hebb’s postulate; we actually can break down and extinguish old pathways that were creating the problem and build new healthy pathways that will facilitate health moving forward, facilitate that gut to actually move things through it properly.

Lindsey: 

How long do you have to do that to retrain the brain and gut?

Dr. Deacon:  

We tend to do about 45 minutes to an hour long sessions. Typically, we’re going to do it two or three times a week. We run people generally through a minimum of 16 to 24 retraining sessions. In most cases that are of mild to moderate severity, that is quite sufficient. The way that we describe it’s like you’re working out and you’re working to lose weight. You’re training your body. You’re training muscle memory. It takes time; it takes repetition. We get that foundation and then typically, people will maybe do one every session every week or two to four weeks. Can continue that just as a maintenance type program; we do have a lot of wear and tear on our brains through mental emotional stress, through physical stress, when we do have a lot of wear and tear on our on our gut as well in terms of environmental toxicants, in terms of dietary contaminants, biotics, medications, etc. We do typically put people through maintenance sessions as well. We’re hoping in the next year to two years for us to actually have an at-home system developed for the gut, particularly. The gut is a lot simpler. I mean, it is complex, but in terms of its motor rhythms, it is a simpler animal. We hope to have something like that to be able to bring it to an app and the cell phone. And people can do this type of training at home. There are actually options for neurofeedback at home training right now. If it is a brain driven issue, people can get units that they can actually do at home as well. We know that health is a long-term maintenance policy. That’s sometimes what’s required.

Lindsey: 

When might people develop these kinds of problems in their gut with the going the wrong direction or wrong speed?

Dr. Deacon:  

What we’ve seen is emotional and physical trauma. Emotional trauma triggers long-term issues with something called the dorsal-vagal nerve division. We have two divisions of this vagus nerve: one is the ventral and one is the dorsal. It means that the dorsal is higher up and the ventral is lower down on the brainstem. When we’re in a joyful, exciting, motivated type of a rhythm, we’re happy; we’re content; we’re relaxed; we’re in a rest and digest state, which is also called the parasympathetic state, also known as the ventral-vagal state. When we get chronic stress of any sort, this could be an emotional trigger or it could be a physical trauma that happens, we can actually head up into the dorsal vagal state, which is actually through the fight or flight state into this other division, which I call freeze or appease. It’s the fainter, the play dead response. Essentially, when that happens, motility virtually shuts down in the gut, but it doesn’t shut down everywhere. The gut will pull resources to where the most important areas are at that time and the other areas will go sluggish. If you’ve had a head injury or anything else that can cause a vagal nerve encephalopathy (encephalopathy is just a fancy term for nerve dysfunction or brain dysfunction) but when there is a nerve encephalopathy or neuropathy, it doesn’t function properly. Toxins are notorious for causing this, like a mycotoxin or mold toxin problem. Stealth chronic infections will cause this as well, so you’ll see it with Lyme and coinfections. I particularly see it a lot with a Bartonella infection in the gut. What happens is all of a sudden, the gut doesn’t have the energy that it used to. The energy resources are being directed elsewhere. It only has so much; it’s kind of like it’s living off of scraps. The energy is directed to parts of the gut that are needed. Typically higher up in the gut, lower down in the gut for bowel function you’ll get a lot of areas where all of a sudden, they’re not firing at all or they’re wanting to fire backwards, because it’s actually easier for the gut to move things backwards or stay still did from an energy perspective. One of the things that I’ve found with phase reversal, which is a fancy term for when things are traveling the wrong direction in the gut, back up the gut instead of down, is head injury. There’s so many different manifestations of the dysfunction that will happen to that vagus nerve. We don’t know exactly where it’s going to happen, but we can see where it has. If it tends to move around, you know that there’s typically a toxicity or an emotional trauma. If it tends to stay in the same place and the problem’s always in the same area in the gut, typically I’m looking at the physical injury phenomena.

Lindsey: 

These ares where it is is something you would know from the EGG, right?

Dr. Deacon:  

You got it; you got it.

Lindsey: 

You couldn’t just feel like, “Oh, I always have a problem here in my gut”?

Dr. Deacon:  

You can, but we like to measure it so that we can actually have something objective to go off. Then we can see if we’re actually improving. There’s a point you start working with people and you might not see improvement in four weeks; subjectively where symptoms are getting better, but you might be able to see that you’re at least on the right path. Sometimes it does take a little bit of time and so we always want to know: are we on the right path, are we actually getting changes or are we just stuck because if we’re stuck, we need to look under another rock. Yeah, it’s something you could tell. Like I remember when I dealt with all my head injuries, it was always lower gut right in the middle of my abdomen. You could tell that it was lower small intestine, I had a fairly good idea. But what I didn’t have a good idea of was, is it just not moving, is it just inflamed, is it phase reversing and so there’s different approaches depending on what is actually triggering those problems.

Lindsey: 

If somebody came to you with IBS and no history of head trauma, what would you start with in terms of testing? Would you start with the EGG or would you start with a stool test or something else?

Dr. Deacon:  

We always start with an EEG, and if it is a gut complaint, an EGG. I want to see what the electrical function’s doing because the chemical problems that go on have an effect on the electrical system and we can predict that. I can actually start figuring out if it is just something that is gut centered or whether it is a peptide problem. I never take people’s head injury reports as gospel because so many people forget that they’ve had head injuries. You would be blown away by how many times I do that in my intake: have you ever had an injury, and I’ll usually ask about four or five different questions: ever had a whiplash injury, ever had a car accident, etc. No. Then I asked, when you’re little, did you ever hit your head? It’s like, oh, yeah, I fell off my swing set when I was little and I landed on the top of my head. Does that count as a head injury? Yeah, it does count as a head injury.

Lindsey: 

I don’t think anybody’s not had a head injury by falling down and hitting your head while you’re little.

Dr. Deacon:  

That’s right. Little things like that they can add up and they don’t always trigger issues right away. Personally for me, I played football and hockey and I had never formally been diagnosed with a concussion. I think this is important for listeners to know is you don’t have to have a diagnosed concussion to have a problem with brain injury. So especially if you’ve had multiple hits to the head. It actually only takes about a 10th the amount of energy or force to injure the neck as it does to get a concussion. If you have enough injury, enough force to injure the neck, you have enough for us to actually mess your peptide hormones up and your vagus nerve. I actually just had somebody come in for an initial, right before I started talking to you, and she’d had a car accident, diagnosed with a whiplash injury. They were very careful to tell her that she’d never had a concussion. It was not a head injury; it was only a neck injury. She’d kind of gotten away completely from even thinking that this could be a head injury problem. Migraines triggered a month after and gut problems triggered six months after and nobody was connecting them for her. So as soon as we did our assessment, I looked at everything. I mean, right away, you can tell that neck injury triggered a vagal nerve dysfunction and you could see from the EEG and the EEG exactly what was happening. She’d never made the connection because she was told, well, I didn’t have a concussion. You don’t actually need a concussion to trigger these problems. Subconcussive blows, which is a fancy term for a blow to the head that didn’t actually cause concussion symptoms, that is actually enough for us to cause the problem.

Lindsey: 

Well, now that you’re talking about this, I’m thinking my son had a concussion about a year ago and he has periodically had headaches that I think of as migraines because he’ll say they’re really pounding hard and I don’t actually know if they’re fitting the definition of migraine but here in the US, in Arizona, should I should I him in for an EKG… what’s the one for your head?

Dr. Deacon:  

Yeah a quantitative EEG. That’s what you want to look up. If you go to bcia.org, you will be able to find practitioners in your area that are board certified in neurofeedback. They may even be diplomats of quantitative EEG. You want to go into there and then look at the clinics, look at their websites, give them a call and make sure that they’re doing a quantitative EEG. That will compare his brainwaves to other boys his age and you’ll be able to start seeing if there are communication problems. We use software called neuro navigator that actually can see cerebellum. The cerebellum is an area that sits kind of right behind the occipital lobe just above the neck, really important for balance and coordination. If there’s an asymmetry in the cerebellum, it is almost 100% the chance that this is brain being affected by a head injury. These things don’t always reverse on their own. Even though we might get better functionally and symptomatically, the brain doesn’t really have an idea of what its baseline is. It’s a machine that reads what’s happening in the environment and then creates perceptions and reactions. It doesn’t always know like, hey, I’m not functioning like I used to be. I should function this way, not the way I am. It doesn’t have that feedback. All it does is it gets shocked, it gets hit in the head, you get shearing of white matter and communication problems and it just keeps continuing, adapting that way because it has no information to tell it that is not how it should be functioning. This is where neurofeedback is incredible, because we actually have the ability, it’s like putting a mirror in front of our brain and going here, this is what you look like. It’s like to say to people, it’s kind of like trying to shave without a mirror or try to put your makeup on without a mirror. You can do it, it just might not look pretty at the end of the day. Whereas when you can use neurofeedback, your brain gets that exact feedback. It’s like looking in a mirror and it goes, oh, okay, I’ve got to adjust myself this way, and you can actually get to get that those pathways to reorganize themselves. Then there’s usually less of a need for medications as well, if anybody’s on medications, which is very cool.

Lindsey: 

Okay, so back to the gut. If you go through the neurofeedback process, you fix the migrating motor complex and everything’s running smoothly, will that take care of SIBO or Candida overgrowth and things by itself or will you still need to use medications to get rid of those?

Dr. Deacon:  

Yeah, great question. Some people yes; that is enough for them to get it under control. Other people depending on how well it’s laid itself down, if you’re speaking particularly about SIBO, it may still require treatment. The nice thing is it won’t recur; the chances that it will recur and come back are very low because you’ve actually dealt with the reason why it was able to grow in the first place. Now, there’s still stomach acid and that sort of thing. That’s the other cool thing is you’ll see people with low stomach acid, all of a sudden, their gastrin is working properly, which is a peptide hormone, known to be affected by head injury tends to drop low. The gastrin regulates; so now your stomach acid, your natural production actually starts working better.

Lindsey: 

Do you use the IBS smart test at all that can tell you about the antibodies to vinculin and anti CDTB antibodies that cause problems to the migrating motor complex?

Dr. Deacon:  

I’ve seen the test itself and I’ve seen some of the research. I haven’t actually started utilizing it yet but I am meaning to. I just like to really dig deep into things and know as much as I can before I start integrating them. I’ve seen it. I think it’s great.

Lindsey: 

Yeah, I’m just wondering if you have that autoimmune post food poisoning problem in your intestines, whether you could still use the neurofeedback to repair the damage.

Dr. Deacon:  

Yes, and so this is interesting. It depends. What I see is what I call illness trauma. When people all of a sudden lose their health, it’s traumatizing. If that trauma lays itself down and the switch gets stuck on in the brain, the limbic system, it will actually cause the immune system to fall out of balance. The immune system, I like to say, is like a three-legged stool. If one of the legs gets too short or too long, all of a sudden the stool is off balance, and if it gets way too long, or way too short, the stool falls over. This is what happens with autoimmune reactions is you get one or two divisions of the immune system cranking themselves up and another division going too low. I investigate what might be throwing that out, because oftentimes a head injury or food poisoning is the trigger but there’s something else within the terrain of the body that’s allowing that reaction to continue. You’ll see the same thing in PANS and PANDAS, which is a pediatric autoimmune reaction, that’s a neuropsychiatric syndrome from strep infections. That’s the same thing. It’s like the strep infection was the trigger, but there’s a milieu or the underlying terrain within the body, something else is going on that it’s keeping that immune system out of whack. One of those things that will do that is trauma. If the trauma response or the trauma switch is stuck on in the body, that immune system will stay completely out of whack. I’ve seen some interesting cases of this. I haven’t run the smart test for IBS yet to see if this is happening, but I have seen cases of Hashimoto’s, which is the autoimmune thyroid, where when we address the emotional component of their illness (they worked with a psychologist doing some trauma-centered therapies), their autoimmune reaction went away. They’re very interesting but if you look at the effect of the limbic system on the innate immune system, it makes sense. When it’s active, it upregulates all these inflammatory cytokines: interleukin 1 and 10, tumor necrosis factor alpha, your TGF beta, C3A’s, C4A’s and now you can get all sorts of activation of microbes. Your immune system, if it’s not balanced, you’re going to be in trouble.

Lindsey: 

It’s all so complex. I’m sure that people listening are thinking, wow, now there’s 1000 different ways I thought I needed to approach this problem. And here’s one more. For people who are interested in maybe getting an EGG for themselves, you’re in Calgary, do they need to come see you?

Dr. Deacon:  

No, people do not need to come see us necessarily; a lot can be done through a distance now. We do see people from all over North America; some people opt to come up here, just to do the initial assessment and initial testing. We can ship things to people, test kits, EGG machines, etc. We can also coordinate with people who may be able to run and collect an EEG near them. So like you said, you’re in Arizona, you know, we’re happy to help facilitate with clinics down there: get the raw data from the EEG, or if somebody is doing EGG; there’s very few people doing it; we can get the raw data and we can help people work out different protocols and things that can be done. We do offer, if anybody’s interested, a 30-minute complimentary phone consult with a health care advisor in our clinic. They can actually just book a 30-minute comp. call and we can talk about what they’re dealing with and maybe help them figure out what a good direction is for them; maybe decide are they the right fit for us and if you are, then yeah, we can talk about how we can work at a distance or, or like I say, some people are just wanting to come to get the initial assessment and go from there. Retraining, though obviously, it would have to happen up there over an extended period of time. It would be pretty tough to do if you lived far away. Yeah, so again we’re trying to coordinate with clinics that are near them. 

Lindsey: 

Yeah, who else does this in the US? Do you know? The EGGs?

Dr. Deacon:  

Neuro and biofeedback is pretty much everywhere. There’s 1,000s of practitioners within that realm. If you go to www.bcia.org, you can see where all the practitioners are. Some people are doing biofeedback, neurofeedback, and different types and there’s a lot of different software and that sort of thing. We can help find someone that might be appropriate for them. The other thing that people will do too is come down maybe for a week, come up to see us for a week. We just do an intensive program at that point and then they might do that a couple times a year. That is an option as well.

Lindsey: 

But the EGG, are there other people in the US who are doing those?

Dr. Deacon:  

The only place that I actually know of and this could be obviously there’s others, but the only people I know of is at the University of California, San Diego. The guy actually to get in touch with there is Dr. Todd Coleman. They’re the ones who’ve rejuvenated the research on all of this and are developing some amazing things. But I would just run a run a search electrogastogram or EGG in your area. It’s not really heavily marketed and advertised. So it might be something you can find and then we can always take a look at the raw data as well.

Lindsey: 

Is this prohibitively expensive test or what’s the cost on that?

Dr. Deacon:  

It’s not at all actually. We include it in our initial assessment. I mean, it probably has a base cost of around $50 to $100. It’s really not overly expensive. We weighted it around the $100 Canadian mark, including time spent going through the data.

Lindsey: 

Yeah, so if somebody wants to order it from you, it costs how much.

Dr. Deacon:  

I would essentially price it at $100 Canadian.

Lindsey: 

Okay, well, yeah. Not bad at all. Okay, so I think this is a lot of information for people to absorb in one podcast. We should wrap it up, anything else that you wanted to mention that we didn’t talk about?

Dr. Deacon:  

Lots of things, but not on this topic. I always I always find it fascinating just how interconnected everything is. We started talking about the gut and all of a sudden, you can’t only talk about the gut anymore, because there’s influences from all angles.

Lindsey: 

This is interesting, because you’re the first guest who’s talked much about the brain with regard to the gut. This was good new material for our listeners.

Dr. Deacon:  

Great. Yeah, I would just add, if you’ve had injuries in the past, whether or not your symptoms were triggered immediately after, maybe it took years before they triggered; it’s definitely something to keep in mind. It could be affecting the problems within the gut.

Lindsey: 

Okay, great. Well, thank you so much for this information and I hope maybe to have you back on some time to dig in deeper.

Dr. Deacon:  

That would be great. Thanks so much for having me. I had a great time.

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

Adapted from episode 72 of The Perfect Stool podcast and edited for readability.

Einar Jordan has Associates degrees in chemistry and microbiology, a Bachelor of Science and a Master’s in Project Management. He is a quality and process engineer currently working as a Project Manager in Research & Development in the biotech industry. He has worked for over 25 years with Tissue, Medical Devices, Pharmaceutical, and Biologic companies in different capacities. He has done repeated fecal transplants on himself using his son’s stool to address various conditions including interstitial cystitis and chronic bladder pain, fibromyalgia, IBS, histamine intolerance, chronic tendonitis, joint pain and hair loss. 

Lindsey:  

So as I understand it, before resorting to a fecal transplant or FMT, you had already done a lot of things to address your health issues. Can you just give me a brief synopsis of when your health went downhill, why and what you did to address it up to the point of doing FMTs with your son’s stool?

Einar:  

Okay, my health probably started going down around age 10, but it was not really noticeable until about 2006, when it really hit me like a ton of bricks. I developed interstitial cystitis of the bladder; they still call it today prostatitis, but it does not seem to have a significant link to the prostate. Eventually, with time, I started developing IBS, fibromyalgia, etc. So every couple of years, I was developing something new. The tendonitis was so probably before even the IC of the bladder, and my eyesight started deteriorating. I needed to have new glasses every year or two years; then my blood pressure started skyrocketing; triglycerides; I was prediabetic. I lost all my hair. The list… it’s hard to even remember the list of things that I was developing. I did not think I was going to live this long. 

Lindsey:  

TMJ, I think was another one on there. 

Einar:  

Yes, TMJ was probably one of the last ones. I thought I had an ear infection. So to treat this condition, I had to take Clonazepam for five years, which is an awful medication. I mean, it saved my life for that period of time. It allowed me to sleep. Eventually, your mental health starts to deteriorate and I had chronic anxiety and depression as a consequence. I had it before, but it got much worse, around four or five years.

Lindsey:  

A lot of people may not know all these abbreviations or even what these conditions are about, but just briefly, interstitial cystitis is like urgency and just sort of a constant feeling almost like having a bladder infection, except that you don’t.

Einar:  

Yes, you have to go to the bathroom about 50 to 60 times a day, so every 15 minutes or so. You feel like your bladder is full of blades and battery acid. You lose your ability to sleep, you start losing your mind very slowly; it is a horrible condition. I have a PhD in pain.

Lindsey:  

Okay, and then TMJ stands for… what is it? Ten…

Einar:  

Temporomandibular joint (corrected). I think it is sort of an arthritis condition of the jaw, where you feel like you have an ear infection at the same time as very bad discomfort in the jaw. Every time, you try to chew things, your jaw really starts getting inflamed. This kind of arthritis of the jaw.

Lindsey:  

Okay and fibromyalgia. Talk a little bit about what the symptoms of that are like.

Einar:  

Fibromyalgia, they sometimes call it separately, so brain fog, but it is pretty much a part of the same thing. You feel like you’re burning and you lose your capacity to process thoughts. You think very, very slowly. You’re exhausted all the time. You have very, very little energy. I never had chemotherapy, but that exhaustion that you get from chemotherapy and that weakness, it is something sort of like that to give you an image.

Lindsey:  

Okay, and so when you say burning, you’re talking that your skin feels like it’s burning. 

Einar:  

Yeah, your skin and your muscle. For me it was the upper shoulders and arms. Anytime I lifted a 10 pound weight, I’d be exhausted for days, I’m burning.

Einar:  

 Okay, so go on with your story about what you did about all that.

