Fixing The Root Causes Of Irritable Bowel Syndrome with Dr. Todd LePine

Coming up on this episode of the Doctor's Pharmacy.

There's really, you know, listening to the patient antibiotic use. Did they have a lot of ear infections? Did they have a lot of strep throat? Did they get a lot of antibiotics? What's going on in the family? Does anybody else in the family have any digestive issues? So just taking the time to get that history allows you to sort of play detective and try to figure out, okay, what are the things that are potentially playing a role in driving this and what might have triggered it? and then personalizing, you know, diagnostics and treatment and everything else.

Welcome to the Doctor's Pharmacy. I'm Dr. Mark Hyman, and that's Pharmacy with an F, F-A-R-M-A-C-Y, a place for conversations that matter. And if you've ever suffered from digestive problems, from irritable bowel syndrome, bloating and discomfort, you better listen to this podcast carefully, because it is a special podcast of the Doctor's Pharmacy, which I call the House Call Series. And I'm sitting down with my colleagues from the Ultra Wellness Center in Lenox, Massachusetts. And today I'm joined by Dr. Todd LePine to discuss how we, as functional medicine doctors, tackle specific conditions we see at our practice every single day. And I'm going to focus today on irritable bowel because that is affecting so many people. It's the number one reason people actually go to the doctor is digestive complaints. It's a big problem and it causes disability and dysfunction and misery for so many people. And it's fixable. So Todd is a great friend and colleague. We worked together for pushing on almost 30 years now. Long time. We're still standing. He's an extraordinary physician, a leader and thinker in the field of functional medicine. He graduated from Dartmouth Medical School. He's board certified in functional medicine and he worked with me at Kenya Ranch for many years. He teaches all over the world in various faculties and is just a brilliant functional medicine physician and honored to have him as part of our center here at the Ultra Wellness Center. So, Todd, welcome to Doctor's Pharmacy again. Thanks, Mark. It's great to be here.

Okay, so let's talk about this thing called Irritable Bowel Syndrome. What did we learn about it in medical school? Not much. I mean, we basically learned that it was one of those conditions where you sort of treat the patient and it's not serious, you're not gonna die from it. And I can remember actually at Dartmouth, we had Dr. Alme and he was an expert in irritable bowel. And back then it was felt to be more of a neurologic, sort of like stress related thing.

Psycho-emotional.

Psycho-emotional. And actually, I'll tell you, this is an interesting side story. He did a test where he took some medical students and was measuring the manometry of them. And while he was doing the sigmoidoscopy, he was measuring the tension in the colon. and then he, while doing the, you can only do this to medical students, and this is back in the 50s, and he told them, he goes, I think I see cancer. All of a sudden, there was a spasm of the colon.

Oh.

Yeah, and it was like he wanted to evoke to see what it was, what was going on with the irritable bowel, and they thought it was a lot of those were nervous related, and which there is a stress component. And so back then, the concept of irritable bowel was that it was all.

Sort of in your head. It's all sort of like, you know, we had a very fancy word for it in medical school. We called it supratentorial, which is a doctor's way of saying it's all It's.

All in your head.

It's all in your head. The tentorium is that thing that kind of separates your top of your brain from the lower brain. And it was a joke, but it was very pejorative. And we often thought that these patients were malingerers.

It was called functional bowel disease.

Yeah, there's a lot of terms. There was no real cause for it. It was more psychological. And maybe stress related. And these people are all emotional and upset. Turns out it's not so, right? And we call it syndrome, right?

Syndrome. So when we say syndrome in medicine, what do we mean? It's a constellation of various symptoms. And, you know, we now- yeah, we don't know what the hell's going on. We don't know what- it's like, yeah, it's like, you know, chronic fatigue syndrome. You know, it's like, you know, how many different things can cause chronic fatigue?

It's like there's 23 flavors or how.

Many flavors of Baskin-Robbins ice cream? Same thing with- 31. I used to scoop Baskin-Robbins ice cream. That's one of my jobs. Right, right. And then probably cause earlobe bald. Probably. With all those artificial flavorings and sugar. So, yeah. So, and, you know, nowadays we sort of classify irritable bowel into irritable bowel with constipation, irritable bowel with diarrhea, and then mixed irritable bowel. That's how we're sort of, you know, putting an ICD-10 code on it. And that's a way of conceptualizing it, but there are lots of different things that play a role. Without question, I think stress does play a role with irritable bowel. And I think that, you know, stress can manifest in the body in so many different ways. We've talked about this when we talked about autoimmune conditions because Oftentimes when we have a patient and some stressful event happens, it triggers a host of things and sort of like a ripple effect that goes on in the body. And without question, there is a stress component to some irritable bowel syndrome.

Well, yeah. I mean, you've got your second brain in your gut. There's more serotonin in your gut than in your brain. You've got this whole nervous system that connects the two that is extraordinary complex and feeds back both ways. So, from the top down and bottom up. irritable bowel can cause irritable brain and.

Irritable bowel, it goes back and forth. Right. And you want to have a happy.

Bowel, a happy brain.

That's, that's, you know, that's really. Sounds like the key to a happy life. Happy, happy bowels, happy brain. Exactly. Exactly. And then, yeah. And there is that, it's an interesting thing that you talk about because you have that gut brain connection. And it's like a two-way highway in their bot, they're basically communicating, the brain's talking to the gut and the gut's talking to the brain. And then you also have the enteric nervous system. And, and some people sort of forget about the enteric nervous system. And that's the intrinsic nervous system to the gut. So literally, if you if you sever the spinal column and there is no connection to the gut and the brain, the gut still works. You can still poop fine if you sever the spinal cord.

