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

Lindsey: 

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

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

Stasha Gominak, MD: 

It is and can I go from there?

Lindsey: 

Please.

Stasha Gominak, MD: 

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

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

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

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

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

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

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

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

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

Lindsey: 

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

Stasha Gominak, MD: 

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

Lindsey: 

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

Stasha Gominak, MD: 

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

Lindsey: 

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

Stasha Gominak, MD: 

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

Lindsey: 

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

Stasha Gominak, MD: 

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

Lindsey: 

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

Stasha Gominak, MD: 

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

Lindsey: 

How many people are we talking about?

Stasha Gominak, MD: 

1500 at the time.

Lindsey: 

1500 with IBS?

Stasha Gominak, MD: 

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

Lindsey: 

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

Stasha Gominak, MD: 

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

Lindsey: 

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

Stasha Gominak, MD: 

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

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

Lindsey: 

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

Stasha Gominak, MD: 

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

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

Lindsey: 

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

Stasha Gominak, MD: 

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

Lindsey: 

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

Stasha Gominak, MD: 

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

Lindsey: 

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

Stasha Gominak, MD: 

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

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

Lindsey: 

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

Stasha Gominak, MD: 

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

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

Lindsey: 

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

Stasha Gominak, MD: 

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

Lindsey: 

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

Stasha Gominak, MD: 

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

Lindsey: 

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

Stasha Gominak, MD: 

Very unusual.

Lindsey: 

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

Stasha Gominak, MD: 

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

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

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

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

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

Lindsey: 

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

Stasha Gominak, MD: 

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

Lindsey: 

What’s the relationship chemically between choline and acetylcholine?

Stasha Gominak, MD: 

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

Lindsey: 

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

Stasha Gominak, MD: 

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

Lindsey: 

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

Stasha Gominak, MD: 

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

Lindsey: 

A lot of choline in egg yolks.

Stasha Gominak, MD: 

Egg yolks. It’s famous for that.

Lindsey: 

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

Stasha Gominak, MD: 

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

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

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

Lindsey Parsons:

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

Danielle Daem:

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

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

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

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

Lindsey Parsons:

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

Danielle Daem:

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

Lindsey Parsons:

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

Danielle Daem:

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

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

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

Lindsey Parsons:

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

Danielle Daem:

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

Lindsey Parsons:

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

Danielle Daem:

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

Lindsey Parsons:

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

Danielle Daem:

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

Lindsey Parsons:

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

Danielle Daem:

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

Lindsey Parsons:

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

Danielle Daem:

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

Lindsey Parsons:

What kind of withdrawal symptoms do people experience?

Danielle Daem:

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

Lindsey Parsons:

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

Danielle Daem:

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

Lindsey Parsons:

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

Danielle Daem:

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

Lindsey Parsons:

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

Danielle Daem:

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

Lindsey Parsons:

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

Danielle Daem:

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

Lindsey Parsons:

Briefly, what oils do you recommend people use?

Danielle Daem:

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

Lindsey Parsons:

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

Danielle Daem:

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

Lindsey Parsons:

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

Danielle Daem:

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

Lindsey Parsons:

Nor am I.

Danielle Daem:

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

Lindsey Parsons:

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

Danielle Daem:

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

Lindsey Parsons:

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

Danielle Daem:

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

Lindsey Parsons:

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

Danielle Daem:

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

Lindsey Parsons:

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

Danielle Daem:

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

Lindsey Parsons:

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

Danielle Daem:

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

Lindsey Parsons:

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

Danielle Daem:

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

Lindsey Parsons:

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

Danielle Daem:

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

Lindsey Parsons:

Okay, great. Do you coach individually as well?

Danielle Daem:

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

Lindsey Parsons:

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

Danielle Daem:

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

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

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

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

Lindsey: 

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

Erin Dunny, RD: 

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

Lindsey: 

What’s an EGD?

Erin Dunny, RD: 

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

Lindsey: 

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

Erin Dunny, RD: 

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

Lindsey: 

Right. And you were eating dairy?

Erin Dunny, RD: 

Yes.

Lindsey: 

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

Erin Dunny, RD: 

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

Lindsey: 

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

Erin Dunny, RD:  

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

Lindsey: 

And how many years ago was that?

