Gut Interactions with Autoimmune Disease, Anemia and Hormones

Welcome to The Perfect Stool: Understanding and Healing the Gut Microbiome. This is your host, Lindsey Parsons, and today I'm talking with Dr. Ian Holliman, who is a doctor of chiropractic and also has a master's in nutrition and functional medicine focusing on autoimmunity, a certification in functional medicine through the Institute for Functional Medicine, and functional neurology neurofeedback certification through the American Functional Neurology Institute. Like many functional medicine practitioners, he found his way to the field through becoming chronically ill and going through 8 providers before finding a functional medicine doctor who brought him back to health. But before you listen, press pause, and if you haven't yet, pop over to my website, HighDesertHealthCoaching.com, to pick up my new free ebook, Finding Your Root Cause Through Stool and Organic Acids Testing. If you haven't yet followed or subscribed to the show, be sure to do that so you don't miss an episode, and please with a friend who you know has gut issues or autoimmunity issues in this case, or in your favorite gut health or autoimmunity Facebook group if you haven't seen it mentioned there before. Now on to the show.

Welcome to the podcast, Dr. Ian. Thanks for coming on.

Well, thanks for having me.

Yeah, it's my pleasure. So why don't you tell me a little bit or tell us all a little bit about your journey to wellness?

Well, of course, wellness is a— it's always a moving Moving target. Yeah, moving target for sure, especially with all the challenges that we face on a day-to-day basis. But back, what got me started was in grad school, I was going through what we call a hell quarter. And that just basically means we had a lot of tests, a lot of pressure on us academically at the time. And unfortunately, I was actually also breaking up with my girlfriend at the time of 4 years. So, kind of what happened is everything fell apart. Started with a lot of brain fog. I just really felt like I was floating. I started kind of developing some neurologic symptoms. And then, on top of that, focus and concentration, and then some insomnia, and then some chronic fatigue, and then, you know, it kind of just, and then, and then, and then, right? So I got really concerned about that because I actually, it started to really dramatically impact my performance as a grad student. And, you know, I was your typical Type A student in front of the class and asking all the annoying questions that those people do. And then I kind of went to the back of the class because I was embarrassed about what was going on with my body and not understanding what was going on. I actually started to do really poorly. So I started going from, you know, practitioner to practitioner, and this is probably super familiar to a lot of your listeners. And what happened was people would kind of say, well, you know, you need this or you need that. I kind of was being fit, I think, into people's boxes rather than the 9th practitioner who said, hey, let's take a look at, you know, your diet. Let's look at your lifestyle. Let's look at what's going on with your nutrient status. Let's actually do some blood chemistry on you. And the amazing thing was, is, is he really dialed me back into where I was feeling optimal wellness within about a 3, 4 month period of time. I didn't realize it, but at the time that was probably one of the most important events in my life because I realized that was the kind of doctor that I wanted to be. And I just didn't understand that that's not how doctors are taught. And then more, of course, I started to realize we're taught to learn clusters of symptoms and that equals a diagnosis. And then you treat the diagnosis and you're not really actually treating the person. And so, that kind of launched me into that functional medicine world of just trying to understand that root cause. And it's really ignored so much or, again, we're told you have anxiety, so you need to take an anxiety pill. You have leaky gut, so you need to take a leaky gut formula. But we're not actually asking the question why, why, why, why, right? And I think I annoy my clients sometimes because I ask that question to them. And many times they know the answer, but you actually just have to give them enough opportunity to self-reflect on what's actually going on in their life.

Yeah, no, I've heard very similar stories from many of my clients of seeing many practitioners. I think I was lucky because I had my autoimmune stuff diagnosed before it, it really impacted me.

I have Hashimoto's and yeah, and I was, I had an enlarged thyroid.

And the doctor caught that. So I was sent for an ultrasound and then they saw the damage from the Hashimoto's on the thyroid. And this was well before my TSH was even far from optimal levels.

Right, right. So you're in that thyroiditis kind of experience and not quite the hypothyroid. And that's— I mean, God, I mean, how many millions of people are actually out there dealing with that issue? And of course, many times the doctors aren't listening or they're not doing a physical exam or maybe your thyroid isn't enlarged, right? So they kind of miss it, right?

Right.

The crazy thing is the American Endocrine Society specifically says, hey, TSH should be between 1 and 2.5, and then you have a 4 and your doctor's going, well, you're within the normal range, I guess you're okay. And it's like, wait, wait a second, like, are you comparing me to all these other sick people through standard chemistry analysis, or are you actually looking at me through the lens of what optimal chemistry is?

Right, right. So tell me about what autoimmunity has to do with gut health.

Oh, nothing. No, I'm just kidding. So it has everything to do with gut health, right? So Alessio Fasano is the dude who really figured out the mechanism behind celiac disease. And if you guys aren't aware what celiac disease is, it really is this condition where when you're consuming gluten, your gut becomes permeable or leaky. And then you actually get confused on what is yourself versus what is non-self. So you actually kind of start going after and targeting your own tissue. Now, how that relates to this, again, Alessio Fasano guy, was he is kind of now considered the godfather of celiac disease, and he's the one who discovered the mechanism behind what it takes to actually have an autoimmune disorder. And there's 3 things, right? So we've got genes, which like for me, I have celiac, right? And so, there's this HLA-DQ2 and 8 gene. Yes, you can test them, but you need a genetic predisposition. There is environmental issues. So, for example, being exposed to pesticides, being exposed to glyphosate like Roundup. And then, there's these triggers, and triggers can be traumatic events in your life, auto accidents, after you gave birth, a divorce, something like that. And, you put all these 3 things together and it turns on on your genes. And all of that is actually occurring in the gut where then you actually then start to create again this leaky gut or another way to say it is intestinal hyperpermeability. And that's of course why so many of us as healthcare practitioners, we try to understand people's symptoms, but we're going to look at the system and that gut is what, 70%, 80% of your immune system is in the gut. That's why we kind of make that connection there and why we want to then look to that as the root cause.

