Autoimmunity and the Gut

Hello and welcome to The Perfect Stool: Understanding and Healing the Gut Microbiome. This is your host Lindsey Parsons, and today I'm interviewing Dr. Drew Sinatra. Dr. Drew holds a doctorate in naturopathic medicine from Bastyr University and has a successful naturopathic medicine practice at Clear Center of Health in Northern California. He also works for Healthy Directions, where he writes, develops products, and has a podcast that he just launched with his father called Be Healthistic. His father, Dr. Steven Sinatra, was a traditional cardiologist for many years but moved towards integrative medicine by the end of his career. So that's a fun listen. On today's show, we'll be talking about autoimmune disease and the gut, what the research says about the gut microbiome and autoimmune disease, Dr. Drew's approaches for treatment of autoimmunity, immune supportive supplements in the age of COVID-19, and much more. Now onto the show.

Welcome, Dr. Drew, and thanks for coming on the show.

Oh, it's great to be here. Thanks for having me.

So tell me about how your new podcast is going. What topics have you covered? Has it been—

Oh, thanks for asking. Yeah, so it's called Be Healthistic, and I'm co-host with my father, Dr. Stephen Sinatra. He's an integrative cardiologist, and we've covered all sorts of topics from— one of them was called From Poop to Pot, actually, where we talked about fecal transplants and the use of CBD. We've dived into diabetes. We've had talks about red light therapy, peptide therapy. I actually do a session with my wife, which is Ask Dr. Mom and Dr. Dad. So we talk about, you know, how to feed our children healthy foods and how not to fight at a dinner table, you know, all sorts of topics like that.

Awesome. I'd love to find out more about not fighting at the dinner table.

Yeah, it's a challenge. It's a challenge.

Yeah. And, and I, I'm curious that you mentioned the peptide therapy cuz somebody just asked me about, do I know about peptides? And I was like, no, I've never really heard of that. What is that?

Yeah, so peptides are— well, they're, they're naturally occurring compounds in your body. They really form proteins. And in medicine, the original one was insulin. So insulin is technically labeled as a peptide, but it acts like a hormone in the body, obviously. And there's lots of different peptides that you can use for anti-aging purposes, for tendon recovery, for a nootropic to help support cognition. So there's lots of different uses for the peptides and typically they're, they're helpful, I will say, but they're not necessarily practical because a lot of them are subcutaneous injections that people have to do on their own. And a lot of people have needle phobia and don't wanna do that.

Oh, okay.

Interesting. Okay. Anyway, back to the topic of our conversation today, which is the gut and autoimmunity. So can you talk to me about what the relationship is between the two?

Sure. You know, I think a lot of us functional medicine practitioners, we've kind of fall into line with, you know, in terms of the development of an autoimmune disease, there's 3 things that I tend to look for and I'm sure that you look for too working with your clients. And that's you need to have a genetic predisposition. So, for example, with celiac disease, you must have either 1 or 2 of the HLA-DQ2 or HLA-DQ8 genes. Number 2 would be there has to be an exposure to an environmental trigger that will instigate an immune response. And gluten being a classic example of that, that's the trigger that, you know, creates all this inflammation. And then third And then thirdly, there has to be intestinal hyperpermeability in the intestinal lining, which will obviously allow substances to go from the gut lumen into the bloodstream and the immune system become activated, and that will set off an all sort of systemic inflammatory type reaction. So generally speaking, that's kind of like how I look at the development of autoimmune diseases. And also, you can use those 3 parameters for treatment as well, right? If you want to sort of remove the trigger, which will— today we'll talk about some triggers for autoimmunity in the gut. And what I found doing a lot of research into this is that unfortunately there's like no unified theme when it comes to certain bacteria or certain phyla that might be increased or decreased, or looking at byproducts like short-chain fatty acids, whether those are increased or decreased. It seems like there's just this huge variability all across the board in terms of, let's say, a condition like rheumatoid arthritis might have an elevation in Prevotella, but in MS you might have a decrease in Prevotella species. So I was hoping for more of a concrete unifying theme around these parameters, but I didn't necessarily find it. And so that's why I still come back to treating those 3 parameters in terms of development of autoimmune disease and also using them as treatment.

Okay.

And so how important do you think gluten is for most autoimmune conditions?

Oh, I'm so happy you asked that. I take every single autoimmune patient that I see off gluten, and the reason I do that is because I'm sure you've read up on a lot of Alessio Fasano's work in regards to zonulin, but gluten is one compound that can elevate and increase the production of zonulin, which then leads to the disassembly of tight junctions, which therefore sets the stage for leaky gut. And that happens regardless if you have celiac disease or or if you have non-celiac gluten sensitivity, or if you don't even have any sensitivity or allergy to gluten. It happens in everyone. There's this increase in zonulin that's temporary after consuming gluten. So that being one of the 3 parameters, right, you need to have that intestinal hyperpermeability present for autoimmune disease. That's why I always take every single patient off of gluten that has an autoimmune condition. And I will say this too, out of all the treatments I've done over the last 12 years in private practice, this is including supplements, medications, dietary changes, gluten removal has been the most profound in terms of changes.

Talking about the zonulin and the fact that it opens up the tight junctions for everyone, why is it that some people can seem to be okay with gluten, not get autoimmune diseases? And I guess I'm sort of— you've already answered the question in the sense that those other two things have to be present beyond the intestinal permeability. But does zonulin impact people differently or does gluten impact people differently?

