Fixing Crohn's and Colitis

Welcome to The Perfect Stool: Understanding and Healing the Gut Microbiome. This is your host, Lindsey Parsons, and today on the show I have Dr. Ina Lukianowski, who's a doctor of pharmacy, a functional medicine practitioner, a gut and hormone expert, and a creator of digestive solutions for Crohn's and colitis, and the bestselling author of Crohn's and Colitis Fix and Digestive Reset. If you haven't yet subscribed to the show, be sure to press subscribe so you don't miss an episode. Now on to the show.

Welcome, Dr. Ina. Thanks so much for coming on the podcast.

Thank you so much for having me.

So I know that you have a story related to all of this. How did you get into this work on Crohn's and colitis?

That was my long journey to healing, and I originally I got sick with Crohn's in the early 2000s. I was originally misdiagnosed with colitis and then properly diagnosed with Crohn's. And I tried all kinds of medications and it didn't bring me much relief. Being a pharmacist myself, I also was skeptical and was worried about the side effects, which doesn't help at all when you know them all, right? And I tried different methods. I went for different modalities of healing. I traveled, and nutrition was not at the point where it is now, but tried changes, and I did succeed to a degree until I finally found functional medicine. That really brought me to a whole different level, and that's how I started the practice because it helped me.

So you were already a PharmD at the time when all this started?

I was an RPA, a registered pharmacist at the time. The reason I took PharmD recently, just a few years ago, I graduated in 2017 with my doctorate from University of Florida. The reason I did that, I wanted to dig deeper into the studies and learn way more about evidence-based because here I was a pharmacist, then I took a lot of education upon and learned about functional medicine, integrative solutions. And then I decided here's the time to do my doctorate to be able to really extrapolate all the details and learn about the evidence-based and studies.

What year were you diagnosed with It was colitis?

Original colitis, 2000, and then 2003 was Crohn's disease, the final diagnosis.

When you see a Crohn's or colitis patient in your practice, what is your first step in working with them?

It's the initial consultation. I take them on a really long consultation. We discuss history. We go all the way back. I listen to them. I need to hear their goals. I need to understand their gut story. And by the end of the session, I am more or less on top of what functional diagnostics they should run and what route we should take for them to heal.

So do you typically have to do some more testing with them, or is a diagnosis of Crohn's or colitis sufficient to start working with them?

With most of my clients, I recommend functional diagnostics. They really can open up and show us a whole different picture. It really, especially the stool test with the PCR technology right now, something where even others— there's toxicity-related testing that doctors at this point don't have an option or don't have the education to dig for. And that can really be it. That could be the root cause. And it's great, it's great to find out.

So what do you use for diagnosing toxicity?

Well, it's really not diagnosing. I try to steer away from that term. But to recognize and to see and to get a lab check out— I really love— first I would do organic acid test for a client, and sometimes just from that lab alone we could see we have to dig in and see if there is metal toxicity. Then we're gonna do more extensive testing, for example, for metals or for mold toxicity or other toxins.

So whose testing do you use for metals?

I love GPL. They're great. There are plenty of labs now. I just had really great success with that lab. It's very thorough.

Great place.

Mm-hmm. Yes.

Correct. And then for mold, what, what kind of test do you use for that?

For mold also, I love to use GPL for their mold testing.

And what's that one called?

Multitox screen, I believe, or full tox screen.

And then the organic acids test, do you, do you do that also through Great Plains?

Yes.

And have you ever used the organics—

organic acid test for myself or for my clients? For your clients, around 10 years by now, close— as close as possible to 10 years. I've seen hundreds of these.

Yeah.

Okay. So what made you choose the Great Plains over the other?

It was one of the— probably second lab Genova was the first one at that point. I met the rep at the Integrative Healthcare Symposium. They were very compatible to Genova. Genova at that point changed from Metametrix and pharmacist license was no longer okay to order, and that was a perfect choice for me. GPL.

Oh, okay. What kind of information will you see on an organic acids test that will lead you to believe that it's perhaps a metal toxicity issue?

It could be a combination of things. It could be the fact that we see that there is a lot of issues with the liver detoxification, a symptomatic presentation along with combination of things, plus the liver, plus the, the look of a client. It's really at least a few different ways you could see and then go for metal testing.