Erin Dunny, RD: 

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

Lindsey: 

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

Erin Dunny, RD: 

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

Lindsey: 

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

Erin Dunny, RD: 

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

Lindsey: 

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

Erin Dunny, RD: 

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

Lindsey: 

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

Erin Dunny, RD: 

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

Lindsey: 

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

Erin Dunny, RD: 

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

Lindsey: 

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

Erin Dunny, RD: 

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

Lindsey: 

Does Vibrant Labs have that marker then?

Erin Dunny, RD: 

Yes.

Lindsey: 

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

Erin Dunny, RD: 

Gotcha. Yeah. As far as the supplements?

Lindsey: 

Herbals, yes.

Erin Dunny, RD: 

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

Lindsey: 

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

Erin Dunny, RD: 

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

Lindsey: 

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

Erin Dunny, RD: 

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

Lindsey: 

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

Erin Dunny, RD: 

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

Lindsey: 

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

Erin Dunny, RD: 

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

Lindsey: 

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

Erin Dunny, RD: 

Absolutely.

Lindsey: 

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

Erin Dunny, RD: 

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

Lindsey: 

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

Erin Dunny, RD: 

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

Lindsey: 

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

Erin Dunny, RD: 

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

Lindsey: 

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

Erin Dunny, RD: 

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

Lindsey: 

So what did you do for yourself?

Erin Dunny, RD: 

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

Lindsey: 

Did you have H. Pylori too?

Erin Dunny, RD: 

No.

Lindsey: 

Okay, yeah.

Erin Dunny, RD: 

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

Lindsey: 

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

Erin Dunny, RD:  

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

Lindsey: 

And did you have fatigue?

Erin Dunny, RD: 

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

Lindsey: 

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

Erin Dunny, RD: 

I did not.

Lindsey: 

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

Erin Dunny, RD: 

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

Lindsey: 

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

Erin Dunny, RD: 

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

Lindsey: 

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

Erin Dunny, RD: 

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

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

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

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

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

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

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

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

What causes SIBO or IBS?

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

Testing for SIBO

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

Treating SIBO

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

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

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

Lifestyle Factors in Preventing SIBO Recurrence

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

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

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

How does my diet impact my SIBO?

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

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

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

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

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

Is my SIBO/IBS autoimmune?

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

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

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

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

Prokinetics for Recurrent SIBO

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

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

What to do when my SIBO comes back?

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

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

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

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

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

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

Lindsey: 

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

Kyrin Dunston, MD:

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

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

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

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

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

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

Lindsey: 

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

Kyrin Dunston, MD:

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

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

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

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

Lindsey: 

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

Kyrin Dunston, MD:

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

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

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

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

Lindsey:

Air Force, Marines.

Kyrin Dunston, MD:

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

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

Lindsey: 

Right. That’s, that’s my situation.

Kyrin Dunston, MD:

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

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

Lindsey: 

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

Kyrin Dunston, MD:

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

Lindsey: 

Okay. Got it

Kyrin Dunston, MD:

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

Lindsey: 

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

Kyrin Dunston, MD:

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

Lindsey: 

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

Kyrin Dunston, MD:

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

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

Lindsey: 

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

Kyrin Dunston, MD:

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

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

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

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

Lindsey: 

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

Kyrin Dunston, MD:

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

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

Lindsey: 

Yeah.

Kyrin Dunston, MD:

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

Lindsey: 

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

Kyrin Dunston, MD:

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

Lindsey: 

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

Kyrin Dunston, MD:

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

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

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

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

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

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

Lindsey: 

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

Kyrin Dunston, MD:

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

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

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

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

Lindsey: 

Are we talking about creams or over the counter pills?

Kyrin Dunston, MD:

Oh yeah cream.

Lindsey: 

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

Kyrin Dunston, MD:

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

Where to find Dr. Dunston:

Herhormoneclub

Kyrin Dunston’s Stop the Menopause Madness Facebook Group

Kyrin Dunston, MD’s Instagram

Kyrin Dunston’s Youtube

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

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

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

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

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

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

Lindsey:

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

Camila Smith, LCSW, DHSc:

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

Lindsey:

So you were there all the time.

Camila Smith, LCSW, DHSc:

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

Lindsey:

Great. So what was your dissertation topic?

Camila Smith, LCSW, DHSc:

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

Lindsey:

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

Camila Smith, LCSW, DHSc:

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

Lindsey:

The enteric nervous system.