That's a good question. I think of it as— and the association that I found here, at least digging into the written— the literature, was that overall it seems to be with autoimmune diseases there is an increase in zonulin that is found, and therefore a higher incidence of leaky gut. Now, in regards to connecting that to gluten, it's hard to know really what's happening there, but we do know from Alessio Fasano's work that regardless of whatever condition you have, there's still a release of zonulin when you do consume gluten.

Do you recommend to all patients to get off gluten or just the ones who are having the particular problem?

That's a great question as well. I think I'm slightly biased because I've, I've been gluten-free myself for probably, you know, 10, 15 years now. And I know that when I have it, I, I experience random symptoms in my body. Like I have eczema or psoriasis that actually comes on when I do consume it, even in small amounts, like, you know, high-quality IPA beer, for example. Like I can't even consume those anymore. So Considering that I have bias there, I do tend to take a lot of people off it as a trial. Let's say if they come in and someone's having skin issues or they're having digestive issues or they're having brain fog or they're having joint pain, I'll use it as a trial to say, "Hey, let's go 3 weeks without gluten at all and let's see how your body feels. If you don't feel any difference at all in 3 weeks, well then, gluten may not be that bad for your body and you can continue eating it." So I also am gluten-free and have been for about, eh, probably coming on 6 years now.

And I do find that I can cheat. I can occasionally have it. 4 or 6 times a year I might have a pizza. I, I'm also dairy-free. So that one is the worst one for me. So if I'm gonna eat dairy, I might as well eat gluten too. But I just take some enzymes and, you know, I may not feel great the next day, but I mean, it's not, it's not all over the body. I seem to be able to pull that off. Since I have reversed my autoimmune diseases completely, which is to say— well, I shouldn't say all of them. It's not totally clear that all of them, but at least my Hashimoto's, my, my last antibodies were totally normal. I'm wondering what your opinion is. What would you say to your patient who, who said, you know, I've— I'm totally back down to normal. Is it okay now for me to go back to eating gluten?

Well, gosh, that opens up a whole can of worms because, you Have you read any of William Davis's work? He wrote Wheat Belly back in 2012. Have you read any of—

I didn't read that book, but I've read, I've read blogs and things like that.

It was one of the books that came out that really opened my eyes to why gluten is such a problem for so many people, and it really comes down to the way it's produced in our country. And I'm sure that you've noticed too, working with your clients, that they may say, hey, you know, I went to Australia, I went to Europe, and I was eating baguettes and pizza there and I was fine, but I came back to North America and I started to have issues again. So, I think inherently there's some issue with the way that we're producing wheat in North America. And that's unfortunate because so many of us like gluten, right? We love consuming baguettes and pretzels and all these types of food products. But I do find that at least here in North America, it's more of a problem than around the world.

Yeah. Now, I did see an article at one point that pointed to the fact that the Khorasan or Khamut ancient grain did not have the same impact on, you know, the tight junctions and, and was even potentially safe for celiacs. And so I have a, there's a local bakery here called Barrio Bread, which makes incredible bread. They're now using ancient grains on some of them and locally sourced. And anyway, so I went out and I went there and they do it, they do a croissant loaf. And so I got that and seemed to be fine eating it, but The funny thing was I was like, I kinda like my gluten-free bread better. Yeah. 'Cause this is a sourdough and I've never been a big fan of sourdough.

Right. Well, that's an interesting study you can do on yourself too if you wanna kinda consume it somewhat regularly and just take, take note of any changes that you feel in your body. Yeah.

It's the kind of thing where I would have to get my antibodies checked because my Hashimoto's never was medicated and it was caught early and so It was never something— I mean, of course I sense when I ate gluten that my stomach is bloated and I see it the next morning when I use the bathroom. But other than that, it's not totally obvious.

Well, actually, I'll ask you this question. Have you seen, and how fast have you seen your antibodies rise after having gluten, if that's the case?

I haven't tested them right after sort of just one incidence of gluten since it's a bit of a hassle to go get a blood test. You gotta get the order from your doctor and all that. So I've tested at intervals where I've been eliminating and I think that they're likely to be low to confirm that I've been doing well and that I'm doing better not to, not to do the opposite. Although I did do a test with soy that way.

Oh, I see.

Yeah.

But I've kind of gone back on soy, at least insofar as it's involved in chocolate.

Right. Yeah. The soy lecithin.

I've been persisting for 7 years. I've turned everything around. Like, I really want to just get, get back to somewhat more of a normal diet.

Well, have you tried some of those chocolates that don't have the soy lecithin in it?

Yes, I have. But we happen to be in unique times right now in which for some reason the Theo dark chocolate almond bars seem to be something that people need to be stocking up on in case of an emergency. So I've been driven to getting ones with soy.

Well, when you have a chance, when things are back to relative normality again, you can go to Seattle and visit that chocolate factory. It's fantastic.

Oh, is that where it is? Good to know. So, okay. Got a little bit off topic here, and since we're off topic and talking a little bit about the crazy times we're living in, are you giving your patients any advice on preventative supplements during the whole COVID-19 crisis?

Yeah, that's a good question. I think in general I'm kind of working with people on immune support of stuff, and so I'm recommending a lot of the basic supplements and herbs and vitamins and minerals, and that would be vitamin A, vitamin D, zinc. I'm a big proponent of colostrum. I really do think that colostrum— oh, huge proponent, yeah. And even something like IgG where it's not coming from the milk, it's coming from bovine.