So what will you see in the look of a client that would lead you to believe they might have—

that's often a grayish skin, black under their eyes. They're often feeling cold, cold sensations in the hands. Sometimes they have metallic taste in their mouth. That's liver unable to process often, or being the, the bile ducts being congested. They usually have that color.

And would these be people who have had some knowledge that they were exposed to heavy metals, or people who were just sort of, oh, I have no idea how that happened?

We get both. So I often have someone that would say, oh my goodness, I had no idea, and I have so much, uh, lead, I have so much aluminum. But I did have a client that was completely positive they had mercury poisoning. He goes, I went through I ate so much sushi in the past couple of months, maybe I have mercury toxicity. And here we go, there it was. That can happen.

And that, that I assume is primarily from like the tuna or— yeah, the bigger fish.

Yeah, yeah, large fish. Again, some companies are very, very responsible and they can grab the fish before it reaches a certain weight, so that's very much less of a mercury in the tuna, like Vital Choice. Their ventresca pretty much doesn't have— tuna ventresca doesn't have any mercury.

Oh, didn't know that.

Yeah, which is great.

That's what I get.

So don't buy all of it.

Vital Choice, you said?

Yeah, Vital Choice.

Canned tuna.

Yeah, it is, but BPA-free and very, very sustainable and organic. Very clean company. Very responsible guys.

Good to know. So we were talking a little bit about the mold. What kind of signs and symptoms might lead you to that, or things on the organic acid test might lead you to that, so that you suspect mold?

To suspect mold, with my clients it gets a little harder because my clients usually are Crohn's and colitis, and they're very sick to begin with. So the symptoms can kind of mix in all together. So that gets tough. Usually mold, I would mostly recognized from like the organic acid test. And that's like right in the beginning of the test, we would get Aspergillus being high, that there are different kind of markers, tartaric marker, 5-hydroxymethyl-2-furoic, that they're really high numbers indicating, or furoan marker, we would really go straight for mold. Test.

Oh, okay.

Pardon this brief interruption, but I wanted to mention that if you're struggling with your gut health or suffering from an autoimmune disease and would like help reversing these problems naturally, I work with clients locally in Tucson, Arizona, and virtually all over the country. You can set up a free 1-hour breakthrough session with me to talk about what you've been going through and hear about what health coaching is and how it might be able to help. And I also offer single consultations if you just want some ideas and advice on moving forward, and you can find links for that in the show notes.

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And then how often do you find that people with Crohn's and colitis, the root cause is, is some gut stuff like Candida or bacterial overgrowth?

Super often. Very often. Many, many of my clients have Candida overgrowth. Many, many.

Have you begun to form theories about what the most common root causes are for Crohn's and colitis?

That's a question I've been asked recently a lot. Common root cause, would you believe that it's the personality? Yeah. Yeah. My common thing in my Crohn's clients is Type A personality. They push themselves. It's a combination, of course. It's a multifactorial situation. There's so much is involved. Type A personality is very common in Crohn's patients, and they really push themselves. They're one of those go-getters and without slowing down. And that can really get you in trouble. It's— root cause for Crohn's is a multifactorial base, except that being like an overdrive and not letting yourself relax enough and not remembering yourself and not prioritizing your health often is an issue.

Tell me how that relates to gut issues. What's the physiological process there? I assume we're talking about stress.

Sure, it's adrenal imbalance. It's the fact that, you know, gut microbiome— this is something interesting many people probably don't know. If you're having a perfectly balanced gut microbiome, or as close as perfect as you could get— probably no one is perfect— but as diverse, because we want it to be very diverse to be, to be healthy, as diverse as possible, and Overnight, there's some kind of severe stress— fire, major fight, something really horrible happening. The next day, if you tested that microbiome, it would show someone's super sick and really, really different microbiome. So gut microbiome, of course, plays a major role. Is it as easy to repair after the damage? Not as, as it could go down in overnight stressful situation.

And so I presumably the stress releases cortisol. And then how do you think that impacts the gut microbiome?