It's got a mind of its own. That's what you're saying.

It's got a mind of its own, exactly. Right.

But, Todd, I want to come back to what you said, which is really important. You said, we categorize irritable bowel as with constipation or diarrhea or whatever, and there's a whole classification system that that is driven off of symptoms. And the difference between functional medicine and conventional medicine thinking about any disease is that it's not focused on the symptoms, it's focused on the causes. So just saying people have irritable bowel doesn't tell you anything about the cause. It tells you they feel uncomfortable, they're bloated, they have diarrhea, their bowels are weird, they're uncomfortable, cramping, whatever the symptoms are, is irrelevant when it comes to trying to figure out the cause. I mean, yeah, okay, you have irritable bowel, but that's, When you start to think about the problem, in traditional medicine, you name the disease, you stop thinking. Right. You know, and our colleague, Sid Baker, always had this great term. He says, you know, traditional medicine is naming and blaming. You name the disease and then you blame the name for the problem. Oh, I know why your stomach hurts. You have irritable bowel syndrome. No, that's just the name of the problem. Exactly. But he talks about thinking and linking, which is functional medicine, right? Yeah. You think about the problem and the cause once you get the diagnosis and you link everything together to see what the factors are. And there's no such thing as irritable bowel syndrome. There's irritable bowel syndromes. Like you said, there's 31 flavors and.

Each one is different and each one needs to be treated differently. Exactly, exactly. Yeah, it's so, so, so true. And there is this web-like interaction in the body and it's very important to understand the whole interconnectedness of it. It's very, very important.

So typically go to the doctor and you have irritable bowel, what do they tell you to do? Well, you know, they, they, you know.

They'Ll, they'll often tell you, you know, take some metamucil and I'll see you later. That's, that's.

Eat more fiber, drink more water.

Yeah, that's, that's the sense. Learn to live with it. And, yeah, that's essentially what they're dealing with stress. Yeah. That deal with stress. Yeah. And they'll, the interesting thing, this is, I had a patient just the other day who I was seeing for GI symptoms. It wasn't specifically, Irla Wall. And the patient's GI doctor said, diet has nothing to do with your symptoms. I mean, it was unbelievable that a GI doctor told her, diet makes no difference. I couldn't believe it.

Actually, I was on a consult with a patient yesterday, and she said, I went to my gastroenterologist, and I wanted to show my stool test. he says, oh, gastroenterologist, don't look at stool. I'm like, well, then who does if you're a doctor? And I'm like, you know, that just doesn't make sense. You don't look at which goes in and you don't look at what comes out. How are you supposed to know what's.

Going on in there? Right. And that's the difference in functional medicine. Yeah, exactly. Yeah. It's, it's, it really, it's, it's sort of, it's a little bit mind-blowing and.

You know, you talk about, like, you.

Know, with going back to Sid Baker and sort of name it and, and claim it kind of a thing is, blame it. Yeah. Name it. Name it. Blame it is that, you know, and then tame it with a drug. Right. And then I, I always, I always tell my patients, you know, I went from being a medical student to a student of medicine, I'd like to always learn about things.

I love that.

And yeah, and it's a very important thing that you have to remain open-minded and I think you also have to remain curious because every patient's different. That's actually the joy of actually practicing functional medicine is it's not boring by any means. You're constantly growing and learning and helping patients with the latest diagnostics, the latest therapeutics, to personalize their treatment. And that's the fun part. I mean, doing functional medicine is a wonderful profession as opposed to regular mainstream medicine where most doctors are burned out. You know, they really are. They're just, they're unhappy. They're burned out. They're doing rubber stamp medicine. You know, I'll see you.

Here's your proton pump inhibitor. Next, next patient. That's it. That's it. So, you know, doctor sees you, you.

Have irritable bowel, they give you metamucil. What else can they do sometimes? Well, sometimes they'll give prescription medications. I think one of the older ones that they used to do for I guess was Zelnorm. Remember that one? Yeah. They took it off the market 'cause it was like really hurting people.

I think people were getting- Librium was the other one. Remember that? That was like a Valium, which is basically taking Valium.

Is it Valium for the gut? Yeah, Valium. And they're actually, in certain patients, there were some benefits from that 'cause it did sort of calm down the nervous system, I think.

Sure, anybody taking Valium?

You're gonna feel good.

A couple of shots of akilah, a little Librium.

I feel good. right.

But that's really not what we do with natural medicine. You're, you know, you were talking before about how you never know what the issue is when someone comes in. I was thinking about it's much like Forest Gump medicine. You know, Forest Gump has a box of chocolates. Life was like a box of chocolates. You never know which one you're gonna get. And I think in traditional medicine, you got irritable bowel. It's a thing. You treat it all the same. Functional medicine is not like that. We see some with irritable bowel, and then we go, wait a minute, what is the cause of their irritable bowel? And like you were saying before, it's very personalized.

Right.

So how do we start to think about identifying what their particular issues are? Because before we can even treat it, we have to understand the why. And that is what I always say, functional medicine is the medicine of why and regular medicine is the medicine of what, what disease and what drug.

And I think the big thing is time, taking the time to talk to a patient and, you know, what?

Talk to a patient.

Actually, and listen to the patient.

That's, wow, listen to the patient.