Since I'm somebody who's dairy sensitive, I've always been a little wary of trying colostrum.

Yeah, we can come back to that. But colostrum— so for a lot of people that have dairy sensitivities, they can actually handle colostrum, no problem. I've had probably 2 to 3 people total that have not done well with it, and I've given that stuff out so much over the last 2, 3 years.

Is there a particular product you like?

I do like Sovereign Labs. They have like a grass-fed version of it, which I think is pretty clean. But there's other ones out there on the market too.

And could you just explain for people who don't know what— how IgG relates to colostrum and what that is?

Oh, so colostrum is what is excreted out of the breast, at least. So let's talk about humans for a moment. So if you've ever breastfed a baby for the first couple days or 1 or 2 days, colostrum was primarily coming out of your breast, and it's rich in these immune globulins, these IgG. And there's other compounds in there as well that have immune supportive properties, but IgG is the main one.

Pardon the brief interruption, but if you're struggling with your gut health or have an autoimmune condition, would like to get back to great health in a natural way, I offer free 1-hour health restoration breakthrough sessions to anyone who's interested to hear about what you're struggling with, understand what's been keeping you from getting better, and to explain whether health coaching may be a helpful tool in restoring your health. We can meet by phone or video chat from anywhere in the US. Typical gut or autoimmune health packages involve 5 to 12 coaching sessions over an extended period of time, recommendations for gut testing that you can order yourself whose results I can help you understand, and education and support on supplements, diet changes, and lifestyle changes that will help or even reverse your condition. You can read more about my coaching program and set up a breakthrough session by going to highdeserthealthcoaching.com and looking under Work With Me, Health Coaching, or by clicking the links in the show notes. Now back to our conversation.

So, you know, I've been thinking about IgG a bit recently because I see different products advertised, and the question that keeps popping up in my head is IgG is not specific to a particular substance, it's just a general antibody.

Correct. That's my understanding too. I mean, we've got IgM, IgG, IgA, and For some reason, IgG tends to be the primary immunoglobulin found in colostrum.

Mm-hmm. Okay. So that's why it's good to take that to just sort of suck up any kind of toxins or pathogens that are in your system.

Yeah, that. And also it's, it's actually really my go-to for helping heal a leaky gut or increase intestinal permeability. I find that it's incredibly helpful for most people.

Oh, okay, great.

Let me just delve back into that then. If you do see a person with an autoimmune disease, so one of the first things you do is take out gluten, then what, what else do you do you typically do?

Yeah, so this is where all the research was helpful for me looking at because yes, there was associations with increase in Firmicutes or decrease in Bacteroidetes and Prevotella this and decrease in Prevotella that. And so, it's interesting because some conditions like lupus, for example, there's a lower Firmicutes to Bacteroidetes ratio, but in RA and Sjögren's, you've got an increased Firmicutes to Bacteroidetes ratio. So, what do you do with all this information? And I think it comes down to the basics. And for you, you mentioned, okay, what else do you do besides giving up gluten? And I think a lot of this depends on more of the personalized approach to medicine that is so important with our patients in that you need to figure out what is the underlying trigger or triggers. And at least with autoimmune disease in the gut, I found that throughout the literature, there's lots of reference to dysbiosis. And that can come in many different forms, whether there's an increase in a certain species or there's a decrease or really the diversity is not doing well. And SIBO or SIFO, which is small intestine bacterial overgrowth or small intestine fungal overgrowth, those are two classic examples of pretty common dysbiosis pictures that can present in someone. So, I think it's important to really figure out, okay, does this person have dysbiosis? What form is it? How are you going to go about treating it? Are you going to use more of an herbal approach? Are you going to use more of the antibiotic approach. And of course, looking for other triggers as well, like for example, Epstein-Barr virus may be a trigger in certain autoimmune conditions. Or I read up on, I think it was, it was Sjögren's syndrome where they found a higher incidence of H. pylori antibodies in those patients, which then begs the question, is it H. pylori that is contributing or is it mainly a dysbiosis of H. pylori that's contributing to the condition? Because there's a great book out there. You may have read this. It's called Missing Microbes by Martin Blaser. Oh, so good, right?

Yes.

And it talks all about how H. pylori may even have a protective effect against allergies. And so it's exciting to me to learn all these things, right?

Mm-hmm.

So again, going back to the trigger piece, that's, that's really what I'm trying to figure out for someone. Is it— oh, and mold, right? Mold and mycotoxin exposure can, can wreck the gut and create an autoimmune-like picture. So can heavy metals. So for me, it's always about identifying the trigger, removing that trigger, and then working on healing the gut.

Let's back up a little bit to Epstein-Barr because that's come up a little bit recently with some of my clients, and I'm curious. So I have heard people say that Epstein-Barr that's still active will travel to the site of an injury and sort of occupy that space and causing inflammation and such. Have you— is there any truth to that?

I, you know, I haven't heard that, but I, I could believe that if I saw some research on it. Sure. I do find that Epstein-Barr virus— obviously most of us have been exposed to it. I think it's around, what, 95%? And it becomes a problem when it's, when it's reactivated. And, and for a lot of people, it's kind of like an opportunistic organism. It doesn't affect most people, but for some people, when their immune systems are not functioning as well as they should be, that's when they start to get affected by it.

Right. And so what do you do to treat that?