Stress releasing cortisol. We don't have the exact connection to how it affects microbiome. We do know that cortisol being released in really high amount, we feel that overdrive sometimes. You can't rest with the high cortisol. When your cortisol is constantly high, you will have some kind of other hormone imbalance, sex hormone imbalance, that leads to possibly blood sugar instability. Blood sugar instability, now the release of insulin, now you're not going to— now you'll have the cravings, now you're not going to eat properly. It's a chain reaction. And then you get like indirectly to gut microbiome imbalance.

Okay, so when you work with clients, do you also test their adrenals?

I do. It's part of fixing the entire body. I really appreciate Dr. Kalish's course from way over 10 years ago now. I know there's a lot of controversy with adrenal fatigue diagnosis. Of course, I do not diagnose, but fixing, correcting things is really helpful. For those that have chronic conditions.

So tell me what kinds of things you'll find when you test the adrenals.

All kinds of things. High cortisol for someone, super low cortisol for another when they're like really been in severe chronic situation. DHEA falls down quite often, and for women that sometimes really, it affects their sex hormone health. Like they're, they're symptomatic for low progesterone because of pregnenolone steal. Now they're symptomatic because of pregnenolone steal.

Steal?

Yes, it's a term with adrenal health. What happens when you have that low cortisol for too long, when it reaches that point when it really can't go back high enough because it's exhausted, right, the adrenals, you cause a situation called pregnenolone steal. And from there you're going to have trouble making a sufficient amount of sex hormones, and that creates other symptoms. A lot of my Crohn's patients, for example, have low progesterone. Young and old, at any age point. And therefore, with low progesterone, it is harder to maintain pregnancy. So no wonder now that they're confused why they having miscarriages. Low progesterone often leads to miscarriages.

I know all about that. That's exactly what happened to me. Yeah. I had low progesterone and had trouble getting pregnant and staying pregnant. So I was lucky to have one live birth though.

Yay. This is where I find this to be completely overlooked problem. You often hear from a traditional gynecologist, it happens, you know, miscarriages happen. It probably wasn't a good embryo. Seriously? Did you check my progesterone levels?

Yeah.

How often do they do that?

Yeah, I had to supplement with progesterone for many, many years to get pregnant and to maintain it. So if you find someone with low cortisol, what do you do to treat that?

Often it's adaptogenic herbs. For others, sometimes I would do bioidentical herbals, bioidentical plant-derived supplementation. Nothing, of course, by prescription, because that's not what I can do. But these are a really effective supplement.

What adaptogens do you like to use, and are you an herbalist type or with the drops, or do you get to tell people to use the pills, or—

I often mix, but with my favorite one right now is Adaptocren from Apex Engine Energetics. That's my go-to at this point. I've seen great results with it.

Okay, so is that a mix of different adaptogens?

Yes, it's a mix of great adaptogens, but again, that's a blanket adaptogenic herb combo. But if there is a need for more of plant-derived bioidentical hormone for just a short term, DHEA, pregnenolone, they work well.

I know that the adaptogens help both with low and with high cortisol. Do you use the same thing in that case or something different?

Very often I do, yes. More often with low force activity. And if I see overreactive and if I see this is just a very recent case and I'll be able to fix it with a quick fix, I don't even go there. But most likely it would be for both cases.

Is there something different between Crohn's and colitis in your treatment approach or in typical protocols, or—

It's a very good question. I understand what you're asking me. Not one of my protocols has been the same for the past good 3 or 4 years. Everything is so individualized for every single— like, no Crohn's patient is the same. More probably Crohn's patients than colitis patients. Not one wellness plan that I create, it looks the same as the other.

Do you typically, though, you use the herbal products in helping people?

Herbal and nutraceuticals.

What kind of diet changes do you recommend for people?

Anti-inflammatory. That's where I really focus on. As long as the diet is very anti-inflammatory and stable for macro and micronutrient balance, I don't restrict completely the SCD diet. SCD can work for, for a short period of time, for sure. Except completely without carbohydrates, usually weak patients, Crohn's patients and flare, they really need some carbs. To flourish. So yeah, I do allow that in the diet.

The SCD is the Specific Carbohydrate Diet?

Correct.

