Adapted from episode 65 of The Perfect Stool podcast and edited for readability.
So recently a potential client asked about my success rate in helping clients deal with their gut issues, and being a data-driven, evidence-based person myself, I wanted to give a clear, honest answer, which I didn’t have at the time. But after thinking about it for a while, I realized that an answer to that question is complex. But it seemed like the kind of question I would ask of someone I wanted to work with and have asked of many of my guests, with less than satisfying answers, especially as it pertains to functional approaches to various gut health conditions. And after working with clients for a few years now I understand why.
But being a hard core data nerd who loves creating and playing with databases and spreadsheets and running queries and working on statistics, I thought – I’m going to find an answer to that question.
And in thinking about how to give a fair, honest answer, I realized that I’d have to understand and label what went wrong when I didn’t succeed in helping someone. Which led me to the whole concept of how to be a good client or patient, which will ultimately help you in fixing your gut health issues, which is why this could be a helpful blog for you and not just a giant advertisement for my services, because I’m truly not that shameless. ( :
And overwhelmingly what I discovered as I went through the data on my prior and current clients, there were concrete reasons why I wasn’t able to help some of the people I’ve worked with.
So let’s start with the first and biggest reason I wasn’t able to help the biggest chunk of people, which represented about 40% of my former clients (excluding those who are still in progress) and that was lack of follow through. So looking over the list of names, I see some who only set up one appointment. Maybe they were working with another practitioner who wasn’t addressing their complaints adequately, or maybe I resolved their complaints and they never told me about it, but in any case, when I followed up with them, they didn’t let me know how things were going and I didn’t know if they followed through adequately on my recommendations. So in reality, some of them may have been doing better but I don’t know.
Another subgroup of that 40% came to me in very fragile health with very complex health issues, like chronic fatigue, debilitating and very advanced Crohn’s disease, mold illness, multiple autoimmune diseases, or breakdown of multiple body systems. In that group, many were unable to follow through with my recommendations due to their fragile health, being on the conventional medical rollercoaster and not wanting to mix what I was recommending with their doctor’s treatments or an adverse reaction to something I recommended. This can happen often when treating long-term dysbiosis, especially when it involves H pylori or candida. Unfortunately, for someone who only signs up for one appointment, when that happens, they often disappear rather than coming back to try something different. Sometimes the body needs to be ready to handle the killing of bacteria or yeast, and we need to address detoxification ahead of time, go more slowly or try a different product. But if a client doesn’t communicate with me about what’s going on or come back to see me, it’s hard to help them. When you have long-standing, complex health issues involving multiple bodily systems, sometimes there are multiple false starts before you find what’s going to work. So communication with your practitioner and persistence are really key in finding solutions. I’m 100% committed to finding solutions that are workable for my clients, in changing directions, or in trying something new if what we’re trying isn’t working, but you have to be completely honest about what you can and can’t do and how you’re feeling.
Another subgroup of the people I would describe as not following through are people with complex conditions like IBD who weren’t willing or able to make the dietary changes I recommended, or follow supplement protocols that I educated them on. This occurs for different reasons from eating disorders, vacations, family and other life things getting in the way, lack of faith that dietary changes are as key as they are, or not being the person most committed to your own care, which has happened in cases where spouses or parents approach me about helping their loved ones.
Another subgroup of the non-follow throughers were people with really high anxiety. I’ve had a few people who fit this description, and because of their anxiety, they found it hard to follow my advice, because of fear of side effects of a taking a certain or really any supplements, or being too attached to the conventional medical paradigm and not trusting that alternative treatments are safe or effective. Or when it came to gut stuff they trusted my advice but weren’t willing to try out my advice when it came to other health issues. And almost everyone who sees me has other health issues, usually precipitated by gut health issues, so I have a good bit of experience at this point with those other issues. And when someone has anxiety, if they’re not already on an SSRI, I usually try to start with amino acids to bring up serotonin levels and calm them a bit before dealing with gut issues, because that’s an area where you can have pretty quick impact. And once you’ve brought down anxiety, follow through is much easier for people. But sometimes I just can’t get that far with a client because their anxiety is standing in the way.