That's a difficult one to treat, and it's hard too because when you run labs on someone, I typically look for the early antigen that might be positive on someone, and that's what I track the most in terms of at least improvement in labs. Surely symptom improvement happens over time, and, you know, their fatigue improves or the headaches go away, or maybe some autoimmune markers might decrease. But the labs, especially if someone has a high, a really high early antigen above, let's say, 35 or 40, it sometimes doesn't come down. And I'm talking over years. And that's frustrating because you're asking the question, is Epstein-Barr still present? Likely it is, but yet now their, their immune system's in a such stronger state that they're not reacting to it anymore. In regards to treatment, there's lots of different herbal protocols that I use. I use some, some products called gemmos, gemmotherapies, and there's, there's 3 in particular if I get these correctly off the top of my head, Acer campestris, Tamarix and Juniperus. And you can combine that with this homeopathic from Professional Complementary Formulas called Silver, Copper and Gold. And I like to add on artemisinin, like a liposomal variety. So I like to use the, the Quicksilver artemisinin product. And then I also add on H2 Plex by Priority One, which contains some vitamin A, and some lysine and some other antiviral compounds in there. And I find that that combination of the Gemmos, the homeopathic, the artemisinin, and the H2 Plex for antiviral components really seems to move the dial for a lot of people. And of course, adding on something like monolaurin, which has been like a classic Epstein-Barr antiviral type supplement.

Yeah. Do you find that monolaurin by itself is ever effective or it always needs the additional things?

It seems to need the additional things. Yeah.

Okay.

But it's worth a try. I think if someone has a low-grade activation of Epstein-Barr, then, then certainly starting off with, with monolaurin and seeing what kind of effect it has.

And how long do people have to, to stay on those types of treatments?

Yeah. So it can range anywhere from, you know, a minimum of 6 weeks to no exaggeration, 6 months or even longer.

And we're not talking about eliminating it, we're just talking about essentially keeping a flare down and—

Correct. Yeah. And we're really working on symptom improvement. Exactly.

So if somebody comes to you with an autoimmune disease or maybe just vague symptoms like fatigue and skin issues or gut problems, what kind of types of screening tests might you use to uncover or rule out autoimmune disease?

Yeah. So I, I always start with the gut there. So if someone's coming in and they're, they're bloated and they're having joint pain and their brain isn't working and they're tired and they're moody, then I'll typically rule out SIBO, right? And, and obviously look into like diarrhea, constipation, and other things like that. And I, I like to rule out SIBO because I feel like that's a low-hanging fruit for us to pick because we know how to treat it pretty effectively. And in most cases, there is some form of dysbiosis that's present in someone with autoimmune disease. So I typically do like a Genova breath test, like the lactulose 3-hour breath test. There's other, obviously lots of other ones out there, but that's typically one that we use. And if that's positive, then I'll obviously treat it more, at least if someone's willing to do it from an herbal approach, that's, that's my preference. And I use all the SIBO herbs that I'm sure you're familiar with, like the berberines and the artemisia and neem. And olive leaf and garlic. And so we tailor it to whether if they're more methane dominant or hydrogen dominant. And if they are improving with a SIBO type of protocol, then I always ask the question, is there SIFO? And, you know, small intestine fungal overgrowth is really hard to diagnose. I mean, you got to do an aspirate really to like determine if there is fungal species there. So that one's kind of harder to diagnose, but I do find that a lot of people do have that. So you got to add on a little bit more of the antifungal approach with oregano oil or something else like that. So I kind of start there and then I watch for symptom improvement over a 6-week period. And if bloating is going down, if they're noticing that their brain is functioning better, maybe they're noticing improvements in their skin, their fatigue is improving, then we're heading in the right direction. And I don't need to do more fishing in terms of testing with looking at viruses or mold or other infections.

Okay, so, but in the case of where you might suspect an autoimmune disease, what is the— what is your protocol for the— for testing with that?

Oh, good question. If you kind of want to look at autoimmunity in general, you can run the antinuclear antibody test, the ANA, and of course you can run subclasses on that to sort of determine, well, if that comes back positive, is it more of a Sjögren's type presentation? Is it more of a lupus type presentation? And I'll just run that as a as a baseline. I will say that I don't find that's an accurate test because I've had people come in with a positive ANA and then I test it 2 months later, it's negative. Then I test it again, it's positive, and then it's negative again. And so maybe it just fluctuates kind of normally like that, but I've just not come to rely on that particular autoimmune marker. I do like to run TPO, thyroid peroxidase, and TG as well, thyroglobulin, on every single patient that walks through the door regardless this even if they have any like hypothyroid-like symptoms. So I think that's an important one to run. And of course, if there's any type of gastrointestinal involvement, whether there's diarrhea, there's constipation, if I'm suspecting malabsorption, if they're having an iron deficiency anemia type thing, I'll run a celiac panel because I find that you just have to run that one to make sure that they don't have celiac disease, which would be something that would be really simple to miss there.

Yeah, no, I'm amazed. I, I saw a client who was in his 60s and just got diagnosed with celiac and has been suffering from extreme fatigue his entire life, and no one thought to test for that until recently.

Right. And he suffered for so many years.