Einar:  

So when I try, because I come from a scientific background, I’m able to read a lot of research articles. I started doing experiments on myself based on whatever came out. If there was some medication that came out, I would immediately try to convince my doctor and I’d show him the research or how this is helping, but everything at least on me, was not helpful whatsoever. I even did some things for me because I had a pneumothorax, which means that my left lung collapsed at a very early age so it had to be stapled shut. I tried hyperbaric chamber therapy and that made you feel a little better for a little while, but it was short lived. 

Eventually, some people figured out that dairy was the biggest cause of fibromyalgia. And it seems to be dairy. A big issue for at least most people that I think the theory is that lactose buildup puts pressure on the vagus nerve, so I cut out lactose. I started feeling better. My doctor kept on telling me to eat less meat and less fat and that just got me even worse, so I did the opposite. I actually ran into Michaela Peterson’s and Jordan Peterson’s story of how they healed themselves from multiple diseases with a carnivore diet. I did a keto diet; that was very helpful, then a carnivore diet was even better, but still I was unable to process foods because most of these conditions are very high histamine intolerance. My theory is that the histamine intolerance is due to the fact that the food is not being processed through your body, so it’s rotting. If you tried to eat more food, the higher the histamine, so I run into an IBS study, because the IBS was now driving me crazy, that they were successful for six months to two years doing an FMT and I decided to give it a shot. 

I couldn’t figure out where I was to find the healthy donor. Then it dawned on me that, you know, I subconsciously was raising my children to have a better than average immune system or a microbiome. By feeding them very low carb diets, making sure they’re breastfed much longer. There were also vaginal births. There are all these conditions, all these things that improve the person’s microbiome, and keeping them away from antibiotics. I decided to test my son and it was very, very stressful. I tried to tell everybody that even if I am used to doing experiments, I normally, even if I do them on myself, I normally never experienced this level of anxiety. Within two hours of conducting the FMT and I used capsules for the fecal transplant; I use enteric capsules. I have people call me and this is not a simple thing for a lot of people; they get desperate and they make a lot of mistakes; it’s an incredible number of mistakes they’ll make. Within two hours, the constant bladder pain just stopped. The IBS kind of progressed later on. It got better about a day or two later because when I did the FMT, I had a little diarrhea and I started testing on day one on two different things. Alcohol was something I could not touch; very few types of alcohol; very little amounts. I tested red wines, stout beers, pistachios, dark chocolate, coffee, within moderation; I have very small amounts, which I could not tolerate before in any way or form. And I was able to tolerate them as soon as I did the FMT. So I did the FMT 10 days in a row. Each day, I consumed via capsules, a solution of 50 grams of fecal matter, which I separate from the solids.

Lindsey:  

Okay, and that was how many capsules?

Einar:  

The average I’ll say is about 100 capsules a day; 0.8 milliliters per capsule, that you feel very bloated.

Lindsey:  

Did you do those all at once, or like throughout the day?

Einar:  

The protocol I recommend and I want to specify that I’m not a doctor, not a nutritionist. To make sure that the capsules release in the intestine, I fast for 16 hours, because food can interfere with the process, it could delay it. They could accidentally release in the small intestine or in the stomach, and they can make you sick. I accidentally made this mistake three months later; I had a full stomach, I was like well, let me take a couple of capsules, and I gave myself SIBO, which you do not want to give yourself SIBO. It is a horrible condition. I was able to reverse it. It took me about a week to reverse it. I want to emphasize this, it is complicated. It’s not that simple. For every day and I took a break of one day or two days within this 10 day period. It was a 12 day period. Again, my son produces fecal matter usually every day but not every day. So there were two days he didn’t produce, so I didn’t do this.

Lindsey:  

How throughout the day, you’ve said 100 capsules, are you taking these all at once? Are you taking these like in three batches or how did you do it?

Einar:  

No, I sit in my bed, well back then it was my bathroom. I have a very large bathroom. I fill each capsule and I consume each capsule immediately. I consume it within less than an hour. I processed and consumed within less than an hour. I think two hours is still okay, but you want to take the microbiome as fresh as possible, if you have the ability to do so.

Lindsey:  

Yeah, but most people don’t have a donor who’s right there in their house ready to give each day.  You’re not freeze drying or anything, you’re taking a solution and presumably have some sort sterile way of getting the solution into the capsules without spilling…

Einar:  

Yes. Well, the challenge that the biotech industry has with this procedure is that we are used to being in a sterile environment. And this is the dirtiest thing you can possibly imagine within the biotech industry. It’s poop. There are 500 bacteria species and 90% of our DNA is basically bacteria species. This could explain probably why we have more DNA from the mother than the father, because we inherit all of these species when we’re born. One of my many crazy theories. I fill each capsule because the enzymes of the FMT will start dissolving the capsules from the inside. At the same time, the acid in your stomach, could probably put some pressure on the capsules. Then, once he hits the colon, then it releases. And if you’re healthy and if you can process food fast or normal, fresh capsules are not a problem. If you have a slow digestion, I normally tell, when people call me and ask me for my advice, I say, “Well, I would personally do an enema if I’m constipated”, but if I am digesting very fast, I do capsules and I would fast 16 hours before, and not eat anything for two and a half hours. Part of the biotech industry testing for any product is we take whatever you consume, it’s called the acid simulation or the stomach simulation test. You take a strong acid, I’ve got a swimming pool, so I got the acids from a swimming pool and I put the capsules in it. The capsules will last in a stomach acid for a long period of time but that does not simulate the pressure your stomach will put on or your colon areas that are going to put on the enzymes that are there. That’s why when I do it fresh, I do it within very quickly for any type of capsule. And the frozen they normally have to use a double capsule to prevent them from falling apart. If you actually put it in, you will see within two or three minutes, the capsule, once you put the fecal matter in the capsule, the capsule starts dissolving from the inside, they start getting soft. So I just fill them, take it and when people call me and ask me for details I say, “You don’t sit and do 10, you do one. If you’re really sterile, you do two or three, and if you can swallow three at the same time, sure. If you can’t, do one at a time.”

Lindsey:  

Okay, but do you have some sort of a capsule filling system to make sure there’s no fecal matter on the outside of the capsules is what I was getting at?

Einar:  

Oh, yes. I use a syringe with the blunt needle to make sure that all the drops go in. Sometimes I use a pipetter. After 25 years working on many, I have the dexterity of a god. I was born in a veterinarian’s house because as a child, I was mouth pipetting from age 5. I’m actually very good at dispensing things. Again, the normal person might not have- it sounds like I’m exaggerating. No, it is actually hard to dispense and pipette. People have to go through extensive training to do this for years.

Lindsey:  

Let me stop you for a second; you said you went on the carnivore diet. What changes did you see from that versus the ones you saw after doing the FMT?

Einar:  

They were very similar. They were a little slower. For the carnivore diet, it took close to a week to start feeling the pain stop in the bladder. The fibromyalgia also went away, the IBS did not.

Lindsey:  

Was your IBS like a IBS-D or an IBS-C?

Einar:  

IBS-D. I mean it started with a C probably earlier on but usually in most people it’s then progressing to a D, but it is possible that mine might have not been as much IBS because a high fat diet makes you very regular. Some people take nine months to a year and a half for the stool to solidify. I did it for six months and then I added some carbs on and off, but in most conditions, tendonitis improved significantly, my hair started growing and my eyesight started getting better. I don’t remember when my graduation was, but it improved by 50% so where I needed to see you before with glasses, I don’t need them now for long distance. I only need them for reading. I’m still shocked, and they are sort of things that I didn’t list that were unexpected. Some people ask me, “oh, well, maybe what it was, it was in your head. It was a placebo effect. I’m like, “I used to bite my nails since age 10. I was constantly biting my nails. I won’t bite them anymore.” When I came off Clonazepam. I had a hat fetish. I could not leave my house or be anywhere without a hat, including inside my house. I have a 30-hat collection right now. All of a sudden, within two hours, it took me a week to realize that, hey, I’ve been a week without wearing a hat. It was a very odd thing. So I have some theories about the nail biting, it’s that your body is so starving so much for this bacteria that it is looking for any dirt under your nails to pick it up in your stomach. 

Lindsey:  

Interesting. Okay, and then some other things that you had put on the list for me, high cholesterol and triglycerides.

Einar:  

Oh, that disappeared with a carnivore diet. I was shocked. 

Lindsey:  

HBP, high blood pressure, was it? 

Einar:  

Well, sorry, my blood pressure did not change a lot. I’m not sure if it’s because I was not eating enough salt and I was having the occasional drink. About a few months ago, I did quit cold turkey, alcohol, or at least like cut down to a significant level. This is the problem with FMT. Everybody wants to go party the moment it works and live again. You feel you want to be normal; we all want to be. I went to the doctor and my blood pressure was 190/50 about a few years ago. I went to the doctor about a month ago, and it was low: 120/70. I think it was, which I was like, I haven’t had that blood pressure since I was in my late teens.

Lindsey:  

Oh, so you were saying it was 190 before?

Einar:  

 Yeah, well, 150 or 190.

Lindsey:  

Okay, because I thought you said 90, which I had blood pressures taken like that that were 90/50 and the people were a little bit nervous. They’re like, is it usually that low?

Einar:  

I work with a lot of pathologies, that I’m not a pathologist or a doctor. I do remember that there is a significant difference between women and men on blood pressure and it may be also diet related. I’m not sure. 

Lindsey:  

Yeah, no, I’ve had doctors tell me eat more salt.

Einar:  

Yeah, you know. We’ve been told that salt was horrible for us and I nearly cut off all salt and my blood pressure did not drop. I’m eating fistfuls of salt. And my blood pressure is beautiful. 

Lindsey:  

Yeah, I tend to think of high blood pressure along with the entire spectrum of metabolic syndrome, prediabetes and I think high cholesterol goes along with that. So your prediabetes, that also resolved under the carnivore diet?

Einar:  

Yes, yes. It improved significantly; it went away. I don’t get those blah after you have a meal. I can run all day. Let me go back a second, I did a whole video on the night after. I was feeling a bit of anxiety and I thought it was a lot of anxiety what I was feeling when I did the FMT, but because I had that surgery on my lung, I can tell changes in my breathing pattern better than most people. So I felt my lungs started stretching. I had free breathing abnormally compared to how I was breathing normal, not abnormal, but I always been breathing abnormal, so I couldn’t tell the difference. What I realized is that, children breathe through the diaphragm, so all of a sudden, I’m using my full lung capacity, I’m standing straight, like I always had like a hump, and scoliosis. All of a sudden, I’m standing super straight. Same thing happened with a carnivore diet, you start standing a lot more straight than before, your muscle mass and tone improves significantly. I’m breathing and I’m only needing to sleep 4 hours. I’m all wired, like a two year old running around the house with so much energy. I wrote like a 30,000 page book in a week. I have come down since, but those 10 days of FMT were just…

Lindsey:  

It was like Superman.

Einar:  

Yeah, and with the carnivore diet, your sleep pattern gets reduced because you get better quality of sleep. You don’t need to sleep 12; I used to sleep 12 hours today and I was exhausted. Now, four-six hours I can. I’m trying not to run a marathon because I’m done with that, but…

Lindsey:  

Feeling so good, okay, and so just to differentiate between the carnivore diet. It sounds like you did the carnivore diet and most of your things cleared up, but then you started eating some more carbs and then maybe some of those things were sort of coming back?  What was coming back or what was still an issue at the time you did FMT?

Einar:  

One of the problems with a carnivore diet for me is that I didn’t have the right bacteria to process some types of meat. So I couldn’t do dry meat, aged meat and a lot of different meats that are higher in histamine. I had to basically eat raw beef almost. I seared it 30 seconds per side. That was it. It’s not the worst life but it’s not the greatest either. When I did the FMT, it allowed me to process all these other meats I couldn’t eat before and occasionally cheat and have a normal life. I can go out and I can have sushi, and I don’t have to just eat the sashimi. I can add some rice to it. I don’t have to pay for it heavily. I’m trying not to do that every day because my research indicates that human beings are not supposed to eat as much carbs as we’re eating now. That’s seems to be the root cause of all these illnesses, or at least what then starts the illnesses progressing. That and antibiotics seem to be the issue. The carnivore diet was very interesting in that it helped me improve, but the quality of life was not the greatest when you can’t do a social life.  Eventually you get bored and blah of eating fat and lard. It’s just… you need at least a day off once in a while. 

Lindsey:  

That sounds pretty miserable. How did you assess your son’s fitness as a donor for FMT?

Einar:  

Well, I developed a very long questionnaire and probably won’t bore you with every detail, because I don’t have it open and it’s hard to remember every single step of it. I developed this for a couple of tissue banks in my career, where you have to assess a donor. It’s not just blood work, that does not tell you what the microbiome is like. The microbiome is associated with pretty much everything. If you’re losing hair or your hair is thinning, that’s a microbiome issue. If you don’t have good muscle tone, microbiome isssue. Your eyesight; your skin. I looked at my son and the first thing is okay, how was he born: vaginal birth. Ding ding, that’s a good one. Breastfed through it was one year and eight months. I exposed him to dirt and that’s a huge thing for children right now. They’re trucking, I can’t remember what European country, is trucking dirt to kindergarten so kids can play with dirt. So I had run in a previous study from Mongolia, where they find out that Mongolian people consume more dairy than anybody per capita, I think, and they don’t have a genetic abnormality to process that much dairy. And the reason is, because they don’t sterilize their dairy products. They’re still heavily contaminated with the organisms that live in the natural environment, so I let my son play with a dog. I didn’t sterilize the house, I just clean very, very normal. We go out into dirt like with cow manure and throw it everywhere in the garden. He plays; he gets dirty; he finds the dog’s . . .  sticks his hand in it. Sometimes I cringe when I say, he sticks the dog bone in his mouth. I let him do his normal things that I guess Paleolithic men were doing. That’s where they were healthy and strong. I was born in a third world country; the healthiest people are the countryside people that work directly with the farm and the animals. I did that because children are the harder target to get. You also examined the mother, because their microbiome comes from the mother. The mother doesn’t have any health issues that at least I’m aware of and you also want to see the demeanor of the person that you’re transplanting from, that the demeanor is also a big indicator if a person has depression, anxiety, sad in thought, erratic behaviors and so on.

Lindsey:  

In terms of pathogens, you did a GI Map on your son, right?

Einar:  

Eventually I did. At first, I didn’t do it because I didn’t suspect him to have any pathogens. Most pathogens show in different patterns. At the time, I had nothing to lose.

Lindsey:  

It does sound like it. I saw the GI Map from your son and I noticed that he does have H pylori in his gut. I’m just curious about your thoughts on taking in stool that has H pylori.

Einar:  

Yes, H pylori is natural. There is H pylori and then there is H Pylori and then there is an amount of H Pylori. If you read, there is a target and then there is a number. The number is below the target. So, I think the target is 10³ or 10⁴, and then the amount he has is about one log below that. That is normal and then I think below you have all the pathogenic type of H pylori, because you can consume, for example, raw food that has E coli and nothing happens because it has not switched or you could drink dairy that has Candida. You’re not going to get sick from Candidiasis.

Lindsey:  

It doesn’t have the virulence factors. I do see a lot of clients who have H pylori with no virulence factors, but they are very symptomatic. And even clients whose H pylori shows up on the GI Map below the reference range, but still again are symptomatic and very much improved after it’s gone. I’d be hesitant to be honest. I would be hesitant to take on H pylori, but as you said, you didn’t have much to lose.

Einar:  

Yeah, but you’re not going to find or is very rare to impossible to find a person without any amount of H pylori. That’s why you do the examination. Okay, you have H Pylori. Is it making you sick? No. So then you have normal, healthy amount of H pylori, right?

Lindsey:  

There’s enough of other good bacteria to keep it in check.

Einar:  

Yes and for example, my ex-wife and one of my cousins, they develop the bad type of H pylori, but they are symptomatic. If you’re asymptomatic, is very likely that H pylori is not really pathogenic.

Lindsey:  

Okay, and so, you did over 10 days, you were taking a bunch of capsules a day, did you do any kind of ongoing FMT protocol then after that?

Einar:  

No, I chose the fasting before and after 16 hours. I tried to eat a low carb diet, except for the foods I was introducing on my experiment. My reasoning is that every person has yeasts, aerobes and anaerobes. You want to say they have… let’s call it an army, let’s call it the 300. You can have about five to 25 pounds of poop in your gut. What you’re introducing is let’s just say, most companies sell about 10 grams per dose. It is a very, very small amount. The 300 is fighting the Persian army of a million. To give it a fighting chance, you have to cut down on the bad bacteria you have in your gut. So you give them a fighting chance. A lot of people just go crazy eating carbs and this is why it doesn’t work long term or if it doesn’t work at all, for most people, especially unless you get the dose that I introduced myself. I also put my son under the same diet. I increased the chances of his microbiome to be strong. My son has always been on a paleo diet with dairy and high fat. I myself am on a high fat diet and that probably helps with that.

Lindsey:  

Okay, and so just to go back to interstitial cystitis. After the fecal transplant, did that completely resolve or is there still some trace of that?

Einar:  

No, there is some trace. The frequency improved significantly around day 10 of the experiment, but eventually the frequency when I started introducing more carbs started getting worse. Right now I’m going back to eating a more carnivore diet again.

Lindsey:  

When you say carbs, are you talking about vegetables or we talking about rice? What do you…or bread?

Einar:  

Any type of carbs. Yeah. So I spoke with a Candida expert and she explained to me that the reason why her and a lot of other scientists suspect that a lot of these conditions are caused by candidiasis. The reason you can’t really eliminate it entirely is because it fits through the bloodstream directly, not through the stomach only, even if you cut off all carbohydrates and sugar, you just basically put them dormant or slow them down, but they’re still going to be there.

Lindsey:  

Your body converts protein to glucose.

Einar:  

Yeah, currently, yeah. Glucose. Sorry. Yeah. So I guess until we figure something out, I’m stuck with it.

Lindsey:  

Yeah. Have you tried reducing oxalates? Well, I guess if you’re eating meats, you’re not having any oxalates but any kind of…

Einar:  

Oxalates, I forgot the names of them. I have reduced all of that and it makes a difference on other things, but on IC the bladder, not as much. I’m going guess it’s just glucose; the issue with that.

Lindsey:  

Yeah. I see a lot of people who have urgency and maybe not an official IC diagnosis, but then when they go on calcium citrate to help absorb oxalate crystals and then also reduce their oxalates in their diet, that improves a lot.

Einar:  

I mean, you also going to get some oxalates from animals that consume these vegetables and then you’re processing because they are not already eating the natural diet that they’re supposed to be eating. We’re feeding them a high corn diet, but I can’t afford to go. I mean, a carnivore diet is already expensive enough, to do an all grass fed diet.

Lindsey:  

Yeah, I can imagine. I know you have posted several videos to YouTube. Can you tell me about what those videos are about and I’ll link to those in the show notes.

Einar:  

Well, I wanted to teach people how to do the process as asceptic as possible, because I’ve seen a lot of videos but they don’t explain a lot of things about the process in the FMT. I did an entire video on how to assess a donor based on the characteristics of the donor. I did another one explaining high histamine… so a lot of people we see or call me- SIBO is a tough one to help people with – but I did a video explaining why the histamine reaction happens because of the slowing down on the body of the food processing, that it starts rotting. You don’t have the right bacteria to clear that out of the way. It just sits there, rots and creates all these histamines and you start getting worse. I got requested to do it also in Spanish. I’m multilingual. I did a video called tricks and tips on how to process FMT because of the gagging reflex. We have been programmed to think of poop as a bad thing and then all of a sudden, you’re trying to no matter how you encapsulate it, you have to sit there, process it and smell it. It smells awful. I have worked with cadaver tissue. I have worked with a lot of things that were disgusting, but this one was the worst. I explain how to put Vicks under your nose to help you a little, it’s not a perfect thing. How to maybe run an extractor. If you’re in a bathroom or near a bathroom, how to stay away from water sources, because there can be contaminants, although poop is already heavily contaminated, but keeping pets away so the dog hair can’t just get in it or cat hair. On how to clean the area, what materials and equipment to use, what’s the right type of capsules, and the type of syringe is probably going to be more beneficial because a lot of people want to use a pipette, sounds cool, but it’s not, it gets plugged very easily. A 10 cc syringe is probably the best with a blunt tip, even if you cannot get the blunt tip, the 10 cc syringe will be good enough. I originally bought a 60 cc syringe, which was very big and bulky to maneuver, but I settled after all the equipment that I bought, on a 10 cc syringe.