Camila Smith, LCSW, DHSc:

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

Lindsey:

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

Camila Smith, LCSW, DHSc:

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

Lindsey:

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

Camila Smith, LCSW, DHSc:

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

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

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

Lindsey:

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

Camila Smith, LCSW, DHSc:

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

Lindsey:

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

Camila Smith, LCSW, DHSc:

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

Lindsey:

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

Camila Smith, LCSW, DHSc:

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

Lindsey:

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

Camila Smith, LCSW, DHSc:

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

Lindsey:

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

Camila Smith, LCSW, DHSc:

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

Lindsey:

And so those are free as part of the service?

Camila Smith, LCSW, DHSc:

Yes, they come included.

Lindsey:

Okay.

Camila Smith, LCSW, DHSc:

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

Lindsey:

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

Camila Smith, LCSW, DHSc:

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

Lindsey:

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

Camila Smith, LCSW, DHSc:

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

Lindsey:

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

Camila Smith, LCSW, DHSc:

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

Lindsey:

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

Camila Smith, LCSW, DHSc:

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

Lindsey:

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

Camila Smith, LCSW, DHSc:

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

Lindsey:

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

Camila Smith, LCSW, DHSc:

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

Lindsey:

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

Camila Smith, LCSW, DHSc:

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

Lindsey:

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

Camila Smith, LCSW, DHSc:

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

Lindsey:

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

Camila Smith, LCSW, DHSc:

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

Lindsey:

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

Camila Smith, LCSW, DHSc:

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

Lindsey:

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

Camila Smith, LCSW, DHSc:

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

Lindsey:

Wow.

Camila Smith, LCSW, DHSc:

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

Lindsey:

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

Camila Smith, LCSW, DHSc:

Yes, just for your people.

Lindsey:

How long will that last?

Camila Smith, LCSW, DHSc:

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

Lindsey:

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

Camila Smith, LCSW, DHSc:

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

Lindsey:

That’s awesome. I appreciate that mission.

Camila Smith, LCSW, DHSc:

Yeah.

Lindsey:

Any final thoughts before we go?

Camila Smith, LCSW, DHSc:

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

Lindsey:

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

Camila Smith, LCSW, DHSc:

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

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

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

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

Combating GERD: Are PPIs the Answer?

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

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

What is GERD?

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

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

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

What is LPR?

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

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

What are the risk factors for GERD and LPR?

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

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

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

Is GERD always caused by high stomach acid?

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

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

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

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

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

What is the cause of excess stomach acid?

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

Another common cause of excess stomach acid is an H. Pylori bacterial infection. Usually with a new infection, stomach acid increases, but then after the infection continues and increases, the damage to the stomach cells can lead to low stomach acid. This is caused by the release of an enzyme from H. Pylori called urease, which breaks down in the stomach into carbon dioxide and ammonia, causing burping and bad breath that are commonly associated with H. Pylori, and which neutralizes stomach acid.

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

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

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

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

Symptoms of ulcers include

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

And some more severe but less common symptoms are:

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

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

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

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

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

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

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

Are PPIs a good treatment for gastritis?

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

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

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

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

Is it dangerous to take PPIs?

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

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

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

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

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

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

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

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

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

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

Lindsey:

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

Stasha Gominak, MD:

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

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

Lindsey:

Could you define trophic factor?

Stasha Gominak, MD:

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

Lindsey:

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

Stasha Gominak, MD:

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

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

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

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

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

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

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

Lindsey:

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

Stasha Gominak, MD:

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

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

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

Lindsey:

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

Stasha Gominak, MD:

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

Lindsey:

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

Stasha Gominak, MD:

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

Lindsey:

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

Stasha Gominak, MD:

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

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

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

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

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

Lindsey:

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

Stasha Gominak, MD:

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

Lindsey:

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

Stasha Gominak, MD:

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

Lindsey:

I mean, in Arizona, so similar.

Stasha Gominak, MD:

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

Lindsey:

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

Stasha Gominak, MD:

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

Lindsey:

But were they as broad spectrum?

Stasha Gominak, MD:

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

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

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

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

Lindsey:

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

Stasha Gominak, MD:

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

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

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

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

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

Lindsey:

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

Stasha Gominak, MD:

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

Lindsey:

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

Stasha Gominak, MD:

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

Lindsey:

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

Stasha Gominak, MD:

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

Lindsey:

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

Stasha Gominak, MD:

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

Lindsey:

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

Stasha Gominak, MD:

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

Lindsey:

Where can people find you?

Stasha Gominak, MD:

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

Lindsey:

This is the Right Sleep program.

Stasha Gominak, MD:

Yes.

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

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.