Revisiting My (Gut) Health Journey

Welcome to The Perfect Stool: Understanding and Healing the Gut Microbiome. This is your host, Lindsey Parsons, and today I wanted to revisit something I haven't done since the end of 2019, and that is give you an update on my gut health and my health journey, as I think it may have pieces that will speak to a lot of you, and also because I've referenced it in various podcasts up to this point. So I wanted to make sure you had it all in one cohesive whole. And I also kind of wanted to pull it all together for myself so I could make better sense of how things went downhill. But before we get into the meat of the podcast, if you're not yet following or subscribed to the show, please do that now. And if you're on iTunes and you're a lover of the show, it would be awesome if you left me a 5-star rating and review. And if you're a regular listener and your health has benefited from listening, if you'd consider a small monthly donation on Patreon, that would be awesome. I will link to all those in the show notes. Okay, so I just wanted to start by saying that this story may not be the same one you have read on my website, if you have read that, or the same one you've heard me mention in podcasts, because I got some information recently that has changed my perception of how everything came to pass. So this is my reinterpretation of events in light of that information. So that new information was that I have autoimmune IBS, which is something I found out from taking something called the IBS Smart Test about a month and a half ago. Thank you, IBS Smart People, for the free tests. They call it post-infectious IBS because it follows on a bout of food poisoning, of which I've had 3 pretty memorable in my life. But at the end of the day, it is autoimmune in nature. So the IBS Smart Test tests 2 types of antibodies, anti-vinculin and anti-cytolytic distending toxin B, or anti-CDTB for short, antibodies. So the most common bacteria that cause food poisoning, like Shigella, Campylobacter, C. diff, Salmonella and E. coli release CDTB toxin into your body, which your body fights as it would any other invader by creating an antibody. So if you've had a recent infection of that type, you'll see the anti-CDTB antibody elevated on the IBS Smart Test if you take it. My anti-CDTB antibodies weren't elevated, but then again, my food poisoning was a long time ago. Now vinculin is a protein in the gut that helps nerves migrate and interconnect. And as is common with most other types of autoimmunity, when you have a reaction in the body to some type of invader, you often have some other protein in the body that looks like that invader. Well, vinculin unfortunately looks like CDTB, which means that your body can create antibodies against vinculin as well and start attacking that. And so my anti-vinculin antibodies were elevated. And then the result is damage to the nerves lining your gut and/or motility issues, or more specifically, improper functioning of the interstitial cells of Cajal and the migrating motor complex. So the interstitial cells of Cajal are involved in the communication between the autonomic nervous system and smooth muscles, and then injury to them can create dysrhythmias or an abnormality in the rhythm and movement of the GI tract, a slow intestinal transit time, or gastroparesis, which means problems with the stomach emptying itself of food in a normal fashion, which can cause heartburn, nausea, vomiting, and feeling full quickly while eating. Now, the migrating motor complex is what clears food out of your small intestine, which normally happens every 1.5 to 2 hours. For about 30 minutes. And during that time, you may hear your stomach gurgling, which is a good thing. It means you're having peristaltic contractions starting the stomach and moving food through the small intestines, clearing the food out so it doesn't stagnate. So if you've ever seen a stream drying up or a stagnant pond, you know what happens— it gets covered with algae. Well, the same sort of thing happens in your gut when it gets stagnant, except that it's bacteria that overgrow. The result is bloating from those bacteria fermenting the food you eat, a premature feeling of fullness, and then typically soft stool, diarrhea, or a mix between constipation and diarrhea. Now, don't assume that because you have problems with small intestine motility that this means you'll be constipated. Not necessarily. What happens with this stagnation is the overgrowth of bacteria in the small intestine, also known as SIBO or small intestine bacterial overgrowth, or also possibly SIFO, small intestine fungal overgrowth in the form of Candida. And those two typically will leave you with diarrhea, soft, messy stool, or a mix between constipation and diarrhea. And constipation alone is also possible, but that tends to be more from an overgrowth somewhere in your intestinal tract of methanogens, or methane-producing bacteria. So anyway, back to my story. I had two incidents of food poisoning before I started having any diagnosed health issues that I think are important in how things went south for me. The first was during a study abroad program in Costa Rica in the summer of 1993. And I don't know what I got in particular, I can't recall, but it involved me having no appetite and stomach pains. And ultimately required me taking special antibiotics. And I remember that distinctly because I had traveler's insurance and the antibiotic cost like $70 American, but they misconverted the currency and sent me like $700, which was absurd that any antibiotic would cost $700 in a country like Costa Rica. But of course, completely believable in the US context, given our ridiculous drug