Lindsey:  

Just to make sure people don’t go off and just grab their kid’s stool and start doing FMTs, I do want to say it is a good idea to test for all types of pathogens. I can link to a list of all of the different things one should be testing for. I think it’s the European consensus or something on stool testing for FMT. 

Einar:  

Yes, there is the European consensus. The FDA has some guidance. I mean, the GI Map is a good test to conduct and you have to go through a doctor. You can call him and ask him or talk to a microbiologist or somebody. I have read on reviews a lot of and I’m not, I don’t work as a microbiologist, but I work with a lot of laboratories that were under my supervision that I have I understood enough and I have to release tissue products as part of quality engineering. I can read them well enough, but I wouldn’t call me to release for other people. Better an expert.

Lindsey:  

Okay. Are there any supplements that you took in addition to doing FMT that were useful for your situation?

Einar:  

When I did it, I didn’t, because in itself, the FMT is going to be much better than any anything you can take. Later on, I discovered there are some supplements and other bacteria you can take that can help different conditions. I ran into a study that used L-glutamine to rebuild the gut, because most of our conditions seem to be linked to leaky gut or they’re causing the gut to leak for some reason. The L-glutamine, I think, study suggests that 15 to 20 grams a day and it helped about 70 something percent of people with IBS. Then I ran into a few other studies, one used S boulardii.

Lindsey:  

Saccharomyces boulardii. It’s a yeast.

Einar:  

Saccharomyces boulardii. I used that yeast. They use S boulardii to treat SIBO. So if you cannot get your hands on FMT, I would try that and then Lactobacillus casei. It’s been a couple of years since I’ve dealt with microbiology. So my apologies, Lactobacillus casei seems to help people with prostatitis or chronic bladder pain, IC of the bladder, sometimes it’s called BPS, which means bladder pain. BPS, PBS; it has many different acronyms and names. The consensus is still out there. I personally think that all of them are the same condition. This is my theory. Your microbiome is about 70% of your immune system and then your genetics are the other issue that you have. Your microbiome can protect your genetic deficiencies, if they’re still not being stressed out enough, so it protects. Once the microbiome starts dying, then all your genetic conditions start causing problems. My theory seems to make sense it’s, for example, people with schizophrenia, when you do an x-ray of their brain, you can tell that the person has schizophrenia, but not everybody that has that brain condition is schizophrenic. My theory is that it’s the microbiome that basically protects that person. There are people with a genetic trait of celiac; you don’t see them with celiac disease. It is complicated and I think that using these other ways can probably improve your odds if you’re doing. I didn’t know then what I know now. Right now, I’m taking boulardii, casei, and I’m doing the L-glutamine.

Lindsey:  

Yeah, that’s a pretty common supplement for leaky gut sealing up or concurrent with the gut healing protocols.

Einar:  

I’ve got to tell you, it’s very hard to think straight when you have all these conditions on top of you. You’re coming out of Clonazepam. So the things that are clear and simple and make sense now . . . I don’t even know how I held a job for the last 15 years. I’m still wondering about that.

Lindsey:  

You read all the studies and did all that stuff. So it great that you’ve been able to…

Einar:  

I rebuilt houses with fibromyalgia. I was passing out every now and then. Raised children… I don’t know how I did it.

Lindsey:  

Sheer will power, I think. Having a positive attitude has a lot to do with it. Because even if you’re feeling miserable, if you have a good attitude, you’re still hopeful and you just keep pushing through, then somehow . . . versus hopelessness. I can see people who are truly hopeless and it’s a heck of a lot harder to push through.

Einar:  

I want to do a video on this, but I don’t really know how to do it. I don’t really like videos that much but I get people calling me on they’re like: “I’ve been suffering for a couple of years.” And I’m like: “try 40.”

Lindsey:  

Just to back up, what do you think destroyed your microbiome? Did you take a lot of antibiotics or…

Einar:  

Yes, when I was around 10, I was very thin and the doctor thought that there was a bacteria in my gut that he needed to kill. I was given an abnormal overdose of tetracycline. I do remember that. I developed a lot of skin cancer since. It was like every year. That also seems to have stabilized.

Lindsey:  

Skin cancers?

Einar:  

Oh, god, yes.

Lindsey:  

As a child? 

Einar:  

From age 12. Yeah.

Lindsey:  

Basal cell carcinoma, not like melanomas?

Einar:  

All of them. 

Lindsey:  

Really, even melanomas?

Einar:  

Yeah. I had several melanomas, one of them in late stages. It almost entered my bloodstream. It was about an inch, inch and a half in diameter. I am a human wreck. I’ve got more stitches than a baseball.

Lindsey:  

I’m glad that one didn’t go metastatic! . . . Well, thank you so much for sharing about your experience with us. It’s very interesting.

Einar:  

It’s been an absolute pleasure. Anytime you need to reach out and talk to me about anything. I’ll do my very best. I’m not an expert on all of this because it’s not my full time job, but I do what I can to help people because I know what you suffer, what I’ve gone through. This is not good.

Lindsey:  

Well, I appreciate you coming on!

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

Adapted from episode 70 of The Perfect Stool podcast and edited for readability.

I’m going to start with some basics about autoimmune disease and then get into how it relates to gut health, because the two are all tied up together. 

For those who don’t know, autoimmune disease is where your immune system attacks your own body’s cells, tissues and organs. I personally have two autoimmune diseases, which you may have heard me talk about on other podcasts: Hashimoto’s thyroiditis and post-infectious IBS. The latter is when a protein called vinculin that’s involved with the migrating motor complex, attacks my small intestine, which creates stagnation in the small intestine and bacterial overgrowths. I did receive a third autoimmune diagnosis in 2013 of ITP or idiopathic thrombocytopenia, which is an autoimmune disease impacting your platelets. However, the doctor has subsequently told me he didn’t think I ever had it, as the diagnosis criteria have changed. And I was also diagnosed at one point with pernicious anemia, which is an autoimmune attack on the parietal cells lining the stomach, which leads to malabsorption of vitamin B12, but have since had negative antibodies there, so I don’t consider that a current diagnosis. 

If you think of individual autoimmune diseases like Hashimoto’s thyroiditis, lupus or rheumatoid arthritis, you may not think it’s all that common, but when you add up all the different autoimmune diseases, it comes to more than 50 million Americans impacted, which is a threefold increase in autoimmunity over the last 50 years. Interestingly 78% of those impacted by autoimmunity are women. 

Other than the ones I just mentioned, some of the other most common autoimmune diseases are Celiac disease, Grave’s disease, Type 1 Diabetes, vitiligo, scleroderma, psoriasis, inflammatory bowel disease, Addison’s disease and Sjögren’s. There are more than 100 autoimmune diseases that are either systemic or attack individual organs. 

Based on twin studies, about 25% of autoimmune disease can be attributed to genetic causes versus 75% environmental causes. In reality, it’s always a combination of genetic and environmental factors that lead to the manifestation of an autoimmune disease. Thanks to the work of Dr. Alessio Fassano, a world-renowned gastroenterologist and gluten intolerance expert who is chief of Pediatric Gastroenterology and Nutrition at MassGeneral Hospital for Children and Director of the Center for Celiac Research and Treatment, we know that there are three necessary precursors to autoimmunity:  a genetic predisposition, an exposure to a trigger such as trauma, stress, toxins, the use of certain medications or exposure to an antigen, and intestinal permeability or leaky gut.

Now before I delve deep into gut related infections and triggers, let me just mention the other autoimmune triggers. So in terms of antigens, which are toxins or other foreign substances that induce an immune response in the body, there are viruses like Epstein-Barr Virus, aka mononucleosis, including a reactivation of a prior infection, cytomegalovirus, mumps, rubella, Herpes simplex virus and Hepatitis C. Then toxins can come from your diet and the environment, including chemicals and heavy metals, which can provoke intestinal permeability and other gut health problems, which we discussed in my last podcast. 

In terms of medication-induced autoimmunity, one of the most common is drug-induced lupus, in which more than 90 medications from more than 10 drug classes have been implicated.  Don’t think this is just rare, unusual drugs.  There are case reports of drug-induced lupus from drugs as common as statins, antibiotics, PPIs and NSAIDs. And there are even reports of drugs used for other autoimmune diseases, called TNF blockers, that have induced lupus syndrome.

Other autoimmune diseases for which drugs have been implicated include RA, polymyositis, dermatomyositis, myasthenia gravis, pemphigus, pemphigoid, membranous glomerulonephritis, autoimmune hepatitis, autoimmune thyroiditis (Hashimoto’s), autoimmune haemolytic anemia, Sjögren’s syndrome and scleroderma. 

Now let’s zero in on the relationship between autoimmunity and gut health, starting with the role of leaky gut or intestinal hyper-permeability. I did a whole episode just on leaky gut on March 17, 2020, so you can check that out if you want to go super deep on this topic. There are several ways in which the gut can become permeable. First, you can have openings between the cells lining the intestines or the enterocytes, whose tight junctions hold them together, but also allow for them to open up and let nutrients and water through. When there’s dysfunction, they open too wide and for too long. This has been observed in celiac disease and gluten sensitivity in particular, but can also happen with other food sensitivities. The most common culprits are other grains that may be gluten free, in particular corn; pseudograins, including quinoa, amaranth, buckwheat and chia; diary; eggs; nuts; seeds; legumes (in particularly soy and peanuts) and nightshades (which are tomatoes, eggplants, potatoes and peppers). 

I believe that most of the more obscure food sensitivities are secondary to a gut infection, dysbiosis, stress, a poor or very repetitive diet or some other cause, although I have found that gluten, dairy and nightshades tend to be common primary causes. 

You can also have a permeable gut because a substance or infection causes direct damage to the enterocytes, or cells lining the intestines, which actually creates a hole in the lining of the intestines. This can come from certain foods containing lectins. There are two potentially harmful subclasses of lectins, called prolamins (found in grains, legumes and pseudo-grains, including quinoa, rice, peanuts and soy) and agglutinins (found in grains, pseudograins and nightshades). Legumes also contain saponins, another substance that can harm enterocytes. Keep in mind that even though there may be negatives associated with legumes (meaning beans, peas and lentils, but not including green beans, snow peas or sugar snap peas), overall they are super healthy foods with high fiber and the lectins and agglutinins found in them can be reduced by soaking, sprouting and fermenting.  They’re also deactivated by the heat during prolonged cooking, so if you do need to go off these foods for a time while healing your gut, you should eventually try to reintroduce them, if you’re cooking them properly. Some beans are worse than others, such as soy, peanuts and kidney beans, and the agglutinins found in them are more resistant to deactivation than others, so if you do have an autoimmune disease, you may want to steer clear of those ones forever, and the others until you are feeling better, and then slowly reintroduce a variety of legumes rather than focusing on one or two. 

Two other potential disruptors to proper digestion and mineral absorption that can cause a leaky gut are digestive enzyme inhibitors and phytic acid or phytates, which are both found in raw nuts and seeds, which is why when you have too many nuts you get that full, bloated sensation. If kept in low quantities, it’s fine. But if you really want to clean up your nuts, you can soak them in salty water then dehydrate them.

Finally, the more obvious and common culprits of damage to enterocytes in a standard Western diet are alcohol and synthetic food additives. 

An autoimmune paleo diet systematically eliminates these potentially problematic foods and then reintroduces them slowly so you can test your body’s reaction. While some people may need to eliminate these foods long-term, especially if they experience autoimmune symptoms when they’re reintroduced, many can be reintroduced in reasonable quantities in the context of a varied, healthy, whole-foods diet. 

Another potential cause of leaky gut is a gut infection causing damage to your intestinal lining. This includes parasites like Blastocystis hominis and giardia, as well as bacteria such as Yersinia enterocolitica, Helicobacter pylori, Klebsiella, Campylobacter, E. coli, an overgrowth of proteobacteria and Borrelia (the bacteria that causes Lyme disease). Gut tests like the GI Map, which I have many of my clients order, reveal most of these types of hidden infections and dysbiosis. 

Let me just mention that while many healthy people have Blastocystis hominis in their guts, there are two different types – the amoeboid form and the protozoa form. While the former is associated with chronic hives and adheres to the gut cells more, the latter is not, which may be one way to distinguish a Blastocystis hominis infection that should be treated versus one that can be left alone. 

Then SIBO or small intestine bacterial overgrowth, can be another cause of leaky gut. This can happen for a whole slew of reasons related to either low stomach acid or slow motility in your small intestine. However, a prior episode of food poisoning is one culprit that can lead to post-infectious IBS like I have, where you have elevated vinculin antibodies, which are tested using the ibssmart test. When you have that, you’ll likely have a lifelong struggle with SIBO, but it is manageable. 

And of course, invasive candidiasis can lead to intestinal permeability when the candida turn into their hyphal form and send tentacles out through the gut epithelium or lining. Note that we all have candida in our gut, but it can grow out of control due to a poor diet, stress and certain medications, including antibiotics. 

Speaking of stress, 80% of patients reported serious emotional stress before the onset of their autoimmune disease. Why would this be? Chronic stress leads to elevated cortisol levels. This leads to decreased digestive function, lower secretory IgA, which is your gut immune defense cells and elevated blood sugar. This opens you up to first gut infections, when your gut immunity is decreased, as well as poorly digested food, which has proteins that can trigger autoimmunity when they escape out of a leaky gut from a gut infection. 

Which gets us to the mechanism for autoimmunity. So when you have a hyper-permeable gut lining, and especially if you aren’t digesting your food well, which can be from a lack of digestive enzymes or hydrochloric acid from a variety of causes, undigested proteins will escape out into your system and trigger your immune system. When your immune system is triggered against certain proteins, it can also end up attacking similar proteins in your body. This is especially the case with gluten and Hashimoto’s thyroiditis, which I have, because the gliadin protein in gluten resembles the cells in your thyroid gland. However, studies have shown gluten to be an issue in many autoimmune diseases, and in creating intestinal permeability, so if you have any autoimmune disease, gluten is the first thing to eliminate for the long-term. 

Another contributing factor in Hashimoto’s and leaky gut can be a depletion of two key nutrients for gut health: l-glutamine, which is an amino acid, and zinc. Both are necessary for rebuilding the gut lining. They can often become depleted because of high stress, because they are also used in producing adrenal hormones. You’ll find zinc carnosine, the form especially good for the gut lining, as well as l-glutamine in leaky gut sealing powders like GI Benefits, which you can find in my Fullscript Dispensary. Before you go out and buy that, if you think you have a leaky gut, note that I generally don’t recommend using something like that until you’ve healed or while you’re healing SIBO, SIFO (aka small intestine fungal overgrowth) or other gut infections. 

Given it’s one of the most common autoimmune diseases and one I’m very familiar with, and because it has a special relationship with SIBO, I’ll just go a little deeper on Hashimoto’s, which is the cause of about 80% of the cases of hypothyroidism. First, it was found in one study that more than 50% of people with hypothyroidism had SIBO as well, because the slowing of your metabolism from being hypothyroid causes a slowing and stagnation in your intestines leading to bacterial overgrowths. This is often the case with constipation-related SIBO. But of course it can occur the other way around – where SIBO causes a leaky gut that leads to Hashimoto’s and hypothyroidism, as I already mentioned. Symptoms of hypothyroidism include constipation, pale dry skin, hair loss, muscle aches, weakness and tenderness, a goiter, a puffy face, brittle nails, excessive or prolonged menstrual bleeding, enlargement of the tongue, memory lapses, depression and joint pain and stiffness. If you have a TSH or thyroid stimulating hormone test and your level is above 2.0 (which is still within the standard reference range but not the optimal one) and you have any of those symptoms or symptoms of SIBO, I’d recommend asking for further testing including thyroglobulin antibodies and thyroid peroxidase antibodies to rule out Hashimoto’s. If you have SIBO, I’d recommend asking for your TSH to be checked because if your hypothyroid is caused by Hashimoto’s, then you can address it naturally, starting with gut healing and removing gluten and dairy from your diet, as well as testing and replenishing key nutrients. Left unchecked or just medicated with standard thyroid medications, which are important and necessary if you’re hypothyroid, Hashimoto’s will gradually destroy the thyroid gland, enlarging it and inflaming it. That was what my doctor told me would eventually happen to me in 2013 when I was first diagnosed. Happily, 9 years later, because I’ve done all the natural things I could to reverse the process of autoimmunity, my TSH levels remain normal and my antibodies have been normal for about 2 years now. 

Reversing Autoimmunity

Ok, now on to what to do if you have an autoimmune disease and want to try to put into remission and reverse as much as you can of the damage to your body. This is a brief summary, but I work with people to help them do this, so please reach out if you need some help. 

First, work to identify any food sensitivities using at minimum an elimination diet for 4 weeks of dairy, gluten, added sugar, artificial sweeteners (but stevia and monk fruit extract are ok), alcohol, processed foods, processed seed oils, soy and corn. If you have a very debilitating autoimmune disease, then I’d go full on a full autoimmune paleo diet (AIP) and also eliminate other grains, pseudograins, caffeine, nightshades, legumes, eggs, nuts and seeds, including spices derived from nightshades and seeds. There’s a specific way to eliminate and reintroduce foods on the AIP diet. Also, for some people, another helpful adjunct in decreasing immune activation and food sensitivities is proteolytic enzymes. One particular brand, Wobenzyme, has been studied and found to be particularly helpful in decreasing Hashimoto’s antibodies when taken in large doses on an empty stomach. 

Second, do stool testing or Organic Acids testing to determine whether you have any gut infections. Even if you’re not symptomatic, sometimes a combo of different gut pathogens combine to mean you have neither diarrhea nor constipation but you may still have an issue that’s causing inflammation and a leaky gut. Of course, if you have any gut symptoms, then that’s definitely a likely factor. Usually herbal antimicrobials, probiotics, prebiotics and polyphenols, through diet or supplements and digestive supports like Betaine HCl to replace low stomach acid, pancreatic enzymes or bile support may be needed, depending on what is found on your tests. 

If nothing comes up in your gut testing, you may need to be tested for other viruses like Epstein-Barre to see if there’s been a reactivation there, so you may need some antiviral support. 

Third, after gut infections are dealt with, a gut sealing and healing supplement is helpful in sealing up a leaky gut and rebuilding the gut lining. 

Fourth, you may need to test for and address nutrient deficiencies of key nutrients like vitamin D, omega 3 fatty acids, B vitamins, selenium, zinc and magnesium, which can also be a factor in autoimmunity, or at minimum take a multivitamin, fish oil and any other nutrients that show up as deficient on an Organic Acids Test. Testing for nutrient deficiencies and supplementing where necessary gives your body the tools it needs to modulate your immune response, fight bacteria and viruses and support an appropriate inflammatory response.     

