Naturopathic Medicine and the Gut

Thanks for joining me for episode 3 of The Perfect Stool: Understanding and Healing the Gut Microbiome. In today's episode, Naturopathic Medicine in the Gut, I, your host Lindsey Parsons, talk with Dr. Emily Poetsche about naturopathic approaches to gut health. I hope this gives you some leads on how to approach your gut health problems or ideas of where to turn if you've run out of traditional medical options.

Hi, this is Lindsey Parsons with another episode of The Perfect Stool, and today I have on Dr. Emily Pocha, who is a naturopathic doctor practicing in La Jolla, California, and her practice is called Wildcraft Medicine.

Hi, Emily. Hi, thank you so much for having me.

Yeah, no problem. Thanks so much for being here.

Of course.

So can you tell me first about what naturopathic medicine is?

Sure. So naturopathic medicine is science-based medicine. It's all about figuring out where symptoms are coming from and treating the root cause. We're also looking at making sure to treat the whole person. You know, if a patient comes in with a headache, we're obviously going to address that, but we really want to figure out where's the headache coming from, how else is it connected to the rest of the body, and how do we support that person as a whole.

And so how is that different from functional medicine?

Yeah, so actually it's very similar, if not the same. So, um, we go to a 4-year accredited naturopathic medical school. We're trained as primary care physicians. We can run labs and diagnose, prescribe a variety of different supplements, nutrition, counseling. We do a lot of botanical medicine. Some of us can prescribe actual medications depending upon what state we're in. And so functional medicine is really about looking at the optimal functioning of the body and all the organ systems and how they interconnect. And so that's And that's really a major principle of how we're taught in school to look at function, not just, you know, is someone in a disease state or not in a disease state, but is the body working as optimally as possible? And that's really what functional medicine is all about.

So what are some of the most common gut issues that you tend to see?

Well, I have a lot of patients that come in with things like gas and bloating. That tends to be a very common thing, which ends up really meaning they have something like SIBO or Candida, which is an overgrowth of yeast or bacteria in the gut. I see that quite often. I see things like acid reflux that can be coming from just too much or too little hydrochloric acid. I have some patients that have ulcers from H. pylori. And the other major thing I see is leaky gut, or an increased permeability of the gut lining, which can cause a lot of inflammation and throughout the body, throw off the immune system, create some food allergies or food sensitivities. So those are the most common things that I see in terms of gut.

So you mentioned acid reflux, and that's something that I dealt with for years, and my father has that as well. Hope he won't mind me disclosing that on the air. And I'm wondering, so when you get to the point where you have Barrett's esophagus and you start to see that damage, can that still be too little stomach acid, or is that probably more likely to be too much?

Great question. That's most likely hyperchlorhydria. Also having too much hydrochloric acid in the stomach, which is more rare than people think. When we're told acid reflux by a typical medical doctor, I think our minds always go to having too much hydrochloric acid, but most of the time it's that they don't have enough. However, if you are starting to get to that Barrett's esophagus, that's typically from having too much hydrochloric acid. It's not as common as the other way.

Of course, there's over-the-counter medications that, you know, obviously it makes it seem very harmless to take those for years, and I did, personally. So I'm just curious, what do you think, or what do you see as long-term effects of taking those proton pump inhibitors for years?

Right, right. When someone comes to me on a proton pump inhibitor, as long as they don't have hyper, so too much hydrochloric acid, I try to get them off of it as soon as I can because the PPIs are proton pump inhibitors. They're blocking our stomach's ability to release acid, hydrochloric acid, which will help with symptoms, but it will in the long term prevent us from absorbing some really important nutrients— calcium, zinc, B vitamins, etc. Which can make us feel tired. It can start to affect our bone density, start to affect our overall immune functioning. So over the long term, PPIs can be really damaging to our ability to absorb really important key nutrients.

Okay, interesting. So how do you deal with someone then who comes to you with too little stomach acid?

Yeah, great question. So typically what we're doing is, um, obviously we still want to get rid of their symptoms, right? They're miserable, they have a lot of irritability after they eat and burning throughout their esophagus and their stomach. So I, I want to palliate the symptoms while we still treat the underlying cause. So I'll give them different herbs that are demulcents, which means they help to line and coat the throat, the esophagus and the stomach so that it isn't getting as affected by the acidity and the inflammation. So we'll calm the inflammation down with different herbs and then we'll actually help stimulate their body to produce more, more enzymes. So that can be anything from digestive bitters, which help to support that. Things like apple cider vinegar diluted in water can help support our body to create more hydrochloric acid. Or we'll actually give supplemental digestive enzymes. And there's different types of enzymes. You can do a broad spectrum enzyme which has maybe some HCl, it's got some pancreatic enzymes, it's got some things like Ox Bile to help support bile production. Or you can give just something like Betaine HCl, which will really obviously increase HCl so you can break down your food better and have it continue down the digestive tract and not go back up.

Okay, so just as a general picture, we kind of delved into some specifics there, but as a general picture, how do you diagnose and treat gut health issues differently than an MD might?