prices. But I was a good citizen and I did return the money. So anyway, that may have been a parasite, but I'm not really sure what it was. The next and most memorable food poisoning incident was when my future husband and I were living in Costa Rica about a year and a half later, and we went on a weekend trip and decided to defrost our very much not frost-free refrigerator. We had a weird washing machine that had a separate compartment for washing and spinning clothes, and the spinner part was the closest thing we had to a cooler. So we put all the food in there with ice and left it for more than 2 days. By the time we came home, the food was completely warm. Now, if my mother hadn't gifted me with an almost pathological aversion to wasting food, I may have just thrown that mayonnaise out. But no, instead, that very evening, I used it to make tuna salad. Now, within 90 minutes, my husband, whose system is on a hair trigger, was throwing it up, and then I was up all night with the runs. So that may have been when it all started. The other possibility is an incident on our honeymoon to Italy. I probably ate some bad food or drank some bad water there, as I spent about a week of the trip not really being able to enjoy food and having stomach pains, not unlike the first incident in Costa Rica, although I never took anything for it after that that I recall. But what I do remember is that after that, while working at the University of Georgia as a study abroad advisor, which incidentally was my previous career, I remember distinctly that my stool quality changed for the worse and I ended up having to use those, quote, flushable wipes that ended up clogging up our pipes as they weren't really flushable. I remember at the time I couldn't leave home without a pack of them. So just a brief interlude to tell you that if this is you, that is not normal stool. Your gastroenterologist may not call in the cavalry when you tell him you have soft stool, but I will, because normal stool is solid and continuous, a 3 or 4 on the Bristol stool chart, and comes out cleanly such that when you wipe, there's nothing on the toilet paper most of the time. But honestly, I never thought to talk to a doctor about this, and I had bloating every time I ate out for most of my life. So when it became more common, I don't know that I noticed it that much or thought it was something worthy of telling a doctor about. Now I just want to stop to say that the diagnosis of IBS was never given to me at any time by a doctor, and I feel a little uncomfortable owning it because I've never had diarrhea 6 times a day or accidents because I couldn't get to a toilet. But I will tell you this: when I had to go, I had to go. And that was different from my husband, who could put off going to the bathroom if he had to. But I thought that was just me and how my body worked. But now I know the difference. When I'm having an episode of SIBO, I will have urgency that gives me about 5 minutes warning, and sometimes I'll have full-on diarrhea several days in a row. But when it's under control, I can hold a bowel movement in for 30 minutes or sometimes even longer if it kind of decides to recede back in. It's not fun, but, but I can do it. Think about that in terms of what normal bowel function should look like. To continue my story, I was in Georgia for about 6 years, and I don't think I saw a doctor about GI issues at all. I was too busy trying to get pregnant in those latter years and experiencing infertility, which was likely related to the dysbiosis in my gut, as I believe in retrospect that I was estrogen dominant. And I was ultimately diagnosed with endometriosis, but that was long after that and long after I had succeeded in getting pregnant and had my older son. So after Georgia, my husband and I moved to Australia. And again, I never saw anyone about my gut, but did soldier on with the bloating and the premature feelings of fullness and soft stool. I did my doctorate in education there at Griffith University in Brisbane, by the way, which was awesome. And while I was there, I did go through infertility again and was diagnosed with endometriosis and had an operation to remove it in order to try and get pregnant. And I did get pregnant, but ultimately lost my baby at 10 and a half weeks, which is why I did end up adopting my second son from Thailand. So after about 3 and a quarter years, we came back to the US and ultimately we moved to Tallahassee, Florida, where we lived for 5 years. And again, I never really saw anybody about all this. I kind of ate everything, never really changed my diet. I did just take lactose digestion tablets when I ate dairy from about age 22 or so on, as I realized I was lactose intolerant. And kind of racked up most of my symptoms to that. And I did have GERD or gastroesophageal reflux disease, and I took omeprazole for like 10 years. So that may be contributing factor also in things going downhill, but I can't be sure of that. So after being in Tallahassee for about 5 years, we moved to Washington, DC. And soon after arriving, the doctor noted that I had what felt like an enlarged thyroid, and I also showed low levels of platelets on a blood test. They may have been just below normal. I'm not sure, but I think I may also have been having symptoms of B12 deficiency, which was tingling in my extremities. So she sent me to an endocrinologist and a hematologist. The endocrinologist did an ultrasound and diagnosed me with Hashimoto's thyroiditis from the damage to my thyroid that, that could be seen on the ultrasound, which is an autoimmune thyroid disease. And at that point I was not hypothyroid. My TSH levels were normal. But my thyroglobulin antibodies were elevated. And by the