Taming Gut Inflammation: Fiber, Prebiotics and Crohn's Solutions with Will Bulsiewicz, MD

Welcome to The Perfect Stool: Understanding and Healing the Gut Microbiome. This is your host, Lindsey Parsons, and today I'll be speaking with Will Bulsiewicz, MD, known as Dr. B, a gastroenterologist and adjunct assistant professor of medicine at Emory School of Medicine and the founder of 38Terra, a gut health supplement company, and the bestselling author of Fiber Fueled and the Fiber Fueled Cookbook. His scholarly work includes over 20 articles in top-tier scientific journals like Nature Medicine, and he's delivered more than 40 presentations at national forums, including sessions with Congress and the USDA. He has a bachelor's degree from Vanderbilt University, a medical degree from Georgetown University, and a master's in clinical investigation from Northwestern University. 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 ebook, Finding Your Root cause through stool and organic acids testing when you sign up. 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 on to the show.

Welcome to the podcast, Dr. Bulsiewicz.

Oh, thank you, Lindsey Parsons. It's a pleasure to be here. Thank you.

It's great having you.

So I'm sure my listeners would be interested in hearing how your own health issues brought you to where you are now in the search for root causes for gut health issues. So can you tell us about that?

Yeah. I mean, I think that this is an important part. Like it informs many of my personal motivations in terms of the way that I approach health. So, you know, I think as a background, an allopathic medical doctor, it was my lifelong dream to become a medical doctor and went through medical school and residency, basically looking up at these people who were before me as like, these are my heroes. This is what I want to be like. And then it all sort of was quite sobering when I started to have health issues myself. So essentially what happened is that the things that were bad patterns, bad habits that I had from my childhood and carried into adulthood that I think I doubled and tripled down on during times of stress or when I was short on time or, you know, things like this, which I frequently was in my 20s going through my medical training. It ultimately came to a head where I found myself in my early 30s and I was unwell and I was having a crisis of health and I was 50 pounds overweight. I had high blood pressure and high cholesterol, but even more importantly, like I didn't feel well. I was depressed. I was anxious. And also I had tremendously low self-esteem. And I knew I wanted to feel better yet in that moment when there I was, I was a board-certified internal medicine doctor at that point. I was in my specialty training as a gastroenterologist. Neurologist. I had won many awards. I was the top award recipient at Northwestern among 60 doctors. And yet, like, I didn't actually want what I was trained to do for myself. I wanted something that would actually address like, why do I feel this way? Why do I have these issues? I don't want to just like take a blood pressure pill for blood pressure and take a cholesterol pill for that. And then like take something else for these other feelings. I want to repair the person starting with the inside and working my way out. And so, and I didn't really know how to do that because that's not what I was trained for. So I tried to exercise my way out of things. There were definitely things that were beneficial from exercise, but it didn't really fix the problem, to be honest.

And so ultimately— I always say you can't exercise your way out of a bad diet.

That's, that's exactly right. And, and I didn't even understand that, right? Like this seems so obvious. It seems so obvious. And yet there I was in it, living it and not seeing it. And so anyway, it was changing my diet that really changed everything for me and the realization that, oh wow, like not only do I feel better, my gut feels better.

So what was your diet like and what is it now?

Well, so this period of time that we're talking about, so I'm now in my mid-forties, right? And so we're talking about a period of time that was like on the order of 12 to 15 years ago. And so leading up to that, I mean, when I was in high school, my parents were divorced. My mom was at work and I would come home from school and I had two brothers and we, we grilled hot dogs almost every single day. Um, we, loved like going to fast food joints and drinking soda. Like the, these were like, hey, if you had some money, that's what you would spend your money on. So then I went to college and medical school and I'm independent now. I have my own life. What do you think I ate? And—

A Tuxen soda?

Exactly.

Oh, wow.

You know, or I'd like, imagine this, I work a 30-hour shift, right? This is like literally what would happen. Every fourth night during my residency in my twenties, I would work a 30-hour shift, not sleep, come home around 1 in the afternoon, completely exhausted, stop at Taco Bell, grab $15 worth of food, which is a lot for Taco Bell back then. And basically like devour it and then pass out and wake up the next day and go back to work.

Yeah.

So I had a very unhealthy lifestyle, but again, like I didn't see it or understand it. And so, so anyway, you asked me, how do I eat now? Well, I just want to give the caveat that like how I eat now is a build. And I've always been working on ways to try to improve little things, not trying to be perfect, just trying to like tweak and work my way up. So I feel like I'm in a great place now in terms of the balance between it all. But where I started was like, the first thing was just actually drinking smoothies. And it was almost like drinking smoothies as a supplement. And it had fiber and polyphenols, phytochemicals, and all kinds of good stuff. But that was my way of having something that I could prepare quickly, effortlessly, and still feel like I was doing something decent for myself. So that's where I started and it really actually made a difference.

Yeah. Where did you end up now? What do you do now? Do you cook for yourself? Do you, Do you eat lots of fiber?