Okay. So when you have somebody who has an autoimmune disease and they have no gut symptoms at all, will you still test their gut?

100%. So about 60% of my clients don't have gut symptoms. You do not have to have IBS. You do not have to have colitis or Crohn's. You do not actually have to have a single gut symptom. One is because your body may have actually become accommodated to those symptoms. But the fascinating thing, right, is that we have I think over 100 different autoimmune conditions, and there are actually over 26 cancers that are associated with autoimmunity. I'm just quoting the experts, right? As Dr. Fasano specifically says that to have an autoimmune disorder, you have to have had leaky gut. Our ability to express and modulate and quench inflammation, it goes to the gut. So absolutely, no matter what, you could have zero gut symptoms. I am still going to look at your gut and try to understand, is there a way that we can leverage that piece to actually help your health?

Okay.

So now thinking about what Dr. Fasano revealed was the action of zonulin in opening up the intestines and making them leaky, and in particular in celiac, whereas I guess a normal person might have that an opening that was very brief from Zonulin, someone with celiac has a very long one.

Yes.

And then where gluten sensitivity fits in with that, I'm not sure. Can you help me with that?

Yeah, absolutely. So basically, if you look at what is commercially available right now, you can do panels that will look at about 6 markers for celiac disease. And then there's actually another 18 that I can commercially get right now for gluten sensitivity, right? So we've got actually different and separate conditions that again manifest in different ways. And the confusion— why this is so important is that gluten sensitivity can trigger that leaky gut process. You don't have to have celiac disease to have a leaky gut, right? You actually may not have the genes for celiac disease, and so you can actually do a blood test and check these antibodies and see if you're reacting to gluten. Because again, essentially you can have 3 reactions to gluten. You can have an actual typical allergy, which is, you know, like we think about peanut allergies and those kinds of things, right? And you're getting an immediate response. We call that an IgE reaction. You can have celiac disease, and which is— that's the autoimmune process where that gut tissue is broken down because you've been exposed to gluten. And again, there's the genes and other triggers there. And then you can actually also have gluten sensitivity, and again, why that's so important is that it is an underlying facet behind so many chronic disorders, and it's very, very commonly not tested. And so then when you go to your doctor and they go, okay, or you say, hey, look, I read this cool thing, it says maybe I have celiac disease, let's test for it. Your doctor tests it, it's negative because maybe they ran 1 or 2 antibodies for celiac, not the full 6, but usually just maybe 1 or 2, and that's usually tissue transglutaminase antibodies. But if it's negative, they'll say it's okay to eat wheat. And that may 100% absolutely be not the truth. And if you leave that other part out, you get exposed to gluten, you can have inflammation for months with one exposure. So it really is a game changer for people. And it's why so many clients or just people that, you know, anecdotally you talk to people, oh yeah, I eliminated gluten and then my life changed. I'm like, well, me too.

And so are you talking about the Cyrex arrays? That you're using?

I use Vibrant Labs. I used to use Cyrex, and they're both really good companies. Kind of just came down to price. And so I tend to use Vibrant more often. And they actually were, I believe, a spinoff of Cyrex. So, you know, these different labs kind of pop up. They're both very good companies. I love them both. I actually, for example, Cyrex, who's headed by Aristo Vojdani, one of the most preeminent immunologists in the world. The panel that I probably do the most with him is something called a gluten cross-reactivity panel. I think it's number 3 if you go onto their website. And so it tests, I believe it's 24 or 26 different foods that cross-react to gluten, meaning if you eat that food, your immune system may be mistaking it as gluten. And then it's like, oh gosh, like my body's freaking out because I ate dairy. My body is freaking out because I ate tomatoes or corn or rice, and there's just enough of an overlap between the amino acids in those structures where your immune system is already kind of flared up and it's now saying, oh wait, you ate gluten, you ate gluten, but wait, you actually— you ate a gluten-free grain and you still had a reaction to it, right?

So Vibrant Labs, what's the test then that you run for celiac and gluten sensitivity?

Yeah, it is their gluten sensitivity and celiac disease panel is what they call it.

Okay.

It's a comprehensive test and it tests 24 different antibodies.

So I find that there's often budget constraints and, you know, this is one of those things where an elimination diet usually does the trick in telling you whether this is a factor. So I'm curious how you think the two compare.

Yeah. So, I mean, you can test and treat or treat and test, right? And a lot of my mentors basically kind of just said, hey, look, like you're just going to run into these situations where people don't have thousands of dollars to spend. And sometimes you just don't really need to anyways. So, you can absolutely— you can do it in different ways, right? One, the only caution I give to people is if you really truly are celiac disease or you do actually have autoimmunity, if you're going to go back and rechallenge gluten, just be aware that that inflammatory cycle that kicks back up can induce other autoimmune conditions, really can put you backwards. So, I love elimination diets. We do them all the time. But I also say, what is the end result and what kind of condition are we working with?

Yeah.

You know, if you're working with a colitis patient and they're like potentially going to lose gut tissue, or MS patient and they're going to lose eye tissue, right, as one of the complications of going back on gluten to challenge it, so to speak, right, the elimination versus then the provocation of bringing it back in. That's where I say, you know what, I would rather you spend a couple hundred bucks and you be 100% compliant than you take the risk of actually losing tissue as a result of the autoimmune disease kicking back up. That's just me.

Yeah.

And people get to make their own choices, of course, right? And we want them to— we want people to own their health. But I just say, hey, look, what do you guys want to do? Would you like to test for it, or would you like to just make sure that you're going to be 100% compliant and be able to get yourself off of that to then see if we can actually see an improvement.