way, if you've only had your thyroid peroxidase antibodies tested and you're hypothyroid and you suspect you may have Hashimoto's, make sure you get your thyroglobulin antibodies tested too, as my thyroid peroxidase antibodies were never elevated, although I have heard that those tend to elevate first. Then after I saw the hematologist, he diagnosed me with ITP, which is an autoimmune condition where your body attacks its platelets because of elevated antibodies and low platelet levels. And he also diagnosed me with pernicious anemia, which is the autoimmune attack on the cells lining the stomach that help produce something called intrinsic factor, which helps you absorb B12. Now the cells lining the stomach are called parietal cells. And because I had low levels of B12, and then originally the parietal cell antibodies and intrinsic factor antibodies were elevated, he gave me that diagnosis. But in my most recent visit to a hematologist, I have found out that my platelet levels weren't really that low to begin with. And that the antibodies they thought related to ITP no longer are considered accurate for that. So that doctor has told me he thinks I never had ITP. So who knows if I ever had it or not. But for sure, at one point I did have elevated parietal cell antibodies and intrinsic factor antibodies, which meant I couldn't absorb B12 in my stomach and had to either get B12 shots or use sublinguals. Now, in theory, this pernicious anemia is not a reversible condition other than through getting regular B12 injections. Now, I only ever had one injection, and I've used sublingual B12, and I have progressively healed my gut. And I just had both the parietal cell antibodies and intrinsic factor antibodies tested, and both were negative. So there, medical establishment. And my Hashimoto's antibodies have been normal in my last two blood tests. So three autoimmune diseases down, one to go. So anyway, now that I know that the SIBO was autoimmune in nature, I might rethink the role of antibiotics in my disease process. Well, I do think it's best to avoid them whenever possible. I had a couple of rounds of Cipro one year before my diagnosis, and honestly, each time I took it, my stool got solid and I actually felt better gut-wise because it was killing the bacteria. I didn't make the connection at the time, nor did the doctor I saw and eventually and talked to about it, but I didn't feel worse on antibiotics. Now it's possible they were also bringing up my Candida levels because when I did ultimately take an organic acids test, I did have two elevated fungal markers. But I don't see the antibiotics as a primary causative factor for me, but who knows. And I should mention that at some point in DC, I did see a gastroenterologist about the bloating and soft stool, and he did an upper endoscopy, which was normal, and he gave me something called Hycosamine, which is an IBS medication that stops the stomach from cramping, which I used very sparingly. In fact, I'd only take one about every 4 to 6 months when I'd go out to eat and gorge on gluten and dairy and feel terrible, and I would take it and it would take away the pain, and I was like, these are my magic little pills that take away all the pain. But I only finished one month's prescription like 2 months ago, and it was like 5 years old. So I was very, very sparing in my use of prescription meds other than the acid reflux meds, which I eventually went off after I stopped eating dairy. And that kind of took care of the main symptom of my reflux, was a chronic cough. And then the other thing I'm rethinking is how the Hashimoto's came to pass. I'm thinking that it was most likely the SIBO that caused leaky gut, as gut infections tend to do. That led to the Hashimoto's. Hashimoto's is often attributed to molecular mimicry involving the body attacking your thyroid because it looks like gliadin, which is one of the proteins in gluten. And there's also a strong correlation between Hashimoto's and pernicious anemia, with Hashimoto's often preceding pernicious anemia. So I'm thinking that the food poisoning may have been at the root of all of this. So on to how I got better. So first of all, I did start with an elimination diet and felt a whole lot better on it. I started by eliminating gluten, dairy, seed oils, corn, alcohol, sugar, caffeine, and processed food. And I stayed off gluten for a time after that, and I think dairy more solidly after that. That's always the first step in my opinion on these gut and autoimmune issues, because even if food isn't the cause of the problem, it's contributing to not getting better by slipping out of your leaking gut into your body. And then your body is starting to attack your own cells when it sees the proteins that resemble them floating around where they don't belong. Also known as molecular mimicry. And a side note, if you have SIBO, your gut is most likely leaky. I also started taking fiber, psyllium husk in particular, in my smoothies, a tablespoon a day, to help solidify my stool. And that was also helpful, but not a complete solution. So a bit after that, I saw a functional medicine doctor who was actually an MD with training in functional medicine in DC, who gave me a SIBO breath test, which came out marginally positive for hydrogen. So given my symptoms, he put me on antimicrobial herbs for 6 weeks along with a low FODMAPs diet and betaine HCl to bring up my stomach acid. But after that, the bloating wasn't quite gone. So I requested Rifaximin, which is a prescription antibiotic that only impacts your digestive tract. If you can get it covered by insurance, it's very expensive, but it's a lot quicker route to the same endpoint. So that took 2 weeks. And then at the end