Fifth, another factor that can often impede healing is a congested liver that is overloaded dealing with toxins, which can be identified on an Organic Acids Test. If you find this, there are certain supplements that are recommended to support your liver in detoxifying your body. In initial interviews, I also ask people about signs of potential heavy metal toxicity and mold exposure. But other basics like making sure your water is pure and you’ve eliminated toxins in your personal care products, cookware and food is important in decreasing the burden on your liver. 

Sixth, since stress is so intertwined with autoimmunity, finding and addressing causes of stress, and managing unchangeable causes is an important step. This may involve starting therapy, ending toxic relationships, leaving a stressful job, or a program of meditation, mindfulness, prayer, yoga or breathwork. 

Finally, and probably the most important step, is persistence. Reversing autoimmune disease doesn’t happen overnight. It takes long-term persistence and commitment to yourself and caring for your health. I was diagnosed with Hashimoto’s in 2013 but didn’t see my antibodies normalize completely until a couple of years ago, so it took patience to eliminate foods and change my diet, clean out my liver, stabilize my nutrients, work on my gut health issues until they were truly under control and then stick with all those positive changes over time. Of course, the rewards are great if you can persist.

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

Adapted from episode 70 of The Perfect Stool podcast and edited for readability.

Wendie Trubow, M.D., MBA is a functional medicine gynecologist with a thriving practice at Five Journeys, and is passionate about helping women optimize their health and lives. Through her struggles with mold and metal toxicity, Celiac disease, and other health issues, Dr. Trubow has developed a deep sense of compassion and expertise for what her patients are facing. She is the co-author of Dirty Girl: Ditch the Toxins, Look Great, and Feel Freaking Amazing!

Lindsey: 

So I understand that you started your career focusing on gut health. So I’m wondering what got you into gut health, and then what moved you towards a focus on toxins?

Dr. Wendie Trubow: 

I think at the end of this conversation, you’re going to think that I’m completely self-focused. But as a celiac who was undiagnosed for many years, my gut was a hot mess and so I really naturally gravitated toward that, because I wanted to fix my own struggles. Then I saw the impact of how much of a difference it made for my patients and then simultaneously, I fell into the toxins hole because I was full of them and had a sort of second health crisis in my late 40s. So that really then served as the jumping board, springboard, for developing all my toxins expertise, because, again, I was struggling really badly and had to learn about it so I can fix myself, so I can take care of people.

Lindsey: 

Interesting. Now, when you say your gut was a hot mess from celiac, so that other people who might have celiac could potentially hear their symptoms called out and go, “Oh, maybe that’s what I’m going through.” What might that look like?

Dr. Wendie Trubow: 

Sure. And I think I would broaden it to not just celiac because you can have gut dysfunction, and not have the autoimmune component of it. If you think about it, a gluten allergy doesn’t just develop overnight for most people; it’s slow and steady and goes from no reaction to a little reaction, which could be some gas or bloating after eating. Then you maybe get constipated or maybe you have some diarrhea, or maybe then you get an irritable bowel. So it’s this whole progression of symptoms. I kind of had all of the above: I had stinky gas, bloating, constipation some days, and then some days, same day constipation and diarrhea, or maybe back and forth between them in any given day. Then the celiac part, the part where I had the autoimmune issue, was where it started to impact outside of my gut. So because of the celiac, it causes this degradation of the lining of the gut, you don’t absorb your minerals and nutrients properly. So I had mineral, nutrient deficiencies and that was ranging from iron to magnesium to B12 and folate; often celiacs have osteoporosis because they don’t absorb the calcium and the vitamin D. So I kind of had all of the above without the osteoporosis; and then head to toe issues so brain fog. I’m not an anxious person, but I had anxiety and difficulty synthesizing information: so executive function was impaired, I had thyroid disorder, I had heart palpitations, asthma, all the gut stuff, fertility challenges, bad periods, heavy periods, the wasting… I was wasting, like I was about 10 pounds lighter than I am now.

Lindsey: 

So a lack of nutrients will kind of destroy your body all over?

Dr. Wendie Trubow: 

Yes, yes. Head to toe. It was a mess.

Lindsey: 

Okay. And I imagine with all that, lack of B-12 and iron, you must have had some fatigue?

Dr. Wendie Trubow: 

Oh, yeah, I didn’t mention that.

Lindsey: 

I didn’t hear that one.

Dr. Wendie Trubow: 

Sorry, I got out of bed because I was the primary breadwinner and otherwise I would have been quite happy to stay all day in my bed curled up.

Lindsey: 

Yeah. Well, I have to say I had one client who came just for one appointment. And he had not been diagnosed with celiac until he was in his 60s. So you can imagine the fatigue that builds up over that many years of poor absorption of your nutrients?

Dr. Wendie Trubow: 

Yeah, yeah.

Lindsey: 

Okay, so tell me what the connection is between toxins and gut health?

Dr. Wendie Trubow: 

Sure. It’s so great. It’s creepy, but it’s awesome. So there’s a million levels at which this occurs. So toxins themselves irritate the gut: just flat out irritate the gut. If you do quote unquote everything right and you just can’t get a handle on your gut, it’s often because there’s this underlying thing called a toxin, which I’m referring to heavy metals, mycotoxins, which are the mold that when mold gets in you, it puts out these toxins called mycotoxins, or others like gasoline fumes, nail polish, phthalates, BPA, all that stuff that in the other category, so that flat out irritates the gut, A. B, if you’re somebody who has toxins, it’s creating this enormous pull on the body to detox and in order to detox you need to have your adrenals, your liver and your gut in good shape because your liver is responsible for in some way converting the toxins into a water soluble form that you most often poop out. But if you have dysfunctional poop, so say you’re constipated, and the poop is just sitting there and your gut not moving properly. You have you have these enzymes called beta glucuronidase and their job is throughout the body, but in the gut, what they’re doing is taking the toxins that your body has already packaged up nicely with a binder and they’re separating it from the binder. Now remember, I told you it’s water soluble to go be pooped out; the minute you separate it from that binder, it becomes fat soluble; it can’t stay in the gut; it gets recycled into your body; it’s super toxic. Your body freaks when it sees it; you put it in your fat. So if you have any dysfunctional processes in the gut, and by the way, any gut dysbiosis can have inappropriate secretion for beta glucuronidation for some of these nasty bacteria, so it’s like circling the drain, right? You know, you have this toxin that irritates the gut, the gut gets thrown off and then it doesn’t properly function and then you can’t get rid of your toxins. You just keep going around in circles.

Lindsey:

So the beta glucuronidase when elevated is an indication of some improper processes and the toxins are becoming recirculated?

Dr. Wendie Trubow: 

Yep and by the way, Lindsey, it’s not just toxins that you think of like bleach; its toxins like hormones, which can be toxic.

Lindsey: 

Right, of course, and a potential cause of breast cancer is elevated.

Dr. Wendie Trubow: 

Yep.

Lindsey: 

Recycling of estrogen.

Dr. Wendie Trubow: 

Yeah, yes.

Lindsey: 

I know, I have a client in this very situation.

Lindsey: 

Oh, no. No, I’m sorry to hear that.

Lindsey: 

Post breast cancer situation: elevated beta glucuronidase, but we’re bringing it down.

Dr. Wendie Trubow: 

We’re going to fix that, right?

Lindsey: 

Yeah. Okay, so are there specific conditions that have their root in toxins? Like, does it tend to to be more one condition than another or could it be any of the IBDs, IBSs etc.?

Dr. Wendie Trubow: 

Yeah, can really be any of them because it’s just how your body is responding to that particular stressor. You know, I get this question a lot. Why? Why is this my symptom and not that, or why am I having any symptoms? And I’m like, well, that’s just how your body’s processing it. So you really can run the gamut from just bloating, just gassiness. You could have poor digestion of stools or IBD, IBS, etc. I mean, it runs the gamut; you can develop anything from exposure to toxins.

Lindsey: 

Oh, speaking of which, I’m wondering, do regular doctors test beta glucuronidase? Or is this only within functional medicine?

Dr. Wendie Trubow: 

No, ma’am. That is a functional medicine test.

Lindsey: 

Okay. And I was just curious if it was the kind of thing that you could get an easy follow-up at the doctors, but obviously not.

Dr. Wendie Trubow: 

Nope, nope.

Lindsey: 

And so do toxins have an impact on your hormones?

Dr. Wendie Trubow: 

Yeah. So again, it’s like circling the drain. So some of these xenoestrogens that we get from plastics, they mimic the estrogen in your body and they look kind of like estrogen enough that your body goes down the let’s process you like estrogen pathway. And so it all ties together. So if you have these toxins, they look like your estrogens, then you’re not processing your estrogens properly. You can also go down the harmful processing of estrogens pathway with these xenoestrogens, when they wind up in your gut and they confuse the body. So that’s one part to it. But then, if your hormones are not properly processing, that can make it more difficult to deal with your toxins. And because a lot of it winds up in the gut, it throws the gut off. It really is this big circle of dysfunction.

Lindsey: 

So when you have the xenoestrogens in your diet, does that then increase your estrogen? Decrease your estrogen? How does that work?

Dr. Wendie Trubow: 

Yeah, so if you imagine that there’s 100 people in a room and the door is a foot and a half wide. So basically, one person can go through that door at any one time. Say now there’s a fire in the room and everyone’s trying to get out of that door but still that door is only a foot and a half wide. You have essentially people building up in the room trying to get out; that’s like your hormones. So your body can deal only with what it can deal with. But when you start to pile on,  there’s xenoestrogens in the room, there’s estrogen in the room, there’s testosterone, there’s progesterone; they’re all piling on. Essentially you’ve flooded your body’s ability to take care of it so one can increase the other and vice versa. So they’re tied in together.

Lindsey: 

Okay. And then what are your sources of xenoestrogens typically? I mean, you mentioned the plastics, but how far do you have to go in trying to eliminate that? What’s a reasonable way to work on that particular problem?

Dr. Wendie Trubow: 

Yeah, I mean this is not just limited to xenoestrogens. I think the question is, how can we systematically decrease our exposure to things that really increase the risk of making us quite sick, right?

Lindsey: 

That’s right.

Dr. Wendie Trubow: 

So when you take it from this big picture, look, you go, “Okay.” Really easy, low hanging fruit for a lot of people is how do you level up on your food: start with food, it’s foundational. You do it every day, multiple times a day. So aim for food that’s minimally processed, organic, if possible, local, and in season. That’s sort of the basis and then with that goes your drinks. So don’t drink anything from a plastic bottle because that’s a source of the xenoestrogens. Don’t drink alcohol because alcohol is straight up a toxin. And so that makes it harder for your liver to deal with the other stuff it’s being presented with because it’s busy dealing with a more important toxin, essentially. Alcohol will directly kill you if you don’t deal with it so your body knows we have to deal with this and get rid of it. So that’s the easiest way. And then all of us through our lives have exposure to hundreds of chemicals throughout the day. So what I say to people is, pick the thing you’re running out of, I don’t care what that is, whatever you’re running out of: be that house cleaner, weed killer, makeup, deodorant, hair products; it doesn’t matter. That’s an ideal moment to go to either Think Dirty, or EWG.org and look to see, what’s a better option here? What’s something where I can get three steps better, or 10 steps better? Depending on how bad it is, right? Maybe it’s really bad and you want to go a lot or maybe it’s not so bad. And you go, you know what, this isn’t a priority right now. But to systematically do that throughout your life as you start to run out of things.

Lindsey: 

Okay and so we’ll get back to the toxins and getting rid of them in a minute, but I wanted to ask first, what is the best and most economical way to test for the various toxins?

Dr. Wendie Trubow: 

Sure. So I’m not clear that I can say it’s necessarily economical straight up. The testing is a little bit pricey so, we use urine testing. You can test in the blood, but for metals, that’s only indicating if you had an acute exposure. You know, like the kids in Flint, Michigan, they have acute exposure; their lead levels are elevated, but for the rest of us, we’re not getting acute exposures, so blood’s not that accurate for that reason. We use urine, and the metals testing is not that expensive to test for. The system we use, it’s $69 for the test; you do two of them, because you always do a baseline and then you do a provoked test, and the provoking agents cost like, I don’t know, 35 bucks, so it’s not that expensive.

Lindsey: 

And what do you provoke with?

Dr. Wendie Trubow: 

We provoke with DMSA. And that’s pretty cheap to test because there’s so many prongs to treating metals, the treatments more expensive, but the testing is cheap. And then we usually do a urine test also, for the mycotoxins, the other environmental toxins and the pesticides and glyphosate. You can break those up or you can do them all together. So if you do them all together, it’s 500, just under six, $560, basically, which is not cheap. You can break them up, so it’s like 300, 201 and 100; you can do them piece meal, but you are going to need to see a functional medicine provider because your conventional doctor doesn’t have these tools in the office. It’s like going to the mechanic and asking for a haircut. Right? It’s just the wrong access.

Lindsey: 

So the $69 test is that urine for metals.

Dr. Wendie Trubow: 

Yeah, that’s urine for metals. It’s a cheap test.

Lindsey: 

Okay, what about hair testing?

Dr. Wendie Trubow: 

I’m not a huge fan of hair testing, personally, because hair testing is showing what your body’s basically voluntarily getting rid of, and this is for metals not for mycotoxins; you’re not going to see it there. For metals, it’s really only looking at water you’re kind of voluntarily excreting; it’s not looking at what’s stored, because 95% of your lead in particular is stored in your bones. You’re not going to see that in your hair. You know, it’s like a fraction of what’s really present.

Lindsey: 

But it would be in the urine.

Dr. Wendie Trubow: 

Yes. Well, when you provoke it.

Lindsey: 

Right. Okay, so you take the DMSA that prompts your body to start releasing toxins and then you see.

Dr. Wendie Trubow: 

Yep.

Lindsey: 

Okay, got it. How far apart? Or how long will you treat with DMSA before you do a provoked test?

Dr. Wendie Trubow: 

It’s the same day: what we do is we say to people, we need a baseline, “Get up and pee”. That’s the test. That’s the first $69 test. And then as soon as you’ve emptied your bladder, you’re starting with a clean slate. So take your DMSA and we collect for six hours; for six hours, collect that information and then at the end of six hours, empty your bladder so you complete the test at six hours. And that’s what we’re comparing against. We treat people if they have high levels; we treat over eight, which is just the reference range for that lab. Say someone comes in and for example, they have no hair anywhere on their body. I’m sure we’re going to see high levels, but say we didn’t; say their detox is so shut down, you don’t see it. We’re going to treat them anyway and keep monitoring them.

Lindsey: 

Okay, so no hair would be a sign of toxins.

Dr. Wendie Trubow: 

Yes.

Lindsey: 

Okay. And so how much DMSA will you give them then?

Dr. Wendie Trubow: 

It depends on how big you are and how old you are. So I don’t treat kids so I won’t speak to the dosing for that; for our adults as long as they’re a normal weight, we’re going to give them 1500 milligrams, and then we have that compounded by a pharmacy.

Lindsey: 

Okay, so you mentioned there’s the metals, then the mycotoxins, and then there’s also the all the pesticides right?

Dr. Wendie Trubow: 

Yep.

Lindsey: 

Are these Great Plains tests*?

Dr. Wendie Trubow: 

Yes. This is who we use. Yeah.

Lindsey: 

Okay. And then other… is that a whole separate one?

Dr. Wendie Trubow: 

Well, it’s on the same Great Plains test, but that’s all the stuff that we’re exposed to throughout our life. So the MTBE which is the gasoline fumes, the styrene plastics, asparagine, the burnt foods, tobacco, smoke; all of the chemicals in all of these things: makeup, nail polish, hair products; all of these things are captured in this test. And so it’s looking at all of them and really, I typically look for a level of 75 percentile or above, at around the 75th percentile and like, “Hey, we got to treat this.”

Lindsey: 

Got it. Okay, and what kind of gut conditions might prompt you to think that there could be a toxin issue?

Dr. Wendie Trubow: 

So we do a ton of toxins work in our practice, because we get a lot of people who say, “Okay, I eat right, I’ve done a stool test, I fixed my dysbiosis; I fixed my SIBO; I don’t eat gluten, do everything right. And I’m still not right. You know, I have this irritable bowel or bloating, gas, diarrhea, any of the above, right?” So if you do everything, right, and you’re still having symptoms, that deserves a toxins look, because what else is it; unless you’re so super stressed that your body can’t process? It’s a toxins issue.

Lindsey: 

And so talking about getting down to the level of specific toxins, what are the most common sources say of lead?

Dr. Wendie Trubow: 

This is great. So for lead, the most common sources are lead pipes, living in a house built before 1978, because almost all of them had lead in the paint. And everyone says to me, “Dr. T., I’m not licking the walls.” I’m like, dude, I know. I know, you’re not licking the walls. However, as that house settles down, you’re getting exposed to all of the lead dust and you absorb it in your skin; you breathe it and you touch it; you eat it, so you’re absorbing it in various ways. The most likely causes are living in homes built before 1978 or lead pipes. However, there’s lots more causes and one of the other really subtle ones is being born to someone who had lead in their system who also nursed you, because it will cross the placenta and it does come out in breast milk. My poor kids, right? I’ve got four kids; I nursed them all and I was like, “Nursing is a detox event for the mother.” And tox up event for the kids.

Lindsey: 

Perfect example of this: I have a friend who got really sick at a workplace she was at. I’m not sure what ultimately contributed to it, but during her pregnancy, she felt healthy. And then her son ended up with all these food sensitivities and allergies. And then as soon as he was out, you know, then she was really sick again. She was just transferring all those toxins to the baby the whole time.

Dr. Wendie Trubow: 

We’re so generous to our children, right?

Lindsey: 

Exactly. Okay, how about aluminum? What are sources of aluminum?

Dr. Wendie Trubow: 

Aluminum is usually just aluminum foil and that’s actually one I look at less. I usually focus on lead, mercury, cadmium, thallium and arsenic. The big five. Mercury… it’s so funny, Lindsey. So Mercury is fish and fillings. The fillings are the mercury amalgam silver fillings and even having one in you is enough to create problems for some people, and then the heavy mercury fish. So what’s horrifying is that as wildfires occur, say in California, they release all of the stored mercury in the forests. That mercury gets into the water system, which gets converted to methyl mercury, which the fish eat, it hangs out in their bodies. They can’t excrete it any better than we can. Then we eat the fish. So one serving of a heavy metal fish such as Mahi Mahi, tuna, swordfish, tilefish, Chilean sea bass; one serving, theoretically, it has enough for like a month’s supply of mercury. But if you’re someone like me, who’s not the best detoxer, I say to my patients, you should not be eating that period. It’s not like, “Oh, once a week.” It’s like no; we’re not going to eat that. It will make you sick.

Lindsey: 

I think I literally had just Chilean sea bass last night. I never thought of that.

Dr. Wendie Trubow: 

 I know, right? All the super yummy fish are high in mercury.

Lindsey: 

I think that is what I had last night.