Okay, so when you say anti-inflammatory, is that— what does that mean exactly?

The diet I create for my clients, usually a mix of a paleo with a little bit of carb, with focus on a properly balanced plate, macro to micros, all thought out and colorful plate. To get the most out of your nutrition, like not to have repeated meals all the time. Very important to rotate, rotate.

What grain do you recommend to people?

I concentrate on gluten-free grains like quinoa, buckwheat. Well, quinoa is really a berry, it's not a grain, but the buckwheat, millet, occasional rices are fine. Many of my clients love buckwheat, actually. They haven't used it before. We spoke, so that worked.

That's funny because I remember as a child being offered buckwheat pancakes and the first time I tasted them, I'm like, this is the most vile thing I've ever had.

Dark looking. What is this?

And even now I eat gluten-free, but I make a mix. I usually use sorghum and millet and cassava and tapioca starch as my starch or arrowroot and something like that. And then throw a little extra fiber stuff in and, you know, sometimes like the tiger nut or coconut flour.

Those are all perfect, all in my pantry. I even managed to be able to make crepes out of it, really, really thin pancakes. Yeah, it takes time, but yeah, you learn.

And almond flour, of course, that's my go-to flour as much as possible.

And the key is to rotate. Obviously you don't want to be stuck on one because then you might create another problem, you might create another food intolerance for yourself.

I think I probably live like 50% on almonds.

See, see, they gotta rotate for you, my dear.

Yeah, except that I just don't eat all that many grains anyway. Okay, so what about elemental diets? Do you use those at all, or semi-elemental?

I try to steer away unless there's a specific rare cases when I would recommend it for really short term just to kind of calm everything down, but not for too long, maybe a week or two.

And why is that?

I, again, I won't find an evidence-based study on this. Strictly from my experience with so many clients, when the stomach is empty, first few days it feels great. There's no pain. When your gut is inflamed, what happens? Food passes, it creates pain. So food is associated now with pain. People are afraid to eat, commonly found with Crohn's and colitis patients. When you restrict them on like chunky food, you will now decrease the pain. So they feel better first couple of days to a week. Things are great. What happens afterwards is that microbiome cannot be really sustained and be really well balanced without the chunky meal, or at least a smoothie. You need to feed intestinal lining, you need to feed gut microbiome, and unfortunately, Elemental Diet won't provide that. My opinion with a decade of experience: people start to feel gassy, they will start losing natural probiotics in the gut flora, and they start to feel worse later.

In pain.

So yes, it's a very short-term— my practice only. I'm not putting anybody's products down. If they had success, great. Just doesn't work for my people.

What about fiber?

Fiber, again, very carefully, but it's a must to refeed that flora. You can't avoid fiber. You're just gonna have to be very careful and do a proper job putting back the fiber into a client's diet. And I've been Pretty good. I've learned there's overgrowth of bad bacteria, no good probiotics in there, and you give them fiber, they hurt. There's gas, there's pain. They're like, what the hell? I'm like, listen, I read your test and it said you need fiber. And in the beginning, it took me a while to understand how to gently, gradually put it back in.

When they're flaring, do you use fiber or do you wait till the flare stops?

Or it depends on the flare. If it's a real flare, then yes, I would wait a little bit. Until they're better. Yeah. And then we start.

And how do you gently introduce fiber?

Small amounts, little by little. Pinches in the beginning only. And then we grow. And then your probiotics will regrow as you go on and it gets so much easier.

And are we talking about supplemental fiber or you're talking about just within the diet?

Depends. Often the diet is not enough. Depends on if I, if I see a GI map results. And if they're in need of a lot of prebiotics, then we do fiber from a supplement.

Okay. Is there a particular one you like?

There's a lot now. I like Paleo Fiber from Designs for Health. It's a great combo. Mega Prebiotic from recently from Kieran's company, Microbiome Labs. That's also a really great choice. Sometimes I get to the point when I would even use both of those products. For a patient.

Do you use probiotics then with patients as well? Oh, of course.

That was my doctorate paper.

Oh, okay. What was it?