That's, that's actually, you know, that actually sometimes the less I talk during an interview and evaluation of the patient, the better I do. Because oftentimes we want to jump in and ask this question. They'll say something and we ask a question. I think in the average doctor's office, a patient speaks for 30 seconds and the doctor interrupts them.

Yeah, no, actually there was a study published years ago in JAMA. It was 18 seconds.

18 seconds.

20 seconds before the doctor interrupts.

Exactly, because we're trained to probe the questions and they have their own path of thinking going down that. But I think the big thing is, you know, we spend a lot of time listening to the patients and getting a history and a story. And, you know, an important thing is interesting thing in terms of IBS patients is that babies who have colic and they've actually looked at what is it that causes colic in babies, you know, you know, the latest evidence is that babies that have colic have high levels of Klebsiella. Klebsiella is a bacteria. And we know that Klebsiella is actually associated with other inflammatory conditions and autoimmune conditions. So Klebsiella excess in the gut is actually associated with ankylosing spondylitis, which is inflammatory bowel disease, which manifests systemically with arthritic symptoms. So, getting a history of colic is important. Listening to the history of, you know, were they vaginally birthed? Were they breastfed? What type of diet did they have as a kid?

And when did they get food introduced?

Yeah, and all those things can play a role in terms of- Like early gluten for dairy.

Yeah, exactly.

Trigger a leaky gut. Exactly. and just there's really, you know, listening to the patient, antibiotic use. Did they have a lot of ear infections? Did they have a lot of strep throat? Did they get a lot of antibiotics? What's going on in the family? Does anybody else in the family have any digestive issues? So just taking the time to get that history allows you to sort of play detective and try to figure out, okay, what are the things that are potentially playing a role in driving this and what might have triggered it, and then personalizing, you know, diagnostics and treatment and everything else.

It's all about personalization. I think it's very, very different what you're saying. This approach really is being a medical detective. Absolutely. And it is relevant whether you're breastfed or, for example, or vaginally birthed because that affects your gut flora and the development for your whole life. I mean, I recently read a study that showed bottle-fed babies have a high levels of a, what we call a short-chain fat, which is made by the good bacteria. This one is called propionic acid. Now, this is not such a good one and it's been shown to induce autism in animal studies and has been associated with autism and ADD, that is increased when you're bottle feeding. When you breastfeed, you get increase in butyrate, which is the beneficial short-chain fat that actually heals the gut and reduces inflammation, does all sorts of good things. So we think, oh, it's the difference, bottle-fed breastfed. That's not to make people feel guilty if they have to bottle feed. You have to do it sometimes, but you can fix that by making sure they have the right prebiotics and the right probiotics, because breast milk has undigestible fibers that are prebiotics and sugars that are prebiotics for the good bugs that aren't actually digested by humans.

Absolutely. Milk knows that. Exactly. And the other interesting thing about breast milk, I mean, if we could sort of bottle breast milk, it's very, very powerful stuff. There's a thing in breast milk called milk oligosaccharides and these are very, very complex sugar moieties, sugar chemicals, and they're actually so complex that for a long time science didn't even study them because they were too complex. It was like this Lego set that was this incredible building blocks. And what they've done now, there's a couple of companies, one company in specific out of Europe, has actually synthesized one of the oligosaccharides in milk, and there are actually hundreds of them. And these act like fertilizer for the good bacteria. So these these these things that are found in breast milk are very, very powerful things. Yeah, yeah. So powerful. And so so we dig down into the story and figure out when did.

It start and what's connected to it. Did you have foreign travel? Because people often have post infectious irritable bowel syndrome. People can get it after antibiotics. people can get after any kind of stress or trauma. And people don't realize that it's connected to so many different things. So let's talk about what are the causes and then we'll go into sort of a case of how we would deal with this. So what are the top causes that you found in functional medicine that are driving irritable bowel syndrome for people?

Well, a lot of irritable bowel also is probably misdiagnosed, I think, as sort of SIBO. I think a large number of, and SIBO is this diagnosis of small intestinal bacterial overgrowth.

So a bunch of people there will about have SIBO or bad bugs growing where they shouldn't be in the small intestine.

Exactly, yeah. And I think that we're sort of finding that a lot of these people that we're diagnosing with this catch-all term is real, they're really by having potentially small intestinal bacterial overgrowth, there are tests.

That you can do for that. We do the, that's also known as a food baby. when you eat food and you get a big bloated tummy right after and as a food baby, that's what SIBO is.

Right, because what's happening is the, you know, there's, we have bacteria on our skin, we have bacteria in our mouth, we have bacteria in our stomach, the small intestine, large intestine, most of them sort of live in the colon. But there are times when the colonic bacteria start migrating upwards and they go higher up and it's sort of like, you know, invading a neighborhood. that's, you know, and they mostly sterile up there. Most, it's, yeah, it's, it's, yes, it's not, it's, it's, I think, not, not necessarily that we always thought it was sterile. Even the stomach has bacteria. Right. And, but it's just much less. And they're all different kinds of bacteria. So the, the lower bacteria are more fermenters. They, they ferment things. Yeah. And that's where we get, I think I have talked about that. I, and I, I've seen this a couple of times in the auto brewery syndrome where patients, in fact, I just recently had a patient, a fantastic case, and he actually heard me, one of the podcasts where I was talking about auto brewery syndrome. So, I did a consult with him and he ended up going and buying a breathalyzer. Yeah. And he confirmed that he has auto.

Brewery syndrome because he was producing alcohol. He was driving over the limit.