Right, well, diagnosis starts from taking a very thorough history like any doctor, MD or ND, would do. You know, I'm asking questions about when it started, where you feel it, does it read anywhere, you know, what makes it better or worse. So this is really important. I'm also asking about past medical history, family history, things like diet and stress and exercise, sleep, All these things really matter because it tells me your overall health status and what else may be affecting the current symptoms that you have. So I spend typically about an hour and a half with my new patients, which is probably a lot longer than most MDs would spend, and then follow-ups are 45 minutes. So after I take an intake and do physical exams, we'll decide what tests to run. So some of the testing that I run for gut in particular is a comprehensive stool test, and this may show if there's any overgrowth of things like bacteria, yeast, parasites. It will also tell us if there's inflammation in the gut, how you're digesting your proteins and your fats. Some of the tests will show us the diversity and the amount of beneficial flora your gut has. So it's quite comprehensive. It tells us a lot about your overall digestive system. And that's a very typical test that I'll do, a stool test. Um, some of the— sorry, go ahead.

I was just going to say, I have certainly done and seen the, you know, the microbiome testing where you're actually seeing which bacteria— do you think there's, there's utility at this point, or are those still kind of too early to do anything about?

You know, I think it's a good start. There's so much we still don't know about the microbiome, and we're discovering new things all the time. So I think it's going to be a really valuable test. I don't do the specific microbiome test, I think the Viome test, but I know I've had some patients that have come to me who have done it, and it will tell them, you know, what their microbiome is like and what foods to eat specific to support their microbiome, which sounds really promising. I don't have much experience with it, so I can't speak too much to it. But the stool tests that I do still show different categories of different types of bacteria, the beneficial bacteria, and how much you have or how little you have. So it'll kind of give us an idea of the diversity and the amount, which is really important when you're looking at gut health. That's probably one of the key things. Is making sure that our microbiome is very diverse and there's enough of the beneficial flora without being too much or too little, obviously.

And you were— before that, you were maybe going to mention some more tests that you do.

Yeah, yeah. So stool testing is a great place to start, but we have to understand too that we want to take the results from tests like this with a grain of salt. So it can tell us some really amazing information, but it's possible that you can be dealing with something, something that doesn't show up in your stool. So I always tell people that, my patients, you know, just because a parasite didn't come up doesn't necessarily mean you don't have one. Let's just say if all their symptoms were pointing to parasites, I may still treat for parasites.

And what kind of symptoms might, might those be for a parasite?

Parasites have all sorts of different symptoms. You know, obviously the gut symptoms, loose stool, diarrhea, that kind of thing. They can also have symptoms like ringing in the ears, night sweats, fevers, hot flashes, that kind of thing. You know, pain, pain in the stomach. Uh, some people actually feel them move around, which is kind of really gross.

Um, yeah, they're pretty big.

Yeah, sometimes, or just a lot of them.

Yeah. Yeah.

But they can start to affect cognition as well, kind of brain fog and other things like that. Also depending on your history, right? Like if you just came back from, you know, somewhere, Mexico or somewhere where they're, you know, maybe the water isn't as clean or you're not used to that kind of water and you pick something up, then it's possible that that could be still something that we'd wanna address.

Right, and I've heard that we all practically have parasites at this point, whether we live in the US or not, that that's so common.

Right, right. And that brings up a good point. I mean, a lot of looking at health is not necessarily about finding something or not finding something. It's probably likely that it's there, but it's really about how well your immune system does at kind of balancing everything and keeping everything in homeostasis. So if you have a really strong immune system, you may not have any symptoms of overgrowth of bacteria something else. But if your immune system is already compromised, you're under a lot of stress, you just caught a cold or flu, you may have more symptoms than someone else. And so it's really about strengthening and balancing the immune system just as much as it is about getting rid of whatever is there causing the issue.

Yeah.

So one of the other tests I run— some stool isn't everything, it definitely helps, but there can be other issues going on— is something called an organic acid test. This is a urine test. There's actually two different types. You can do an organic acid test or a microbial organic acid test, which is just kind of a smaller version of of the test. And what this test is looking at is metabolites or breakdown of different microbes or pathogens in the body, like bacteria, yeast, and parasites. So it'll actually show us when the bacteria are feeding off of things, they release, you know, any kind of metabolites and things that they're not using anymore, just like we do, right? We, we excrete things through our feces. Well, bacteria kind of have that same metabolites, um, when they're using different nutrients for fuel. So it will pick up on those metabolites. So it can tell us, are there bacteria that we may not— maybe didn't pick up in the stool, but it's maybe still systemic throughout the whole body.

That's a Great Plains Laboratory, right?

Exactly. Yep. There's a few people that do it, but I do use Great Plains.

Yep. Okay.

And then, so the microbial organic acid test will just really show us, is there any metabolites from bacteria, yeast, and parasites? And then if you want to do a full organic acid test, they'll look at those things, but they'll also look to see if there's what some of your nutrient levels are. It'll look at your mitochondrial functioning, some neurotransmitters. So it's a really interesting test. It can tell us a lot of information, not just about what's going on locally in the gut, but kind of your whole body, throughout your whole body.

Is that a relatively new test?

