Microbiome and Motility Hacks: Probiotics, Prebiotics, Fermented Foods and Fiber for SIBO and IMO with Alyssa Simpson, RD

Welcome to The Perfect Stool: Understanding and Healing the Gut Microbiome.

This is your host, Lindsey Parsons, and today I'll be speaking with Alyssa Simpson, a registered dietitian and certified gastrointestinal nutritionist based just up the road from me in Phoenix, Arizona. She specializes in helping individuals with IBS, SIBO, and other digestive issues find lasting relief through natural solutions, all while enjoying the foods they love. She also educates and supports the public through her podcast, The Gut Health Dialogues, and her online program, The IBS Relief Blueprint. But before our conversation, if you haven't yet followed or subscribed to the show, be sure to do so. If you want to get transcripts of the podcast, pop over to my website, HighDesertHealthCoaching.com, and sign up for my newsletter.. You'll also get my free ebooklet, Finding Your Root Cause Through Stool and Organic Testing, when you sign up. And if you haven't yet done my quiz on which stool test would help you get to your root cause, you can find a link in the show notes and take that. Now onto the show.

Welcome to the podcast, Alyssa.

Thank you. I'm happy to be here.

Happy to have you. So we had a great conversation about autoimmunity on Alyssa's podcast, The Gut Health Dialogues, last week, and I'm glad to have you here this week to talk about prebiotics and probiotics and fiber and stuff like that. Mm-hmm. So before we get head into the meat of it, can I ask how you got into working with digestive issues? Yeah.

You know, it's actually kind of funny because I didn't really have digestive issues till I started working with people with digestive issues. It was actually, I had been a dietitian for about 11 years, just doing general nutrition, a lot of diabetes. I was a certified diabetes educator, and then I had always wanted to be in private practice. So I left my job, quit my job, started a private practice around the same time I was learning more about integrative and functional nutrition, which is a whole nother learning curve. And there was so much stress between starting a new specialty, starting a new business, and I developed really, really severe acid reflux and constipation, just general chronic stress-related. I know that's what triggered it. And then the whole landslide that came with that of food sensitivities and then learning how to really manage my stress as the root cause. And it's been a journey because I was initially like waking up, you know, it was affecting everything, my sleep, because I couldn't fall asleep because I was coughing from the reflux and it was affecting, you know, my throat was sore all the time. And it, I mean, I, I actually was downing Pepto-Bismol in between clients and I thought, I'm a gut health dietitian. What What am I doing? So I did end up getting more interested. I was focusing on integrative and functional, but that made me really start to focus in on gut health. And it's been a journey. And even most recently, everything's been under control and managed, but I'm still learning more. One of the things I learned about recently was vagal nerve stimulation. And so now I'm doing that and that kind of has brought me to a whole new level of calming my nervous system. So that's my story. And I am now focusing mostly on— I think I just, as a result of having the connections I have, a lot of the people that find me, they don't know what's wrong with them. They've seen a gastroenterologist, maybe they have, maybe they haven't. A lot of them have just because I have a lot of gastroenterologists that refer to me, but they're just still having issues and they don't know why. So if that's, that's kind of the person I'd help and you, you know, often those are functional issues, especially if there isn't something that's been structurally diagnosed. So we're looking at IBS, SIBO, things like that.

Yeah. So for people with SIBO or EMO, intestinal methanogen overgrowth, first of all, do you recommend probiotics while treating SIBO or EMO, or is that something you like to leave for after treatment, or is it part of the treatment itself?

You know, yeah, I actually do. I, I don't start off with them. I definitely know a lot of people that already, that come to me, they've already tried probiotics. A lot of times they tried it and it made things worse. And that's because that's actually happens because if you do have SIBO, and this might be true whether or not they know they have SIBO, but if you do have SIBO, sometimes a probiotic, depending on what strain it is, can actually add to the overgrowth you already have and it can stimulate symptoms. So tho— that would be especially Lactobacillus strains, cuz those can tend to kind of accumulate in the small intestine versus other strains that tend to populate more in the large intestine. So the answer to your question is I actually am all for starting one early on in the SIBO process. So in a perfect world, I do, and usually it's gonna be a spore-based. I, I was using Bifido Blend for a while and I'm still liking that, but I've switched to spore-based for that purpose. But those are both ones that are less likely to aggravate SIBO while the overgrowth is active. But the reason there's a little caveat there is I do notice that throughout the protocol, people have very sensitive systems. There's a lot of supplements sometimes that we need to use. And so I tend to layer things in just for the ease of the patient and not just load them up with a whole bunch of things. So sometimes I don't add the probiotic till a little bit later for that reason, just pill burden and patient sensitivity.

What about the whole consideration of, am I just killing off whatever probiotics I'm putting in there?

Oh yeah. So even with the spore base, cuz technically the spore base should be protecting itself, right? But I'll still have them face couple hours away from the antimicrobial just to decrease that.

Right. And are there particular probiotics you like in like a situation with diarrhea versus constipation, or the spore base good for all those?