He was driving. He was just short of the limit. It saves your money on beer for sure. It was actually quite interesting because he actually was doing a very strict low-carb, no-sugar diet. And even with a really good diet, he was pushing making alcohol. quite interesting. So, yeah. But anyway, so, you know, talking about, you know, how do we, how do we diagnose this? So you can do stool testing. I like the, the GI map test, where you can do quantitative PCR for bacteria, yeast, fungi, that's looking for the.

Like, the genetic material of the different bugs.

Yeah. It's like CSI. Yeah. You see CSI. It's, it's, I find it to be a very, uh, very helpful tool. You can also do the, uh. hydrogen methane breath test. Although, the thing about the hydrogen methane breath test is that I've had some patients who have significant irritable bowel, SIBO type symptoms. They're bloating and they're negative. And, I think based upon my reading and literature is that they're probably producing hydrogen sulfide. And, I think that when you just sort of get a history of they pass very foul smelling gas, it smells.

Like rotten eggs, that's usually the people that are producing hydrogen sulfide. People don't realize it, but cows just don't produce methane. Humans can produce methane if you have this. And we measure that coming out in your breath, we measure hydrogen, we have to take this drink. And that's really a clue that there may be these bugs growing in there.

And they have to be treated directly and that can really help a lot of people. Oh, huge, huge amounts. And it's often missed. It's very much missed. And you also have to do the test properly because everybody produces small amounts of hydrogen methane. It's just that you want it lower down in the colon. It really does doesn't become as much of a clinical issue. The other thing is to also think about in those types of patients is to make sure that they have sufficient amounts of stomach acid. Stomach acid is very, very important at helping with the proper digestion. So you can actually do testing for gastrin levels. And I've been surprised at how many people have high gastrin levels. So when you're, you don't have enough stomach acid, your body produces more gastrin, which is the hormone to pump out more hydrochloric acid. It's like acid flogging a dead horse. Exactly, absolutely. And I would venture to say that most people's issues are not high acid.

In the stomach, it's low acid. It's low acid. And we're taking more of these acid.

Blockers, which by the way also cause irritable bowel. So they help your heartburn, but they cause trouble bowel. And now there is a role for short-term use of these acid blockers, like in the ICU, the studies have been shown they've been very helpful to prevent stress-induced ulcers and hospital acquired pneumonia, but they're really to be used short term. And when you start using them long term, they are very toxic. Yeah, they are very toxic. They produce increased intestinal permeability. They cause malabsorption of nutrients, vitamin B12, iron, other trace minerals.

Yeah.

And they cause bacterial overgrowth.

And they cause osteoporosis and malabsorption.

Oh, yeah.

Huge, huge, huge.

And I actually, I am really surprised that these things are over the counter. they really should not be over the counter.

Yeah, no, I remember, I've talked about this before, but I remember when I was in medical school, the rep, these just came out and the drug rep was like, these are super powerful drugs. You never want to give them more than six weeks. They're designed to treat ulcers. After six weeks, you gotta stop 'em. Don't take 'em long term. And now people eat 'em like candy all day long, every day. And I'm like, this is not good. And we see so many complications from that. So if your irritable bowel is there and you have these acid blockers that you're taking, there might be a correlation. Hi podcast listeners, it's Dr. Hyman. I want to take a pause from today's episode to talk about something pretty important, air. If you're listening to my podcast, it's likely that you have a piqued interest in nutrition and health. You might be eating healthy and exercising and meditating, but one area that a lot of us tend to neglect is something we literally cannot live without. I'm talking about air, specifically clean air. Here are five reasons why I think you need to consider an air filter today. Studies show that our indoor air is up to five times and sometimes in other places up to 100 times more polluted with toxins than outdoor air. Do you know that many household items are covered in toxic chemicals? New carpet, furniture, paint, perfumes, cookware, mattresses, even many baby items are doused in the chemical flame retardants that we use, preservatives, phthalates, chemicals that are slowly released and off-gassing into the air that remain trapped in your home. Indoor air pollution can contribute to short-term health effects, things like sneezing, wheezing, itchy throat, nose, skin or eyes irritation, nasal congestion, runny nose. Could this be your air if these are only happening at home? Air pollution also contributes to chronic diseases. Long-term risks include respiratory diseases, heart disease, asthma, cancer, and worsening of other conditions. Contaminated air can also contribute to sleep apnea and other sleep issues. And poor sleep is associated with irritability, anxiety, depression, brain fog, fatigue, weight gain, hormone and blood sugar issues, and a whole slew of other conditions. And air filters can remove lots of these toxins and pollutants. However, not all air filters are created equal. The Air Doctor is the only air filter I trust and use, and it's affordable. It removes 99.99% of particles and the vast majority of toxic compounds in the air, including volatile organic chemicals and gases from your indoor air. It features an ultra HEPA filter, which is 100 times more effective than ordinary HEPA filters, and is 100% sealed, which ensures all the air you breathe is pure and filtered. Now, I'm offering an exclusive special deal to my listeners. Right now, if you go to DrHyman.com/air Forward slash filter, that's drhyman.com forward slash filter, you can access the Air Doctor filter for $329. That's $300 off the normal price. So head over to drhyman.com forward slash filter to access this deal today and stay safe out there. So we talked about SIBO and we talked, we can talk about how to treat that, but essentially it's killing the bad bugs and re-seeding the gut and what other things are driving your valve besides that?

Also, you can also potentially have problems with part of the intestine that causes peristalsis. So normally you think of the gut as like this conveyor belt that's always moving things through. So you eat and within about 24 hours everything should sort of move through. And there are some patients, especially with the patients who have problems with constipation that will have problems with motility or really motility disorders and there's a test-.