You know, I don't think so. It's been around for, you know, since I was in school about 4 or 5 years ago. So I don't think it's new. I don't think it's a very common, typical test that's used. Definitely not by many MDs, but I will say that it's all science-based. I mean, the testing companies that do these tests are very scientific. They have lots of guidelines that they have to make sure their, their testing standards are up to date and up to standard. So they do have some really good results and ways that they look at results too. And then some of the other tests that potentially would throw in there, sometimes we do a food allergy panel. Which is really looking at if there's increased sensitivity to certain foods. You know, you may be, you know, doing a whole gut regimen to heal your gut and eating really clean, but there's still just something off. Maybe you're having a cross-reactivity. A lot of people come off gluten when they're having gut issues, but sometimes you react to things like oats the same way you would to gluten, and they are not realizing that until they kind of do an actual food sensitivity panel.

And who do you typically use for that?

Um, I love Cyrex Labs. They have a really wonderful food panel that looks at— the reason why I like theirs is because I think there's about 90 or so foods, but they look at the foods in both the raw form and the cooked form. And I think that that's the only testing company that does that. Most of the other food sensitivity panels are looking at just the raw form of the food, but we know when you cook things, it changes the chemistry and it can change how your body responds to that food. So it is kind of important to look at that. And Cyrex actually also has a cross-contamination gluten panel. So like I was just talking about, people who took gluten out but they're still reacting to things they're not sure about, things like dairy, things like oats, things like rice, can still make your body respond the same way as gluten. And so it can be helpful to see if there's any other foods causing the same issue.

And how would you say that doing that kind of a test compares to doing an elimination diet?

Great question. I'd say the most accurate way to do anything is an elimination diet, but you'd have to be really, you know, have a really good plan and be strict about, you know, the whole process. Typically taking foods out for about 2 months minimum, I'd say, and then slowly adding in each major food group at a time. You typically give yourself 3 days of eating that same food multiple times a day to see if you have any do you have a negative response to those? And if you do, you take it out and you move to the next food. And that's one of the most accurate ways to do it. It just takes time, right? It could take up to 3, 4 months by the time you take everything out and then slowly reintroduce everything again.

And in your experience, do the tests that you send out for, like with the Cyrex test, do they tend to bring the same results as the elimination diets? Do they confirm that?

You know, it's a great question. I haven't had too many patients who have done both, the elimination plus the food sensitivity panel. They're either doing one or the other. But the nice thing about the food allergy panel, especially from Cyrex, is they actually test each food 3 times. So they're looking to make sure that they get the same result 3 times in a row before they actually give you the results. So it does have quite a high accuracy.

And how does it—

but again, I still take that with a grain of salt. I'm not 100% sure their mechanisms, to be honest. Is it a blood test? It's a blood test.

Yeah, yeah. Okay. Yeah, yeah. So I know there, yeah, there's a bunch of labs that do this kind of thing and, you know, it's hard to know which are legit and which are, you know, pseudoscience.

Totally, totally. You know, and like I said, I don't do a lot of food allergy panels, but if I had to choose a company to do it through, I would do BCIREX. They are a little bit pricier, just so patients know that up front, and I tell them. And if that's not a realistic option, then we'll pick something else. I mean, Great Plains has some I think Genova has a few. So there are different— BioHealth has one. US Biotech, I'm sorry, is the one I have used too. That's a decent price. But I do still take it with a grain of salt because sometimes things come up high if you just eat that food a lot. You know, your body— if you have a leaky gut, increased permeability, and you eat the same foods over and over, you know, you may not have an actual sensitivity to it. It just could be that your gut is inflamed, and healing that up will help to reduce the sensitivity.

And how do you test or find out if someone has a leaky gut?

So that was— I'm happy you brought that up. Um, the next thing that we'll do sometimes is look at things like zonulin, LPS, and occludin. And these are different materials that come from the gut lining and can be released when there is leaky gut. And it kind of helps tell us just at least some idea of where the inflammation is coming from. So like, if LPS is really high, it's typically coming from some sort of bacterial infection that's causing leaky gut. Zonulin can be more of an issue with the tight junctions. So it kind of helps a little bit of understanding, is there leaky gut or is there not? So that's one of the ways to actually look at the material from the gut that starts to break off. The other way is if you do a food allergy panel and you have 10, 15 foods that are— the person is sensitive to, that's typically a pretty good sign that there is increased permeability.

And do you typically see that kind of, that kind of result with 10 to 15 foods on, on a patient who's experiencing problems?

Yes, absolutely. Which is the reason why I don't do the food allergy panel very often, because most of the time, okay, we know there's inflammation in the gut, most likely there's some, you know, leaky gut. We're going to heal the gut regardless.

Right.

And so I'd rather you spend money on treating, and if you still don't feel well after treatment, then we can kind of go back and look at the food allergy panel. But if If we just do it right off the bat when I know you're inflamed and know you probably have leaky gut, then yeah, those foods are gonna be off, you know, off the map and it's not gonna really tell us, it's not gonna change our treatment protocol necessarily. I mean, maybe it would just help us take out some extra foods that we may not have before, but you know, it's really about healing that gut first.