Finally, there’s one more subgroup in that 40% of people who didn’t follow through, and that’s the folks who for whatever reason disappear and don’t use up the appointments they paid for. I have to say I’m really sad when that happens and I usually follow up at least three or four times over time to see what happened and why they disappeared. I know that sometimes there are major life issues going on that need to be addressed before being ready to address health issues. But I also imagine that sometimes there’s a mismatch in my approach and people’s expectations, which is a shame because my approach is totally flexible. If you come to me and want to work primarily through diet changes to address your issue, I’ll do my best to help you do that. If you are open to and willing to take supplements, as most people are, I’m also willing to teach you about that. But at minimum, when I suggest a protocol, speaking up for yourself and advocating for what you’re willing and able to do is so important in being able to help you. Sitting quietly then leaving and never saying why doesn’t really help anyone. I have no ego invested in your treatment. All I care about is helping you get better, so if you think we’re going in the wrong direction for whatever reason, I’m all ears about changing it.
So to summarize the lessons I can impart to you from the folks who haven’t followed through are:
- Before signing up with a practitioner, count the cost – are you at a point in your life, mental health and medical care where you can follow the recommendations of a practitioner, make hard changes to your diet and lifestyle, afford natural supplements to address your condition and stick with them long enough to know if they’re working?
- Can you advocate for yourself and speak up when things aren’t going well or do you just give up and switch to another provider when something gets hard or overwhelming or you can’t follow through?
- Does the practitioner that you’re seeing have a flexible approach or are they focused on one solution to everyone’s problems?
So back to the question of success rates, pulling out the people who didn’t follow through, I was able to come up with a list of people who came to see me for gut health issues and followed through with my recommendations. I calculated that 82% of those people had their gut health issues completely resolved or significantly improved, including diarrhea and soft stool, constipation, bloating, gas, stomach and intestinal pain and cramping, excessive burping, IBS, SIBO, candida, H. Pylori and ulcerative colitis. The ones where it didn’t resolve only saw me for 2 or 3 appointments, and I’m not really sure how their gut is doing but in the short time we worked together we weren’t able to resolve it. Or in another case, it’s still in progress following a final appointment but this is a case with IBD and I find those require a lot of trial and error to bring into solid remission.
So as I mentioned above, most people come to me with more than gut health issues. I calculated the percentage of people who had other significant health issues and it was 83%. Those included things like anxiety, depression, bipolar disorder, schizophrenia, eczema, psoriasis, rashes, autoimmune diseases of all types, including Hashimoto’s, Rheumatoid Arthritis , MS, POTS, spondyloarthritis and dermatomyositis, joint pain, chronic fatigue, low energy, extreme food sensitivities, incontinence, prostate issues, frequent urination, frequent UTIs, brain fog, type 1 and type 2 diabetes, hormonal imbalances, gum inflammation, arthritis, sleep issues, nasal polyps and congestion, excessive allergies, headaches and migraines, asthma, COPD, mold illness, rashes, infertility, dizziness, heart issues and osteoporosis just to name a few.
Now some of these things are related to the gut and can be dealt with through dealing with gut health issues but of course others are not, so I don’t claim to be able to help people with all those issues. But of the folks who followed through, half of the people with other issues saw resolution or improvement of at least one of them, including headaches and migraines, dizziness, joint pain, depression, anxiety, fatigue, food sensitivities, inflammation, including in the gums, psoriasis, frequent UTIs, sleep issues, blood sugar dysregulation, hypothyroidism and remission or a decrease in symptoms of autoimmune diseases, including Hashimoto’s, RA and dermatomyositis. And in some cases, I helped people identify potential health issues and recommended tests to have their doctor do that led their doctor to diagnose and treat issues that were underlying their health complaints.