I'm just not moving down.

Not moving down. And there's a part of the intestines which is called a migrating motor complex. And you can actually test for antibodies against the migrating motor complex. It's called IBS-SURE test.

And I'll do that in the future.

It's almost like an autoimmune thing. Yeah, it's a little bit like a paralysis, if you will, or a weakening of the gut. And we talked about that earlier how in some cases, you'll have patients who have Lyme disease. I actually had a very good integrative gastroenterologist who brought my attention to this is that he had a lot of patients who had refractory C. SIBO. So, SIBO was one of those things where it sometimes can come back and oftentimes does come back. And what he was finding is that some of his more difficult patients with refractory SIBO actually had underlying Lyme disease. And Lyme disease affects the nervous system. He tied the two together because there is a paper, it's called Bell's Palsy of the Gut. And in fact, Bell's Palsy is where you get facial paralysis. And I'll never forget this, when I was in my private practice, the first time I saw a real acute a case of Lyme disease, the patient presented with Bell's palsy. So her face was paralyzed and I did testing on her and the patient had acute Lyme disease and that is one of the known complications. And it's thought that also that Lyme disease can actually affect the gut and you get paralysis and decreased motility of the gut.

Yeah, so that is a very important point because there are the typical things that go on, food sensitivity, gluten, dairy, some people react to the chemicals in food that are food additives.

Food additives, food colorings, sugar alcohols, people.

Emulsifiers, emulsifiers, all these things that are in our junk and processed food do have a huge impact on people. There's obviously the SIBO.

So many people get parasites. Yeah.

We, we, little, little microscopic hitchhikers.

Yeah.

And there's, there's one called Blastocystis, which is really common.

It doesn't, it doesn't cause a horrible disease, but it can cause you to bow in about 30% of people with IBS. oh, yeah. I'm going to venture to say that I have picked up a lot of these. I call them little microscopic hitchhikers. And when you actually look in the, in the mainstream literature, they, you know, they basically say that, you know, a lot of these, you don't need to treat it. So there are times when somebody can, you know, they have died to me, but histolytica and blastocystis and sometimes endolimax, Nana. And sometimes people will have these and they'll have a small amount of them, and they may not cause any symptoms whatsoever.

But if I find them in the, in the stool test and patients are having symptoms, I treat yeah, absolutely. And then, and then there's also other things people have, like, enzyme deficiencies we can see on stool tests. They're not digesting their food well. Yep. And also, you know, for me, I, I had terrible irritable bowel, you know, almost 30 years ago. It was for Mercury poisoning, because Mercury affects all your enzymes. It basically interrupts the enzyme function of many different enzymes throughout your body, including your gut. And until I got rid of the Mercury, my irritable bowel wouldn't go away no matter what I I just ate turkey and broccoli and brown rice for six months and nothing worked. And so you have to keep being a detective and thinking about what are all the variable causes. And we look at the stool testing, we look at breath testing for bacterial overgrowth, we look at organic acid urine testing to see if there's markers of bugs in there. And we sometimes dig down deeper to look at things like metals or lime or other tick infections. So there is a real deep thinking about what is going on with this person and it's guided by their history, right?

Exactly. Yeah. And it's personalized. It really is. It's totally personalized and it takes time to figure that out. Yeah. And sometimes it may take several visits. I mean, you and I have had patients where we've been seeing them for a long extended period of time and they make some progress, they get better, they may backslide, then they'll have incremental things. So, we sort of uncover, as you say, the layers of the onion. Yeah.

No, it's true. had a very bizarre case once. They just reminded me of who was suffering terribly from digestive issues for years and years was overall systemically inflamed. And it turned out he had Babesia, which affected his gut. He also had histamine intolerance.

Yeah, that's another one.

Yeah, there are histamines in food. And so we put him on a low histamine diet. We treated his Babesia and his symptoms got better. So, It sounds like it's a little bit of a roundabout way to think about it, but what case have you seen in your practice that sort of stood out for you around irritable bowel?

Well, I recently had a patient who came in with the diagnosis of irritable bowel. That was the official diagnosis. And interestingly, she gave me through the history that her symptoms seemed to have been triggered when she had Lyme disease. And her Lyme disease also was complicated by POTS, which we've talked about before, which is postural orthostatic tachycardia. which basically means that you have autonomic nervous system dysfunction as relationship to Lyme. So that sort of means when you.

Stand up, you get dizzy.

Yeah, when you stand up, you get dizzy and your heart starts going really fast. And so, you know, there are certain, a couple of things that, you know, that make me think about Lyme disease. So when I have a patient who's got pots, and sometimes people just come in and that's their only, their only diagnosis is pots, I said, okay, well.

Why do they have pots? I love medical terms. postural orthostatic hypotension, which is called POTS. It sounds like a fancy diagnosis. What does it mean? It means when you stand up, your blood pressure drops. It doesn't tell you anything about why or what caused it, and it's just so frustrating to me that nobody keeps.

Thinking about what's going on here with these patients so they can actually fix the problem. Right, right. So this lady had this history of lime and POTS, and then she ended up having cancer of the uterus and went through radiation. She was supposed to get like 25 rounds of radiation. She had to stop at 12 because she developed diarrhea.

Radiation colitis.

Radiation colitis, radiation enteritis, exactly. And, believe it or not, the doctors who were treating her said, oh, that has nothing to do with your symptoms. I mean, they literally, you know, they didn't want to, they didn't want to.