And then once that gut's healed, the assumption is that the people can go back on those foods?

Most of the time. So maybe not all of them, you know, maybe you still have to avoid gluten or dairy or eggs, or, um, you know, maybe there's those few that are actual sensitivities, not just from a leaky gut. And that's where the reintroduction part is really important, doing one food at a time so you can tell what's what.

Did you have any other tests you wanted to mention? I have interrupted you a few times.

No, no, no, that's fine. Um, no, those are the main ones when it comes to gut that I'll do. Um, Yep.

So you've obviously mentioned testing that most MDs don't come anywhere near. And so talking about the modalities for healing, what do naturopaths and functional medicines use that typical MDs don't do? Or what, what conditions can you address that typical MDs are kind of stymied about?

Yeah, um, you know, again, I think we just look at the body and healing differently. So, you know, MDs are taught to that medicines heal people, where we're taught that people heal themselves with the help of, you know, whatever kind of medicine it is that you're using to support the actual healing process. So I think that's where it can be a little bit different. And so the, the question you're asking is, is what we can treat differently? Is that what you're asking?

Well, what are the conditions that, that MDs really— like, like SIBO, for example. I once was able to get a SIBO test from my doctor, but I mean, well, nothing came back conclusive, so they didn't do anything about it, but—

Right.

What would they do for SIBO, an MD do for SIBO, for example, versus what would a naturopath do?

Right, gotcha. Yeah, so I mean, SIBO is one of those tough ones too, right, because it's a small intestinal bacterial overgrowth. So there's overgrowth of bacteria in the small intestine, which is a very, very hard place to get to to test and see what's going on. So the typical testing there is a hydrogen breath test, which really isn't very accurate. It's about 50% sensitive. It's specific, it's just not very easy to get to that area, so it's hard to tell. So I really go off of symptoms, to be totally honest, when it comes to SIBO. And sometimes certain things are on the stool test. When it comes to treatment, I use, um, you know, obviously we want to get rid of the bacteria that's there that shouldn't be there in the first place, but we still always want to be making sure that we're asking why. Why was there an overgrowth of bacteria in the first place? And so there's different reasons for that. Sometimes people don't have enough digestive enzymes, like we talked about before, to fully break down their food, and so it starts to ferment and the bacteria kind of live there and feed off of that. Sometimes people's just motility in their gut, their peristalsis, how they move the food and the stool through their GI tract, is slow, and so again, things start to kind of build up where they shouldn't. Sometimes it's stress, sometimes it's overuse of antibiotics in their life. So again, we're wanting to address what's the root cause, and while we're trying to figure that out, we're going to be using— typically I start with some antimicrobial herbs, so things that are known to go after bacteria, things like the berberine herbs, things like garlic, things like uva ursi. There's all sorts of really good herbs out there that will help fight off these types of infections. One of the major herbal tinctures I'll use is called BioCidin. It's how we met because it's a really broad-spectrum antimicrobial. And so what that means is it has the ability to go after bacteria, it can go after yeast, and it can go after parasites all at the same time because it's got multiple different herbs that address these different microbes. So I find that that one is extremely helpful for things like SIBO. And sometimes I'll add some extra oregano, which is a great antibacterial Things like that.

So I have this— I have a pet theory about SIBO because I went through it, I was treated for it, and so I'll periodically start to feel like I'm starting to bloat again. And so what I started to do was try and space out my meals more and have a really good long break at night where I didn't eat and just let my system clear out.

Yeah, yeah.

And I see the bloating kind of stops and I kind of reset.

Great. Yeah, like intermittent fasting. So absolutely, diet is really huge when it comes to— and that's probably one of the biggest things we'll talk about more than just a typical MD. You know, especially for SIBO, you know, someone could be coming to you eating a very quote-unquote healthy, clean diet, and it may be, but there are lots of fruits and vegetables that are fermentable and the bacteria feeds off of that. So even things like garlic, and I think asparagus is one, and there's a bunch of, you know, quote healthy things that may make your SIBO worse. And so it's really important to talk about what things would be important to avoid, at least for the time period that you're treating the bacteria. To prevent the bacteria from feeding off of these foods. So we talk a lot about diet. We may talk about, you know, how to eat, right? Like spacing them out more could be helpful, or that intermittent fasting where you actually give your body a whole 14 or 16 hours while you sleep and the next morning, um, kind of a time to rest and fast before you eat again. And that can really be helpful too. Um, sometimes I'll be giving digestive enzymes if we know that that's the problem. There's definitely a lot of inflammation and irritability that's happening in the gut from these bacteria. So I'll make sure that we're healing inflammation. So we're, we're really looking at multiple different causes and effects of what's going on and making sure that we're kind of treating that all together instead of just killing off bacteria. Yeah, that may temporarily help the person, but if you're not strengthening their gut and their immune system and making sure you correct, you know, how well they're going to the bathroom and their digestive enzymes, they're going to just get the SIBO right back. After you kill it off. So it's really important to look at all those different aspects.

And you mentioned healing inflammation. How does one go about doing that?