Yeah. And I'm just amazed. I mean, of course, obviously now we're much more attuned to that. In fact, I remember because I moved to Australia for a few years in 2004. And I had never heard of celiac disease at that point. And there they seemed to be really attuned to it. They had gluten-free options on menus. And I'm like, huh, I wonder if we just don't have as much in the US. And then when I came home, it was like all of a sudden everybody had woken up to it here as well. So I don't know if it was just because I was in a bigger city there and maybe in a smaller town in the US or what the, what the story was, but it seems like we just became aware of it some, sometime around that time.

It's so interesting because when I was first in the naturopathic medical school up in Bastyr, it was 2002. And I'd go to clinic there and it seemed like everyone was on a gluten-free diet for no matter what someone was coming in for, right? If it was eczema or if it was an autoimmune disease. And the research wasn't even out then, but it's kind of been along with this naturopathic philosophy of like, well, what could be damaging the gut? And for some reason, gluten has been a culprit for at least a long time in this profession. And then I was so thankful when books came out from William Davis like Wheat Belly, or David Perlmutter was putting out his book on Grain Brain, you know, talking about the dangers and consequences of eating lots of grains for someone. So I'm just so happy that more research has come out over time because it's really provided more evidence to people to get off gluten if truly they're affected by it.

Yeah, I know. I remember that I had a friend who told me that she couldn't eat gluten years ago. It was probably— it was definitely prior to going to Australia, maybe a couple of years prior to that. And she's like, you know, I can't have pasta, I can't have all these things. And I'm just like, this is a strange thing. Like, I've never heard of this. What is this strange thing that takes away everything? Anything that's good in the world.

Well, you know, that's the way two people feel about the autoimmune Paleo diet. When you, you take away grains, you take away dairy, you take away nuts and seeds and eggs and, I mean, nightshades, and people feel overwhelmed when they see that. But back in the day, it was just gluten they did have to give up, right?

Right. Yeah, no, I mean, the first time I caught sight of the autoimmune Paleo diet, I was like, yeah, no. And to be honest, I never actually did the full AIP because I did a much more limited set of, of eliminations and successfully started reducing my antibodies. So I never had to go that far. So I'm curious, how do you recommend the AIP at the get-go or do you tend to do more limited set of eliminations first?

You know, it depends on the severity of the autoimmune disease. So if someone's coming in with just Hashimoto's and their TPO level is at, let's say 150 or something, then I'll typically just recommend gluten-free to start off with. And within 6 weeks to 2 months, and we can talk about other therapies that I do too. If there's no change really by that time, then I tend to bring up the conversation. Well, you know what, we need to do a little bit more of a stricter dietary protocol here. Why don't we do the autoimmune paleo diet? And of course there's lots of resistance when I bring that up and no one wants to go on the autoimmune paleo diet. But I do find that for those that are not improving or have a very severe autoimmune condition, let's say like a rheumatoid arthritis where the joints are incredibly inflamed and stiff and people are in intense pain, I will just start off that with an autoimmune paleo diet because I do find that that's gonna move the dial, dial more than anything else.

And what about people— do, do you see people then who are controlling their autoimmune condition with pharmaceuticals and then you're able to taper them off after they go through AIP?

Sometimes, and I think the key thing to what you said is if they're on medication, at least we can reduce the dose, which is, is still making progress. Sometimes you can't get them off prednisone entirely for a period of time, but at least you can reduce the dose down while doing all these other changes with their diet and lifestyle and supplements that are working on the inflammation. And some people are able to completely get off their, their pharmaceuticals, which is just when that happens. There's just so much excitement and joy in the room.

Yeah, I've encountered a lot of clients who are sort of happily managing their autoimmunity with, you know, they might be coming to me for weight loss and then they say, oh, and I'm on this for this autoimmune disease. And I think, oh, well, we could work on that too. But they're like, eh, don't need to, it's covered. So I'm like, okay, well, if you don't work on it, we won't work on it. I mean, far be it for me to tell you you can't eat 17 different foods that are the primary cornerstones of your diet if you've got this under control.

Well, and that's the thing, you said it exactly right there, is that it takes work to really work on an autoimmune disease. I mean, there's really no magic supplement or anything like that that you can take that's gonna have the same effect as an immune suppressant medication, and it really requires a big change in the way people eat. I mean, it's just— that has moved the dial more than anything else, is really working on the diet, which obviously helps improve gut function.

Yeah. And I think you have to be of the philosophy that you don't want to be on pharmaceuticals to be willing to make that kind of— those kind of sacrifices.

Exactly. Yeah, exactly.

So in general, is there a particular diet that you recommend to your patients?

In general, I think the most common one would be something like the anti-inflammatory diet, which is really giving up gluten and dairy. And any other inflammatory food like sugar or trans fats. And I find that that's pretty simple for people to follow. And if they're really hesitant to starting that because they don't want to give up dairy or they don't want to give up gluten, I'll just start with one of those groups at a time. So let's just start with gluten or just start with dairy and move on from there. And for people that have gastrointestinal symptoms, if you give up gluten and dairy, I'd say 6 times out of 10, you're gonna notice an improvement in your bloating or a change in your bowel habits, whether you're constipated or you're having diarrhea, loose stools. Heartburn might improve. And that's important for people to understand, is that the changes don't happen overnight. So if you give up gluten, you might not notice any change until 2, 3 weeks, or even 4 or 5 weeks later. So sometimes it takes patience to really see a change from, from that change.

Yeah. And do you think there's any dairy with redeeming value like kefir or yogurt or things like that?