You know, admit that it was from the radiation.

Exactly, exactly. Yeah, yeah. And then she came in and she actually had had some testing done previously and what I and I think the doctor who actually did the testing didn't know how to interpret the test properly, but the patient's Calprotectin was elevated. So Calprotectin is a biomarker in the gut. I call it like CRP of the gut. So we have this compound which is called high sensitivity C-reactive protein. When it's elevated, it is a biomarker of systemic inflammation and it's also highly correlated with heart disease. and Calprotectin is found in the gut and it's sort of like the CRP of the gut. So when you see that.

When you see it's high inflammation.

Yeah, exactly. So it tells you. And usually, you know, for classic, you know, what we call irritable bowel syndrome, you don't usually have inflammation per se. There's not really dramatic inflammations. There's dysfunction, but there's not inflammation. So her irritable bowel was actually partly inflammation. And, and I think that was one of the big things that was driving it. The other thing in this particular patient is that she had on her testing undetected. detectable acromancy misophila. That's a big word. Accurate. Right.

Yeah. All right.

So, so this is, it's a, it's a mucus loving bacteria. And what we found is that higher levels of this is correlated with leaner body mass, less chance of obesity, less chance of diabetes. And it's also, you want to have higher levels of this because it's a protective good bug.

It's not, it's not, it's not a probiotic. Yeah. Let's risk of cancer. Yeah.

So, and it's not a, it's not a bug that you can go out and get a pill for, at least. not yet. Eventually we might because it's so beneficial. But what we find out is that this particular bacteria feeds on fibers, specifically polyphenols. What are those? Polyphenols are those compounds that are phytonutrients found in lots of colorful foods and vegetables like pomegranate and green tea and cranberries. Cranberries, yeah.

So your little bugs like cranberry pomegranates and green tea.

Exactly. They love that stuff. This is their, you know, I call it the miracle girl. you know, that's a miracle. You put this stuff on there and.

The good bugs flourish. There's a fairly new understanding, you know, because we thought, okay, you need prebiotics, you need probiotics, but I think the polyphenols are also critically important to optimizing.

Your gut flora, the three P's. Yes, exactly. And, and the, the other thing, which I always come back to when I, when I think about the digestive tract is, is, it's a beautiful visual, is the rainforest. And for anybody who knows about rainforest, rainforests are full of biodiversity. There's lots of flora and fauna. There's frogs, there's birds, there's all different, you know, plants, insects, worms. And the more biodiversity that you have in your personal internal rainforest, the healthier you're going to be. And there's, there's, there's tons of studies that have shown this. And it's a, it's, it's non-linear it's very, very complex because there's this whole ecosystem and there's this cross-feeding and interaction.

That happens when you have a diverse internal rainforest. Yeah. And so Trine, I was talking to, Professor at Harvard who's a psychiatrist and also runs the Department of Nutritional Psychiatry. And she's written a book called this Is yous Brain on Food talking about the microbiome and its effect on psychiatric illness. Absolutely. So we used to think that the crazy person would have the gut problems. Turns out the gut problem people have the crazy thing upstairs because of the gut thing and fixing the gut fixes the depression, anxiety, OCD, all these crazy things that we thought of our psychiatric illnesses. turns out they're really related to the imbalances in the microbiome and the lower diversity. And Western societies have increasingly lower diversity.

Oh, huge, huge. Yeah, exactly. And it happens very, very early on is, and what typically will happen is, you know, there are, there are some people that, you know, they're, they're, you know, they're very picky eaters and they will, they'll be eating the same food over and over and over. And, you know, I always tell patients that, you know, you want to try to increase your intake of diverse fruits, vegetables, you know, try to eat and see it right now in the Berkshires, you know, we have lots of great vegetables that are available that you may not get year round. And, you know, eating, I call it, you know, you want to eat a Crayola crayon box. The more color you have in your.

Diet, the healthier your diet's going to be. And I want to come back to something you said before about this inflammation in the gut. There's a whole new phenomenon we call pre-inflammatory bowel disease. So we thought irritable bowel wasn't inflammatory. it turns out even if you can't always detect it, it tends to be very inflammatory. And, there are cases like you saw people with this pre-IBD. So, it's like pre-Crohn's or pre-colitis.

Yeah, it's not like one night you.

Wake up and all of a sudden you've got Crohn's disease. Yeah, so there's this level of this marker we check and it's often elevated and people have not full-blown Crohn's disease but something's going on in there that's driving inflammation. They have to deal with those factors. Exactly, yeah.

Exactly.

So this patient also had elevated gluten antibodies, right? So she had this low akkermansia, she had elevated gluten antibodies and this high calprotectin. And so this is a sort of a perfect setup for having a messed up gut.

Absolutely, yeah.

So how would you take care of this patient then who came in with the gluten issues, the low akkermansia and the calprotectin?

Well, I mean, to address the inflammation.

And by the way, these are something that your traditional doctor will never look for that we usually look for in functional medicine at the UltraWellness Center. standard operating procedure for us to really look at these things. Yeah.

So, you know, to treat inflammation, I always like to check them the omega-3 fatty acids. When you have low essential fatty acids, you're a setup for inflammation. So, in this particular patient, the patient had suboptimal omega-3 fatty acids, which are related to eating cold water fish. So, I got her to take some supplemental omega-3 fatty acids, had her increase her fish intake. I used an anti-inflammatory supplement called Ultra Inflammax, which has a powder curcumin and other things to help decrease inflammation in the gut.