Yeah, so there's a lot of different ways to heal inflammation in the gut. Um, one of those that I use is glutamine powder, L-glutamine powder, which is an amino acid that really helps to tighten the tight junctions in the gut and the gut lining, kind of keep it from the inflammation from creating spaces in the gut, which is where that leaky gut comes from. That's one option. There are herbs like aloe and BGL, which is a form of licorice, slippery elm. These are all demulcent herbs that kind of help soothe inflammation in the gut, take away irritation. I've been recently using something called SBI Protect, which is also a powder. It's a serum-derived bovine, kind of like colostrum, but it's— there's no dairy component. And that's very good for healing the gut lining, binding up any of the LPS that can be released from bacteria and cause a lot of immune-type inflammation. And then turmeric too. I use a lot of a liquid form of turmeric called Tumero that will help calm inflammation. So lots of different ways to do it. And if you want to just use foods as a way to do it, you can, you know, cabbage juice, which is very high in glutamine, can be helpful for inflammation. Bone broth is another great way. So there are different foods that can also help reduce inflammation. And then of course, taking out foods that cause more inflammation is going to be important too, like the gluten, the dairy, Sometimes it's eggs, definitely sugar, alcohol, those types of things.

So I actually, I was doing a talk just yesterday and someone came up and said, you know, I'm not sold on the idea that sugar creates inflammation. What would you say to that?

I'd wonder why they thought that. You know, sugar is extremely inflammatory. It can alter blood sugar, quite obviously. Which can start to create different types of responses in terms of hormones. So cortisol responses, right? So blood sugar and cortisol talk to each other. Uh, our blood sugar drops too low, cortisol increases to tell us, okay, it's time to eat, time to get that blood sugar back up. Um, if you're constantly introducing sugar, then our cortisol is gonna be spiked and dropped. We're gonna have issues with things like insulin levels not responding we can start to see insulin resistance when people start to have some type 2 diabetes type issues. Sugar then can cause things like, especially in type 2 diabetes, things like the tingling fingers and toes. It can create just overall body-wide inflammation. It's been very well studied that sugar is inflammatory. Yeah, no, I thought it had, but she was saying, "I looked at the literature and I'm not seeing the connection," and I thought, "Hmm, I wonder where you're getting your literature." Yeah, I mean, I'd have to maybe go and find specific things, but even just looking at the sugar cortisol component and insulin resistance with sugar, you know, and just, you know, if there is any infection, I mean, things like yeast feed off of sugar, so you're literally just feeding the, you know, the microbe that's there that you're trying to get rid of.

So in alternative medicine circles, there's some diagnoses that you hear thrown out all the time, like everyone seems to have it now. Lyme disease, SIBO, leaky gut, parasites, Candida. So do you think these conditions have become overdiagnosed or do you think there's legitimate scientific evidence that, that they really are as common as they seem to be if you see an alternative practitioner?

Right, right. Well, there's definitely scientific, legitimate scientific evidence of these types of issues for sure. Whether they're overdiagnosed or not. I'd say maybe it's more of a combination of having names for these things now. I mean, SIBO and even Candida for the longest time were just called IBS and IBD, right? Irritable Bowel Syndrome, Irritable Bowel Disease, which is really a diagnosis of exclusion, meaning that they've looked for everything else and they can't find any other issues, so they just slap on IBS. So now we're starting to kind of have a clearer picture of what is actually causing the IBS, and there can be multiple different types of things, but SIBO is actually a very, very common issue that causes IBS. So I think we're just starting to get a better understanding of what things are actually called, um, or what's actually causing them, which I think is why you're hearing them a little bit more. You know, I started off at a chronic Lyme disease clinic for 4 years, and it is hard to not pigeonhole everyone that have Lyme disease that comes in the door, but it is also a lot more prevalent than people think. In a lot more states. I mean, in every single state, honestly. Um, there's 300,000 new cases each year, and that's just what's reported to the CDC.

And if it's been chronic Lyme and it's been a long time, you can still find the, uh, it's Borrelia, right, in the blood?

You can, but it is very tricky to find whether it's acute or chronic. It's an intracellular infection. Especially if it's been chronic, it can be very hard to pick up in the blood, mostly because it has the ability to change its outer protein surface markers, and so it actually is constantly confusing the immune system that it's a new infection. So sometimes you have chronic Lyme that only shows up as an acute issue, and also times you've had it for so long, your immune system kind of, you know, the heightened response to it dies down, and so you're going to pick it up in blood work. So, and so you're doing it more based on symptoms then?

Correct.

And actually, chronic Lyme is a clinical diagnosis backed by labs. So the labs are helpful, but it's not required to have a positive chronic Lyme test to diagnose chronic Lyme disease.

That's a little, little bit off our gut discussion. So let me, let me go back to the gut. So why do you think so many people have gut problems these days? What's causing it?