That's a great question. I do find that people that tolerate dairy well, let's say for example myself, I don't do dairy either. I'm just like you, I'm gluten dairy free. If I tolerated dairy better, I would probably drink some kefir because I do find that, hey, it's got some probiotics in it, it's fermented. It's gonna be a little bit easier to break down in the body. And people that do drink it, they tend not to have any issues with it. So I, I do find that, and even certain cheeses too, like there's vitamin K in, in harder cheeses and that's really good for your heart, right? So some, some dairy has some health benefits to it. I, I, like for me, I'm, I am so against and I stay away from soft cheeses like blue cheese or camembert or something like that because I'm, I'm really big into like, like mold. And anyone that suffered with a mold illness, they know that they cannot tolerate blue cheese or any kind of moldy grain because that will just destroy their system.

Hmm. Okay. So on, on the question of mold, when you have somebody with mold in their system and then they have potentially— there's, there's no obvious mold in their house, but maybe they test and they see there is some mold in their house, but they just don't have the funds to get rid of it or to move. Is there a point in treating them for the mold if they're still getting exposed? Is there a way to sort of just kind of protect them from the mold in their house?

The number one treatment if you do have mold in your home is to obviously get away from it. That's, that's gonna, that's gonna produce more results than anything. And yeah, you said it correctly with the, the cost because if you're trying to remediate your home from a water leak, it's, you're talking tens of thousands of dollars and people just don't have that kind of money.

Yeah.

So if they can't move, I would suggest getting something like an air purifier. And yes, there's debate out there whether air air purifiers even filter out mycotoxins from the air because mycotoxins are so incredibly small that most air purifiers probably won't do anything with those. But I, I still do find that air purifiers can remove other VOCs or volatile organic compounds, which can then improve the air quality. And at least if you're breathing a little bit of a better air quality in your home, your immune system is not going to be as reactive to the, the mycotoxins, and you'll be able to get better faster. In regards to treatment of the body, yes, I don't see any harm in adding on a binder, whether it's like a charcoal or a clay, or adding on some sort of an antifungal, or adding on something like glutathione, which is gonna help really help detoxify your body from a lot of these mycotoxins.

Mm-hmm.

But surely getting outta the environment that's moldy is number one.

Yeah. I find that the binders are a challenge for me personally and, and often with clients because they're saying, well, I'm already taking all these supplements and I'm having to take some, you know, breakfast, lunch, and dinner, and then trying to get that binder in while you're not— after you've eaten and before you're gonna eat, that it's hard to find a space.

It is. And you know that binder, the pharmaceutical one, cholestyramine? You've heard of that one?

No, I haven't.

It's, it's Dr. Ritchie Shoemaker's favorite in terms of helping with mold toxicity. It, it basically binds out the mycotoxins from your gut and prevents them from re-entering the enterohepatic circulation. That one needs to be dosed 4 times a day away from other medications Good luck. Yeah, good luck with that. Exactly. So I tend to do either once a day or twice a day dosing with a binder, and I'll typically do it like first thing in the morning when someone wakes up, they take some charcoal, and the last thing to do before I go to bed is take some charcoal. So then you're not worrying about taking it with iron or taking it with any other supplement that might affect absorption.

And then where do you— where do you stick the probiotics then? With food?

Yeah, I typically do them with food. Exactly.

Yeah. Are there probiotics you like particularly?

You know, I like to combine all 3 classes of probiotics. So, the Lactobacillus bifidus class, then there's the yeast-derived class of probiotics like the Saccharomyces boulardii and Saccharomyces reuteri. And then, I also like to have a soil-based organism in there as well. So, if they can find a formula that has all 3 in 1, I feel like that's just a better approach to take because it seems that some people respond better to Lactobacillus, others respond well to Saccharomyces, others respond well to the soil-based organisms. So why not have all 3 in one formula?

Yeah, yeah, that's sort of— I've been moving in that direction, although sometimes I, I hesitate because, you know, the cost of all the supplements is— it's overwhelming for some people.

And when you're—

if you want to go with the highest quality or the highest strain count of each one, I find that it can get overwhelming. So sometimes you have to pick and choose.

Yes, that— and so that is the problem with a lot of people, is, is really reducing costs and choosing supplements that we know are efficacious and work well but that don't break the bank. I agree.

But in preparing for this, I asked you to get into the research on autoimmunity and the gut, and I'm conscious that maybe I haven't asked enough questions to get at what you were— what were you looking at? So is there anything we haven't covered yet that you dug into that you want to talk about?

Yeah, why don't we just talk about some of these things that I found, at least these little associations that I found with certain conditions, because you might find this helpful too with your clients. So, celiac disease, we don't need to talk too much about, but obviously, there's a genetic component. And, what I did find really cool about this and I didn't know is that there's a drug called loratizide. Have you heard of this?

No.