of that, I felt much better and my stool was starting to get back to normal and the bloating was gone. And they also put me on monolaurin for Candida in case that was an issue because it showed up on the stool test a little bit. But they didn't really know what to do about the Hashimoto's, so I had to kind of figure that out on my own after I finished seeing them with research that I did. So what I ultimately did for Hashimoto's was another elimination diet like my previous one that lasted a lot longer and was more strict, and then a series of detoxifying supplements. And then I just stuck to being gluten, dairy, and soy-free for about a year before I went to retest myself. And my antibodies did keep going down and I ultimately ended up reintroducing soy since I never felt any concrete problems with it. But that was years later because after my first attempt to reintroduce it, my antibodies rose, which was how I would test whether foods were impacting me since I didn't have big obvious symptoms. And incidentally, my TSH was always normal, so I never took thyroid hormone. So all the while I was learning more and more about gut health and ultimately I began my training as a health coach and got more and more advanced training at gut health. And once I gained some of the knowledge that I have now, especially regarding many of the nutraceutical products out there to treat these conditions, I knew how to deal with my issues myself. Since that time, I have gone through 3 rounds of antimicrobial herbs to deal with both the bacteria and fungi, and I have done a low FODMAPs diet once more and a keto diet once while treating for Candida after I did my organic acids test. And now each time I start to get bloated again, or if I have ongoing diarrhea or soft stool, I'll do it again with the antimicrobials as long as is necessary to get rid of that. So now, armed with the knowledge that what I have is autoimmune in nature, I know that I have to help my migrating motor complex with something called a prokinetic, which is like a motility activator for the small intestine so things don't stagnate and I don't get SIBO again. So what I'm currently using for that is called Iberogast, which is an herbal supplement that you take before bed. It has some good research to back it up. I'm also using butyrate because I have done stool tests showing an elevated level of proteobacteria and because it works beautifully to firm up the stool by slowing motility in the large intestine and promoting a hypoxic or oxygen-free environment in the colon, which will favor the anaerobic bacteria that produce butyrate, which feeds the cells lining your colon and helps that mucus layer be healthy, rather than the facultative anaerobic bacteria, like the pro-inflammatory proteobacteria that I have overgrown. I like the form of butyrate called Tributrin, as the pills are higher dose and smaller to swallow. I'll link to that in the show notes. I went up to 3 pills a day for a while, and when my stool started to turn into rabbit pellets, I backed down to 3 once a day and then 2 once a day, and I just keep adjusting based on my stool quality. Another good butyrate option is called ProButyrate, which you can find in my FullScript dispensary, and it is less expensive than Tributyrin but lower dose per capsule, so you may have to take more, like 3 to 4 pills per dose once or twice a day. The same company also makes something called Aurx, A-U-R-X, it is, which is a powdered butyrate supplement. You know, if you have a kid who's dealing with this, so it can be mixed, mixed in applesauce, or if you aren't good at taking pills, and that's also available in my full script dispensary. And note that these forms of butyrate are different from the less expensive sodium butyrate supplements, which may not make it to the large intestine and have the same effect on stool quality and gut hypoxia. I've also been taking digestive enzymes, partly because someone sent them to me for free, and partly because after talking to the guest who sent them to me, who'll be on my podcast in episode 58, I realized that they the more quickly I can digest and absorb my food, the less there is for the bacteria to ferment. Even if my pancreatic enzymes are normal and that's not an issue, it's just a matter of getting that food digested and absorbed as quickly as possible. So with all of that, I have been consistently enjoying perfect stool lately, which makes me very happy. It's funny how something like that could matter so much, but for me it just reflects what's working in my body and it's like another vital sign. So it is important. So anyway, I hope that sharing my health journey will help some of you. And if you've been hacking at your health problems and haven't been able to get to a place of wellness or all of this seems like a bit too much to you and you need some professional guidance, I'm happy to offer a free 30-minute breakthrough session to any of you kind listeners. I can listen to what you've been going through and let you know if I think I can help you. I have a 5-appointment gut healing program that may be right for you. I also offer single appointments. So links for all of those, um, the breakthrough session or setting, just setting up a single appointment are in the show notes. And if you wanna connect with me otherwise, you can email me at lindsey@highdeserthealthcoaching.com. That's Lindsey with an E-Y. You can join my Gut Healing Facebook group, follow my High Desert Health Facebook page, or find me on any of the other major social media outlets, but I'm a little bit less active in those. And there are links for all that in the show notes. Thanks for listening today, and here's wishing you all the perfect stool.