Ginger, rosemary.

Ginger and rosemary, exactly. And then also used Enteragam, which is a immunoglobulin that helps with patients who have sort of diarrhea type. That's actually a prescription medication.

So, tell us more about what is this immunoglobulin stuff? Because you hear a lot about it.

Yeah, it's serum bovine-derived immunoglobulin.

It's basically colostrum.

Yeah, you can think of it as like colostrum. And yeah, colostrum is, you know, colostrum.

Is that stuff that in mother's milk.

That is before the milk comes on. And it gives immunity to the baby. Exactly. It gives, yeah, it's passive immunity. So, it's the mother's immune system that's passed down to the child. So, which is really quite amazing when you think about from an evolutionary standpoint that the mothers immune system has evolved and learned what to deal with and how to deal with it. And then that immune system gets literally transferred in the breast milk to the baby.

Until the baby can actually develop its own.

Exactly, exactly. And the interesting thing is our immune system has to learn. It's got to go to school. And that's why, you know, when you see these little kids who are crawling around on the ground and they're putting stuff in their mouth, we're developing what's called mucosal tolerance. It's the immune system learning to deal with the planet Earth. and it realizes that, okay, you're going to be around a lot of these things. You don't want to overreact to it. And I know we always talk about, what is a healthy immune system? Well, a healthy immune system is a tolerant immune system.

Yeah, it doesn't overreact or underreact.

Exactly. That's the key thing. And I always say to people, I want a strong immune system. Well, if you have a too strong immune system, that's called autoimmune disease. Right. When your body's reacting to everything and it's like overreacting. So having tolerance and mucosal tolerance is really, really important. And the other thing, which I, and in some of the lectures I do, and I like to emphasize this is you can think of, you know, we have the Boston Symphony Orchestra and unfortunately, Tanglewood is not open this season because of COVID But in the Boston Symphony Orchestra, you have the conductor and the conductor, you know, balances the woodwinds and the strings and everything, and they sort of keep everything in balance. And in the immune system, we have cells called the T-reg cells. and the T-reg cells regulate the immune system between the various parts of the body.

So, make sure it's not too hot, not too cold.

Exactly, exactly. And guess what helps with T-reg cells? Fiber.

What?

Fiber. Yes, so that when you're eating lots of fiber, you upregulate your T-reg cells. Other things that can do that, vitamin A can do that too, but fiber is probably one of the biggest things.

That helps with the T-reg cells. Yeah, and functional medicine is really, practical too, because when you have a patient with any condition, particularly with gut issues, which is often driving so many things. Even if you don't have quote, irritable bowel, a lot of health conditions are driven by imbalances in the gut. Like we talked about psychiatric issues, heart disease, obesity. But we have a very specific framework called the 5R Program, which we use to methodically treat and restore gut function. And we've been doing it for decades, even before people called it the microbiome, our goal was to really optimize the microbiome as a way of treating all sorts of diseases. So how would we do that in this patient? Obviously, you've got rid of the gluten, right?

Yeah, yeah, obviously in a patient to decrease inflammation, you can decrease the foods that typically drive inflammation. So things like trans fats can drive inflammation, sugar, drives inflammation. Dairy, a big thing, especially cow's milk. Sheep and goats tend to be less inflammatory. I'm not sure why that is.

This is the A2 casein.

Oh, ETC. Okay, that's it.

There you go. A1 casein is very inflammatory, which is all the modern cows, all the heirloom cows and sheep and goats still have A2 casein, which is less inflammatory.

It tends to cause less digestive issues for people. Yeah. And then gluten is a big driver. and then other things that, you know, are found in foods. Like we talked about things like emulsifiers and artificial. Processed foods. Processed foods. Exactly. If you can't read it on a label, don't eat it. Yeah. Yeah. Yeah. You don't. Don't eat it.

Another one, which is. I'll mention this is titanium dioxide.

Yes. I was just reading about that. Exactly. Tell us about that. Yeah, it's bad. It's a thing that they add to.

Food to white, you know, white whitening.

And they'll use it in a lot of products, gums. They use it and such. It's in a lot of vitamins you get at the drugstore, too. Exactly. and titanium, your body does not like titanium. It's a metal and your body can react to it. It's almost like a nanoparticle metal that you're putting in the body and it's been shown to, the gut does not like it. Yeah, one more reason to not eat processed food.

Exactly. All right, so we've gotten, we're removing the foods, we're removing these processed ingredients, removing trans fats, gluten, dairy, other food sensitivities. I had a patient, for example, I had diarrhea for years and years. sensitivity to eggs. It wasn't an allergy.

She covered the eggs in her diarrhea one way. Yeah. You know, and then there are some times where, you know, doing a strict elimination diet to try to tease out, because food is complex. There's lots of things when you're eating food. There are also some, some patients that you, I know you've probably done yourself, where sometimes you've got to put them on what's called an elemental diet. Yeah. Where you basically give them the, a, a, pre-digested. Pre-digested. Exactly. And that helps to sort of calm down. quiet the gut. In fact, mainstream doctors will do that for patients where they'll actually put them on parental nutrition where they just give them through the sort of rest the gut.

Yeah, I mean, we're going to be having a podcast with one of our nutritionists. We're going to be talking about the elimination diet and why we do it and how we do it. And there's lots of different versions, particularly for IBS, the FODMAP diet, there's a specific carbohydrate diet, there's traditional elimination diet. So, I think this is a really important thing is to get rid of the things that are causing the problem. and then we look for parasites and other bad bugs, SIBO, breath testing.