Oh, sorry. No, sorry, lorazetide. That's the right pronunciation, lorazetide. And, what it does is it's actually a zonulin inhibitor, so it's a tight junction regulator. And, it's actually in phase 3 clinical trials right now for those that have celiac disease but they still have symptoms on a gluten-free diet. And the overall thing that it's doing is it's really mitigating and reducing inflammation, which I found really fascinating. For rheumatoid arthritis, it seems that— and I mentioned this from the beginning— there is an increase in the Prevotella species. And this is, this is a really fascinating part that I found is periodontal disease is more common in RA patients, and patients with periodontal disease have an increased risk of developing rheumatoid arthritis. And what they found is that there's this organism called Porphyromonas gingivitis, and it's a bacterium that's linked to the pathogenesis of periodontitis. And this is the really fascinating part, and this is where I'm geeking out right now, so sorry if this is like over the top. Go for it. But this organism has the ability to convert arginine into citrulline. It's a process known as citrullination. And when you look for antibodies to rheumatoid arthritis, one of the best antibodies in my opinion to look for is the anti-CCP, which stands for anti-cyclic citrullinated peptides. So you're actually looking for this antibody that is forming in response to, let's say in this example, if someone has this organism, this Porphyromonas gingivitis, there's going to be a greater conversion of arginine into citrulline. So you might find a greater level of this antibody in someone that has this organism in their mouth. So I found that to be kind of a cool little link there.

Ah, so that makes me think about— are you familiar with the BioCiden products? Yes, yes, with their, their dental Ciden product that clears up the periodontic disease and such.

Well, it's— everything's connected, right? Everything in terms of digestion starts at the mouth and ends all the way at the anus. So something in the mouth could certainly affect something in the rest of the body or lower down in the intestinal tract.

Yeah.

For lupus, which for those that really aren't familiar with lupus, this is an autoimmune condition where there is typically like a butterfly rash in the face or there's arthritis or they might have photosensitivity and some have like renal involvement as well. They found, at least in the studies that I looked at, there's an altered gut microbiome, which all across the board, that's what we find with a lot of these autoimmune conditions, right? Altered gut microbiome. In this one, they found a decreased level of Firmicutes. And it's really unclear. This is like the debate with autoimmune disease. Well, is there, is there a lower level of Firmicutes because of the autoimmune disease, or is that happening with something else? So it's always hard to tell, like, kind of what's the chicken and the egg there.

And the Firmicutes are the ones that are digesting meat and fat more, right?

I believe so, yes.

Yeah. Yes.

And they're the ones— and this was really interesting too— they're the ones that produce the short-chain fatty acids. Like butyrate. And then of course butyrate can have this immune-modulating effect on the gut, and it actually helps support the, the tight junctions, and it actually also supports the mucus layer along the gut lining. So if you've got a higher level of these firmicutes in your body, you're gonna be producing more short-chain fatty acids, therefore more butyric acid, which is gonna have a really protective effect on your gut in general.

Pretty cool. Yeah, no, my previous podcast with Lucy Meiling, which just was published, was, was all about that, the oxygen gut dysbiosis theory.

Oh, nice.

Yeah.

That's great. I love that. And then I guess moving on to type 1 diabetes, that's another classic autoimmune condition. What I found really neat was that in animal and human studies, they've shown that the onset of type 1 diabetes may be preceded by the regulation of zonulin levels. And so they found that zonulin levels were really high for someone that pretty soon they could be developing type 1 diabetes. So that, that kind of proves the point of like you need to have leaky gut or increased intestinal permeability in order for an autoimmune disease to settle in or develop.

There's connections between dairy and type 1 diabetes too, is my understanding.

Yeah, and tell me what you know about that because I just vaguely remember about if you've had— if you were breastfed at birth, it leads to something. If you could— I forgot.

Either— I think it was either quantity, or I think quantity of dairy exposure over the course of, I don't know, first number of years of life is correlated with, with the amount of type of type 1 diabetes. It's my—

that's probably— mm-hmm. Yeah, I forgot that information.

What other good stuff did you find?

Oh, another study with type 1 diabetes was there was a deficiency of butyrate. And they were saying that might be a trigger for the onset of, of type 1 diabetes.

You know, what I keep thinking about is these— we're seeing now people with this sort of type 3 diabetes, some combo of 1 and 2, or it's more of an autoimmune— well, I mean, type 1 is autoimmune too, but it's happening later in life. And, you know, where, you know, sometimes with children, because they're children, you're not paying as much attention, or they're not talking about what's happening to them. And so it could— by the time that they find out what's going on, it's often too far along. But whether there might be some potential for stopping it with these adults Yeah, that's a great point.

And I think also they've linked type 3 diabetes to brain health too. Like, they're almost saying it's sort of like affecting the brain as well, if I recall correctly.

Oh, right. Yeah, no, that's, that's a different type of diabetes, I guess.

Are you referring to, like, let's say if there's a type 2 diabetic that's on metformin and they're, they're so obese and their weight is increasing so much that eventually they actually need insulin to help regulate their glucose levels, that, that's that happens too.

Yeah, I'm not, I'm not sure if it's the same thing or not. I've just heard people referring to this additional type of diabetes. I know someone whose child has it, and adult child, and, but, but yes, also the type 3 diabetes where you're talking about, talking about Alzheimer's and dementia as, as from lack of blood flow to the brain and stuff.

Yeah, exactly.

Right.

So I guess in summary, at least with these autoimmune diseases that I kind of dug into here, it seems that there are certainly some associations with increases and decreases in certain phyla and certain bacteria or short-chain fatty acids, but I wasn't impressed with any of those associations. It's not changing the way that I am approaching treating autoimmune disease.

Right. Well, I think that the reductive— it's just this one bacteria perhaps— view of the microbiome is beginning to be replaced by more of a systems theory, like what is the function of the microbiome and is some other organism serving the function that this other one that might be present in someone else doing, and, and that perhaps we might be moving from an era where we look for, you know, one species of bacteria to an era where we look at this whole, you know, family, this whole phylum of bacteria can serve the same function as a different one.