Dr. Wendie Trubow: 

Oh, can I tell you a story? So we have a patient in our practice who had no hair when she came to our practice. And she was just told by… of course people see 20 doctors. If you have no hair, you keep going to doctors. So she came to us and she had seen 10 doctors. All of them had said to her, “Oh, you just have autoimmune alopecia. Nothing to do. Sorry.” So she came to us and she saw my husband first. I stole her from him. She saw my husband and he looked at her. He said, “You have heavy metals.” She had really high levels of lead. So this was about just under two years ago, just as the pandemic was starting she came in to us. She has been successively working on her hair and last year her hair started to grow back. I saw her two weeks ago in my practice; and she said to me, “I feel like I’ve plateaued.” Now by the way, what I will say is she has about two inches of hair growth all over her hair and she now has to go back to waxing and shaving and plucking because she’s grown hair in all the places women tried to get rid of it. But I was like, you know it’s a mixed bag, buddy. No hair on your head, but you didn’t have to wax, but now it’s the reverse. So she’s growing hair on her head but she said, “I feel like I plateaued.” And I said, “So what’s going on? Let’s drill into it.” Well, she was down at a remote job. And as a treat, one to two times a week, she was eating sushi. And I said, “Okay, well, what kind of sushi? Are you eating? You know, what are you having? Are you having salmon? What are you having?” She said, “I’m having tuna.” I was like, “Oh, no. We just got all this metal out of you. You can’t do that. You don’t have good detox.” So I said to her, “That’s it. Like, I hope you enjoyed your last meal. Because no more of that. It’s too much.”

Lindsey: 

Yeah and so do you think you can get away with the safe canned tuna though?

Dr. Wendie Trubow: 

Yeah. As long as they’re testing for mercury, there’s a number of brands that will test for mercury and canned tuna. So yeah, that’s reasonable.

Lindsey: 

It’s Vital Choice* and Safe Catch* that I know… Okay, so yeah, I had my last mercury fillings removed. And I was glad I went to the dentist I went to, although it cost me a pretty penny, I had it replaced with gold. I’ve got two gold fillings and I feel like I’ve got my bling in the mouth.

Dr. Wendie Trubow: 

The price of gold; you’re kind of like a kidnapping risk.

Lindsey: 

I know, seriously, they’re each like $1,000. But I mean, given the number of years I have left to live and you know, the composites are not supposed to last that long. So I had to make my choice. If somebody is getting their mercury fillings removed, I know you should go see the biological dentists and all that. But say you can’t afford that; you can’t do that. What could you ask your regular dentist to do to just keep you safer or what can you do yourself?

Dr. Wendie Trubow: 

Let’s look at things you can do yourself, because I can’t really speak for whether your dentist is going to say yes or no, but I can make some recommendations. So things you can do yourself: one, don’t eat any high mercury fish period. Okay. Particularly as you’re approaching this. Two, on the days preceding the mercury, I would take activated charcoal; especially the day of, take a couple of tabs of activated charcoal in the morning. Then when you get home, take a couple of tabs of activated charcoal and ideally fast so that you’re not bothering your body. It has to digest foods; you’re just focusing on binding the metals because a charcoal will bind to your food too. So don’t take it with your food. So take the charcoal, eat lightly, increase glutathione for a couple of days before and at least a couple of weeks afterwards.

Lindsey: 

By taking glutathione?

Dr. Wendie Trubow: 

Correct, Yeah.

Lindsey: 

Like liposomal?

Dr. Wendie Trubow: 

Yeah, the best one is by Quicksilver, which is a liposomal form. We have another one, it’s called SafeCell glutathione (find both in my Fullscript Dispensary*). It’s a liposomal in a gel, which is easier for people who don’t want to refrigerate it or can’t remember to take it.

Lindsey: 

It’s a Tesseract product, isn’t it?

Dr. Wendie Trubow: 

Yep, yep. So that’s a great product and then you can also do simple things like cilantro, parsley and chlorella help. All these things are super helpful, so I would say load up on those for the days preceding, the days after and the day of so that you give your body every opportunity to bind those metals. By the way, don’t drink any alcohol because your liver can’t deal with metals and alcohol. Yeah, too much. Do all those things. Then if you can find a functional medicine doctor who will give you metal binding IVs. A couple of weeks afterwards, you can get some IVs to bind up those metals so that you’re not just letting them float around and go back into your bones and your fat. So that’s for you to do and manage your stress because if you’re stressed, you’re not going to detox anyway. A lot of layers, right? 

That’s just for you; then what you say to your doctor is, “Hey, can you give me oxygen while you’re doing this? Because oxygen can help…” I’m not sure of the mechanism. It either binds to the metals or it prevents you from absorbing metals. But oxygen helps, A. B, Can you put a dam on the tooth you’re working on so that nothing falls down my throat. You know how they work in those little chips and you swallow them? You want them to not fall down your throat so could you put a dam on the tooth that you’re working on? Most dentists if they’re not comfortable with this are going to be like, “No thank you. And by the way, you can find another dentist.”

Lindsey: 

Yeah, my dentist was not like trained as a biological dentist, but it’s a very simple piece of plastic that you just surround the tooth with. It covers the rest of the mouth and he put that on. He had like a vacuum cleaner under my mouth. Yes. Yeah. I mean, very low tech, but like it did the job.

Dr. Wendie Trubow: 

Yeah, low tech and make sure they irrigate a lot, give you oxygen and keep it from swallowing it. So it’s not rocket science, right? I just can’t vouch for whether they’re going to say yes to doing that. Then the other part to that is, if you have a mouthful of fillings, do not get them all done in a week, period. You’re going to be really sick.

Lindsey: 

Yeah, yeah. So how many at once reasonably?

Dr. Wendie Trubow: 

Not more than two. Unless they’re tiny, you could do three but I was really reluctant to get my mercury fillings out because I said to my biologic dentist, “They’d been here for over 40 years. What difference are they making really?” She said to me a lot. It’s 50% mercury weight, A. It never stops off gassing, B. C, just so you know when we take that out of you, we can’t throw it in the trash. It’s considered toxic hazard. We have to put it in special trash. It’s so toxic. She said, “So that’s in you.” And I was like, “Oh, okay. Persuaded. Let’s get it out.” I got them taken out; but I was pretty resistant. You don’t want to do more than two and you want to give yourself two weeks between every two, at least so that if you have a reaction, don’t go back to get more done if you’re still reacting, right? Don’t pile it on.

Lindsey: 

Keep taking the activated charcoal or…

Dr. Wendie Trubow: 

Yes, and glutathione, it’s really weird: Metals deplete your glutathione and you need glutathione to get rid of your metal. So another case in which you’re circling the drain, if you have metals constantly depleting your glutathione. Okay and now that I see that, I just realized I didn’t take it this morning before I left the house. How aggravating.

Lindsey: 

And in this case, would NAC also do the job as a replacement for the glutathione?

Dr. Wendie Trubow: 

Yeah, so NAC and Alpha Lipoic Acid are precursors for glutathione. They help your body make the glutathione so you can give your body these things and they can help get you where you need to be for the substances your body needs to get rid of the metals.

Lindsey: 

Okay, so we talked about mercury, how about arsenic?

Dr. Wendie Trubow: 

Yeah, rice. No good deed goes unpunished. So… you eat brown rice, because you’re like, “Oh, I’ve got to get the fiber.” Except the whole seems to have more arsenic in it, so white rice, organic Jasmine, white rice has less. It’s unfortunate but you have to pick your battles. If you’re someone who’s really dealing with blood sugar issues and cardiovascular things and when you eat rice, you’re going to want to do the brown rice but be aware that you want to monitor your arsenic. Then otherwise, I would go for white rice and go for a smaller portion so that you don’t have a spike in your blood sugar, but then you don’t get the arsenic.

Lindsey: 

My parents, I had them both do an ION profile and both of them came up with high levels of arsenic. They barely ever eat rice.

Dr. Wendie Trubow: 

I’ll have to look up other sources. It’s not the only source but rice is like far and away the biggest source.

Lindsey: 

I mean, it can come from other grains I think too.

Dr. Wendie Trubow: 

You know, I don’t know the answer to that. I always think about glyphosate from other grains. So I’ll have to look at that. I’m not sure.

Lindsey:

Okay, fair enough. How about cadmium?

Dr. Wendie Trubow: 

Cadmium is west coast oysters, tobacco and I think there’s a couple more that I’m totally blanking on, but really the big ones are West Coast oysters and tobacco smoke.

Lindsey: 

Okay, so don’t get your oysters from the West Coast.

Dr. Wendie Trubow: 

No, ma’am.

Lindsey: 

Get them from somewhere else or avoid them altogether?

Dr. Wendie Trubow: 

Correct, Yeah.

Lindsey: 

Get them from somewhere else. Okay. And how about chromium?

Dr. Wendie Trubow: 

Thallium was the next one I focus on and this is back to the no good deed goes unpunished. So you’re doing a good job, you’re eating organic. A lot of it comes from California. You’re happy because it’s in the United States, you’re buying you’re buying American. However, California soil is contaminated with thallium. The organic vegetables happen to be particularly high so if you’re someone who eats a lot of green leafy vegetables from California, you’re at risk for getting high levels of thallium. Thallium can cause hair loss in high doses and maybe even constant doses. I always say to people, let’s work on improving your detox because I would vote that it’s better for you to eat organic, we’ll deal with thallium rather than eat non organic and then we have all these pesticides, which have even other consequences. It’s pick your poison here, right?

Lindsey: 

Well, if you get your vegetables locally and you don’t live in California, then you’re good, right? So I guess that’s the eat local part.

Dr. Wendie Trubow: 

Yes. Yeah.

Lindsey: 

Or grow them yourself.

Dr. Wendie Trubow: 

We should talk about mycotoxins too.

Lindsey: 

Let’s talk about mycotoxins.

Dr. Wendie Trubow: 

There’s a lot of layers to this. Water damaged buildings are probably the biggest source for people of mycotoxin exposure. Then food is another source; the foods that are the biggest ones – and by the way, I had a patient whose car was moldy kind of randomly. When I diagnosed her, she said, “My car’s moldy.” I was like, “Really?” She goes,”Yeah.” She had her car tested when she had her house tested and yeah, it was moldy. So she sold it. So anyway, foods that can increase your mycotoxin burden: coffee is a big culprit and grains are a culprit because, you know, they sit in these big sills and silos and they’re wet. One way that they dry them out is with glyphosate. Glyphosate was originally developed as an antibiotic and then was converted into agricultural use. In 2014, I don’t have stats beyond 2014; couldn’t find them. But in 2014, there were over 250 million pounds used in the United States, which is just ridiculous.

Lindsey: 

It’s banned in Europe, isn’t it?

Dr. Wendie Trubow: 

I don’t know the answer to that actually.

Lindsey: 

I’m going to Google that while we are talking.

Dr. Wendie Trubow: 

So it’s a probable carcinogen according to the World Health Organization. It wouldn’t surprise me if it was banned in the EU because they actually do a lot better job at preventing harmful things. So only about 500 different items have been specifically tested for whether they’re toxic. And then there’s another 150,000 things that haven’t been tested, specifically. So now we rely on just studies. So it’s pretty horrifying because they don’t have to prove that it’s not harmful, they have to prove that it’s not directly harmful in large doses. It’s a little bit of a nuance but the combined cumulative effect of lots of toxins in small amounts can be just as bad as one major exposure. So back to the mycotoxins, a lot of them are ochratoxins, which comes from grains that are wet.

Lindsey: 

Okay.

Dr. Wendie Trubow: 

Did you find it?

Lindsey: 

I did actually find the answer. Yeah, so it’s currently approved for use in the European Union until December 15, 2022. But Austria already banned it in July 2019. And Germany is going to start phasing it out by 2023. That’s what I got in my quick search.

Dr. Wendie Trubow: 

I mean, it’s pretty nasty. Back to gut health, it disrupts the microbiome because it was developed as an antibiotic. The World Health Organization has classified it as a probable carcinogen, because there are a number of cancers that are associated with it; most of which are lymphocytic, like non-Hodgkin’s lymphoma, things like that. It’s again just sort of horrifying. So I want the listeners to think, “Okay, I have control over this, right?” Because you can take control of the narrative and sometimes you have to get that horrified in order to make a change. When you’re eating the grains, even organic grains are sometimes contaminated with glyphosate because of the drift that occurs. It’s sprayed on these massive farms. And then the wind carries it to adjacent farms, which happen to be organic. There you go, your organic grains are now contaminated, as are like all of the garbanzo beans in the United States are contaminated with glyphosate.

Lindsey: 

Even the organic ones?

Dr. Wendie Trubow 

Yep but eat the hummus. Eat the hummus; it’s better than not eating it, right. It’s good for you. It’s just when you balance it.

Lindsey: 

Okay, so I know there are people out there who are just like, “Well, I don’t eat organic, and I’m okay.” Correct this line of thinking.

Dr. Wendie Trubow: 

Yeah, I think you have to look at that moment in time. So a lot of disease is from the cumulative effect of abuse. Meaning over the course of years, you get exposed to different things. I didn’t have celiac when I was 15 but I had certainly gluten sensitivity. I just didn’t know it. 20 years later, I had celiac. So it’s really about at what point do you want to intervene in the disease process. So there are certainly people I call them strong like bull; nothing impacts them, right? They can take a beating and nothing fazes them, they can eat anything, stay up all night, drink all night and the next day, they’re chipper. I’m not like them. There are some people like that cool. If you’re a bull, cool. It’s going to take a lot to bring you to your knees. The rest of us are generally not strong like bull, we’re more like a mouse. We can be brought to our knees a little bit faster than the like bulls and basically, everyone’s eventually going to break down with things. 

When you look into your optimal health, you can start to see the dysfunction at a cellular level before you see it at an organ level. When I was 15, I had iron deficiency and B-12 deficiency that didn’t respond to supplementation. By the time I was 35, I had wasting, right? So it was a 20 year process. I’m sure I had celiac earlier than 35. I just wasn’t tested. Nobody knew. So when you talk to these people who say I have nothing wrong, well I’m not so sure about that. Maybe you just don’t know about what you have wrong. Have you tested and the other part of it is: humans are very quick to explain things away, right? So when I hit the skids with all my toxins, exposure stuff, I was like, “Well, 48, perimenopause is terrible. Hate it. This is the worst, right?” Except it wasn’t perimenopause. It was a toxins exposure. But in the absence of knowledge, you might assume or chalk it up to something else. Oh, that’s how my family is; everyone in my family has insulin resistance or diabetes or everyone in my family can’t lose that 10 pounds or everyone in my family goes bald, whatever that is, right? We’re very quick to say that’s just how my genes are, as opposed to something’s turning on those genes.

Lindsey: 

So you’ve piqued my curiosity by mentioning perimenopause. Tell me what symptoms you think were associated with toxins that went away after you detoxed.

Dr. Wendie Trubow: 

I was losing hair at a very rapid clip and you can lose your hair in perimenopause. I gained almost 10 pounds and you can have weight shifts in perimenopause. I got a rash which wasn’t really perimenopause, but I was like, I don’t know what else it is so… right. I’m having a terrible perimenopause. So yeah, it was the weight and the hair loss.

Lindsey: 

And what toxins were you particularly high in? And where were they coming from in your life?

Dr. Wendie Trubow: 

Yeah, well sit down, okay, because it’s a long list. So I had lead. I was born in 1970 so I grew up in homes that were built with lead paint. We did construction on homes that have lead paint. We had lead pipes when I was a child, so those exposures. I had mercury from both fish and fillings. I had four strains of mycotoxins. I had seven or eight different environmental things such as nail polish, toxins, gasoline, fumes and plastics, styrenes. I had a whole bunch of those in me. That was really the impetus for writing the book because I got all this tests. I mean, Lindsey, for the last 16 years, I’ve eaten gluten free. I don’t eat gluten substitutes. So I’m eating like no processed food, no sugar; I don’t drink alcohol. I’m really boring on paper. I don’t do anything fun. I exercise to get enough sleep.

Lindsey:

I am sure you do something fun.

Dr. Wendie Trubow: 

But like, I’m not fun. People aren’t like, “Oh, let’s go to her house and have like an ice cream sundae.” No. I’m not that person. So there’s nothing fun in my diet, basically. And yet, I had all these toxins. That was the impetus for the book. When I got all this data, I said to my husband, “I am such a dirty girl.” And then he went, “Oh, that’s the book we need to write because don’t do what I did.” Right? Let’s provide a roadmap so you can avert getting to where I got to where I could not lose weight, hair was falling out, brain fog, fatigue, rash on my face, like all these problems. It’s preventable.

Lindsey: 

Yeah, yeah.

Dr. Wendie Trubow: 

And something else. I forgot to tell you because this is about poop, right? I used to be the canary in the coal mine for gluten. So if we went out to eat, and it had any trace of gluten, I was sick. The worst exposure I got, I was sick for three months and it was awful with brain fog, emotional problems, anxiety and really being sensitive. You look at me funny, I start crying and then got stuff like super sensitive diarrhea all the time, no matter what. It was awful. What was really amazing was when I started to treat the mycotoxins in particular, I only noticed this in retrospect, because you only notice when you don’t have a problem when you have a problem, I guess. So I used to have 6 to 12 weeks of problems with a gluten exposure. Then I noticed, it was like 4 weeks and then I noticed it was 10 days. Then I noticed it was 24 hours and then I noticed it was just overnight. Being someone who couldn’t eat at a restaurant at all, converting that to someone who can now, I’m not indiscriminate, but going to restaurants that are careful. I can eat out. That has transformed my life because my gut is no longer this raging torrent of reaction. It’s a lot quieter. Just an unexpected benefit, but that goes back to that these are all very irritating to the gut and when you start to pull them off, the gut can relax.

Lindsey: 

Your detox systems can handle the gluten because it’s not all preoccupied with everything else.

Dr. Wendie Trubow: 

Exactly.

Lindsey: 

Yeah. Mycotoxins. If somebody, they have no obvious exposure to them in their life. So they’ve never lived in a moldy house that they know of. They’re not having extreme reactions. They’re not losing hair. They’re not, you know, that kind of stuff. Is it worth still worth testing?

Dr. Wendie Trubow: 

Yes and no. So this depends on what your philosophy is. So if your philosophy is, I feel fine; I’m going to wait for a problem to develop and then I’ll deal with it, then no, you should not test. Right? Because there’s no problem that you’re treating. If you take a step back and you’re someone who says I really want to have optimal health. I understand that these mycotoxins are associated with degenerative diseases such as, as Alzheimer’s, dementia, Parkinson’s, cancers. I understand that these are a risk factor and I want to pull off any risk factors that I have, or I’m having symptoms, then yes, I would test. But it depends on your philosophy. It’s very upsetting for people when their philosophy is: I’m going to wait till it gets worse and you try to make them change. They’re not ready because there’s not a problem that they can react to.

Lindsey: 

Okay. So in terms of treating each of these and detoxing, is it specific for each toxin how you detox or is it more general?

Dr. Wendie Trubow: 

It’s both. So there’s basically three buckets. The metals fall into one treatment category and that includes improving the liver’s ability to remove the toxins, binding to them specifically and then replacing the minerals and nutrients that you pull out when you bind the toxins. So that’s the metals. The mycotoxins are specific binders based on what strain you have. So that’s really targeted therapy. You have to test because actually. There is a fiber, propolmannan fiber will bind to all the mycotoxins. But basically, you do want to know what you’re treating to know when you’re done even. Then the environmental toxins and pesticides almost universally trickle down into responding to a smaller group of things that include glutathione, NAC, sauna, B-12, niacin and things to improve phase two. So it’s a lot smaller but again, you want to know like what are you treating? But it would never harm you if you took glutathione, NAC, B-12, cilantro, parsley and did a sauna every day. That would not harm you.

Lindsey: 

Right and can you just explain phase two detoxification a little bit?