Yeah. And are they coming to you still eating gluten? Because I find everybody, by the time they find me, like, they're eating meat and vegetables and fat. Like, that's it, right?

I get a smattering of people, you know, it's pretty diverse practice. So I do get the super complex and chronic and people that have been to all these different clients. And then I just have— like, 2 weeks ago, I was working with a colitis patient, and I was like, Have you ever done a gluten-free diet? And she's like, well, I kind of tried it for a month. And I'm like, okay, so no. And she's like, no, not really.

Right.

So to run these tests, they have to be eating gluten.

No, that is the truth, right? So the thing is, is that for you— so typically the standard of care and testing for celiac disease, they have to eat roughly about a piece of toast about 30 days, and then they would actually test. But again, do you really want to, especially if you've already gone gluten-free, right? Do you really want to go back and tempt the devil here that it's worth it? And again, the other thing that I would also stress to the listeners is many times people switch from a gluten-free diet and they bring on those other products which are refined and processed, and they're like, I feel worse on the gluten-free products. And I'm like, well, yes, because you're feeding simple sugar to bacteria, and then they grow and they produce toxins and chemicals and byproducts. And all of a sudden your inflammation levels go back up and you get the brain fog and the joint pain and the aches and fatigue, and then you're right off again. It's nice to be able to have some of those things once in a while. But the question is, what kind of flexibility does your body have for that?

Yeah. So, I mean, I wonder about the— whether the leaky gut, the origin, maybe that it's different for each individual, but whether the origin is in the SIBOs and the SIFOs, the fungal overgrowth, or in the food sensitivities. So for example, in my case, I went off gluten and dairy and then also went through protocols to clean up SIBO and SIFO. And now my Hashimoto's antibodies are down to normal. So I think perhaps that the SIBO and the SIFO, you know, from so many rounds of antibiotics were what caused that sensitivity to gluten and dairy. Well, maybe not dairy. Dairy, I'm lactose intolerant and You know, I get acid reflux from the casein and all that. But now it's if I take some enzymes and I eat those foods, I don't see any big reactions that I can discern. So I kind of wonder which came first.

Well, yeah, chicken and egg, right? And I think what happens is almost invariably it's potentially both. But I think for probably a lot, a lot of the patients that I've seen, it is, you know, like for example, a common trigger is antibiotic use. People don't realize obviously how much of an asset and how valuable the diversity of our gut microbiome is. When I mean diversity, I mean like the different amounts of species and kind of healthy order that is essentially taming these inflammatory chemicals and processes and so that we can also absorb really efficiently. When you knock all that out, well, guess what? The fungus, he's throwing his party hat on because now he has less competition to basically then be fought off by on a regular basis so that your guys are actually the cock of the walk and they're, they're actually the ones that are actually have the predominant control in the gut. So when we expose ourselves to those standard American diet foods on a regular basis, we are eroding our immune system. And then eventually at some point, yeah, you trigger that leaky gut process. Or what's crazy, like head trauma has been shown actually significantly cause intestinal permeability within an hour after a traumatic brain injury. So that's something that's not really appreciated.

I actually had a speaker on gastro— what are they called? Gastro— gastroencephalogram or something like that. Uh-huh.

That's a fascinating issue. That is, you know, concussions. A lot of times people develop leaky gut after concussions. They get hormonal disturbances. This whole vicious circle basically starts at that point. But for so much of people out there, they just get used to it. Or again, their doctors are telling them, oh, it's just arthritis, right? Or it's, oh, it's just normal to be 50 and postmenopausal and have an absolutely miserable life. And it's like, I don't know if I actually believe that because I have lots of my clients who are 100% thriving after they get their food sensitivities handled, after they get the bacteria handled, after they are actually getting their immune system rehabilitated. And that's really important. I do want to say this before I forget, is that one of the most important things I learned in my master's program, my man named Dr. Vasquez, Alex Vasquez, and he basically said, look, what you're going to find is even after you deal with these triggers, people are still going to have a wound-up immune system. You know, even when you find the gluten, you find the dairy, and you, you remove the bacteria and the fungus, people are still going to have a Essentially, an immune system that's now conditioned to give the same response. And that's when you really need to employ some therapies to stimulate specific subsets of cells called T regulatory cells. And if you can do that really efficiently and you get the diet and you get exercise and stress and all these other things in, but if people are still having issues, that's when I really start to go, hmm, something kind of got broken there and we want to actually now use some therapies and strategies to stimulate those cells in the right direction again.

And how do you do that?

So there are different nutrients out there. That's one of the ways to do it. So I would say probably I can give you 6, maybe 7 different things that I use. One is fibers. So there's different kinds of fibers out there that can do this. Prebiotic-based fibers, inulin, there's something called XOS, so xyloligosaccharides. There is a product that's called SunFiber, which is a modified guar gum. Sometimes guar gum gives people issues, but this is actually a modified guar gum. It does not seem to cause the same gas and bloating issues as other fibers do. But basically, hey, vegetables do this too, right? So, do we need to take that a step higher? And then, beyond that, vitamin A, D, and K as far as nutrients, alpha-lipoic acid, green tea or green tea extract, right? You can do it as far as like a decaf version. And the other one is actually probiotics. And so, really, one of the things what probiotics doing and specific strains of probiotics, is they're stimulating certain chemicals. The chemical that I'm most interested in, in this case, is called interleukin-10. And there's different kinds of probiotic strains that can stimulate interleukin-10 to then actually stimulate those T regulatory cells. So those nutrients in different combinations— I mean, for example, vitamin D, we want your level to be about a 50. It can range anywhere from 40 to 60, but about a 50 is where a lot of the research is kind of pointing towards, is more of kind of optimal chemistry. But then you you can ramp a lot of those nutrients up for short windows of time, and then you can come back and check those thyroperoxidase antibodies, check the thyroglobulin antibodies, check the anti-endomycelial antibodies or the zonulin, right? And see if you're actually now able to quench some of that inflammation, get your immune system re-regulated.