Well, it's so easy, at least in conventional modern medicine, to point out if there's an imbalance in, okay, this bacteria is high, let's do something about it. Let's either get rid of it or replace it or do something else. But that model just isn't really working for this, this whole development here. And so yeah, it takes more of the individualized, personalized approach to support someone, right?

Okay, well, this was all really good, interesting stuff. Anything else that I forgot to ask that I should have?

No, I think we covered a lot today. I definitely loved a lot— some of the tangents that we went on. I love talking about the gluten piece and all that. That was That was just— that was fantastic.

Yeah. I, I like to go on tangents because it's all, it's all very interesting to me in working with my clients and—

You know what we should do? Actually, let's talk about really quickly just the overall approach for treatment that I like to take.

So—

Yeah, go for it. We can leave your listeners with some information. We talked about the diet piece, the autoimmune paleo or anti-inflammatory diet. It's kinda like where I like to start. I always add on vitamin D. If there's overarching inflammation in the body, I'll typically do like a turmeric or a boswellia or an artemisinin, supplement to kind of calm down inflammation. I'm a huge fan of CBD. I don't know if you've dug into CBD at all, but big fan of CBD.

I have to tell you that I have stayed away from CBD primarily because it just exploded here in Arizona. And all of a sudden there were stores popping up everywhere and everyone and their brother selling it and everyone is claiming theirs is the best. And it was just too much, you know, because to, to try and separate out, well, is the water-based one or the oil-based one or, you know, who to believe.

Yeah, and you know, you gotta do is really talk to the company and figure out what they're doing that is special and make sure that their products are organic and they're not overly processed. And then you need to experiment on yourself to figure out which one actually helps you feel different or better. Yeah, that's how we settled on them. I finally settled on one, it's called Sana Botanicals, and I love that company. They have such amazing products that work well, and I tell you, people come back and and they're sleeping better, they have less anxiety, they feel just calmer in their body. And it also helps with pain and inflammation additionally. So anyway, that's, that's my plug for CBD. I love, I love it.

I guess. And then the other thing I should mention was that a lot of the companies that are selling it are multilevel marketing, which I also want to stay away from like the plague.

Exactly. So you got to be careful there. It's a good point.

Yeah.

And then I like to— I also like to recommend LDN. I don't know if you've dug into LDN, low-dose naltrexone at all.

I mean, it's a pharmaceutical, so it's not something that I can tell people to get, but they could always go to their doctor and get it.

Yeah. And it's, it's, it's never good, let's say, as a monotherapy. But when you combine it with everything that we're talking about today, I do find it's helpful across the board for autoimmune conditions. And the reason for that is it's really helping upregulate T regulatory cells, which, which really calm down a part of your immune system that's overactive. And side effect profile-wise, like, people might have some insomnia the first couple of nights or some vivid dreams, but then that tends to kind of go away, especially if you start off with a low dose and work them up. And then, coming towards the end here, I like obviously probiotics which you talked about, prebiotics getting mainly from food are really going to support the gut lining and work on inflammation. And then, something like a GI Revive or something that has glutamine in it or DGL or aloe or marshmallow root, slippery elm, zinc carnosine, all these different nutrients to help kind of calm down inflammation and help heal the gut. That's kind of what I typically do for people.

You know, I tried DGL myself and I just kind of found that it sort of added this mucus stuff, but it didn't have that same feeling of like my mucus layer is intact. You know, when you're using the bathroom, you just know when that mucus layer is intact and it didn't.

Yeah.

It was sort of like, okay, so the substance is in there and it's kind of lining things, but it didn't actually change, say, the quality of my stool the way that a good mucus layer and a properly functioning gut did.

Did you find that taking licorice by itself in its whole form did that for you?

I never tried that.

I'd be curious to see your response to that because yes, DGL is just a component of licorice, right? I never get the pronunciation. It's deglycyrosidated or I can never say it, deglycyrosidated. But that's a component to help remove the whole hypertension piece with it so that people that have high blood pressure issues, they can take licorice without having an elevation in blood pressure.

Oh, I'd love an elevation in blood pressure because mine is always super low.

Yeah, right. Okay.

So if I take licorice in whole form, it'll help the gastrointestinal stuff and help me be a little more—

Well, yeah. And also the mechanism behind that is licorice root. It basically helps sustain levels of cortisol in your body. So that's why it's having an effect on your blood pressure. In addition, there's some potassium piece as well, but it's primarily that elevation and prolongation of cortisol.

Okay, mm-hmm, interesting. Okay, are we, are we through?

What, what?

Yeah, I think kind of covered a lot of ground.

Okay, awesome. Well, thank you so much for so generously sharing your knowledge and the information and the research that you did to share with us.

Absolutely, it was great to be on the show. Thank you.

Thank you so much.

That was a fun conversation. I enjoyed that. Don't forget to press subscribe if you're not yet subscribed to the show, and please join my Gut Healing Facebook group linked in the show notes if you want to ask a question about gut health or suggest a topic or guest for the show. I've also started writing newsletter articles based on each of my shows that include some transcriptions, some additional details and links. So if you want to subscribe to my newsletter and get those, you can do that at HighDesertHealthCoaching.com on the newsletter page under Communications. You can also follow my High Desert Health Facebook page or find me on Instagram, Twitter, or Pinterest. Thanks for listening, and here's wishing you all the perfect stool.