Well, I definitely say one of the major reasons is our food. Unfortunately, the quality of our food is just not very good. You know, our soil has changed. We're using genetically modified organisms. This throws off the microbiome. Anytime we have anything that's affecting the microbiome, we're going to see gut problems. Even things like added hormones to our produce— or sorry, our meat supply. This is a huge issue that can throw off the microbiome. Stress levels, environmental toxins, our water not being as clean as it should. So there's lots of ways in terms of environmentally and from our food. And also, I think culturally, I mean, our— we live in a time when we are hungry or crave something and we can just drive to the store and pick it up. We don't listen to our typical body telling us, "Hey, I've had enough," or, "Hey, you know, even though you're craving that, that actually doesn't make me feel good." No, we have it anyway because we want it, not necessarily because we need it. So, I think it's a combination of environmental but also not listening to our body telling us what it needs and what it doesn't need.

And what about antibiotics?

Oh, for sure. Yeah. So, there's definitely, again, when it comes to traditional medicine, and it's not even to blame them necessarily, but they're trained to give a medication or give an antibiotic when there's some sort of issue. Even if it's a viral issue, sometimes you see people getting antibiotics and they may temporarily feel better from it, but I also wonder, was it just their immune system over time getting better? So there's a lot of antibiotics that are obviously killing off the good flora and shifting the whole balance between them, which can definitely affect the gut.

And so what do you recommend to patients who have taken antibiotics?

Yeah, and there's a time and a place when antibiotics are absolutely needed. So I, you know, if there's a time and a place for that and someone needs them, go ahead and take them. But I really make sure that patients are taking probiotics while they're on antibiotics just at different times of the day. So it should be at least, you know, an hour before, 2 hours after, but ideally at like opposite times of the day completely if that's possible. The other really big thing too is, you know, probiotics are great. I use a combination of the spore-based probiotics and the ones that are refrigerated and have a high CFU, high amount of colonies. The spore-based have been really helpful for a lot of my patients. They don't need to be refrigerated. There's typically less billion CFUs in them, but because they're spores, they're very resilient and they're able to get all the contents of the flora to the intestines where it needs to go. Whereas when you have one that's refrigerated and very delicate, a lot gets killed off from your stomach acid, from just the time it takes to get from your mouth to your, to your gut. You're not getting quite as much as it says on the bottle that you're getting. So the spore-based has been pretty helpful. But the other thing is I'd have people do are making sure that they're eating things like fermented foods if they can handle them, soluble and insoluble fibers. That really helps to support the diversity of your flora and things like butyric acid or butyrate. Probably is— there's more and more studies showing how helpful butyric acid is to the gut, sometimes even more than probiotics themselves.

And is that like a pill or how do you take it?

Yeah. So the only food source of butyric acid or butyrate is from butter. Butter. So organic butter or ghee.

Eat on. Okay, great.

What's that?

I was just saying, yeah, eat on. Boy, I'll tell you.

Right, right, exactly.

Doctor telling me to eat more butter.

Excellent. Organic though, organic.

Of course, of course.

And I'm not saying— especially if you have like high cholesterol and other issues, then you don't necessarily want to just be eating butter the whole time. But you can also take butyric acid as a supplement. Yeah, and that's a really great way. And butyric acid actually helps to Feed. It's actually a byproduct of the flora in your gut, and it helps to support the cells in your colon. And so it kind of has this great way of supporting both the structure of your colon and also the microflora.

So let's veer off a little bit and talk about other problems that may be related to gut health that we don't normally associate with the gut.

Sure. Yeah. And this is something that I talk about a lot with my patients because, you know, our gut is, is the center of our body, obviously, but also the center of our health. About 70 to 80% of our gut, of our immune system, is located in our gut. We also have more neurotransmitters, in particular serotonin is made mostly in the gut, not in the brain. Tens of millions and trillions of neurons that are located all throughout the gut too, more in the gut actually than in all the peripheral nervous system. So we have a lot of things going on in the gut besides just digesting our food and absorbing nutrients. And so we'll see a lot of things, you know, anxiety is a huge issue that can be connected to the gut, brain fog, joint pain.

What else? Depression.

Fatigue, depression, absolutely. Any kind of mental, emotional aspect. We see things like headaches, muscle pain. Issues with like ADD and ADHD, concentration. So there's some other things that you may not think initially are related to the gut, but most of the time there's some sort of connection.

And then autoimmune conditions, right?

Absolutely. So autoimmune is, you know, your body— your immune system is flagging different areas of your body as potential threats. It's not necessarily an immune response right away, but it's flagging it. And then if you do have an immune response to something else, anything that's flagged, your immune system is gonna go after. And so again, because so much of our immune system is located in our gut, we wanna make sure that we're modulating or balancing the immune system by supporting the gut health. And that can really help to reduce or eliminate autoimmune issues.

So as someone with autoimmune issues, I've avoided gluten now for more than a couple years. So what— can you explain to people what that connection is between gluten and autoimmune? Issues.

Yeah, I think there's a few different connections. So gluten is a protein found in a few different grains like wheat, rye, barley, a few others, and it tends to just be a really big protein that's hard to break down. And so again, anytime we have something that's hard to break down, it takes a lot more energy and effort for our body to work through it, and it tends to be inflammatory. The other big thing they're kind of starting to talk about too with gluten and other crops is the glyphosate component. So these crops are very often sprayed with something called glyphosate, which is a neurotoxin, can definitely cause a lot of inflammation on its own, issues with the brain and cognition. And so I think a combination of it just being a big protein that's hard to break down, plus how it's sprayed, tends to create a lot of immune reactions. And then anytime again, we have anything autoimmune, We want to help calm the immune system down so it's not so overstimulated.