Dr. Wendie Trubow: 

Yes, it’s horrifying. I remember when I learned it in the context of hormones. Your liver’s responsible for doing the majority of work to get rid of anything that your body doesn’t need or is harming it. So that largely falls into toxins and hormones. Although alcohol too or medications; I guess I could keep going on. So your liver is responsible for doing lots of work. In phase one, you take this substance and you convert it into what’s called a toxic intermediary. It’s a middle ground substance that’s even more toxic than what it started out as. Don’t ask me why; it doesn’t make any sense to me but that’s what your body does. Then in phase two, there are six different detox pathways you can go down: you can bind it to a methyl group, you can put it on a glucuronic group, you can put it on a sulfur group, there’s lots of things you do to it, but you basically bind it, make it water soluble and poop or pee it out. Phase one is generally pretty fast, especially for women. Phase two is generally slower. So your body, it’s really good at making these toxic intermediates and then it’s like, “Oh, crap. Wait, now what do I do with it?” So it puts it in your storage units, which are your bones and your fat. It hangs out of there, out there until phase two is ready to actually pull it out and deal with it and excrete it. This is why when your gut has overactive beta glucuronidase and you’re recycling these toxic hormones it’s so harmful because not only do you now need to deal with what you’re already dealing with, but now you’ve just piled on more and your body can’t deal with the volume.

Lindsey: 

Is it better then to support phase two detoxification before doing anything with phase one?

Dr. Wendie Trubow: 

You want to do them together and there’s a lot of overlap actually.

Lindsey: 

And phase one supports are things like…

Dr. Wendie Trubow: 

Minerals, nutrients, curcumin, ginger… that’s funny. I’m less versed in phase one, because I’m like, everyone’s fine with phase one, right?

Lindsey: 

Generally, people have that under wraps. It’s the phase two they need help with.

Dr. Wendie Trubow: 

Yeah, they’re generally better. If they need help, I’m like, go to my nutritionist. She’ll take care of you. But then phase two, it’s actually very hard for vegans to do effective phase two, because a lot of support for phase two comes from flesh: meat, chicken, other poultry, fish, eggs, and dairy. So it’s harder for vegans. It’s not impossible, but it’s harder.

Lindsey: 

So they might be more inclined to have a buildup of toxins.

Dr. Wendie Trubow: 

Yeah, counter intuitively, because they eat much healthier.

Lindsey: 

Great. Well, so tell me about your book.

Dr. Wendie Trubow: 

It’s a fun read. Reading our book is like talking to me. So it’s pretty much like a conversation, well conversational. It’s all about: how are the ways that we’re getting exposed to various toxins and what are the things that we can do to control the narrative before you ever get to a functional medicine provider. There’s so many things that you can do to take control of your health: how you eat, how you live, how you drink, how you stress, how you exercise, the supplements you’re taking, all of these play a role and you really can alter it. There are a lot of things people can do on their own until we go through that in the book. We talk about what would make you even think that maybe you have toxins? Because some people don’t even have the awareness that it’s a toxins issue.

Lindsey: 

Yeah, so the things that should make them suspicious of toxins we’ve talked about, like hair falling out, weight gain… any other sort of big red flags?

Dr. Wendie Trubow: 

Unremitting fatigue. Really pronounced issues with any hormone stuff, you know, really bad periods, fertility challenges. Any type of cardiovascular disease or metabolic disease, so high blood pressure, heart disease, diabetes, and pre-diabetes; all those indicate toxins, bad cholesterol profile. Those indicate toxins.

Lindsey: 

Even if you have a genetic predisposition to have high cholesterol?

Dr. Wendie Trubow: 

Yep because your genetics are only one facet of the conversation. Your genetics aren’t your  determinant for life, they just make you more likely, but when you pile on the toxins, it makes it 10 times harder to deal with.

Lindsey: 

So tell me, I understand you have a free gift for my listeners.

Dr. Wendie Trubow: 

I do. I mean, after listening to this podcast, you may be saying to yourself, “Okay, I really need to clean up all the products around me, at least so I can stop being exposed.” Because this was my passion play and I had all these problems, we spent hours looking for products. Then we were like we’ll put it together in a guide, so that people don’t have to do as many hours of research as we did, because we did like… I don’t even know, I stopped counting, actually. So it’s the “Nontoxic Guide to Healthy Living.” It’s meant to really go with the book, but you can also use it alone. And that’s on our website. 

Lindsey: 

Okay, great. I will link to that in the show notes and all the other places and your different social media.

Dr. Wendie Trubow: 

Yep. We also have a podcast. It’s the Five Journeys Podcast. So people can also find us there.

Lindsey: 

Ok, great, wonderful.

Dr. Wendie Trubow: 

Because there’s probably a lot of overlap between us and people who like you, probably like me and lots of other people. So we do that, too. It’s somewhat fledgling, but yeah. Instagram, Facebook, X, LinkedIn is all Wendie Trubow MD.

Lindsey: 

Great. Well, this was really informative and interesting, and I think will be useful to a lot of people who have kind of gotten to the stuck place after trying to fix the gut stuff and are not getting anywhere.

Dr. Wendie Trubow: 

Right. Yeah, definitely. It’s definitely helpful for people.

Lindsey: 

Awesome. Thank you so much for sharing your knowledge with us.

Dr. Wendie Trubow: 

My pleasure, Lindsey. Thanks for having me here.

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

Adapted from episode 69 of The Perfect Stool podcast and edited for readability.

Sabine Hazan, MD is Founder & CEO of the Malibu Specialty Center and Ventura Clinical Trials, where she conducts and oversees clinical trials for cutting-edge research on various medical issues. She’s board certified in Gastroenterology, Hepatology and Internal Medicine and is a top clinical investigator for multiple pharmaceutical companies. She also acts as the series editor of Practical Gastroenterology on the microbiome, a peer-reviewed journal that reaches 18,000 gastroenterologists, and is the lead author of the 2020 book “Let’s Talk Shit: Disease Digestion and Fecal Transplants”.

Lindsey:

So your book, Let’s Talk Shit: Disease, Digestion and Fecal Transplants, I noticed when I was looking at it that one of your co-authors is Thomas Brody who has been doing fecal transplants for years in Australia, right?

Dr. Sabine Hazan:

Yeah. Yeah. Master and pioneer of fecal transplants.

Lindsey:

Yeah. Well, so funny story about him: I’ve been obsessed with fecal transplants and this whole field for years, well before I was working in it. My previous career was in international education. And I was actually working at Georgetown University, in the Center for Australian, New Zealand and Pacific Studies, and we used to bring in visiting scholars and people to do talks and such so I realized there might be a connection there since he was from Australia, in which I could somehow reach out.

Dr. Sabine Hazan:

Oh, that’s funny.

Lindsey:

So I dug through old papers; I found his email and I wrote him and invited him to come and give a talk at Georgetown and he agreed to it in theory, but then I left that job, and I’m not sure, I don’t think that ever came to be.

Dr. Sabine Hazan:

Yeah, he’s a great guy. He’s definitely responsive to anybody calling him over the years; I cannot tell you how many gastroenterologist have said to me, “Oh, my God, Dr. Brody held my hand on my first fecal transplant; I was so scared; patient had C. diff and the colon looked awful and I was so scared to just put poop in there, and he just held in their hands.” And that’s what he does. He’s been a mentor to so many of us; he’s so open with his ideas and his innovations. And probably too much because people take advantage of him and use his ideas to make a business out of it. And I started collaborating with him and I said to him, we need to educate the people on what’s coming and we need to educate them on the microbiome. And it happened during the period of COVID in January 2020, where I thought the end of the world was coming is when I finished our book with Shelley Ellsworth, who basically helped us. And when we finished the book, I said, I’m not going to call it “Let’s talk microbiome”, I’m going to just call it what it is. So people are aware, because this is an emergency. And also in the book, there is a chapter that gives you an idea of how to survive COVID. And we actually mentioned in there, the microbe that we believe could be protective against COVID. And in fact, there’s a publication coming from my lab with those microbes, lost microbes of COVID-19, and that microbe is in there so…

Lindsey:

Then what is it?

Dr. Sabine Hazan:

So I forgot, which chapter it is, but at some point, the first third part of the book, I talk about the importance of bifidobacteria, and how people that have obesity tend to have low bifidobacteria. And if you think about it, that’s the same population that’s been hit with COVID, right? And so the first bacteria that popped up as being lost in patients with severe COVID was actually bifidobacteria.

Lindsey:

And that’s also something that decreases with age, right?

Dr. Sabine Hazan:

Yeah. And also something that decreases with age, is decreased in autoimmune processes. You know, it’s a very important microbe that is in our gut. In fact, it’s the microbe that sustains the whole billion dollar industry of probiotics, right? If you look at the back of all these probiotics, it says bifidobacteria. If you look at kefir, it says, “bifidobacteria”. How many products on the market say they have bifidobacteria bacteria? Right?

Lindsey:

Right, right.

Dr. Sabine Hazan:

And so that was the beginning. So to me, it was so important for people to read the book, because I said to myself, this is going to give them an idea about gut health and how to survive COVID. And at a time where we didn’t even have vaccinations or any treatment. And so that’s why I wanted it to be a catchy name. And also, I figured, I’m embarking in a world where I’m challenging the narrative a little bit. Dr. Borody and I, we’re scientists. So we are the rebels that are going to look the other way when everybody’s looking to the right, we will look to the left for the solution, right? Because if everybody looks to the right, then you never find anything, right? So imagine like you’re looking for gold and everybody’s looking in the same spot, well you’re never going to find anything.

Lindsey:

Yeah. So how did you get involved with FMT?

Dr. Sabine Hazan:

Oh, it was interesting. So my friend Neil Stallman, who was my mentor, and a couple of years older than me, and when I was in residency, he was in fellowship. He was in fellowship of GI at University of Miami and in Jacksonville, at Jackson Memorial Hospital and I looked up to him as a GI doctor, and I wanted to be like him when I grow up kind of thing. So I went into GI because I was always impressed by his way of being a physician. And his vision that nobody’s really right about anything, that we need to be looking constantly for solutions. And no science, no research is wrong. Everybody has an opinion. And so when I was a fellow at University of Florida, he took me around the posters. I was presenting my own poster; it was visceral hyperalgesia at the time, and he took me away from my poster and he said, “Look, look at this data, the future is in the microbiome”, but he didn’t say it like that. He said, “The future is in shit”. And I said, “Neil, if you bring me down that path, I’m going to hate you.” And basically, what happened is he went down that path, right, he started speaking, he would always invite me to all these meetings, ACG [American College of Gastroenterology] and he was always the main speaker. And I remember and I would do the clinical trial side that was cleaner, with pharmaceutical companies. I would basically do the new antibiotic for C. diff and the new pill, and when the pill wasn’t working, or the clinical trial wasn’t working, I would go to fecal transplant, and back then it was a lot.

I remember calling him for my first case that I was doing. And anyway because I didn’t call, I didn’t know Dr. Borody at the time, and I wasn’t going to call Australia. So I would call Neil and I would say, “Neil, how do I do this?” “Go figure it out.” I read all the literature, and then I figured it out. And I figured out my own little protocol, per se. And my first case was a physician. And I was shocked. And you know when you see a colon that’s a disaster inside with all sores and bleeding and mucus. And you go, “Oh, my God, I’m just going to put stools in there, and then it’s going to improve it?” And then sure enough, a week later, a month later, the patient is better, they stopped having diarrhea and something happened, right. And that was the first case for me. But I still didn’t like doing it because I had to put Noxema in my mask. Nobody likes to play with stools. So I was still the clinical trial girl. And if the client – and I would tell my patients, look, I’m going to put you in a clinical trial for C. diff . and if the trial doesn’t work, then I’m going to do fecal transplant on you. And I would use the funds from pharma to basically pay for the analysis of the stool donor and everything. In other words, they would pay me to conduct the trial. And I would use that money to look for perfect donors for these patients and their families, or using the spouse and making sure that that the spouse had clean stools, right.

And that’s how, when clinical trials became fecal material and the capsule, one could say, me and Neil joined forces because clinical trials became fecal transplant in a way. And so I joined the shit business, and then I said, well if we’re going into the pharma world, I better start looking at these microbes carefully, because what’s the complication of fecal material in the future and what are we doing long term to the patient’s short term, long term? Certainly I saw cases of personality changes with fecal transplant, BMI changing post fecal transplant, inflammatory changes post fecal transplant and then you start reading from other physicians, Colleen Kelly, Sahil Khanna and Paul Feuerstadtand you start reading all these other improvement or side effects, right? So you start educating yourself, and you have all these questions that are not answered. And when those questions were not answered, for me, I started wanting to understand the microbiome in a more personal way, because in my family, I had family members that I wanted to understand what was going on in their microbiome. And when I sent those tools to different labs, I wasn’t getting the same validated results. And not only that, but even in the bioinformatics pipelines, the bioinformatics pipelines were different. And so I asked the questions, well, how do we know what’s working and how do we know what we’re doing if the pipelines are not even validated, and the stool labs are not even validated? And so I set myself on a mission to understand the microbiome especially after I had a case of Alzheimer’s where the patient remembered his daughter’s date of birth after fecal transplant. And I did it for C. diff. I published that paper; it actually took probably about five years to get approved then published because they didn’t believe that the patient remembered his daughter’s date of birth. I actually had to send him the mini mental status of the patient with the square the triangles that are drawn perfectly fine. He went from a Mini Mental Status of 20-21 to 26, and then to 29, after six months. So to me, that was like one of those n of one that you go, wait, something’s happening in the microbiome with Alzheimer’s, we’ve got to pay attention.

Lindsey:

And he had C. diff . That was why he was…

Dr. Sabine Hazan:

He had C. diff. That’s how we were able to do it.

Lindsey:

Right.

Dr. Sabine Hazan:

And so I presented that case to all my colleagues, and they’re like, “Wow, that’s an amazing case. But that’s an n of one. We’ve not seen that.” And of course, you know, you saw the case of Colleen Kelly with alopecia areata and two patients. And then next thing, you know, the patients grew hair. And you have to ask yourself, well, what grows hair in the microbiome space? Right? Because Dr. Borody, he tried to do that on another patient and it didn’t work. So which makes you wonder, well, maybe donor matters. Maybe the microbes matter that we’re implanting. And so that was the importance for me to create Progenabiome with the interest and I realized, I was shaking the beehive a little bit, because every time you start something that’s new, and it’s a physician on the frontline of clinical research doing it,  it is shaking the beehive of what’s already there, right? Because if you find answers, there’s a whole industry that’s going to be gone. Right?

Lindsey:

Right, right.

Dr. Sabine Hazan:

Especially if let’s say we find answers for Crohn’s disease in the microbiome space, well, will the biologics disappear from these pharmaceutical companies? But I always believe, and that’s always the fear. And that’s why there’s always powers that try to destroy the innovations, right. But I’m a big believer that the same way that the post office works and email works, we didn’t decrease the work of the post office by bringing on emails; we just expedited the mail transfer back and forth between people in writing, right?

Lindsey:

Then started mailing everything packages and ordering everything.

Dr. Sabine Hazan:

Yeah, but the mailmen are still busy. And you know, I always joke, I say, we used to think like, well, we create internet, it’s going to remove the need for the post office. And it’s going to remove the need for books and library and papers, right? But the reality is, you’re busy in the real world, and you’re busy in the virtual world. You know, my desk is full of papers and my email has over 2900 emails that I need to deal with. So I’ve got this stack of papers on my desk that I need to deal with, and I’ve got these stack of emails I need to deal with. So I think in general, we’ve complicated our lives as human beings, period.

Lindsey:

Yeah, the pharmaceutical companies will find something else to work on if they don’t do the biologics.

Dr. Sabine Hazan:

I think we’re here to help pharmaceutical companies, right? Yeah, we’re here to help them improve their outcomes. You know, in medicine, it’s never a one pill solution. It’s never a one treatment solution. You know, you have patients that respond to Remicade, for example, but then they need nutritional supplements, they need a psychologist to deal with the trauma that started off the stress level that created potentially the dysbiosis in the gut, right? So it’s never a one pill solution. It’s never a one treatment. That’s why a lot of these patients, they need their psychologist, they need the nutritionist, they need their acupuncturist; they need all the ancillary support to help them function because it is a complex disease for a lot of people.

Lindsey:

Yeah. So let me stop you for a second and just ask, how successful is FMT as opposed to antibiotics for C Diff?

Dr. Sabine Hazan:

Very successful. So antibiotics . . . so what we’ve come to discover at Progenabiome is that if you look at the genetic sequencing of the microbes of an individual, you will notice that a majority have non-pathogenic  C. diff in their gut as their fingerprint, right? So if C. diff is in – in fact, it’s in my gut, it’s in all the GI doctors that have analyzed their stools. So one wonders, when did we get colonized with C. diff? We’re exposed to patients. Did I get C. diff somehow in the GI lab touching the handle, touching the door knobs, etc.? Is it part of our signature microbiome? If it’s been part of our signature, and I really believe that it’s been part of our signature for 1,000s of years, I think we all have C. diff in our gut as a baseline microbiome because if you look at C. diff, it’s 10 million years old at least right? They found it in one of the studies I remember seeing.

So if you’ve got C. diff in your gut, and you’re taking an antibiotic, what are you doing with antibiotics? You’re basically depleting the other microbes, right? So you’re allowing, in a way, C. diff to become pathogenic, to secrete its toxin, right? So because if you look at the microbiome of patients with toxigenic C. diff, you will notice that they have a lower diversity than everybody else, right? How did that diversity get killed? Well, it got killed with the antibiotics we gave them. So what am I doing when I give vancomycin? Well, I’m killing the diversity of the microbiome. So if you look at patients with vancomycin, their diversity is much less than a healthy individual and even lesser than a patient will C. diff because you just gave them the antibiotic. So what are you doing when you do fecal transplant, you’re not killing the diversity. You’re replenishing the diversity. So the message here, why is fecal transplant helpful with C. diff is because we’re replenishing the diversity of the human being; we are giving the human being a new garden in their guts; we are removing the weeds, which was the toxigenic C. diff that was taking over the gut because we killed everything around it. Imagine it’s like, basically, you’ve got this group of microbes and you just killed off all its families. Well, what is it going to do? It’s going to try to kill the host now right? You just killed off all its families. So now, what do you do when you’re replenishing? You’re replenishing new families. You’re calming that little microbe in a simplistic way, right? You’re appeasing the balance of the microbiome system and therefore the individual is healthy again.

Lindsey:

And do you use antibiotics prior to doing the fecal transplants?

Dr. Sabine Hazan:

Yes. So you always want to kill off as much as everything because you’re going to give a new microbiome.

Lindsey:

And how long do you use and which one?

Dr. Sabine Hazan:

So I use I usually do either vancomycin or fidaxomicin. Depending on coverage of the patient. Sometimes I’ll do flagyl; it’s not really great, mostly because most patients can’t tolerate it. But usually vancomycin or fidaxomicin.

Lindsey:

For how long?

Dr. Sabine Hazan:

For 10 days; 10 to 14 days. And then basically I do fecal transplant.

Lindsey:

And are you finding it hard to find donors who are qualified? Like will you take a donor that has C. diff?

Dr. Sabine Hazan:

No. No. Wait, wait. You mean non pathogenic C.diff?

Lindsey:

Yeah.

Dr. Sabine Hazan:

Oh, I’m going to find… yes, all donors have non pathogenic C. diff in their gut.

Lindsey:

Okay.

Dr. Sabine Hazan:

In the genetic sequencing. And this is a very, very important thing to mention. Toxigenic C. diff is the C. diff that secretes the toxin and therefore causes diarrhea. Non toxigenic C. diff is just a fingerprint of the microbe that’s really doing nothing in your gut. So even if you find it in the gut, it doesn’t mean that it’s doing anything,

Lindsey:

Is it a different strain, then what’s the name of the strain?

Dr. Sabine Hazan:

No, it’s still the same bacteria, but it’s not but it’s not potent, right?