When I got my PharmD, it was the clinical effectiveness of probiotics in Crohn's and colitis patients. Nice. Yep. At that time they let me. I'm really grateful. I'm not sure if they would today. Things are becoming a little weird again with nutraceuticals. But yes, I have really great evidence-based studies to support the use. Now, of course, now, as we speak, actually, more information comes up on probiotics, more and more and different ones. And we're learning more about different species in the gut. So eventually we'll be able to bottle more species. We are limited right now. And since we know the changes are so rapid and more information is known, there's no manufacturer that can keep up with changing all this so fast. So we kind of stuck with the original blends from 10 years ago. Yeah, but there, there are some changes. I see really great stuff coming up. So we're, we're on top of things. So which probiotics did you study in my paper? The number one probiotic that showed at that point was VSL3. Here we go. That's right. So VSL3 showed that best evidence at that time. Remember, this is 2020. My paper was finished in 2017. Yeah, I don't use that in my practice.

Okay, so which probiotics do you use?

I really use a lot, and I use probiotics depending on results that I see on the GI map and OAT lab. I love Garden of Life Original Professional Formulas and Multi-Probiotic. They're soil-based. I love it. Espilardi depends only for if there is a need. I love Probiomed from Designs for Health. I like True Bifido from Master Supplements. I am very choosy and I pick and choose.

And for every case, will you typically have people do multiple kinds of probiotics like the spore-based and the lactobifido and the Espilardi, or more particular?

Depends. Most of the cases I do not combine. Most of the cases I don't. I've had a few where I had to, there was a need.

And so this is basically based on what you see on the GI Map, you'll decide what they're most lacking in?

Yes, exactly. What they're lacking in, what they would benefit from. For example, MegaSpores by Microbiome Lab for certain cases, but if there's Bacilli overgrowing, of course I won't give that to a client. So. It has to be review and then recommend.

So you mentioned Dr. Kalish, you did his course. That's Dr. Daniel Kalish, right?

Yes. Love him.

So he was one of your primary mentor in this field?

Correct. Yes. I learned the entire basics from him and then I stayed on for years for clinical rounds. I am forever grateful. He's an amazing teacher and there's a lot of ways now to learn functional medicine. But you need to learn from someone that can teach. And he's amazing at teaching.

And what would you say is unique about his approach to functional medicine?

Number one, he loves what he's doing. Number two, he truly believes in what he's doing. And number three, he's constantly searching and thirst for more learning. Like, he's learning right now. He's learning with another doctor on— he's on another agenda and learning about organic acids. And then he went on to learn— he's doing more research on Genova Lab, whatever it's called. So he's, he's amazing. He's now working with IFM, teaching with them.

Institute for Functional Medicine.

Correct. Yeah.

Do you have a philosophy when it comes to at least the gut health stuff? Say it's not— say it's not metals and it's not mold, but it's, it's, you know, maybe it's the overgrowth of bacteria or it's overgrowth of Candida or dysbiosis of some sort. Do you have a— I know a lot of people have like, you know, the weed and the seed and the, the, you know, that, that type of order of operations. Do you have philosophy there?

Kind of, sort of the 5 Rs, but I often change things up. Like I said, everybody's program is super individualized. I, in many cases, on 5 Rs, first, yes, let's do that. But I also incorporate the adrenal balance, and I also think it's extremely important to recognize if, if you're going after someone's— lots of different infections in the gut lining, and that person has severe inflammation, and you do nothing for inflammation, you're not going to be extremely successful. So 5R kind of doesn't to recognize that. It's a lot of different philosophy.

Spell out what the 5 Rs are.

5 Rs is based on first removing, then replacing, reinoculating, repairing, and rebalancing. When we remove, we remove stressors and infections. Replacing, we're replacing with healing, like enzymes or bile acids, things to support digestion, reinoculate with putting beneficial bacteria like the probiotics, prebiotics, repairing, which I often— number 4, repair, for most of 5R, I, I often put it, put it way higher and start sometimes along with number 1 as far as repair part and supporting lining. And number 5 is rebalance. It's, it's all different aspects of gut health, emotional health, your optimal health and lifestyle choices. And I work with my clients on a, on a really different level. They, we speak about what's going on in their life, how they could address their emotions and how they can handle the situations. My programs offer my personal coaching throughout the entire time, and they know they can ask me anytime at any point. So it's a lot more to gut healing than just like the 5R.