Now, is there any measure of inflammation other than looking at the specific markers for any given autoimmune disease? Like hs-CRP or what is the filtration, is it GFR, is that? Yep.

Well, yes, they are for sure. I mean, C-reactive protein high sensitivity, right? There's different kinds of CRP. There's more of a nonspecific, there's more of a very specific. So the cardiac or high sensitivity is always the one that we wanna choose for that. That's gonna be the most common commercially available inflammatory marker. There are other ones out there, something called ESR, erythrocyte sedimentation rate, Oh, that's the one I was trying to think of.

Yeah. Yeah.

There you go.

So ESR, it's not really in vogue anymore. It's not used as often. I mean, there's a condition called polymyalgia rheumatica and ESR is actually, is kind of appropriate for that. There are what we call cytokine panels and these are a little bit more advanced and quite frankly, they don't always really dramatically change the recommendations I give for care, right? So like, again, going back to the whole kind of budgetary concern. It's like, again, test and treat or treat and test. And if I know in general people should be on good nutrient-dense diet, taking the kind of crap out of the diet, and if they might need some nutraceuticals for a short period of time, or maybe they need a stool test, you know, maybe that's going to really change the recommendations. That's usually what I'm going to focus on. For inflammatory bowel diseases, I will actually though add a marker called calprotectin. And calprotectin is very, very sensitive as it relates to the differential diagnosis or the, the kind of decision between inflammatory bowel disease or irritable bowel syndrome. So if your calprotectin is really high, we know you have a much higher chance of having like a colitis or Crohn's, much more serious condition than something like IBS.

Right.

You can check zonulin. And you can check antibodies to zonulin, and that is a great way to tell us if you actually have leaky gut. And like I was saying, you know, again, I'm not a rep for Vibrant. I take no kickbacks from Vibrant. Again, it's like the cheapest lab that I can find that actually gives me really good data. On that gluten sensitivity and celiac disease panel, they run anti-zonulin antibodies. So if you have a high anti-zonulin antibody, you know you have leaky gut. And if you really want to, you can go back and retest it and verify that actually those markers have decreased. It's probably going to correlate with you getting better anyways. So most of the time I don't rerun it, but if I'm managing an autoimmune condition and I'm helping people to know, are we really kind of under control, I do really like to repeat the standard antithyroperoxidase antibodies in the case of a Hashimoto's.

Right.

I'm gonna repeat that maybe about like every 3 to 4 months. There needs to be enough time, right, where you're actually allowing your immune system to calm down.

Right, right. And so if somebody is testing the zonulin antibodies, obviously if they ate something like gluten ahead of time, I imagine that would cause it to be elevated. Do you tell them to be careful about what they're eating prior to the test?

Hopefully. The idea here is that they've been behaving.

Right.

And of course we, we can all get exposure. We can all get cross-contamination. I mean, I have plenty of times when I've had people just so upset because on their stool test they've got a gliadin antibody high and it's just like, how the heck did that happen? And you know, it's shared equipment or they traveled or something came up. It's usually not that I just said, you know, well, screw it. I'm just gonna go eat pizza. That happens too sometimes, right? Yeah. But if what we kind of wanna just do is test the normal conditions. We've been trying this, it's this therapeutic trial we've been doing. Let's see if this is actually working for us.

So in other words, they're normally off of gluten. They take the test. Yes. And you will see over time that in theory that would go down.

Well, yes and no. So, for example, so for the case of celiac disease, right, we know that 60% of celiacs on a gluten-free diet after one year have absolutely no improvement in their intestinal microvilli. Basically meaning that they studied a group of celiacs, they had them on a super strict 100% gluten-free diet, and at 1 year they came back and did another biopsy on their gut, and they found specifically that they did not have any significant healing to their brush border. This is the thing that basically is what the celiac disease is attacking. And so why that's so important is it goes back to what you're saying, like, did they have bacterial overgrowth? Did they actually have other food sensitivities? Sensitivities? Did they have another autoimmune disorder that celiac turned into colitis, right? Was there a high burden of chemicals that we weren't aware of? Were they under a massive amount of stress and they were secreting cortisol, which was degrading all their healthy bacteria in their body? Those mechanisms we have to look at because this is why we're seeing a higher rate of mortality with people with autoimmune disorders. It's the same reason my, my grandfather got Parkinson's after he was diagnosed with celiac. And I am convinced at this point, because everyone that I work with so far in my practice who I've tested for autoimmunity with Parkinson's, they have autoimmunity. And so, if I could have tested his blood, I can almost guarantee you he would've been autoimmune. He was so strict on his gluten-free diet. My grandmother was so good on that, right? Bless her heart. But he had an inflammatory issue that was never really fully controlled even after he actually removed gluten from the diet. And, that's what's so frustrating about this is that Western medicine is on average 15 to 20 years behind published research. And really, again, there's no drugs to treat leaky gut. I mean, that's the kind of sad reality, right? They haven't developed anything. And so, then you get this issue where there's no incentives for them to train people to actually help heal people.

Yeah. When you're thinking about your grandfather, are you thinking there were maybe other food sensitivities or there was gut infections that went untreated or—

Well, really a couple things is one, my guess was because of the Parkinson's, one of the other key pieces of that is environmental chemical exposures. He was a World War II veteran. He was in the Battle of the Bulge. He was exposed absolutely to persistent organic pollutants on probably a very high level. And so as a result of that, no one said, hey, you might want to do some detoxification of those chemicals. They're associated with cancer, they're associated with autoimmune disease, they're associated with increased mortality. We just— again, it's like that diagnosis just kind of lands on him, and then all of a sudden he started having this tremor, and it's like, oh, you have Parkinson's, we want to give you a dopamine medication now because that's going to help you with the symptoms. Rather than looking at why did it happen in the first place.