Actually, for diarrhea, Saccharomyces boulardii is really good. So a lot of times, especially if somebody really has no idea what's going on yet. So typically with that person, I'd wanna do a stool test and a SIBO test just right off the bat, unless they've had one already. But I'll just start them off on the Saccharomyces boulardii sometimes, cuz sometimes that can be really helpful in calming down the diarrhea.

Mm-hmm. I'm curious how you dose that, cuz I just heard Lucy Mahling talking about using it when you're on antibiotics, 2 pills 3 times a day, which was the highest dosing I'd ever heard about for S. boulardii.

I do 2 and 2.

2 and 2. Okay. Yeah.

Yeah.

I was curious.

Okay.

Quite a lot, but yeah.

Well, if you wanna get that diarrhea under control, I know it has been studied in traveler's diarrhea and such.

Yeah. Yeah, exactly.

And what about with hydrogen sulfide SIBO, which I recently found out has now been renamed ISO or intestinal sulfide overproduction? Are there probiotics?

For that one, I would just do the same. I haven't seen much on researching probiotics for hydrogen sulfide SIBO, so I would go with the general because it's still a type of SIBO, so it's an overgrowth in the small intestine. So I would still be cautious with Lactobacillus in that case. And yeah. Yeah.

And what about, what about constipation? Is there one you like for that? Or just for this, then.

So for constipation, yeah, there's actually some strains that are more beneficial in general. So the Lactobacillus reuteri would be the one that I most commonly like with that. And then usually because again, I'm adding this in a little bit later in the protocol, so I'll probably try to include some other probiotics. As well, but if there's someone that's constipation prone, like the BioGaia Gastris one or, or, uh, yeah.

Yeah.

The BioGaia, I guess it's, yeah.

Cactus or Gastris, I guess both of them have that. It's like DSM something, something, right?

Right.

It's after that.

Yeah. Unfortunately we don't have too many products to choose from with that. So that's the one I use as well.

I know. I keep wondering whether that one's like patented or whether you can get ahold of it.

Yeah.

Yeah. If I ever make my own probiotic, it's like the, the research is there.

They, you'd think they would jump on it, but yeah, indeed.

So what about fermented foods? I know I, you know, I have post-infectious IBS and, and have sort of recurrent SIBO hydrogen dominant, and I do okay with sauerkraut, but I mean, I'm only eating all of, all of a teaspoon and a half, I'd have to say, or 2 teaspoons in the morning. And, and I can eat some yogurt, but like if I eat a whole thing of yogurt, even it's only like 4 ounces, I start to feel sick. So I'm kind of curious about, about probiotic foods and, and is it problematic or is it just uncomfortable?

Well, it's okay. That's a great question. I would say probiotic foods are such a slippery slope and it's, it's so sad just how nuanced this gets because I feel for people trying to figure this out. A lot of the things that you think are gonna be good for you actually are the very things that aggravate you. So this fermented foods, the probiotic foods fall in that category where, and for a few reasons, but they can do a little too good of a job. Just like we were just talking about with the lactobacillus probiotics, they can add to that bacterial overgrowth and, and trigger symptoms. They also are high in histamine, and a good percentage of people with SIBO also have histamine intolerance because there's histamine naturally occurring in many different foods and we produce histamine in reaction to certain antigens. And so we have a histamine load in our body. And if you have SIBO, it can decrease your production of the enzyme that breaks down histamine in the intestines. And so you become sensitive to foods that are high in histamine. Fermented foods are in that category. So anything aged actually can build up in histamine. So that's That's probably the most common reason people feel bad or get symptoms when they, when they have a fermented food. Is that the type of, is it a histamine-like reaction? Do you, or do you feel like it's bloating?

No, it's more like bloating. And I actually feel nauseous when I eat too much yogurt. And this, this happened too when I made my own bifido yogurt out of the VIVO strain, the Bifido Infantis.

Okay. And you think the lactose was low, so that's Not, it was a coconut yogurt. Okay. Okay. Yeah. Even with the bifido yogurt. Okay.

Yeah. So I don't know.

I just think maybe I just have that gut ready to ferment things and yeah, that it is, it is a slippery slope and I almost never start somebody out with fermented foods, but they are a wonderful thing for maintenance as you ease into that, you know, start low and go slow. So. I'm a huge fan of them in general. Don't use them very much because I'm working with people who are not well and we need to fix them first so that they can get back to those things. But I do think that fermented foods are just really a great way to populate and keep and maintain good bacteria, maybe even more so than probiotics, because I think there's— I don't know why they just seem to do better. And I've seen that in the research as well, as far as maintaining. Hmm.

What fermented foods do you like to eat? Probably.

Well, I like kombucha and sauerkraut. Those are my two favorites. And I like kimchi, but it's a little less convenient. You have to make it or you can buy it, but it's even less convenient to buy, to find all the time. So how about you?

Yeah, sauerkraut is my go-to and I've been trying to make the bifido yogurt, but by that, I mean, I've made one successful batch and one not so successful batch. It took me about a month to get through it and you're supposed to eat it within 3 days. But if I ate that much buffalo yogurt in 3 days, I would be a balloon.

So, right. Yeah. Yeah. That's why the practicality plays in for sure.