Lindsey:

And how can you discern that in a…

Dr. Sabine Hazan:

Well, in a genetic sequencing world, you have to do a messenger RNA pipeline, to basically see if it’s reproducing. In a research world, in a clinical world, you have to do a PCR to see if you have toxigenic C. diff.

Lindsey:

Okay, so who does that test?

Dr. Sabine Hazan:

Oh, anybody does that test, all the GI doctors do that test. So if you have diarrhea, and you’re basically, you know, you’re going to go to your doctor and your doctor is going to do a C. diff by PCR to look for toxigenic C. diff.

Lindsey:

Okay. Got it.

Dr. Sabine Hazan:

And they’re looking at that point for a specific strain that stimulates… that, basically, they… if you’ve got the diarrhea symptoms, and you’ve got the C. diff positive by PCR, then by all that’s C. diff in the patient. What we look at is the genetic imprint of C. Diff; that doesn’t mean that that C. diff is doing anything. It’s most likely doing nothing, especially if the patient is asymptomatic. When you look at a patient and a donor, you have to do a whole bunch of a workup, right? So the first thing is obviously you do a GI panel. You know, you want to make sure you don’t have C. diff  and that donor toxigenic, toxin A and B so your test for C. diff toxin A,B, you’re going to look for Adenovirus, Campylobacter, E coli, Entamoeba histolytica, Salmonella, Shigella, Vibrio cholerae, Yersinia… you know there’s a lot of bugs that live in the gut. You want to make sure they’re not active in your donor because if you give those stools to a donor and there’s a lot more microbes, obviously, especially now with COVID, you have to make sure the donor doesn’t have COVID, right, in the stools, because if you’re giving it to an immunosuppressed patient who has C. diff to begin with, because he’s immunosuppressed, you could kill him. And that’s why we’ve seen the four cases post fecal transplant that died.

Lindsey:

Four? I didn’t realize there were four. From that same single donor?

Dr. Sabine Hazan:

No, no, no, no, there were two other cases that were brought up in probably in the last two years, I think. There’s been four cases altogether.

Lindsey: 

And were they from… I think the originals were from E. coli. Right?

Dr. Sabine Hazan:

Yes.

Lindsey:

And what were the others?

Dr. Sabine Hazan:

Yeah, I can’t remember what the other two were but I remember, it was like four cases.

Lindsey:

Okay.

Dr. Sabine Hazan:

I don’t think the other two they even knew what it was that we’re concerned about. You know, the patients were extremely immunosuppressed to begin with. So you don’t… in those patients, you have to try no matter what the risk, to look at the risk benefit ratio. But definitely, you know, that brought up the idea of looking for vancomycin-resistant E. coli. And I looked up, and then that’s basically why we are doing all these tests. And now with COVID. Look, we were looking for a donor recently in one of my patients that had C. diff, and I used her daughter as a donor. And low and behold, I found COVID in her stools, you know, so I can’t donate it to her elderly mother with COVID in the stools. So you know, so it is becoming challenging to find good donors. It is also becoming challenging, because with COVID, the microbiome changed with potentially vaccination, maybe the microbiome is changing; with the stress that people underwent, the post-traumatic stress from COVID and the quarantine and the wearing masks, the microbiome changes. Certainly wearing these masks all day long, full of infections, you know, is not really helping your microbiome because it’s… they’re infected and you’re just breathing in all these germs that are in the mask. So all that affects your microbiome, in my opinion, and so it is difficult to find good donors right now.

Lindsey:

Yeah. I know I’ve had a few people who’ve come to me wanting to use a relative for fecal transplants just doing it on their own. And, you know, I told them what tests to run and invariably, they show up with H. Pylori and with C. diff , and with all these other things, and I’m like, I can’t recommend that you use that person.

Dr. Sabine Hazan:

Well, that’s it. That’s the problem, right? I mean, it’s like that daughter that was healthy to begin with. But then I found COVID in her stools, right. So I’m not going to be giving a stool donor with 4000 copies of COVID, that I found in the stools to a little elderly woman, God knows that would shut down fecal transplants really fast. So we have to be careful. And it’s funny, because even the procedure, you know, we joke in the GI lab, because sometimes we’re sterile, we’re very clean, in the way we process putting the stools into the colon, right? And things happen and you’re like, “I can’t believe I’m that sterile, because I’m dealing with poop to begin with.” But we have to be sterile because unfortunately, the microbiome is fragile, it’s not meant to be put back right? Fecal material is meant to be out; that’s why God created us to have colons that evacuated our secretions, right, the bad stuff from our bodies get out. So that’s the whole process of putting it back into the earth, right? And then the earth processes and all these microbes, right? It was never meant to be put back.The fact that we’re finding some improvement with C. diff. To me, I think that C. diff was really the can that got opened to look at the microbiome and to look at the destruction that we’re doing, to say, “Hey, guys, you’re killing the microbiome.” And C. diff is popping up in these people and all these bugs, by the way that are super resistant, these virulent bugs. Bugs don’t just become Super Bugs, unless we do something to them to make them Super Bugs. And I think that’s the most important thing to reflect on, right? Especially with COVID. COVID just didn’t happen, right? The human microbiome has got to be pretty messed up for COVID to penetrate and create disease to begin with, or create people to die. So when you look at the people that are affected, the autoimmune people, the people with cancer, the people that are elderly, the people that are overweight, there is a picture there that tells you dysbiosis of the microbiome, penetration of COVID, penetration of COVID wouldn’t happen if that dysbiosis didn’t happen. I really believe that if you have a strong microbiome, and those are the people that are fascinating to me to study, and you’ve probably seen me on X, saying, if you’ve not been vaccinated and you’ve now gotten COVID, please call me. I think these are the people that are super fascinating to study. Because in my opinion, they hold the mystery to why they survived COVID.

Lindsey:

Well, that would be my sister.

Dr. Sabine Hazan:

Yeah, so I’d love to test her stools, because, okay, those are the people that are… Yeah, no, I mean it’s fascinating, because I’ve been the guinea pig on this pandemic. And, you know, I test my stools on a regular basis, because I own the genetic lab. And I have to tell you, it’s fascinating to see my microbiome progress over time, during the pandemic. I mean, it’s been fascinating to watch so because I test if I take a medication, or if I get a vaccine, or if I get anything. I look at my microbiome. What is my microbiome doing while I took something?

Lindsey:

And yeah, what kind of differences do you just see over time?

Dr. Sabine Hazan:

Well, that’s going to be published, so I can’t really talk about it, but you are going to see it, because like I said, I am doing my timeline and I’ve been following myself and what I’ve done and what it’s done to my gut. But I think also, we’ve been following the guts of a lot of people and we’ve also looked at before the pandemic. We have probably over 1,000 stool samples. And we’re going to be looking at after the pandemic to kind of say, “Okay, well, what is different, right?” Because I think that’s fascinating data as well. And also correlating with those patients: whether they got vaccinated, whether they got treatment, some people are taking hydroxy, some people are taking ivermectin, some people are getting boosted and vaccinated. So it’s important to look at it to see what is all that doing to the microbiome, and then get a better idea of what the future is going to be and how to survive the next bugs.

Because you can imagine if you’ve gotten COVID, there’s obviously a dysbiosis in your gut that predisposed you to having COVID. So now the next virus that comes around has a potential of becoming super virulent in that person, so that’s why when you follow people who have gotten COVID the first time, then they get COVID the second time. If we don’t address the microbiome dysbiosis, it’s a domino effect constant until, you know, you wake up one morning with an autoimmune process or something. And you go, well, what happened? Well, the domino started way back when you had COVID. The first time that was your first sign, right? It’s like C. diff patients; you hear the story of a patient that gets C. diff and then down the road, they’re given antibiotics and then down the road they get an autoimmune process going on. You have to wonder that C. diff … was that the beginning? Was that the sign that said, “You know what, see, this was my first sign of dysbiosis. I should have paid attention.”

Lindsey:

But I mean, 80% of Americans at this point have had COVID. So I mean, how can you say that that’s all dysbiosis generated?

Dr. Sabine Hazan:

Well, is America a dysbiosis… dysbiotic country?

Lindsey:

Sure.

Dr. Sabine Hazan:

Is it

Lindsey:

What percentage of people in other countries? I don’t know those numbers? Are they getting a much lower infection rate?

Dr. Sabine Hazan:

I mean that’s it. Those are the things to look at; I mean, certainly America is high in processed food; they certainly take on a lot of microbes. They’re eating tomatoes in December; you look at Europe: they don’t mix microbes so much. You look at the American way of life: high, stressful, high go go go. Not as much as, if I look at the Spanish population, and again, Spain is becoming more America today. But if you look at the olden ways, where people used to sleep from two o’clock to three o’clock and rest, and it was like work, family and pleasure. Now we’ve become a society that’s just go go go; we’re on our cell phones constantly. We’re not doing any yoga, meditation, breathing; we’re not outdoors in nature; we’re not gardening. Certainly when you look at kids with ear infections, and you see kids in the classroom have more diseases and more infections than kids that play in the gardens. I mean, we’ve certainly seen those studies, where exposure to microbes from the earth definitely protects these kids, right? Is the American population, big on going outdoors, hiking, playing with the earth, gardening? Not really. So 80% of the population. If you look at the statistics of the American public, probably the 80% that got COVID is because they were not doing all these things. I can tell you that just with the people that I’ve treated, because I’m correlating that the people that do amazingly well are my farmers and my gardeners, you know. I have like husband and wife where the wife is gardening constantly, got COVID, mild symptoms and then the husband’s a physician and he’s high stress, he barely made it. So I think severity of symptoms also probably correlates to lifestyle and stress factors. Definitely, you know, in the stress from the news and listening to the television, and, you know, the drama, the conflicts and all that, what is all that doing to your microbiome, right?

Dr. Sabine Hazan:

Okay, well, let me stop you. Let’s dig into some other gut issues stuff. So with the testing you’ve done, have you noticed that there is a pattern of bacterial dysbiosis for certain diseases?

Dr. Sabine Hazan:

Yes. But nothing I can really discuss because it’s all preliminary data. So with me, you always hear that because remember, all data needs to be validated, verified and reproducible. There’s definitely a lot of interest. I wouldn’t be continuing this if I didn’t see something. But we are looking aggressively at diseases like Parkinson’s, Alzheimer’s, autism, ALS… That’s all interesting to me.

Lindsey:

Yeah. Okay. Now, on the Progenabiome website, I see blurb that says, “Want to learn more about gut refloralization, contact us below and we’ll follow up with you.” So I’m wondering, do you have options for FMT for people who don’t have C. diff?

Dr. Sabine Hazan:

We do not. We work with the agencies; we work with the FDA; we submit what’s called an IND [Investigational New Drug] to the FDA for emergency cases. So for example, I had a case of metastatic mesothelioma. So I submitted that case to the FDA to allow me to do fecal transplant; they approved it and we did it. So that was one case. We got allowed to do autism in one child; we are trying to get approved to do 30 kids. We’ve been working on it, mind you, for the last two and a half years. So it’s time consuming. It’s extremely expensive to put these protocols in to the FDA. We’re lucky because I’m a Research Center. And so therefore, I have a portal with the FDA that I use to submit all those INDs. However, it is expensive; it’s a lot of back and forth with paperwork. I think if you look at Alex Caruso, and there’s a lot of videos on the Malibu Microbiome Meeting. There’s a lot of videos because I do a lot of lectures with doctors that are doing fecal transplants. There’s going to be lectures from Dr. Sahil Khanna, Dr. Borody. It’s going to be on that website. So I encourage everybody to go to the Malibu Microbiome Meeting.

Lindsey:                                                                                   

I’ll link to that in the show notes.

Dr. Sabine Hazan:

Yeah, and this way, they can see the videos. Neil Stallman does a great lecture on Microbiome 101 for anybody that doesn’t know. Refloralization, I put it in there because it’s a vision of what I believe the future to be. I didn’t like the term fecal transplant. I know it’s been we retermed, Alex is calling it, Dr. Cruz is calling it microbiome transplant, which is a more appropriate term for it. I like refloralization because I believe we come from flora and we go back to flora. You know, the process of dying is our microbes in our gut get stronger and then they decompose our bodies back to the earth. So to me we go back to the earth; those microbes go back to the earth; the foods we eat come from the earth. So essentially, we’re feeding ourselves constantly with microbes from the earth, so from the earth to the earth. So I believe that in the future, it’s probably going to be more of a refloralization procedure, in the sense that finding what’s out of balance and replenishing it by what to create the balance. I think that’s the pharmacy of the future. That’s my vision. So that’s why I put the term refloralization; we are seeing certain microbes are improved with certain nutrients and certain vitamins and certain products. So that all plays a role in the refloralization process, in my opinion.

Lindsey:

So assuming most of the people who are listening to this podcast, they don’t have super healthy microbiomes. But assuming they can get back to a state of a healthy gut microbiome, what would you recommend for people staying that way?

Dr. Sabine Hazan:

Well, I think if you’re healthy, then keep doing what you’re doing, right? If you’re healthy, don’t do anything because whatever you’re doing, you’re doing great, especially if you have longevity in your family. Don’t mess that up, right. If you’re unhealthy and you have a family history of heart disease, etc. Well, that’s time to take charge of your health, right? And that means starting to educate yourself: seeking nutritionists, seeking naturopaths, seeking functional medicine doctors, seeking someone that will guide you in in a good way to proper nutrition and also help you with, I like to call it the fermentation of your gut right, so gut health really is what it’s all about. And gut health is not necessarily the same for every culture, right? Because you could see a Japanese person is eating Mexican food, you probably won’t tolerate it. And a Mexican person eating Mexican food will not tolerate Japanese food. You know, certainly I’ve been a gastroenterologist long enough to know that there’s certain foods that people don’t tolerate. You know, I think probably we’re born with a certain predisposition to eat foods from our culture and our races. And I think that’s your comfort food, you should stick to the comfort food. I think anytime people try to change what’s working is when they get themselves into problems.

Lindsey:

Okay, so I’ve had this theory for a while that issues with vaccinations are often related to antibiotic use and a dysbiotic microbiome. Do you have any insight into that?

Dr. Sabine Hazan:

No, I stay away from vaccines or discussing vaccination because I want to stay alive. Not that anything would happen but to me, but you know, vaccination is a complex product. It’s a complex issue. I don’t think anybody’s really looking at it. I think it needs to be looked at. I think anytime, look what we learned from antibiotics. Twenty-five years ago, antibiotics were given for everything, right. And what we learned from antibiotics is that actually, if you take too many antibiotics, eventually you’re going to have a little bug called C. diff. Because you’ve killed all your microbiome; you’ve killed your gut. I think that’s definitely established now. And people understand that:  if you take antibiotics, you have a risk of killing your gut. And that’s why the whole probiotic movement came on, because if you’re killing it with the antibiotics, you have to promote your gut with the probiotics, right? And thus, the movement of the yogurts and the drinks, and the probiotics, etc. I think there’s going to be a time that we’re going to figure out the same thing with chemo drugs; if you kill the tumor, you got to work on the gut, to support the killing of the tumor because you can’t just kill kill, kill, you’ve got to replenish. And again, the same thing we were doing with C. diff. We were trying to kill kill kill with antibiotics. But instead, we got people worse. What we needed to do was add more microbes. So I think there’s going to be a time that also people are going to start looking at vaccination and seeing maybe there’s something we’re doing with vaccination that needs to be supplemented with something else to balance the benefits of the vaccination with the disbalance that could be happening in the gut, for example. Okay, and I’m not saying that there is, but I’m just saying that I think we need to look at it, because it’s never a one pill solution. And it’s always a domino effect: action leads to a reaction with everything.

Lindsey:

Yeah, I’ll just add to that though, that I’m a supporter of vaccination, I have had my children vaccinated and myself and all that. But I’m just, I just look at..

Dr. Sabine Hazan:

I vaccinated my kids, I got vaccinated…

Lindsey:

Because there’s so many people now, because of the politicization of the COVID vaccine, now that are anti-vaxxers. And I feel like it’s an important point to not completely deny that there’s ever been any problem with any vaccination, because that’s what promotes conspiracy theories.

Dr. Sabine Hazan:

Yeah. And I think, yeah, and I’m not a big conspiracy theorist. And you know, it’s so funny because on X; people think I’m an anti-vaxxer because I asked questions. Because listen: I’m a scientist. So if I’m going to have a person that comes to me and thinks they have a side effect to a vaccine, it’s my job to look, is that what’s going on there, right?

Lindsey:

Yeah.

Dr. Sabine Hazan:

So because in my world of clinical trials, when you have any investigative product and a patient has a side effect, any side effect, be it you know, pain in the mouth, be it headache, you have to document that; it’s called an adverse event. And if they end up in the hospital, or they’re having something that’s serious, like they’re paraplegic, you know, I look at the case of Mattie de Gabbé, which I got involved in looking at her; you have to pay attention to that, because that’s a serious adverse event. And serious adverse events, we cannot ignore them because they tell us something else in the future. So I think it’s our job to pay attention to everything. I think, also, you have to pay attention to the people that it doesn’t work for, right. So the people that got vaccinated and still got COVID:  you’ve got to ask the questions.

Lindsey:

Yeah.

Dr. Sabine Hazan:

So just because I’m asking the questions, doesn’t mean I’m an anti-vaxxer. It just means that I’m a good scientist for asking the question.

Lindsey:

Yeah, yeah, no, I and my children were vaccinated and boosted and still got COVID, but it was Omicron. So that was sort of expected since that was less sensitive to the vaccines.

Dr. Sabine Hazan:

Yes, yes.

Lindsey:

Okay. So you mentioned that the people who were most susceptible to COVID had low levels of Bifido and I’m just wondering because actually I did Thorne’s sequencing of the microbiome, and they said I was lacking Bifido. And to take rice bran… well, they said… I can’t remember the name of the actual fiber, but it was essentially rice bran.

Dr. Sabine Hazan:

Right.

Lindsey:

So I’m taking that, but other than taking probiotics with Bifido and that, what else can boost Bifido?

Dr. Sabine Hazan:

So I have to warn on that, because I never put myself in the position to kind of say, yes, we found this. It’s research, right? So it’s my hypothesis. It’s a finding. It’s a small study and needs to be done as a bigger, larger scale, obviously. So I don’t want people like leaving this and saying, Oh, my God, I’ve got to check my Bifido to see if I’m alright. Right? Because until other doctors validate, verify, and we produce the data, it’s still research on one site.

Lindsey:

Right, right.

Dr. Sabine Hazan:

So I think if it doesn’t hurt, yeah, take whatever was suggested. But if it becomes like a heavier treatment or something that is risky, I probably would stay away from that, not necessarily trust those labs. Remember, these labs are not validated and not clinical, right? They’re just a consumer product that’s out there. But the majority of these labs are not even CAP or CLEA certified. So it’s very important when you do your stool testing. And remember, we’re in the research; we’re writing the data. And we’re not a commercial stool sample yet, because there’s so much to learn. So you got to be aware of stool companies that are selling you these tests. And then telling you, you have low Bifidobacteria, because maybe they’re trying to sell you a probiotic for one. I know, we have validated a couple of those lots, because my patients come to me and say, “Look, I just took this probiotic from this company. And you know, my Bifido was low, and then we compared it and we couldn’t find that their Bifidos were low. So you got to be careful of anything out there. It’s all research. And everybody needs to understand it’s all research.

Lindsey:

Well, it wasn’t the first low Bifido reading I’d had. I certainly had other probably 16s sequencing that showed low Bifido as well.

Dr. Sabine Hazan:

Yeah. So that’s good. So you validated yourself.