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I wanted to talk a little bit about anemia with you because we talked a little bit about that, about my own anemia as we prepared for this. So I was first diagnosed with just, you know, your basic iron deficiency anemia around age 16. And there seem to be a lot of different types of anemia. So you get your iron deficiency, but then later on I was diagnosed with B12 anemia. Mm-hmm. And then I know there's names like megaloblastic and pernicious anemia. So first let's just go over what is anemia. Right. And whether there's some autoimmune roots to anemia.

Sure. So one thing that's really important to kind of stop and think about is that there are certain things when they're present I call them deal-breakers. And for me, there's 3 things that are deal-breakers. One of them is anemia, another one is blood sugar handling issues, and the third one would be gut infections, or really actually any infection to a mucosal surface. Those 3 are probably the 3 most common things I see in my practice that really, really dysregulate an immune system. So anemia, by definition, just basically means the inability of the body to produce and actually distribute oxygen to tissues. And so what we most commonly think about is iron deficiency anemia, and that's what we call a microcytic, meaning that the red blood cell actually starts to become smaller. Now there's also macrocytic, and that's when the actual red blood cell starts to become larger. There's some other kinds of anemias out there. There's something called anemia of chronic disease. There are things like sickle cell, which is more of a genetic-based or a familial-based anemia. So we have kind of different categories and classifications, but anemia in general essentially is going to mean you cannot deliver oxygen to the tissues. That means that tissue is gonna essentially start to starve and die off. And at the same time, it actually also means you can't bring nutrients to those tissues because blood flow is gonna be compromised. In, again, microcytic anemias, what most commonly is thought to be the root cause is because of lack of iron, and as a result of menstruation and heavy menstruation. I actually don't agree with that.

I was gonna say, I never had heavy menstruation, right? So that always rang kind of false to me.

Yeah, no, actually the most common form of microcytic anemia is going to be small intestinal bacterial overgrowth. Because a lot of times people will be like, well, yeah, I'm eating meat and I'm getting iron, but yet they're saying that I actually have an iron deficiency anemia. So clearly the solution here is to have a transfusion. I'm like, no, no, no. Clearly the solution here is to look back at your gut and figure out what they're missing, because there's a good chance that the bacteria that are becoming overgrown are actually using your iron preferentially before you get to use it. And then of course that then creates a chronic cascade of issues. In menstruating females, this is also very, very common, right? So I always look to that piece. Yes, in fact, actually the most common cause hormonally, it is truly a hormonal mechanism, is going to be endometriosis and/or fibroids. And so if there's really truly an estrogen dominant condition causing the growth of this tissue, well iron can actually feed that tissue and then it can actually present as anemia. And so, that's where it's like, okay, especially if we start talking about hormonal symptoms, you really actually need to do a good workup. There needs to be a transvaginal ultrasound. We need to actually see if there's now growth tissues going on in there because if you give people iron in those conditions, they will actually make their hormonal issues worse.

Hmm.

And, I speak of that from experience. I have made my clients worse. Right. And this is why we call it practice. It's a little sad. People don't really think that's how it works. But, you know, I am light years beyond where I was when I first started functional medicine because I've actually worked with clients now and I've seen that happen.

Okay. This is blowing my mind because I had endometriosis and I started taking iron probably around the age in which I was diagnosed with iron deficiency anemia, probably around 16. And then at some point eventually when I couldn't become pregnant for a second time, was diagnosed with endometriosis and had surgery for it.

There you go.

So if you don't give iron, what do you do?

If we're bypassing the gut and you actually are doing an iron transfusion, okay, then you will actually then also hopefully not cause nearly the same level of damage. So if it's a critical issue and it's a medical issue, You're going to have to get the iron somehow.

I was borderline anemic. I wasn't like, you know, dying.

And most people are not that bad, right? That they don't actually have to go to those kind of heroic extremes and get hospitalized and actually have a transfusion. Majority of people, what's actually happening is they probably had a bacterial overgrowth going on that then actually triggered a hormonal dysregulation. And now that hormonal dysregulation is actually feeding back into the gut. So to break that cycle, I would actually typically want one, again, nutrient-dense diet. I want them potentially consuming foods that have iron in it, but I'm not gonna actually go to iron supplementation initially. I'm gonna actually use compounds like diindolylmethane or DIM, and I'm also gonna actually want to use things like broccoli seed extracts or sulforaphanes. And that's actually a great way to actually create an estrogen detox, okay? The other main way to actually detoxify estrogen is gonna be through something called methylation. And that requires specific B vitamins. Now, the methylation topic is a whole nother topic because it gets into genetic issues, and the vast majority of people with autoimmunity actually have these genetic issues— Yeah! —where they don't methylate, right? MTHFR. You got it, right? I got it too. And so what happens is we're told to take folic acid. Well, actually folic acid can make us worse. Because we're not taking the methylated versions, which is 5-MTHF or methylcobalamin. But that is another way that we detoxify estrogens. And then on top of that, the main way that people are actually regulating hormones is through birth control. Well, guess what? That actually creates a bigger burden on the methylation of your B vitamins. So this is why we're seeing side effects with people that are on birth control long-term. And they don't really understand it. They're doing it for the right reasons, but unfortunately they're creating a bigger issue by actually doing that. And so again, that just comes back to an education process and figuring out what's going on. But again, just, just to tie back to what the endometriosis piece is, if it is really at a point where it's grown to a size, some of the natural stuff, actually there's limitations there. There may actually be surgery required. For me, I'm always gonna try to be conservative first. You can actually give people like that whole tin of broccoli seed extract, not broccoli seed extract but broccoli seed and in the kind of sprouts version. And so, a whole container of that once a day is actually pretty therapeutic. And then, on the dim side, you can get that actually from cultured cruciferous vegetables. So, you're getting your brassicas and typically it's going to be something like sauerkraut or kimchi. But again, that has a lot of this dim compound in there. If you hate those things and you can't tolerate them, and it's like, oh my God, that's the death of me if I have to consume this stuff, you can get it in supplementation form as well. And there's plenty of companies out there that carry this stuff.