So is there hope then for people who have autoimmune issues to go back on gluten at some point?

You know, I would probably say no to that. Like I said, there are some foods that you should just avoid. Same thing with like Hashimoto's thyroiditis. The first thing that we do is take them off gluten and you're never having gluten again. I mean, obviously if you're going to have a little bit here and there, you just know, you know, it may make your symptoms a little bit worse for a day or two, but in general, as a part of your diet, it really shouldn't be there.

Yeah, no, I— that's one of the things I have is Hashimoto's. And I have tested various foods against my antibodies for Hashimoto's so that I know which ones I react to. And it's— for me, it's gluten, dairy, and soy. And I will periodically cheat and go get pizza and just enjoy myself.

I tell people that too. Like, sometimes you have to just feed your soul a little bit.

Yeah. So I have heard from some of the experts, well, if you have one bite of gluten, that's 3 months that your system's reacting to it. But I've taken my antibodies not even 3 weeks after and not seen them elevated because of my one cheat.

Yeah. The other thing too is, I mean, there are now enzymes that will help you break things like gluten and dairy down. I take those. Exactly. If you know you're going to cheat, taking— and I'm not saying to cheat, especially not to cheat all the time, but you know, that one or two, you know, your birthday, Christmas, whatever. Exactly. Then it's nice to at least have those enzymes that can help mitigate some of the symptoms from it.

Yeah, no, I take a whole slew of pills when I do cheat.

Yeah, yeah, yeah. That's probably why you're not having such crazy reactions after you cheat once or twice, right? Yeah.

So what would you recommend for a parent whose child was born by a C-section, or for pregnant moms who might get C-sections given the rates so high?

Yeah. So, and I'm guessing you're bringing this up because, you know, when kids are born by C-section, they're still exposed to different bacteria flora, but it's from the skin, not from the vaginal canal. And so when infants are born vaginally, they are exposed to all this different flora from the vaginal canal that is really protective to their immune system. So it's not necessarily that they're not getting any good flora, but it's just very different from a C-section than it would be from a vaginal. So I would definitely suggest, if you know, if your child was born C-section or you're thinking that may be the option, to get a good probiotic that you can add to the milk or some water or even directly in their mouths. I believe Designs for Health has an infant probiotic. That'd be a great thing to add in for them. And even moms too. I mean, they can take some extra probiotics. Pregnancy probiotics would be very, very helpful regardless of her C-section or vaginal.

We often don't know, right?

Right, exactly. And if for some reason you do have to get a C-section, one of the other things I tell moms to do too— this is like maybe a little bit different than gut health necessarily— but you can apply some castor oil once the incisions are, you know, you're okay to put things topically on it. Um, the castor oil will actually help to bring in circulation to the area to reduce inflammation and also prevent scar tissue.

Oh, okay.

That'd be a good thing for moms to do. But yeah, I would definitely have the mom and the baby take some probiotics.

What do you think about reseeding the microbiome for C-section babies?

What do you mean reseeding?

Re-seeding through taking—

Oh, reseeding. Sorry, yeah. I mean, it's better than nothing. I mean, the other thing too would be to really, if you can, make sure that the child is at least breastfed so at least they're getting a lot of immunoglobulins that way and supporting their immune system through breast milk. You know, it's obviously not gonna be the same adding in probiotics versus them getting it naturally through the vaginal canal, but it's better than, you know, I'm not getting any in the beginning, right?

No, I was talking about the practice though of putting like gauze into the vagina after birth and then you've—

I see—

all over the baby.

I don't know much about that. I'd have to look into that.

Oh, okay. Yeah, yeah, I've definitely heard it recommended in alternative circles and Ubiome just put out a post about it, and then there was a doctor condemning them for having, you know, promoting a dangerous practice that could transfer, you know, they could transfer like STDs or strep B or things like that. And I'm thinking, well, it's only as dangerous as, say, having a baby the normal way.

Right, right. I guess it would be really, you know, knowing the health of the mother, right? So if she doesn't have any STDs or anything like that, then I don't see why that would be an issue or harmful.

Right, because that's how the baby was supposed to be born.

Exactly, exactly.

You know, obviously if you have something, you wouldn't, you wouldn't choose to spread it.

Right, right, absolutely. Because there are some women that, you know, need to be on antibiotics the whole time they're pregnant and to prevent any kind of transmission of anything. So, you know, in that case they wouldn't necessarily want to do that, but I don't see why a healthy woman with healthy vaginal flora wouldn't want to do that if they had to have a C-section.

Yeah. Okay, so for someone who does have a healthy gut, or who, you know, isn't, isn't so far off, they're seeing a doctor about it, but you know, they wanted to support a healthy gut, what kinds of things should they be doing diet-wise or supplement-wise?