And when you said you, the repair, you sometimes put up at the beginning, what, what is repair about?

L-glutamine for gut lining when there's, for example, leaky gut, when the zonulin is really high. I would do L-glutamine from the very beginning. Sometimes zinc. Sometimes it's extremely important vitamin C. Vitamin A if there is a need. I do that often with number 1.

Okay, and do you wait to introduce probiotics after you've done removal, or do you introduce those early?

Depends, uh, but I would say majority of my cases I give the antibacterials, antimicrobials a chance to work before I do the probiotic load.

Do you use butyrate at all in your practice?

I do, of course. Love butyrate. I, I have a product that I absolutely love, Enterovide by Apex, and it's great stuff.

I think they just sent me some of that. I think I just got a free sample and gave it to a friend to try.

It's really good stuff.

Do you use that early on, or do you wait until sort of the removal process has completed?

Depends on the case. Sometimes I start it from the very beginning along with the entire process because it's anti-inflammatory, part of the anti-inflammatory approach.

I think that was really key for me. I tried it relatively recently. It seemed like that was the final missing piece of the puzzle to try and switch that because I was a high proteobacteria case. So I've just submitted a new stool test and I'm excited to see if I've brought them down.

I'm sure it's better. I've seen that over and over.

It certainly seems better.

Good. Very good.

Okay, well, I think I've asked everything I was planning to ask. Anything I should have asked?

I think you did an amazing job.

Okay.

Any final words of wisdom you'd like to leave our listeners with?

Yes. When you're healing, it's extremely important to put yourself first. Your health is your priority at any point, whether you're feeling better or here, I'm feeling better. Let me, like, push on it and let me do this now. Like, I feel guilty. I'm feeling better.

No.

Your health is your priority. This way you're able to help your loved ones. This way you are— it's like putting the seatbelt in an airplane for yourself first.

And actually, you know what, here's a question I should have asked is I know there's a lot of people out there who may have never done anything other than pharmaceuticals for their Crohn's or colitis, and they may not know or realize that there are other ways to treat these diseases. Would you say that 100% of people can heal with natural methods, or what percentage of people could give up those pharmaceuticals and heal in some other way?

I didn't study my clients yet to know what percent of them were able to get off the medicine completely. I should, right? I have 10 years of worth of cases that I need to put into study, but a good percent of my clients were able to get off the medicine again with the doctors Okay. Of course, I'm, you know, I'm just their guide, but they make their decision with their MD.

Right. They see when their symptoms are clearing and they can afford to start to taper off. Okay, great. Well, thank you so much for sharing your knowledge with us. And do you want to mention your website so people can find you?

I would love that. Thank you. My website is digestivereset.com. That's where you could get all the information you need to find me. My email is inna@digestiveset.com, and the phone number for the office is 732-414-6223. And where do you practice out of? My physical office is in Marlboro, New Jersey, but I work with clients from all over, even overseas.

Okay, great. Well, thank you so much.

Thank you so much for having me.

Well, I hope that gave you some avenues to explore if you're suffering from Crohn's or colitis. And if you wanna stay in touch and get articles based on each of my shows as well as upcoming webinar announcements, you can join my email list at highdeserthealthcoaching.com on the newsletter page under communications. And just a reminder that there are a few ways you can support the show. On my webpage, there's a recommended supplements page with Amazon and iHerb affiliate links. And then there's also a testing page with links for gut and lab testing through my affiliate accounts with Biome, Longevity, and yourlabwork.com. And then you could also buy high-quality supplements in my online FullScript Dispensary. And there's links in the show notes for all those things. And do compare prices if you find the same supplements elsewhere. And you can also support the show with a monthly donation of $2 or $5 or whatever suits you on Patreon. You can also connect with me by joining my Gut Healing Facebook group if you wanna ask a question about gut health, suggest a topic or a guest for the show. And you could follow my High Desert Health page on Facebook or find me on Instagram, Twitter, or Pinterest, just searching for High Desert Health. And you'll find all those links in the show notes. So thanks for listening, and here's wishing you all the perfect stool.