Yeah, no, that's funny, I was literally just looking at the DIM in the health food store I go to.

Ah, there you go.

Because I was shopping around for something to help with my hot flashes that have Stir it up again. Well, and I saw that in that aisle and I thought, hmm. And then I saw the sulforaphane and I said, wait, I might have some of that at home. I'm just going to take that.

Yes. And I think that would be like first line for me if anyone with hot flashes to deal with that. Do very commonly find hot flashes also can stem from blood sugar handling issues. So I would always ask people, you know, are you getting any fatigue after meals? Are you getting any sugar cravings after meals or are you getting shakiness, irritability, or lightheadedness in between meals? And the reason why that's important is because those blood sugar spikes and dips will actually start to spike your catecholamines, adrenaline, norepinephrine. These are stress hormones. And so then also that can actually then go to your brain and trigger those hot flashes, especially if those hot flashes are happening at nighttime. That is for me— that's a red flag.

So too many catecholamines. Exactly. Okay. So I think I need to back down on the L-tyrosine.

Yep, yep, that could be a good idea. Back down on that one.

That may be why they restarted.

Two of the things that I use very, very frequently and usually pretty successfully would be black cohosh and then also chaste tree. And so those two right there— chaste tree is progestogenic, so it's actually going to increase progesterone-like activity in the body. And then it's actually also on the black cohosh, it's kind of like an estrogen mimicker. So why exactly black cohosh works, I don't exactly know. But it definitely, definitely helps. I think partly probably because part of hot flashes is you see a cycle up and down. People will think, oh my God, it's just this estrogen excess. Not really. It's a drop. Your immune system freaks out and then you actually will spike estrogen up again. And so then your immune system gets confused and it doesn't know what to do. It starts giving you those hot flash symptoms.

Okay. We've gotten way off of autoimmunity.

It's so important, right? Because so many hormonal issues lead into autoimmunity. Right? And so, for example, like if you talk about Hashimoto's, for every 1 man who has Hashimoto's, there are 10 women, right? And one of the things that heavily, heavily influences the immune system is testosterone. And so, if women start to become estrogen dominant, a lot of obesity, they've got fat buildup, their insulin is making estrogen, and they're starting to throw off the ratio of estrogen to testosterone. That is very, very important as it relates to their autoimmunity. And that's something I think that everyone needs to be looking at. Again, I personally use a test called a Dutch test. It's a dried urine test for comprehensive hormones. And you can look at all 3 of your estrogens. You can look at multiple testosterone markers. You start to get more of a comprehensive look at what is going on with their hormones. I mean, hormones are so important, right? From the cortisol rhythm issues to the estrogen and, you know, hormone testosterone-based issues to the gut issues. All of those are just tied into these vicious circles that people have such a difficult time getting themselves out of with autoimmunity.

I'm gonna ask you about the cortisol in a second, so don't let me forget that.

Okay.

But I do wanna go back to the autoimmune roots of anemia. Yes. And did we fully cover that?

No. So the other big topic is, and really, like, you know, this is if you really want to start talking about, you know, having the ability to look at labs, you really need to get very good education and training on that because it's a serious condition, right? You need to have a good provider that is going to be able to actually really say, hey, look, it is really this specific anemia. Here's what we're going to do. We're going to come back, we're going to retest. And so, you know, just to make sure that we're improving things, you know, your life is on the line when you're talking about this kind of stuff. There's serious issues. So the other category was this macrocytic or enlarged red blood cell issues. And so that is going to show on the complete blood count or these CBCs that are run, right? White blood cells, red blood cells, that will show up as a high MCV or an elevated mean cell volume. And why that's important is that your body is making a adjustment because it is essentially meaning that your red blood cells are not replicating at the rate that we need them to. What that basically means is that your cells are enlarging, becoming macrocytic, and that is a good indication that you're probably lacking potentially B12. You could be lacking again B9 or folic acid, right, or again the activated form of folic acid.. And then the other issue that this brings up is that, again, for example, Hashimoto's— about 25% of Hashimoto's patients have a condition called pernicious anemia. And pernicious anemia essentially means that your body is attacking two different kinds of tissues. One is called a parietal cell, which is found in your stomach, and then another tissue is called intrinsic factor. And intrinsic factor helps you absorb B12, right? And this is one of those big buzzwords around energy. And if you have chronic fatigue, and especially if you have autoimmunity— I don't care what kind of autoimmunity it is— I really would want to screen someone for that parietal cell antibody and the intrinsic factor antibody. And if either of those are positive, we know that there's pernicious anemia, which means from a management perspective You can give someone all the oral B12 you want and it's not going to work. At that point, that's where an injection is necessary. What about the sublinguals though? So here's the thing. If you have intrinsic factor antibodies, it's not really going to work. If you have parietal cell antibodies, you can bypass and you can use a sublingual form. That's the kind of differential between those two. Sometimes it works, sometimes it doesn't. But a lot of times I'll say, you know what, you might want to go get something called a Myers cocktail. It's like a B vitamin infusion. You may want to get a prescription, actually, for a B12 shot. My only caution with that for people, because again, people get excited about this stuff, they're like, okay, I'm going out, I'm going to do this stuff and it's going to be great. I highly recommend that you don't use cyanocobalamin. Cyanocobalamin is derived from cyanide. Methylcobalamin is a little bit more expensive, you know, like maybe $2 or $3 more, per injection, but you don't have to worry about it actually creating a problem for you in the long run. Yeah.