So we actually clear out all the bad stuff. Yeah. Yeah.

Take out the bad and put in the good. What's the next step for how to.

Repair the gut on the 5R program? Well, you can reinoculate. Sometimes you can use probiotics along with prebiotics. We call that synbiotics. The big thing you got to watch out with that. And you probably have seen this is if you add that in too soon.

You can actually sometimes flare up bloating symptoms.

Yeah.

It's like a war between the good guys and the bad guys. You got to clear out the bad guys first. I call it the weeding, seeding and feeding program. First, you got to do the weeding.

Then you got to see the good guys, and then you got to feed them. Yeah, exactly. Yeah, that's exactly right. And then the other thing that's also important, just that sort of helps with digestion is, and, and I've been using this more and more, is stimulation of the vagus nerve. So the, the vagus nerve, we have the autonomic nervous system in the body, and there's, like, my analogy is the gas pedal and the brakes. And the gas pedal is a sympathetic, so it sort of gets things going and the brakes sort of slow things down. So the stimulating of the vagus nerve is resting and digesting. And that's what you want to be doing. You want to be in a relaxed state when you're digesting your food. And we tend to have a sympathetically driven society, you know, running, going, where, you know, always on the go.

People say prayers or grace before eating to calm everything down.

On. Yeah.

Right?

Yeah.

And we just kind of eat on the run, eat on the car.

Yeah.

People walking down the street.

And we were all guilty of that. People watching TV. Yeah. That, that the worst thing is actually, I call unconscious eating. You know, it's like you're sitting in.

Front of watching a movie and you got the popcorn. All of a sudden, the big Bowl's gone. They actually did those studies where they literally have a secret trap door on.

The bottom of the bowl, and they, like, fill it up from the bottom.

And people just keep eating and eating. Exactly. Unconscious eating. It's like, it's stop.

Exactly. Exactly.

Okay, so the 5R Program is basically remove the bad stuff, basically replace the things that are missing. Digestive enzymes, digestive enzymes and prebiotics, reinoculate, and then repair, which is the next phase, which is how do you fix.

A leaky gut, right? Yeah, and that's, you know, you talked about butyrate. Butyrate is one of the things that's very helpful for leaky gut, and I've been using that in supplement form.

Yeah.

I also encourage, you know, fiber, fiber use and glutamine can be very helpful. Aloe is, can be really helpful. Quercetin or other, other things that vitamin A, zinc, zinc. Yeah. Zinc. Zinc in the form of zinc carnosine is also. There's some really interesting studies on that with leaky gut, because when you take things like Advil or, uh, uh, a leave, those things cause transient leaky. so you're gonna have, you're gonna develop leaky gut. And for people who are taking them chronically, they've shown that just taking zinc will help repair the gut with the NSAIDs.

So it's really a very specific methodology of diagnosis and treatment. And, and, you know, the hit rate is pretty high on this. I mean, I, I think, you know, people come in with these chronic, lifelong digestive issues. I just talked to a patient yesterday, and she'd been struggling, struggling, struggling. Didn't know she had a parasite. She had back to the liver growth. She had all these issues. and within a couple of weeks, she's back to normal. And I think people are just sort of shocked. And one of the things you use in this patient is a gut shake that kind of combines a lot of these things that helped grow her acromania. Exactly, yeah. So the gut shake is full of.

Polyphenols, contains things like cranberry, pomegranate, maca. Matcha. Matcha, matcha, matcha.

I call it matcha.

Green tea. Matcha, matcha, right, right, matcha, not matcha.

Yeah, and it's got the immunoglobulins, which are talked about that help kind of regulate the immune system in the gut.

Right.

And prebiotic fibers, probiotics.

Yeah, and again, I call this sort of like, you know, miracle grow for your rainforest. It just helps with biodiversity, it helps with this flourishing of the good guys, which have their own way of keeping things in check. It really is.

So, for those listening who have irritable bowel, who've been suffering for a long time without help. There is help. You don't have to suffer. It's actually not that hard to fix. It's sort of embarrassing how easy it is once you know what to do. But most of us in medicine, we're not trained on how to approach this systemically or systematically. And that's what functional medicine is. It's a systematic approach that looks at the causes and then restores normal function, hence the name functional medicine. And we've been doing this at the Ultra Wellness Center for, gosh, I don't know, decades now. With all of us together, we probably have 65 years of clinical experience, and we all are faculty and teach all over the world. So I think your, you know, your, your stories and my stories just, you know, go back so many years and help us really know that we have a way through this and people don't have to suffer. So people are listening and struggling. I encourage you to get help to a functional medicine doctor here at the Ultra Wellness Center. We're doing all virtual visits now. People we also, you can come in for sure, but we do virtual so we can get new patient virtual consults. And, and we're really happy to help anybody who, who needs help because this is a terrible problem to suffer with. And, and there are answers and there's a way to figure it out, and it ain't that hard. And I personally have suffered from it, so I get it. And it's just no fun. So I, I think, Todd, you are a wealth of knowledge, and I'm so glad to have you back on the podcast, and I'm, I'm just wondering out there. If you struggle with this, please share your story with us, leave a comment and subscribe wherever you get your podcasts. And we would love to have you share this with everybody because I think there's a lot of people out there with irritable bowel and then we'll see you next time on the Doctor's Pharmacy.

We want to have everyone have happy guts.

Happy gut.

Happy gut.

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