I mean, it required a high level of sterilization because it ferments for like 36 hours. So the first, the very first batch was totally unsuccessful, was a pile of mold. Then the second batch, you know, I'm literally dipping every single thing that's going anywhere near it in boiling water before I do it, including the plastic tops. All these things, I'm thinking, great, I'm gonna be eating my microplastics. But, you know, mostly that were just in glass jars, so it was just over the top. But, but yeah, crazy amount of effort went into this. So the more times I do it, I'm sure the easier it'll get, but I don't wanna make the mistake of having a moldy batch again. 'Cause after 24 hours I was very disheartened that I had lost—

oh gosh. Yeah, absolutely. Yeah.

A packet of my $85 probiotic and—

yes, I know.

All the effort. So fiber and prebiotics are another area that can be tricky, especially in constipation, because my standard advice for people who are constipated is to get more fiber, or I shouldn't say my standard advice, the standard advice. But in my experience, people with EMO can't really tolerate fiber. So what else do you use to help them poop?

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Yeah, again, that's one of those things that you, you would think that go— going and eating more fiber would help, but absolutely with emo, it can make you worse, cause lots of bloating. Yeah. So first of all, we wanna think about why are we not tolerating it? So you're presenting the question as you know you have emo. We just wanna make sure that we're talking about ways to help you poop, but we also want to circle back around to the root cause. So maybe, you know, you have emo— if you don't know why you're so constipated, or if you don't know why you're not tolerating fiber, a lot of people will say, you know, oh, I can't handle fiber. I know it, it tips me over the edge. You do wanna look deeper and evaluate why that is and ultimately address that. So that's the sort of things we can help with, but the next step, I would say, first of all, think about what is the fiber source. So it can seem like all fibers are a problem because a lot of our high fiber foods are actually high in FODMAPs, fermentable carbohydrates that are, you know, the most gas-producing types of fiber. So it may be that following a low FODMAP version of a high fiber diet would help calm symptoms. And I do see that with Lots of my clients, you know, they feel like they can't tolerate fiber cuz maybe they've tried a fiber supplement, which are just notorious in general for triggering bloating and symptoms in people with IBS or SIBO, or the foods that are high in fiber like bran and beans and all those foods aggravate you. So you think it's the fiber. You may do better with a low FODMAP, high fiber diet emphasizing foods that What I like to use is chia seeds to really get people like up a lot closer to their fiber goal cuz they're low in FODMAPs. So they're not gonna contribute to a lot of gas production, but they are, give you a lot of bang for your buck and they're pretty easy to incorporate into your day. You could stir 'em into anything, a smoothie, a cereal, anything like that. I, I have a really nice overnight oats recipe with different variations to help my emo people move without triggering symptoms. So. That would be the first thing as far as fiber. It's also so important to make sure that you're hydrated. I have clients that'll say, yeah, yeah, I know I don't drink enough water. I need to work on that. And it's like, yeah, I mean, it's kind of like, they're like, next, what else should I do about my constipation? It's like, no, that's, that's foundational. You absolutely need enough water because think about it, your stool is dry and maybe you've added fiber, so it's fibrous, I mean, where's that water gonna come from to soften the stool if the body's not hydrated properly? So we absolutely have to have the water. I would also think about the electrolytes. So let's say you are getting plenty of water, which I would say is at least half of your body weight in ounces. You are getting plenty of water, you know, is the water being used by the cells? Having enough electrolytes will help the intestinal muscles contract like they're supposed to as well. And with this, I would make sure you're not doing some of those general, like Gatorade and stuff. It's just, you're getting a lot of sodium. You're not really getting a full array of electrolytes. So you want a good, well-rounded electrolyte product that has many different minerals to help you. Plenty of potassium, chloride, should be pretty low in sodium actually.

So, which one do you like?

I like Ultima or Hy-Lyte is another good one. Yeah. It has lots of different flavors. It doesn't have any ingredients that I don't like. Tastes good. So electrolytes are number 2. I also, you know, if you just need that extra little push, not, not physically, but that extra little boost, I really like magnesium. I use that myself for so many years till I recently found that with vagal nerve stimulation, I don't need it anymore. So that's That's awesome. That little side note there. Yeah, I, I would suggest if you haven't used magnesium, and I mean specifically magnesium oxide or maybe magnesium citrate, the other forms of magnesium aren't, aren't, well, they're actually better absorbed, which means they're not gonna help stimulate a bowel movement as well. We start around 400, 500 milligrams, but one of the keys with magnesium is you might need more than that. So understand, I would still start there because if you get too much, You're not gonna be happy with that result either.

Yeah. Well, flush of the system.

Yeah.

I would start there and after it, give it a few days to see how that's gonna affect you. And then you might need to go higher, like 600, 800 milligrams. And if you do need to go that high, again, circle back to the root cause, cuz usually there's something else that should be addressed. So in my situation, I had to use 400. Milligrams of magnesium for years to stay regular and then started doing the vagal nerve stimulation. The vagal nerve is just the nerve connecting your brain and your gut. And it's that connection that allows the brain to tell the gut to do all the things that it's supposed to do, including motility. And wow. Yeah. After just like a few weeks doing that, I haven't needed to use the magnesium since then. So I think that that really helped. I think, I think initially stress triggered a lot of my issues and then I think that must have helped to retone the vagal nerve.