So, so when they discovered my B12 anemia, it's funny, I had one shot at the beginning because I was down in the hundreds. It's a wonder I even had any feeling at the end of my hands, but I was beginning to have some signs. Yes, I can do the sublinguals. And after our conversation the other day, I went back to look at my records. I didn't see any tests for the parietal cell antibodies. But I did see that the intrinsic factor, like, they couldn't quite tell.

Equivocal or was it— it was equivocal. Yeah. Oh, okay. So it was borderline.

But I've been taking sublinguals and my B levels are great both on the organic acids test and on regular tests.

And that brings up a really, really good important point is if you are running labs, right, and you are suspicious that there's a B12 issue, you can have have a normal acidic normochromic anemia, meaning you can have a normal MCV, you can have a normal B12 level. The actual test for B12, another more sensitive test, is called methylmalonic acid. That can be normal, and yet you can still be B12 deficient. That's one of the actual things I vividly remember. There was a case series that we looked at in my master's program. It was a presentation of of a man with neurologic symptoms. He basically became ataxic, he had psychosis, he had, again, numbness and tingling, he had every single symptom of B12 anemia, but homocysteine, B12, methylmalonic acid, they were all normal. Now, they gave him an injection of B12, guess what happened? All of his symptoms went away. Hmm. So, when you suspect that there's an issue, treat it, especially when you're talking about like a B vitamin. Oh my gosh, it's cheap, it's readily available, like there's no side effects except for yellow urine. That's it, right? Right. I get it, people get frustrated. They say, hey, look, you're trying to sell me these expensive vitamins and my yellow is urine and it means that I must be not absorbing these B vitamins. Like, no, no, that's not what's happening. It's a normal biochemical reaction to see that yellow urine It's pretty standard when you take any B vitamin complex that you're going to see that. But what again is so important is that people go through this workup process and they go to these specialists and they can't find anything. And then many, many times they're told, oh, it must be psychosomatic, it must be in your head, you must be crazy. And it's like, you know what, maybe you're crazy, but the reality is they're not giving you a very good explanation of why you're having these issues. So I just want to tell those people, don't give up hope. Find someone that has more tools in their tool chest to actually help you figure out what your root cause is and get you back on track.

Yeah. Okay. So cortisol. Ah, so I hear different things going on in the functional medicine community, right? I hear some people saying the whole adrenal fatigue thing doesn't exist. There's no scientific backing to this. And when we do stuff with people's— we test the adrenals, we did stuff with the cortisol, the pregnenolone, the DHEA, nothing happened. And then I hear other people who still are clinging to this, like this is a basic thing in their protocols. What's your take on it all?

So I would have to say that there is scant research on something called adrenal fatigue. What I would say is there is absolutely a condition called chronic fatigue syndrome, or it's also called myalgic encephalitis. And there is absolutely an adaptation that your body goes through when you've been exposed to either high levels of acute stress or long-term chronic stress. So, our body has a natural mechanism by which it actually switches cortisol production into cortisone. And that is done explicitly to save our tissue. So, what very, very commonly happens is as a result of another root cause trigger, okay, that's being overlooked usually, right? An absorption issue, leaky gut, They've got a brain issue going on. They've got chronic stress. There's issues with their spouse. There's something going on, again, that's usually not being addressed. A gut infection would be another thing that would actually require a lot of cortisol to manage. Your body starts to kind of turn the faucet down. And now, all of a sudden, your cortisol levels do drop. We'd classically, right, even when I was trained back in the day, adrenal fatigue. And that really is not I think the most accurate way of looking at that. I think it's saying, look, for the conditions that are present and the issues that that person has, the body is smart enough to realize if we keep pumping out cortisol at this level, the pipes are going to start to break. And so, what happens is it goes back to you do need to go again and actually work someone up in that root cause model with functional medicine. And figure out how do we get the body to actually start making that cortisol over again. Now, some people will actually have antibodies against their adrenal glands. That actually can happen. So you can actually get subtle autoimmunity against the adrenal glands, and that actually needs to be looked at. Now, the other— so that is Addison's. And so Addison's is basically adrenal autoimmunity. Cushing's is more actually when you have a hyper excess of cortisol. And so Addison's, the antibody is 21-hydroxylase. That's the antibody that you actually have to test, and that's what typically is targeted. Now, to go back to that Dutch test, that Dutch test actually looks at cortisone and cortisol, and it looks at the circadian rhythm of cortisol. So If you can actually get cortisol to start pushing back into cortisol, many times people are going to start to actually feel a lot of relief, and a lot of times their energy will start to come back online. The main component that does that is licorice, and it's whole licorice root will actually do that. Now, for some people who are already hypertensive, you have to be careful. It also stimulates another hormone, it's called aldosterone, and so that actually can start to change your retention sodium, and it can actually increase your blood pressure. So just have to be cautious with that if you actually know someone that actually kind of has a tendency to have higher blood pressure. But I can tell you that I think I've changed some people's lives just by giving them whole licorice root, and they were just down in the dumps for so long. Now again, you can't just give someone licorice the rest of their life. That is then just a Band-Aid. You still have to go back and figure out, hey, what are we going to do to actually maybe help you get out of this adrenal fatigue. That, unfortunately, one of the actually ways that I've done that for people, and I say unfortunately because people hate it, is high-intensity interval training. And not P90X, not CrossFit, like you're just gonna jump into 60 minutes of CrossFit or you're just gonna jump into the Insanity workout. But what I mean is that there is something called the cortisol response. Or the cortisol response system. And it's a neurologic mechanism by which, right after you wake up, within 1 hour, your cortisol will double. That actually comes from the hypothalamus, actually also the hippocampus. And so those 2 areas in the brain are actually getting your adrenal glands up and going to actually secrete the cortisol so that you can get up and move, and you can go chase whatever you need to go chase to get your calories. Okay, so one of the ways to actually help improve and reregulate that is that within 30 minutes of waking up, you do high-intensity interval training. I've had so many clients who said, oh my gosh, this is great, I really do feel this way. Now again, the caveat is, if a little is good, a lot isn't better. Yeah, it's sometimes a disaster. I mean, look, you know, our clients are 40s, 50s, 60s. They're not 21 anymore. They're not spring chickens. They're not gonna just bounce back if they, you know, pull a hamstring. So we got to be gentle and easy in how we actually introduce this. I mean, I really do get some consistent results from people that are actually able to 3 to 4 times a week, you know, 4 to 5 times a week, actually integrate that in. And you start really slow and low And then you build up. You actually just, you know, see what your tolerance is and what you can handle, and then you kind of go from there. Put in the licorice with that if you're, again, combining a good anti-inflammatory kind of paleo-Mediterranean diet, if you're addressing other root cause issues. I mean, this is the stuff that I've been doing for 12 years that other people just never figured out. They've been to all these other practitioners. You know, this is what really is why we show up on a regular basis. Yes, okay, money can be great as a doctor, but honestly, I think there's a perception that we're gazillionaires, and it's really not the truth. Not the natural doctors. Yeah, not so much, right? Yeah, you start talking about orthopedic surgeons and, you know, neurologists and people that are— yeah, they're going to be billing crazy amounts.