Yeah, great question. So I think that kind of goes back to, we always want to make sure that the microbiome is as diverse and high enough of the beneficial flora as possible. So the best way to do that is variety, variety of foods. Doing both cooked and raw depending on how you can handle it, but variety of vegetables, variety of fruits, that can be really, really important. The more, you know, go to the food store and pick out vegetables you've never used or cooked with before and look up how to cook them. You can, you know, one doctor who did a talk all on the microbiome said, take, you know, 5, 6 different types of vegetables you never use, put them in a blender, blend them and just drink it. I don't care how bad it tastes, just do it. Because all those natural fibers and nutrients from those vegetables are going to directly help support the diversity of your microbiome. So that's one way, is I would just say variety and just switch it up. Some people say, oh, I have a really good diet, I eat this for breakfast, this for lunch, this for dinner, but I literally only have those 3 meals every single day.

It's the same thing every day.

That's not necessarily good either. We really want to try to switch it up and get variety. So eat the rainbow, not Skittles, but all the other good veggies and fruits. Then the other thing would be fermented foods. Again, as long as you can handle it. Some people who have SIBO or some big issues with overgrowth of yeast and bacteria, they don't feel very good after eating fermented foods. But if you do, that would be a really great way to help support the gut as well.

On that topic, I met someone who had gone through SIBO and sort of gotten over it, but she was saying that she could not eat raw vegetables unless they were super custardy. Small cut up. Yeah, you heard of that sort of thing?

Absolutely. And you know, I would start— if you have a sensitive gut, I would start with cooked vegetables first. They're much easier to break down.

Would digestive enzymes help in that situation?

Digestive enzymes can help with the raw for sure, but I'd start with cooked and then kind of slowly try eating them raw. So some of the— again, some people are eating salads every day and they feel bloated and crappy after, and it's like, well, maybe try eating like a stir-fry instead of a salad. And they're like, oh wow, like I eating the same thing, but now it's cooked and it's not raw, and I'm able to break it down and feel so much better.

So is it a matter of just rebuilding the microbiome to be able to handle that?

Yeah, it could be. I mean, in Chinese medicine too, they talk a lot about, um, the spleen meridian when it comes to raw foods versus cooked. And so that's kind of a whole other tangent, but sometimes it's just kind of strengthening all the other aspects, you know, of the body, um, to make sure that you're able to process and break down raw foods as well as cooked foods.

Okay, so to kind of wrap things up, I just wanted to ask about, are naturopaths typically covered by insurance?

It depends on what state you're in. So I'm in California and it's— they're not covered by insurance, so it's a cash-based practice. I can give someone a super bill, which is kind of like an itemized receipt they can submit to their insurance, but it will just depend on their insurance whether they cover it or not. It's like Arizona, I believe, I think Oregon has— they can take insurance. Connecticut. So there's a few. You just have to look up state by state.

So I'm sure all of us would love to be able to see someone like you, but not everybody can afford it. So what would you say to somebody who couldn't afford to see a naturopath? Like, what, what kind of doctor might they be able to look for that would be on insurance?

Yeah, that's a really great question. You know, there are a lot of medical MDs, medical doctors that do practice functional medicine. And so I'd probably first see if you can find someone that's in your network that is an MD but practices functionally. That would be my first, first suggestion. There are also like chiropractors and acupuncturists that sometimes are covered a little bit more in all the alternative plans than a naturopath would be, obviously, because we're not part of insurance, at least here. So that could be another option to look for a really good chiropractor or acupuncturist that knows a lot about this kind of stuff that could help you. I'd say those are probably the two ways I'd find someone that could treat you this way.

Okay. So where can people find you?

Yeah, so they can find me by going online to my website. It's www.wildcraftmedicine.com. I also have an Instagram that's the same, wildcraftmedicine.com, and a Facebook page. It's Wildcraft Medicine with a capital W and a capital M. Um, so they can reach out there. They can call my office as well. My phone number is on the website, or email me at info@wildcraftmedicine.com.

Okay, and so you see people in La Jolla, California, but also online, or?

Yes, so I see people locally here. They come into my office, or if you aren't able to physically come in, we can do phone and Skype as well.

Okay, great. Well, thank you so much for all this interesting and useful information.

Yeah, absolutely. Thank you for having me.

Thanks for listening to today's episode. If you liked it, please press subscribe so you won't miss future episodes. And you can find links to Dr. Emily's website and mine in the show notes. And as you may know, I'm a health coach who helps women lose weight without counting calories or cutting calories or depriving themselves. So I wanted to share just one weight loss tip for the new year: cut back on added sugars. Too much added sugar in the diet leads to insulin resistance, weight gain, and cravings for more sugar. So if you do nothing else, set that as your goal for 2019. And if you need help, I can set up a 4-week program of coaching to help keep you accountable and help wean you off sugar, or a longer-term weight loss program which can be done from anywhere in the country over Skype, FaceTime, Google Hangouts, etc. But more than anything, I'd love to hear from you if you're struggling with losing weight. You can reach out to me at Lindsey Parsons at High Desert Health Coaching. .com or check in the show notes for my email. And here is to a healthy, happy, and prosperous New Year.