Yeah.

So what did you do to stimulate it?

The TrueVega vagal nerve stimulator.

Is that an electric signal?

Yeah. Yeah. It's kind of like, you know, like the TENS machines that will stimulate a muscle, but it's not a TENS machine. But you put it on your neck right here and like right where you take your pulse, that's where you put it. And you can feel the stimulation. You can feel the tingling and it, it goes for 2 minutes. You do it twice a day. The research actually had the test subjects build up, titrate up to 6 minutes twice a day. So you could choose to go by that, but the thing turns off after 2 minutes. So I just did that twice a day. Yeah. I'm just amazed. So I wanted to try it myself before I recommend it to clients. And now I'm starting to recommend it to clients and to your audience and whoever else might benefit.

Yeah.

I had somebody on the podcast ages ago talking about something that both could be used as a stimulator for the vagus nerve. I, I think it was a frequency-specific, I'm forgetting the third word, FSM, frequency-specific microcurrent. And, and it was, but it was a device like that. That could both stimulate the vagus nerve or be used on the abdomen or that kind of thing. I've done that.

Got it.

Okay. For other purposes. Anyway. That's cool.

Yeah, we went on a side note, but yeah, that, that really helped me.

Yeah. Well, back to magnesium. So how much is too much magnesium? Like I, I get people who are saying, well, I'm already taking 1,200 milligrams. Is there a point at which, okay, this is no longer gonna be useful?

You know, I've heard experts say don't go over 2,000, but I don't go much over, like I wouldn't go beyond 1,200. I just haven't found it to be beneficial, honestly, above maybe 1,000. I haven't seen any added benefit. And so usually then you need to look at other things. So, and sometimes we are in that boat. So vitamin C's another thing. Magnesium works well because it's not the magnesium oxide because it's not absorbed well, so it stays in the, in the intestine and draws fluid in. Vitamin C also has an osmotic effect, but because it's absorbed well, you have to figure out what is your amount that's gonna exceed your tolerance level so that it will have that osmotic effect. So it's a milder effect, but it can work nicely in conjunction with the magnesium. So that might be something I might try next. If somebody's already at 1,200 milligrams, I would probably add vitamin C and see how that works.

Yeah. And how will you dose the, the C then?

Probably I would start at 1,000 and go up from there.

Yeah. And, and are these taken all at once, like before bed or spaced throughout the day?

Normally at bedtime, but I'm flexible on that. So sometimes it, it also depends when the patient can get it in. For me personally, I was doing mine in the morning and it always worked. So I don't think it really matters. I've heard the recommendation to do it at bed, so that's generally what I'll recommend, but I haven't seen much of a difference in the time.

Yeah. And did, have you, did you notice any difference in the forms, like the powders that you mix in water versus pills, for example, of the magnesium, whether, whether one was preferable?

I haven't. Have you?

I mean, I, I kind of feel like the, the Natural Vitality Calm one, like that one's always sort of my go-to because I have had people taking a lot of pills and then I'll say, well, just try this other one. And then it seems like they get more of an effect at a lower dose.

Mm-hmm. What's the form of that one?

Isn't it like, um, so it's carbonate, but when you mix it in water it becomes citrate.

Oh, cool. Okay.

Yeah.

Okay. That's a great tip for me. Maybe I'll try using that one cuz I haven't, but yeah, people do get overloaded with pills, so.

Right. I mean, that, I guess that's the other dilemma is, is if you have to take a bunch of pills, you probably have to drink a bunch of water with it. Of course, if you're drinking powder mixed in water, that's also water and it's all before bed. But of course you can, you know, do it an hour before bed, not immediately before bed.

Right.

So people aren't up peeing 3 times during the night.

Yeah, exactly. That's, I think that's one reason I tell people at bedtime, but if they're concerned about it, I'll usually flex because, you know, Yeah, I haven't seen it to be essential. There are other things we can talk about as far as helping motility, but I'm happy to answer any other questions you have as well.

Yeah, well, I had a couple questions about magnesium. So thinking about the fact that something like a magnesium citrate or oxide is not well absorbed. So when you think about a dosing of like a glycinate or a malate or another type of magnesium versus the citrate and the oxide, how might those differ then knowing that you're not actually absorbing that much of the magnesium? When we're thinking about just a deficiency of magnesium as opposed to exclusively using it for motility purposes.

Okay.

So you're saying if we wanted to use a citrate to actually help get into the body and because that's the form that people are already using for the purposes of motility, you know, what's, is there, is there any kind of a comparison like 800 citrates worth X amount of glycinate or?

You know, I'm not aware of one, but I, now I wanna know.

I mean, I just kinda asked that question to myself because yeah, I know that you get recommendations often from these tests like metabolomics or a NutrEval that says, okay, they need 400 magnesium. And I'm like, okay, well if that's magnesium citrate, they're probably pooping out three-quarters of it.

Mm-hmm. Yeah, exactly. Yeah, I tend to just not use it. Mm-hmm. Depending, or I'll give them a blend. Mm-hmm. There are magnesium blends where you can get a few different kinds in one.