And then maybe the David Jockers and the David Charles Mutters and stuff.

Yeah, 100%. Those people, and God bless them, we need all those people, right? The reality is, is that we're in the trenches and we're working with people on a daily basis. And the gift that we get on a regular basis is thank you. It's the gratitude, right? It's the fact that you can actually give people hope. Like, I call it vitamin H, but you can give people hope on a regular basis that, you know what, maybe if we give this one more shot, this really actually can turn things around. Yeah. Okay.

Now, yeah, that would have been the perfect moment to go You know what? That's a great note to end on, except I still feel like there's something in the autoimmune gut stuff maybe that we haven't talked about.

Okay. Okay. Probably not something small. Oh, man. There's so much to actually really talk about.

Keep in mind, I've already had individual shows on almost every topic that relates to the gut. So you could probably just throw out some things.

I think one of the best tips that I can actually give people is that blood sugar stability is actually gut stability. The reason why I say that is that if you are straying from what actually a good diet is and you're actually creating a blood sugar handling issue, let's say that we start seeing some pre-diabetic issues or some hypoglycemic problems, you actually will start to create more problems for your gut as a result of, one, the foods that you're actually consuming that are creating the blood sugar handling issues, right, are going to be stressful to your gut. But also then as you start to change hormones like cortisol, you actually start to change the actual healthy versus unhealthy, you know, the bacterial load And so, if you are having to put out inflammation because you're eating pro-inflammatory foods, cookies and pastas and pastries and even gluten-free, all these wonderful things that are out there, you actually will start to recruit more cortisol. It actually starts to degrade the diversity of bacteria in your gut, which creates more stress, more inflammation, and it creates more vicious circles. So, for me, what I do personally is I have a protein and fat rich breakfast every morning. And I do that because one, it stabilizes my blood sugar, my cortisol stays stable, I don't get energy crashes in the afternoon. And then, as I then go through the day, I'm gonna actually then bring in more vegetable content. I will do some more protein in there, but much more of the carbohydrates that I consume. And I'm a super high-energy guy. I play soccer. I do CrossFit. I'm putting a lot of calories out on a regular basis, and I'm still going to use vegetables as my carbohydrates, you know, yams, potatoes, squash, those kinds of things, because they're clean, they're green, and I know that they work for my chemistry. So I think if we can again go back to the basics of good fat protein in the morning, good carbohydrates in the afternoon, evening, you know, it doesn't have to all be carbohydrates. We get good fats in there as well, olive oil, good coconut oils, those kinds of things. That goes a long way when you actually look at what a long-term diet can be or should be.

Okay, well then I guess with that we will wrap it up. And I really appreciate you coming on and sharing all this information. This was awesome and detailed and it's like my own personal health appointment because I get to dig into all my health stuff. So that was great. That's great. That's great. Where can folks find you?

The website is www. Autoimmune.com, and I would just encourage people to go there. We're on social media channels, you know, you go to Facebook and you check us out.

Yeah, you can send me all those links and I'll share them in the show notes.

Perfect, I will do it. Awesome.

Well, thank you so much. All right, appreciate it. Wow, I love talking to practitioners like Dr.

Holloman who really understand science. Sorry, that was a good bit inside baseball, but I geek out on this stuff. So if you appreciate the free info that I give you in the show, there are some painless ways to support the show. First, you can buy high-quality vetted supplements in my online Fullscript or Wellivate dispensaries. So there's a link in the show notes if you wanna sign up for an account there. Do compare prices if you find the same supplements elsewhere. And I also wanted to let you know that I've been transcribing the shows and I've been putting that out in blog format about a week after the podcast comes out. So I send out a newsletter with links to that. And if you wanna get that newsletter in your inbox, visit my website, HighDesertHealthCoaching.com. And you'll get a popup box soon after arriving to the website that will allow you to subscribe, or you can visit the newsletter page under the heading Podcast, Blog, and Videos. And I also have an affiliate account at iHerb if you're buying supplements online. So if you follow the link from my recommended supplements page or in the show notes, you'll get 5% off and I'll get a percentage. And you can also connect with me by joining my Gut Healing Facebook group. If you want to ask a question about gut health or suggest a topic or guest for the show. And you can also follow me on Facebook or find me on Instagram, Twitter, or Pinterest, and all those links are in the show notes. So thanks for listening, and here's wishing you all the perfect stool.