Lindsey:

Right, right. Over time. So are there any other diseases where you’ve noticed changes when incidentally you were doing the transplant for C. diff?

Dr. Sabine Hazan:

We are working on autism right now. We’re going to try to bring on a protocol for Parkinson’s and Alzheimer’s. I’m working with Dr. Sheldon Jordan at UCLA, who is the top interventional neurologist, in my opinion. We’re also working with anxiety with Dr. Sasha Bystritsky. So that’s going to be an interesting study. We feel that we see something in anxious patients’ microbiome. So we’re evaluating that closely.

Lindsey:

And are you just looking at what is going on in the microbiome? Or are you making interventions?

Dr. Sabine Hazan:

No, we’re looking and we’re making interventions. So we’re basically… remember, I’m a research center. So we have access to animal labs. So right now, we’re looking at an animal marker for Parkinson’s. So we’ll see. I mean, the future is exciting. We’re seeing some things. And we’re going after it full blast. And we’ve been lucky so far, so we’re still above the ground as far as finances, but people can support the Microbiome Research Foundation, because that’s how we make all these trials possible, and this research possible. The paper for COVID, the lost microbes of COVID, or finding COVID in the stools was paid by the Microbiome Research Foundation. So please put that on the links so that people can support that. So that’s how we advance science through research; through donations.

We’ve been fortunate; a lot of patients I’ve helped over the years that you know, I’m in Malibu, so I have an affluent population; and they’ve been coming forward and been very generous in in supporting us. So and also the patients, you know, the patients support us, so it’s been amazing to help people. And to see and to kind of go into the research with them and see what we see and saying, “Look, it’s research. This is what I see. I could be wrong, but I could be right. And this is the beginning.” You know, and having frank, honest discussion with the patients and giving them a consent because really all our research is consented. Anytime anybody gets tested with us with the microbiome, it’s all research so they have to sign a consent before they get tested or if we test their kids with autism, etc. They have to sign a consent. We are supervised by a regulatory board that overlooks all our IRB that overlooks all our research we’re doing. You know I thought Howard Young at the NIH said, “This is the way to do it.” And I’m doing it. So I wrote 52 clinical trials on the microbiome and disease. I’m looking at every disease and every skin condition.

I’m very fortunate. My sister is the top dermatologist in New York City. I have another sister who brought HARVONI and Ivermectin in the market. So we have a huge database of patients through clinical trials over the years. So we’ve been able to utilize these databases and put patients into clinical trials, to at least get a beginning of a view of what does Parkinson look like in the microbiome; what does Alzheimer’s? So we have an idea and we’re continuing slowly, slowly, and eventually, as we publish, I encourage everybody to go on the Progenabiome website, because it has publications. We’ve published about 35 papers, I think, in the last three years. So you know, it’s moving. I have 52 more papers to go. We have a lot of scientists helping me and we encourage collaboration from everyone. Anybody that wants to be involved, please, you know, we’re all inclusive. Like I said, I’m a Research Center. I’m a research lab right now, research genetic sequencing lab. I’m not a commercial. But anybody that wants to get involved and has something that they want to crack the code of, you know, can help us and together hopefully we’ll join forces. I am fortunate I have a lot of doctors, a doctor from Turkey that I’m working with. Right now, we’re looking at Crohn’s and Ulcerative Colitis together. Dr. Borody has been an inspiration and definitely a huge mentor and a huge brain and genius.

Lindsey:

Yeah, speaking of him, I would love to get him on the podcast. Any chance you would introduce me?

Dr. Sabine Hazan:

Oh, yeah, absolutely. I could do an email. He’s extremely busy right now because he’s trying… we started off that controversial triple therapy for COVID with Ivermectin, doxycycline, zinc. So  he’s busy fighting the wolves, because he wants to see that going. You know, he was behind the therapy for H. Pylori. So patents is his world and combination therapy is his world. And he’s a genius. I’m so fortunate to be working with the man. And I’ve done my part, which was like doing the clinical trial with the FDA. So now it’s on to him to take it to the next level. That was not an easy trial to do, and certainly a lot of politics, controversy behind it so…

Lindsey:

Okay, well, I appreciate that. Even if he doesn’t have time, maybe he will eventually.

Dr. Sabine Hazan:

Yes, yes. Yes. For sure. I think yeah; as he kind of like figures out this whole triple therapy. What he wants to do with it? I think that probably would be the best time.

Lindsey:

Okay well, thank you so much for coming on and sharing about what you’re doing at Progenabiome and I look forward to talking to you in the future sometime.

Dr. Sabine Hazan:

Yes, absolutely. Thank you so much.

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

Adapted from episode 68 of The Perfect Stool podcast and edited for readability.

I’m going to describe the digestive process when it’s working well, which may help you pinpoint where things may be going wrong for you, as well as give you an idea of the symptoms when a certain part of your digestion is off. I’ll be focusing mostly on functional digestive issues, as those are the kind I work with clients on, as opposed to mechanical issues, which a conventional gastroenterologist is best equipped to handle, although I’ll mention a few. And I’ll preface this by saying that of course this isn’t comprehensive, but rather a summary of some of the most common issues I see in clients. 

So first of all, before you even eat, as you think about eating or smell your food before eating it or while cooking it, this alerts your brain to start the flow of saliva in your mouth, which contains salivary amylase, which helps break down starches in your food into simpler sugars. Then next, if you don’t shovel your food down too quickly, you’ll ideally chew each bite a good 20 or 25 times so that it’s a fine mush and it mixes well with those enzymes. 

Then as you swallow, your food travels down the esophagus to your lower esophageal sphincter, which will open up and let the food into your stomach. Now hopefully the pH in your stomach is ideal, meaning not too acidic and not too alkaline, although a stomach with its acid is quite acidic, with a pH usually in the range of 1.5 to 3.5.  

When it’s not acidic enough, or there’s a lack of stomach acid, called hypochlorhydria, it can lead to the opening of the lower esophageal sphincter, which is sensitive to pH and closes when the pH drops under 3.0, which will trigger the escape of stomach acid into the esophagus and the sensations of GERD, or gastroesophageal reflux disease, aka heartburn.  Stomach acid tends to decrease with age but can also decrease due to the presence of H pylori or Helicobacter pylori, the bacteria that causes ulcers and stomach cancer when it possesses certain virulence factors. Other factors impacting stomach acid are alcohol use, poor diet, not being in a proper rest and digest or parasympathetic state while eating, stress and food sensitivities as well as pharmaceuticals such as antibiotics, proton pump inhibitors or PPIs and antacids. Insufficient stomach acid can lead to maldigestion of proteins and their components, amino acids, which can impact the lining of the stomach leading to leaky gut, and puts stress on the pancreas to produce enzymes to complete the digestive process (which are composed of amino acids themselves). And when you have undigested proteins leaking into the abdominal cavity, that can trigger autoimmune reactions as your immune system targets the proteins and other parts of your body that look similar to the offending proteins. Low stomach acid can also lead to overgrowths of candida, parasites, and bacteria, which are normally killed off or kept in check by stomach acid, and can also lead to mineral depletions in the body. 

Another possible reason for GERD, proposed by Norm Robillard who appeared on episode 41 of this podcast and created the Fast Tract Diet and wrote Heartburn – Fast Tract Digestion: Acid Reflux & GERD Diet Cure Without Drugs*, is an overgrowth of bacteria in the small intestine feeding on maldigested carbohydrates, which leads to the production of gas. That gas puts upward pressure on the stomach and causes acid to be pushed back upwards. This maldigestion can be the result of excess starches in the diet and/or excess bacteria, as well as insufficient pancreatic enzymes to help digest the starches. Upward pressure can also happen as a result of a hiatal hernia.

But back to your stomach, when the food arrives there, your stomach’s G cells release a hormone called gastrin, which triggers the stomach to release gastric juice, composed of water, mucus, hydrochloric acid, pepsin and intrinsic factor. The churning motion of your stomach helps to mix up the food with gastric juice and break it down. And then the pepsin, in combination with the acidic pH produced by the hydrochloric acid, breaks down proteins into amino acids. 

There are a few things that can go wrong at the level of stomach that can cause problems. Gastritis, or inflammation of the lining of the stomach, can come about due to a poor diet, excess alcohol consumption, overuse of NSAIDs or non-steroidal anti-inflammatory drugs, especially ibuprofen and naproxen sodium, and H pylori overgrowth, which can be the result of lowered gut immunity due to stress. While virulent strains of H pylori can causes ulcers and stomach cancer, even non-virulent strains can still cause GERD and bloating after eating, stomach pain, especially on an empty stomach, nausea, and other symptoms like lack of focus, especially in children, constipation, diarrhea and even insomnia. 

And while actual tests of people with symptoms of GERD have shown that hypochlorhydria is the most common cause (roughly 80% of the time), you may actually have excess stomach acid or hyperchlorhydria, which is commonly treated with PPIs by conventional doctors, whether or not the state of your stomach acid is known (which is rarely as few doctors have the ability to perform a Heidelberg test, which measures stomach acid). Hyperchlorhydria is also common in the early stages of an H pylori infection but usually turns into hypochlorhydria over time. But it’s important, even if you do have excess stomach acid, to not stay on PPIs long term. Usually a course of 2 weeks is recommended and then other causes of your issues should be investigated. 

So after the stomach, the food goes through the pylorus into the small intestine or small bowel where it’s broken down further with enzymes produced by the pancreas, the primary types being amylase for breaking down starches, proteases (also called proteolytic enzymes, proteinases or peptidases) for breaking down proteins and lipase for breaking down fats, along with bile. Bile is produced by the liver and stored in the gallbladder and it emulsifies fat, meaning it breaks it down into micro-droplets. Also involved in the final stages of digestion of carbohydrates and protein are the brush border enzymes, which are embedded in the microvilli, or hairlike structures lining the small intestine, the most well-known of which is lactase, which breaks down lactose, the sugar in dairy products. Genetics determine the persistence of lactase activity, which many people lose by adulthood, making them lactose intolerant, whose symptoms are gas, painful, soft or even liquid stool, bloating, cramping and discomfort after eating and while eliminating lactose, which is highest in soft cheeses, milk and ice cream. 

Issues at this level can be related to insufficient pancreatic enzymes, which can have many causes. The official name of this is called exocrine pancreatic insufficiency or EPI, whose most common cause is chronic pancreatitis or inflammation of the pancreas. This can result from alcohol abuse or gallstones in the gallbladder. Ongoing inflammation damages the cells of the pancreas, leading to a decrease in enzyme production. Other causes of EPI include celiac disease, IBD, diabetes, pancreatic cancer and weight loss or other digestive tract surgery. Symptoms of EPI are either constipation or diarrhea, abdominal pain, bloating and gas and fatty or pale-colored, oily or floating, smelly stools. 

And returning to the gallbladder, you can also have issues impacting your digestion originating in the gallbladder such as gallstones, clogged bile ducts, sludgy bile or insufficient bile, which is a given if you’ve had your gallbladder removed. Although the liver produces bile, it’s stored in the gallbladder and you won’t have enough to digest a higher fat meal. Signs of insufficient bile or fat maldigestion include trapped and bad-smelling gas, stomach cramps, diarrhea, erratic bowel movements, weight loss and pale-colored stools. Having problems with fat digestion or having had your gallbladder removed leads a lot of people to avoid eating fat, which is a mistake, because it’s part of a healthy diet and is necessary for the absorption of your fat soluble vitamins A, D, E and K as well as fat soluble vitamin-like compounds like CoQ10. If you’ve had your gallbladder removed, you should continue to eat fat but support your gallbladder with something like Bile Acid Factors*. If your bile is insufficient for other reasons, you may need to stimulate bile production with bitter greens, green leafy vegetables, beets, artichokes, pickles, grapefruit, lemons, limes and their juices and zest, spices such as fenugreek seeds, cinnamon stick, turmeric and ginger or drinks like roasted dandelion root tea, lemon tea, celery juice and coffee.

There are also lots of things that can go wrong at the level of the small intestine that can impact digestion. From the bacterial perspective, there’s SIBO, or small intestine bacterial overgrowth, which is usually caused by stagnation in the small intestine due to a variety of causes. That stagnation leads to a buildup of excess bacteria and general dysbiosis, or an overgrowth of the wrong types of bacteria. This can cause painful bloating and distention of the abdomen after eating, and if the bacteria produce hydrogen, usually diarrhea or soft stool. If your overgrowth is of hydrogen sulfide producing bacteria, then you’ll likely also have gas that smells like sulfur or rotten eggs and excessive belching. Other possible signs of hydrogen sulfide SIBO include intolerance to sulfur-containing foods and supplements, weight loss, brain fog, exercise or stress intolerance, burning bladder syndrome, elevated heart rate, insomnia and low blood pressure after eating. Hydrogen sulfide SIBO is also associated with ulcerative colitis, Crohn’s disease and colorectal cancer. 

Then there’s IMO, or intestinal methanogen overgrowth, which used to be known as SIBO-C, or SIBO with constipation, which is an overgrowth of archaea (which are like bacteria but of a whole different domain) including Methonobrevibacter smithii and Methanosphaera stadtmanae, which produce methane gas by metabolizing the hydrogen produced by bacteria fermenting carbohydrates. You’ll often have bloating and gas with a metallic smell when this happens. 

Or you can have an overgrowth of candida, which is a normal resident of your gut but can overgrow and even become systemic in severe cases, and which can form hyphae or sort of tails that go out between cells lining the small intestine. Usually bloating after eating, food sensitivities, skin issues and brain fog are signs of invasive candidiasis. 

Any of the above small intestine issues can lead to a case of intestinal permeability or leaky gut, which means that bits of not quite digested food or bacterial body parts called lipopolysaccharides or LPS can escape either through broken down cells or between cells and get into your system, activating your immune system and often leading to autoimmune diseases. 

But back to the normal digestive process, after the small intestine, food moves through the ileocecal valve to enter into the large intestine. Some people have mechanical issues with this valve staying chronically open or closed. Chronic constipation and tenderness in the lower right quadrant are signs that this may be an issue and it can be a root cause of SIBO. You can actually manually reset this value and I’ll link to a video about how to do that. 

And I should also mention the role of the vagus nerve in all this, because the vagal nerves carry signals between your brain and digestive system. And damage to the vagus nerve from a traumatic brain injury, diabetes, stomach surgery or certain medications, or dysfunction from emotional trauma and stress can impact your digestion, causing problems like gastroparesis, or food not moving from your stomach into your intestines properly, or SIBO. One simple way to check your vagus nerve function, described in the book Accessing the Healing Power of the Vagus Nerve* by Stanley Rosenberg, is to look at your uvula (the thing that hangs down in the back of your throat) in the mirror while saying “ah, ah, ah” and if it pulls up to the right or left, you may have issues. If this is the case, there are exercises listed in that book that can help you return to normal vagal tone. 

And of course you can have autoimmune issues all the way along, starting in the stomach, where pernicious anemia is an autoimmune attack on the parietal cells lining the stomach that produce stomach acid and intrinsic factor, which allows you to absorb vitamin B12. Or you can have post-infectious IBS or irritable bowel syndrome, which is an autoimmune attack on a protein called vinculin, which helps the migrating motor complex function to remove food from your small intestine on a regular basis. Or you can have celiac disease, which is an autoimmune attack on the microvilli lining the small intestine when you eat gluten. Common signs of this are stomach pain, fatigue due to malabsorption of nutrients as the microvilli deteriorate and diarrhea. You can also have other food sensitivities and intolerances such as non-celiac gluten sensitivity or lactose intolerance, which are two of the most common. 

Or you can have inflammatory bowel disease, which is an autoimmune disease that can manifest as ulcerative colitis or Crohn’s disease. Crohn’s involves plaques of diseased, ulcerated tissue anywhere from your mouth to your anus, and in its most severe form can lead to twists and strictures in the intestines, openings or fistula in the perianal area, anemia, shortness of breath and inflammation in your skin or joints. Common earlier signs of Crohn’s are pain, abdominal cramping, diarrhea, fatigue, fever, blood in the stool, loss of appetite, weight loss, food sensitivities, a sense of incomplete elimination after a bowel movement and bowel urgency. Colitis takes many forms such as pancolitis, microscopic colitis, ulcerative proctitis, etc. depending on its location and form, but always involves inflammation and ulcers in some part of the colon. Signs of colitis include abdominal pain, diarrhea, bowel urgency, blood and/or pus in the stool, weight loss, rectal pain, nausea, vomiting, loss of appetite, chills or fever and anemia. 

So back to normal digestion, when the food reaches your large intestine, normally you’ll be absorbing water, minerals and some remaining nutrients from your food. And if you have a healthy, fiber-rich diet, you’ll also have lots of fiber left over for the bacteria, which are most abundant in your large intestine, to ferment. The bacteria will also be providing nutrients themselves, specifically B vitamins and vitamin K, from that fermentation process. And they will also be extracting the short chain fatty acids butyrate, propionate, and acetate from the fermentation process.

Butyrate has been the target of a lot of research recently and I’m sure you’ve heard me mention it, as it produces 70% of the energy for the cells lining the large intestine or the colonocytes and helps maintain a hypoxic or oxygen-free atmosphere in the colon. The colonocytes break down butyrate and the other short chain fatty acids through a process called beta oxidation, which requires large amounts of oxygen. When there’s a lack of fiber for producing butyrate or following antibiotic use, you can have a breakdown of this process, leading to a loss of gut barrier function, and a subsequent increase in oxygen in the colon. That increase favors the expansion of proteobacteria, a phylum of bacteria that contains many gut pathogens like E Coli, Pseudomonas and Campylobacter, which are facultative anaerobes, meaning they can live in the presence of oxygen. This helps them outcompete the beneficial obligate anaerobes, particularly Clostridia, which are butyrate producers. I’ll link to a Lucy Mailing article explaining all about this particular type of dysbiosis. But what I’ve found with clients is that if you tend to have loose, messy stool, it’s often the result of this kind of dysbiosis, and supplemental butyrate in the form of Probutyrate (find in my Fullscript Dispensary*) or Tributyrin* is helpful in breaking this cycle. 

And I should probably mention constipation at this point because that’s something else that can go wrong. Having fewer than one bowel movement a day or having stool that’s very dry and hard or even to the point of rabbit pellets, hard to pass or feeling incomplete is considered constipation. You may also see breakthrough diarrhea as well in the context of constipation or what’s considered IBS-M or mixed.  Constipation can be the result of dehydration, lack of exercise, a low-fiber diet, changes to your routine, an intolerance to or large amount of dairy products, stress, chronic holding of bowel movements and certain medications. This can lead to anal fissures, diverticulitis or infected pouches in the wall of the large intestine, or hemorrhoids, which can all cause pain in the colon. And anal fissures and hemorrhoids can cause bleeding, which will show up as bright red on the toilet paper. 

But if everything is going well and properly with your digestion, you’ll instead have 1-3 regular bowel movements a day, around a 3 or 4 on the Bristol stool chart, that pass easily and completely and result in a clean wipe of the toilet paper most of the time. 

If your digestion is not proceeded successfully as describe above and you’re suffering with any type of gut or digestive issue, you’re welcome to set up a free, 30-minute breakthrough session with me (Lindsey). We’ll talk about what you’ve been going through and I’ll tell you about my gut health coaching 5-appointment program in which I recommend lab tests, educate you on what the results mean and the protocols used by doctors to fix the problems revealed. Or if you’re ready to jump in right away or can just afford one appointment at a time, you can set up an 1-hour consultation with me.

*Product links are affiliate links for which I’ll receive a commission. As an Amazon affiliate, I receive commissions on purchases made from Amazon links. Thanks for your support of the podcast and blog by using these links.