Yeah. But one thing I have noticed though with those blends is that they'll, they'll often come to me already on magnesium and I'll say, oh, okay, what, which one? And, and how much is it per pill? And they'll be like, oh, it's glycinate and it's like 400 per pill. And I'm like, yeah, that's not possible. There's no such thing as a one pill of glycinate that's 400 milligrams. And then they'll look and they'll go, Oh, okay. It looks like there's some oxide and you know, they name like 5 different kinds and I'm like, okay, in my, my estimation it's probably 350 oxide and you've got like 50 milligrams of something else mixed in because yeah, I know they often don't divide it up.

Yep. They don't realize how many capsules they're supposed to do cuz they do try to advertise 400 on some of those products and oh, right.

That too. Right. Capsules.

Yeah.

So you gotta look at the serving size.

I also don't prefer the blends cuz I can't titrate the one I wanna titrate without affecting all the other ones. So, but I'm sure as more of a maintenance thing, it could be a, a decent option.

Yeah. I, I'm kind of suspicious that the whole, I, I think I was just listening to a podcast and they're like, you need all the 5 different types of magnesium in your body and therefore you should buy our blend. And like, this just feels like marketing to me. Like I imagine our body can probably make most of those types from the, raw materials that are in there. So you were, you had said you had some other things you wanted to talk about related to motility.

Yeah.

Yeah.

I have some other things that would be important as we're talking about this. Another tip I have, I like using, and this is again, keeping in mind that we're, we're gonna wanna work on the root cause, but sometimes if you just need relief, I do like whole leaf or outer leaf aloe vera juice. It has other benefits aside from motility. It's very soothing on the mucus layer. It helps to stimulate that mucus production that protects our stomach, esophagus, and our intestines. I also like it because the whole leaf has a chemical in it, aloin, that stimulates the bowel. So I would start with 4 ounces of aloe vera juice. Make sure it's the outer leaf. The inner leaf is not bad, it's just not it's gonna have that helpful chemical that, that helps with motility. Maybe start with 4 ounces. You can have more than that, but again, see how that's gonna affect you per day after a few days. So I like using that one sometimes, especially when we're talking about people who can't handle a lot of fiber. So maybe we're working on building up the fiber and that can help as well.

And is this something they find at like a health food store or do you find that at normal grocery stores?

Sprouts? Sprouts around here is what we have that where I find it. I like the Lily of the Desert brand. Yeah. Usually at a health food store, you'd probably have a better chance.

Alyssa's my neighbor in Tucson. I mean, I'm in my neighbor in Arizona. She's up in Phoenix.

Yes. Yep. Yeah.

Yes.

Yeah. So we have Sprouts.

We do. I love Sprouts.

Yes. But it's a health food store. And so any health food store would probably have aloe vera juice. Sometimes they try to do you the favor of flavoring it. Watch out for that because they may add lemon juice, and if you have GERD, that might trigger you. Be careful of that.

Any other motility tips, or was that the last one?

The squatting position, uh, or the Squatty Potty. So when we're sitting on the toilet, we're actually not in the proper position. And so we actually have kind of a kink, like between the angle and the rectum, there's a little bit of a kink, and so that's helpful when you're trying to hold it in on your way to the bathroom. But when you wanna actually have a bowel movement, having your feet up so that your knees are above your hips will basically open up that angle between the rectum and the anus to allow for a better bowel movement. So you can start out with a stool if you just have any stool you can put your feet on, but the Squatty Potty, especially if this is a major issue for you, is not a major investment and definitely something to consider.

And I think that's, that's pretty important for people who are shorter, right? Cuz they can't really get into that position otherwise.

Mm-hmm. Yeah.

On a typical toilet.

Yeah. Mm-hmm.

Okay.

So what about introducing fiber and, you know, are there particular forms that are easier than on people who are a little bit fiber intolerant?

Yeah. So I do like, well, I like SunFiber, the partially hydrolyzed guar gum. That is the, the most researched and the gentlest I find. I use it with my SIBO people, my emo people. They could be bloated like crazy and I'll still use it. Maybe, maybe do some other things to calm their bloating first, but we, you just start low and go slow with it. So you could start at maybe a third of the dose, or if you're super sensitive, a quarter of the dose and maybe every week go up an increment. If you're super sensitive. But the reason you would wanna take it is it does start to add a gentle fiber. So again, if you've tried a fiber supplement, any of those out there, like a lot of the common ones, you know, Metamucil, Citrucel, like all these things that are recommended to people with IBS and it triggered you, most people do pretty well with this PHGG. And I have a lot of my clients that they are just like, I'm never not gonna use this. I love it so much. I'm like, you could maybe graduate to a different fiber in time, but that's how well it's tolerated. And then another one would be acacia fiber that people do pretty well with too, even the most sensitive people.

Yeah. Are there any prebiotics that you particularly like other than getting it from food?