So if you’re considering looking for an alternative or functional medicine practitioner, I’d give you these few pieces of advice. First, if you haven’t yet seen your PCP or a gastroenterologist about your complaints, that’s the first place to start. Go through the conventional medical system first because it will be covered by insurance and will rule out physical issues and give you a diagnosis. It’s a lot easier to work with people when you know what they have. But don’t let that drag out too much. If you’ve been through that system without positive results, been told there’s nothing else they can do, or been put on a medication for life you’d like to get off, that’s when it’s time to seek out an alternative practitioner. Then look for someone with expertise who is evidence based (meaning they don’t latch onto every new unproven woo-woo thing out there), use peer-reviewed studies to make treatment decisions, and charge reasonable fees for their services. But you have to understand that most of us who are in the field of functional medicine and coaching are self-employed (meaning we have to set aside money for payroll taxes and our own benefits) and spend a lot more time with you than a doctor. For me that means typically around 1.5-2 hours in preparation and follow-up for 1-hour client appointments, checking in every few weeks to see how you’re doing, email support whenever you need it. So keep that in mind when you look at hourly or program fees. And really, you should think of it as an investment in your health because that’s what it is. Because without your health, you have nothing. Nothing else in life is enjoyable when you feel miserable or are in a constant state of anxiety about your health.
Now if seeing an alternative practitioner is completely out of your league financially and you need to try to self-treat, here are a few pieces of advice.
- Do one thing at a time and follow through for a reasonable amount of time. So for example, if you’re going to try an elimination diet, if you have serious health complaints or autoimmune issues, I’d recommend a very thorough elimination diet like the Autoimmune Paleo protocol, and spending at least 30 days on elimination then systematically reintroducing things. If you have more minor health complaints, you may get away with a smaller set of foods to eliminate and test, but gluten, dairy, soy, processed food, sugar, caffeine, alcohol, nightshades and processed seed oils are some of the big ones you’ll probably need to eliminate and test. The part where people tend to get sloppy is usually on the reintroduction because they’re so tired of deprivation they just restart eating their old diet. I wouldn’t recommend that. Even if you don’t feel significantly better when eliminating, you may forget how bad you felt before and only on reintroducing systematically will you realize what you’re sensitive to. But if you end up only eating 3 foods, then you’ve gone too far and likely you need to address gut issues beyond what you’re eating.
- So second, if you have significant gut issues like excessive bloating, soft stool, constipation, etc. it’s not likely that just making diet changes alone is going to solve them, although I have seen people on pretty bad standard American diets eliminate those problems when they started eating in a healthier way. But if you’re already eating plenty of fruits and veggies, organic and pastured meats and wild caught seafood, sufficient fiber in the form of whole grains, root veggies, beans, lentils, etc., healthy oils like olive, avocado and coconut oil and your diet isn’t too high in carbs especially white flour and sugar and you’re still having issues, then I wouldn’t say just a basic diet cleanup will take care of your issues. If you determine that you likely have SIBO or candida, then you could try to find and put together a protocol or find a product online or in a health food store to treat your issue. Just don’t listen to every single podcast out there and throw in everything but the kitchen sink. Sometimes I find people on 30 different supplements and when it’s like that, it’s almost impossible to determine what is useful and helpful. But at most 2 or 3 carefully selected things can help you. Just be careful that when you start taking antimicrobials of any sort, you can have die-off or a Herxeimer reaction, which can feel like the flu as parts of dead bacteria and yeast flood your system. If you get really sick, stop taking your supplements and let your body process it out before continuing. Typically herbal treatments for SIBO are relatively quick, say 6 weeks, twice that at the worst, H pylori a couple months, whereas treating bad candida can drag on for 6 to 8 months, so don’t give up.
- And then finally, if you aren’t getting anywhere and want a little guidance but can’t sign up for a whole program of support, know that most practitioners will do one-off appointments, including myself. For me, that includes follow-up support via email to see you through whatever protocol I recommend.
- And if you think gut health testing will help you know better what to do, you can of course take my gut health quiz that will help you determine which gut health or functional medicine tests are most appropriate for you.
- And as always, you can sign up for a free, 30 minute breakthrough session if you want to talk through what’s been going on and see if it’s something I can help you with or you can jump right to a single, 1-hour consultation if you’re ready to get working right away.
I just hope that you all persist in trying to be as good clients or patients as you can for whoever you are working with so you can see your way to a solution because I do believe that most gut health issues have solutions and that you can get better. And whatever terrible state of affairs you’ve been living with does not need to continue indefinitely. That there are solutions. And I know this from my own life and from my clients so I just want to give you encouragement and hope that you can find the solution to your problems.