Yeah. So prebiotics is here in this whole conversation about the like slippery slope, right? So everything I said earlier about fiber and FODMAPs, like the things that are supposed to help you can actually aggravate you when there's a bacterial overgrowth. And so prebiotics are in that category cuz a lot of the times it's FOS or GOS or inulin or prebiotic ingredients, and those can be the harshest and the most likely to bloat and cause symptoms. So for, I'd say starting with most sensitive, you said other than foods, but I would probably start with foods for the most sensitive people, like the green bananas, the cooked and cooled potatoes.

Some resistant starch.

Yeah, the resistant starch, maybe even a cooled rice congee or something. But as a fiber supplement, when they're ready for some prebiotics, I like Paleo Fiber RS cuz it is basically like starting them with food. It's a little more potent, but it has, I mean, the ingredients are green banana flour and potato starch, and there's one other ingredient in it. So Paleo Fiber RS is my favorite kind of— or so I would either do that as a prebiotic, or you can lean on polyphenols, which are the components in brightly colored plants, fruits, and vegetables that give them their antioxidant benefits. But they also have a very gentle prebiotic effect, but it's a non-fiber. So it's, it's a wonderful thing to start with so that you could do it with foods or with a supplement. There's sometimes I'll just recommend polyphenol nutrients, which is by Pure Encapsulations, cuz if the person needs a multivitamin, that way we're getting some polyphenols in there. And then from foods you can use things like green tea and cranberries and blueberries and olive oil for polyphenols.

Yeah, I've been trying to do this gut shake that I stole from Mark Hyman. It's like a pomegranate. I maybe get it in once a week myself, but it's like pomegranate powder I use cranberries rather than the cranberry powder, just use frozen cranberries and matcha green tea powder.

And then I'm, oh, lovely.

Taking protein powder too. And the, the original formula I think has collagen and glutamine and butyrate and all that other stuff. But I'm, I'm, I'm sort of selectively using the things that I need myself.

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Yeah. Yeah. And then when, when the person's ready, I mean, once you clear the overgrowth, you can gradually add in less gentle forms of fiber. So then I do think it's a good idea. And one of my favorite tips is making a veggie mash, which if you're looking for another— You know, it takes a couple hours. It doesn't take all day. So you basically take 10 to, I guess you could do probably 10 to 15 will work the best different vegetables and you blend them up. I have a recipe that I can actually, I can share with your audience, my Gut Rebuild Veggie Mash, because it has quite a few root vegetables, which I like for the resistant starch. So you steam those, you lightly steam some of the other vegetables, but really the idea behind a veggie mash is you just grab 10 to 15 different vegetables, blend them up in a food processor, works best. And then you just put them in ice cube trays and just pop out a cube to blend up in your smoothie or to mix with your entree or to eat just with salt and pepper by itself. And that way you get a diversity of plant fiber. So we're talking about fiber right now, kind of in the context of fiber amount, like getting enough fiber, but diversity of fiber is so important too for feeding a diversity of good gut bacteria. So I really like the veggie mash because even if you have Brussels sprouts in there, which are high FODMAP, and you, I think the low FODMAP portion is like one sprout or something, or a por— or fragment of a sprout, you know, you will be able to tolerate a little bit in the veggie mash cuz you're only, the whole recipe only has a handful of each thing and then it's making like weeks worth of quantities. I think it's like 10 ice cube trays you get out of it. So.

Yeah, I've heard that technique for reestablishing oral tolerance when you've had a lot of food allergies, like just a little bit of a bunch of different things.

Yeah. And I like this strategy because it's, again, the practicality. It's hard to get a little bit of a lot of different things, especially when things are gonna go bad in the fridge if you don't have anyone else to eat the rest. So, yeah.

And winter squashes are not exactly easy to cook unless you buy them pre-chopped or whatever in, in, right.

Exactly. So I like, mine is pretty root vegetable heavy. It has butternut squash, it has purple potato, it has, it's colorful as well. It has a sweet potato in there. And yeah, I, I like that tip as well.

Yeah. I've started to use the MegaPre with people who don't have any acromancia or any Ficalibractnerium presnitzii or very low levels that need to kick it up cuz it's got some ingredients in there that are, that have been shown in studies to bring those up. Are you, have you used that at all?

Yeah, that's when I, so I'll usually start, I'll, if the person's really sensitive, uh, I'll start with the Paleo Fiber RS, but I like to move to MegaPre if I can, cuz I consider that ideal to use those ingredients and kind of, but I will start at a low dose and gradually increase it as Once I see that they're doing okay with it.

Yeah.

Because even after the SIBO, even after the issue's cleared, there's a period of healing and the tolerance gradually gets better to food. So usually it's easing back into fiber and prebiotics.

And what do you think about like colonics and enemas for people who've been chronically constipated?

Well, I think that's, I think sometimes whatever you need to do to get it out, it's fine. So I don't have any concerns with that. Do you?

No, but I don't have an office that offers things like that, so it's not something that I refer people to, but I know that people who have offices that do that often are more big fans of such things.

Well, I'm probably in your boat cuz I also, I'm 100% virtual. I'm a dietitian, so I'm not doing medical procedures anyway. Yeah. So I usually, if I get that question, someone's wondering if I agree with it, if it's Okay. Or maybe that will clear their SIBO and unfortunately it won't clear bacterial overgrowth, but I'm, I'm all for, you know, if somebody's just needs to get cleaned out doing something like that. And I have even recommended it when somebody just, for example, let's say we find that you have SIBO, but you haven't had a bowel movement in 2 weeks. Well, we can't start, we can't do much about it until we can get things flowing. So yeah, that could be a good use for it to just, just kind of get a jumpstart and then we, we start with the—

yeah.

Sometimes in that scenario I've sent people to do a sea cleanse just to, just to get everything washed out. And then I'm like, okay, then maybe, cuz they're kind of desperate at that point if they haven't had a bowel movement in days or goodness, I don't think I've ever had anybody who said 2 weeks, but, but if it's been a, it's been a while and they're uncomfortable and they're backed up and they're bloated and they're in pain, then, you know, you just gotta get that outta there.

Yeah, cuz it's unhealthy for you and yeah. So, yeah.

Yeah. I mean, I think that that's an important thing that people maybe don't, like, they know it doesn't feel good, but I don't know that they realize like the connection between cancer and constipation. Like there's much higher rates of colon cancer and breast cancer. You know, you don't want to have stuff just sitting in there. This is toxins that are supposed to be getting outta your body.

Right. Or even if you have diverticulosis, you know, that could potentially course, fill up those pockets with stool. A lot of people have diverticulosis. So yeah, that's, yeah, absolutely. And so with SIBO, here we are, we're about to kill off a bunch of bacteria and your body has to detoxify that. And so the worst thing we could do, well, it would not be a good thing to start killing them off only to be reabsorbed into the bloodstream and recirculated throughout the body. Yeah. So you would feel terrible as well. And it wouldn't be healthy. So we gotta get, yeah. So I'm actually all for the anything you can do to, to get things going. And then sometimes people will ask, well, if I do that, will it get rid of all my good bacteria? Well, no, because they live in the layer of the intestine. So you're not gonna flush out all your good bacteria doing that or doing a colonoscopy prep either.

Yeah. I was a bit, a little bit worried about that myself and I hesitated to do the colonoscopy and put it off for a few years. So it did also, cuz I just didn't wanna get a colonoscopy, but True. Did the ColiGard and then 3 years later thought, okay, I'm just gonna suck it up and do the colonoscopy. And it wasn't bad. And I had a nice clean colon. I was happy to hear that. And no follow-ups.

And yeah, I mean, it would be nice if we could clear dysbiosis with just at least colon prep or colonoscopy.

It is a funny thing that, that, that's not that helpful given that the elemental diet is something that seems to work for it, which I guess obviously it's a little bit more extended than a colonoscopy prep. In terms of time?

Yeah. Well, I think it's just like, you're just, just clearing out the stool. I mean, the stool's not where the bacteria live. They live in the mucus layer. So you're not shedding the mucus layer and the elemental diet is starving the bacteria in the small intestine. So, and I'm, and in the large intestine, but yeah, they're, they're resilient. So yeah.

Do you use elemental diets much?

I've used it twice. I've used it twice. It's very hard for people to do. So it's a, it's a last resort.

Yeah. Kind of, I kind of feel the same way.

Like I wouldn't do it, so I'm not gonna ask anyone else to do it.

But sometimes it's like, I, I agree. I've had people who just like no quantity of antimicrobials was getting rid of that bloating. And I'm like, okay, let's try this. And for both people, it was the first thing that really broke it at all. I can't say that it was like 100% and they were done and like, that was it. Because I think there's always other issues that play into it. Like, like stress, maybe that whole vagus nerve question, but it was the first thing that made any dent.

Okay. So that's, yeah, it really does take us, the person, the person has to really be on board. So I don't try to like, You, I haven't been in that situation too much where we've run out of options to really make a dent, but usually it's been the patient's idea if I do it. Yeah. Or I, I will put it out there as an option and the patient has to be the one who's like, yes, I wanna do that.

Yeah. I think sometimes they feel like it's really expensive, but I'm like, well, keep in mind you're not gonna be buying any food for those 2 weeks or 3 weeks. Right.

Yeah, exactly.

But it just feels a bit different spending your budget on a package of powder you're gonna have to drink than it does to go to the grocery store and buy a load of groceries.

It does. And the die-off is tremendous. I mean, the die-off is a problem anyway, but it's, it's so tremendous with the Elemental Diet. That's another thing. Not only are they, you're only consuming liquid for 2 to 3 weeks, but die-off, meaning that kind of reaction that happens when you first start killing off the SIBO and you have your flu-like symptoms and all kinds of symptoms can pop up. And so I've seen that in both people be pretty bad. The other thing is I have a lot of people who are underweight and it's just not a good idea. Now, actually, in reality, if they do drink all the formula and they have malabsorption from the SIBO, they're probably getting better nourished with the element.

Yeah, no, I've heard that for underweight people, they'll gain weight. For overweight people, they'll lose weight. Like that it, it works itself out. Yeah.

So I, I'll actually use, I use Elemental shakes often as a supplement for underweight people so they can get the nutrients in, but not as the Elemental diet. Is designed to, to work. Even though I know it will probably nourish them better, there's still all the issues of like the patient has to be on board with it. It's very difficult to do, and it's just concerning because if the person is already super underweight, it just makes you hesitant to turn their diet on its head in any way, especially if you're going on an all liquid diet.

So I have noticed, and just to send the word out there to people, that people get really kind of scared and desperate when they're losing weight and they're not trying to. Because of malabsorption related to SIBO. But I, I've never seen anybody that's like starved to death. Like they always gain the weight back eventually. Like once you start to turn things around in the gut, like the weight comes back on. They, they don't just fade away into nothing.

Yeah.

Yeah. When people really do that, it's like, there's a certain level of desperation in a person who's been losing weight and just keeps losing weight. Like they really get scared.

Yeah. Yeah. I think it's scary if you don't know why it's happening and you don't know how to stop it. Right.

Yeah. So you mentioned about your guest having gastritis and constipation. I'm curious why those two tend to come together.

Gastritis and constipation, GERD and constipation.

Yeah.

Well, if you're chronically stressed, it can cause a slowing of motility versus if you're acutely stressed, it can trigger diarrhea. Those, these are very general statements. Obviously, but in general, that's how the gut-brain, the vagus nerve works. So I believe that my chronic stress at the time caused everything to slow down. And I was not mindfully eating. I was scarfing down my lunch, trying to pack in as many patients as possible, often missing lunch, eating in my car on the way home. I mean, so there is a lot of factors and I still didn't know very much yet about any of this. Yeah. So I think it was a perfect storm for me with the GERD. I probably had chronic stress and acute stress and wasn't being mindful of my eating. Cause that's a big part too. If you're, if you're rushing and you're multitasking and you're not focusing on your food, then your brain isn't focusing on the food. So it's not telling the gut to produce enzymes and acid. And so Foods sit there longer and then it's, there's pressure on the lowest, lower esophageal sphincter and it, you know, you get the acid coming back up. So it was a whole messy storm.

Yeah. I was thinking that, that there might be a, a, a connection through the question of stomach acid, right? Like if you're stressed, you're probably not producing as much stomach acid and then you're—

Yeah, I think that was a factor.

Right. And then of course low stomach acid can, can cause GERD, so.

Yes. I think that was part of it too. Yeah.

So tell me about where people can find you and the stuff that you do.

Yeah, I see people one-on-one over a virtual platform and help people walk through the process of figuring out what's going on in their gut from a functional perspective. So especially if you've had lots of the standard testing and whether or not they found anything, but if you're still having issues despite, you know, kind of the normal medical interventions, we can look deeper and we'll look at what's out of balance in your gut and we'll walk through the different phases with a personalized approach. I learned about your eating habits. I learned about your schedule and your, your family and you know what Dinner's like with your family, and we, we just come up with a personalized approach that's gonna work for each person. We look at everything else that's going on with your health so that everything is in line to support your goals, all of your goals holistically. And through just the use of simple strategies, diet changes, elimination and reintroduction of some sort, usually, maybe sometimes we're ramping up fiber or calories or whatever it, it might be. And strategic supplements that, like I say, I tend to layer through in phases. And we work on getting not only calming the symptoms down, restoring more normal gut function, but also putting a maintenance plan in place so it doesn't just keep happening again and again to you. So that's what I do one-on-one. People can find me at nutritionresolution.com. So it's like a New Year's resolution, and I'll also provide the link to that veggie mash so that you guys can download that if that sounds interesting. That's helpful for anybody who just doesn't have enough vegetables in their diet to get that diversity to feed a healthy microbiome, but it's especially helpful for sensitive individuals as well. And I'm on IG at, @nutritionresolution on Instagram.

Okay, great. We'll put those in the show notes that way people can find you easily. Any final thoughts before we go?

I definitely feel like everything we talked about today is, are, are the things that are, I feel like logically you'd say, okay, if I'm having gut issues, I should eat more fiber. I should eat prebiotic foods. I should take probiotics. And those can be sometimes the worst thing. So I just feel for anyone out there trying to do their best and it's not working or they're getting worse because it's, it's kind of hard out there sometimes to figure out the right thing to do, but in general, find a good practitioner, educate yourself as much as you can so you know what to ask, and also listen to your gut as far as who it feels right to work with, who kind of resonates with you and gets you excited about what's actually possible for you. I just like, yeah, wish everyone the best in their health journey.

Sounds good. Thank you so much.

You're welcome.

Well, that was some good practical advice about stuff that lots of people are curious about. If you'd like to support the podcast, you can buy supplements at a discount from my Fullscript dispensary, order tests at a discount from my Rupa Health Labs store, or use my affiliate links to iHerb, which is available worldwide, or Amazon. And just to note that you can use my Amazon link to buy anything, not just supplements, and support the podcast. So I'd love it and really appreciate it if you'd bookmark my link and use it for regular Amazon purchases. If you'd like to connect with me online, you can follow my High Desert Health Facebook page, join my Gut Healing Facebook group, or join my newsletter list at highdeserthealthcoaching.com, as well as follow me on X, Instagram, TikTok, and Pinterest. Links for those are in the show notes. Thanks for joining me today, and here's wishing you all the perfect stool.