I eat lots of fiber. Yes. I try to cook for myself when I can. On the weekends, I'll have breakfast. Breakfast for me could be avocado toast. That's like one of my favorites. And also, you know, I should say I have 4 kids. So, and my kids, the age range is between right now, one, she just turned 1, my youngest, and then my oldest is 10. And so anything that I prepare for myself, I've I have to prepare for my kids at the same time. Right. So I'm looking for solutions that are quick and healthy and also delicious. Cause that's what my kids want. So like avocado toast is a family favorite. Yogurt. I might do a plant-based yogurt, but I'm not opposed in any way to regular dairy yogurt if that's what people prefer. And so like a yogurt with nuts and seeds, specifically hemp seeds and berries, that's, that would be like a classic on the weekend. During the week, I typically don't consume breakfast. I usually, Let me be honest. I probably should, but I don't. And I drink coffee and then I have lunch. So for lunch, soups, salads, sandwiches, a big thing, a big kick that I've been on recently has been to take soup and add an entire can of beans to it. And I choose the beans based upon which type of beans fit the soup profile. So like certain ones I'll use garbanzos. Other ones I might use like kidney beans or black beans, depending on what the style of the soup is. But like, again, I've worked my way up to this. If you have gut issues, this is not a starting point. This is where you get to eventually. So, and then dinnertime varies. Like we cook for the family and it varies by day of the week. We sort of have typical family foods that we eat. Tuesday night is Taco Tuesday as an example. And we'll put out the taco spread. And then the key is like, we have all the accoutrements and you just pick and choose which ones you like and then just add it to your taco. And it's pretty nice. So another example of something that I would like for dinner is like, I love making a bowl and including some sort of whole grain and some sort of legume or lentil, and then like adding toppings. So depending on the flavor profile, whether it be Mediterranean or a burrito bowl, you just kind of like put out that spread, add that stuff in, make it taste really great, and then acknowledge that like, this is a healthy meal.

Yeah. Well, I'm hearing the emphasis on the beans and the lentils, which is what I tell all of my clients who are eligible for that. There are some that are, are not, but all of the ones that are ready for beans and lentils, I would say, you know, quarter to half a cup a day minimum, cuz you're just never gonna hit your fiber requirements without it.

They're powerhouse foods when it comes to the gut microbiome. There's nothing more densely packed with fiber-resistant starches, and they also have polyphenols too. So we're talking about like something that was strategically designed by nature basically to feed the gut bacteria. And I totally agree with you, they're not for everyone. And for people who do struggle with their gut issues, the starting point could be something like, for example, lentils, which are soaked. And so typically the smaller ones will be a little more tolerable.

Yeah. So one of the things we wanted to focus on today is Crohn's disease, which I haven't had anybody speak about in a while. So can you talk about the different types of Crohn's and how you might approach them differently?

Yeah. So we think of Crohn's in terms of phenotypes, and I think in the future we may be able to get more specific with this because we're kind of taking this label of Crohn's disease, which indicates, I guess for the listeners at home, this is a form of inflammatory bowel disease. You can think of it in the same family as ulcerative colitis, but to me as a gastroenterologist, these are distinct health conditions. And with Crohn's disease, what makes it unique is that it can affect anywhere from your lips all the way down to your bottom, anywhere in between. And it can be in one spot and nowhere else, or it could be in different locations and skipping around and ha— and be involved. Some people are just the small intestine. Some people are just the large intestine. Some people are both. That's very different than ulcerative colitis, where ulcerative colitis is just the colon. And how much of the colon is involved is the question, but it's always the colon and it always starts in the rectum with ulcerative colitis. Now, when it comes to Crohn's disease, I've given this varied presentation. I think that in the future, we hopefully are going to be able to get more specific at looking at these specific types and then studying them and unpacking them further. But the main distinction that we will make is that there's some people that have what's called stricturing Crohn's disease. Where they form scars and those scars within the intestines get tighter and tighter and tighter, and it closes off and it affects the ability of food to flow through. And the issue with this, with the type of dietary pattern that I recommend, is that this can be trouble for a person who's eating a lot of plant-based foods, particularly the skins. So in my mind, I'm thinking about an apple and a pepper and things of this variety that have a skin. Those skins don't digest. And so they remain intact. You might chew them, but they're still quite large and they can bunch up like a meatball and cause a blockage. Right? So now on the flip side, if we're talking about a smoothie, it's a completely different thing because the smoothie is so particulate, so small. It's not going to form a clump inside your intestines. That's not possible. So we tend to, with these people, be very cautious with how we approach fiber. But I hope that the listeners are hearing me when I make this distinction between highly refined particulate plant-based foods versus things that are closer to whole foods that have a skin and therefore may be problematic for a person who has one of these strictures. I'm happy to talk more about the strictures because there's sort of two main elements to strictures that people need to know. One is inflammation and inflammation. If you properly treat it, that will go away. And the second is scar tissue. Scar tissue is not going away. So if a person does have a blockage, in theory, it may be possible to resolve the blockage in the hospital, the patient treating the condition, getting the inflammation under control. You may be able to do it, but there are some people that do require surgery for this. And then the second major type is what we call penetrating, penetrating Crohn's disease, which basically means that the inflammation is so severe that it may make connections to other parts of the body. And when it forms a connection, we call that a fistula. A fistula is an inappropriate connection between two parts of the body. So like, um, Crohn's disease may connect to the bladder or it may connect to another part of the intestine, or it may connect to a woman's vagina. And all of these things then will have potential manifestations and consequences. So these two types though, stricturing and penetrating, these are different phenotypes. So typically people aren't both at the same time. Typically they're one or the other. And when it comes to penetrating disease, I don't share the concern that I just mentioned a moment ago with the skins and fiber of that variety. All patients with Crohn's disease have deep dysbiosis. So what that means is a very damaged gut microbiome. And fiber is unique because while it is incredibly healthy, it also is the food that requires our microbiome in order to process and digest it. This creates an issue for people that have a very deeply damaged gut. The thing paradoxically that they need the most is also the thing that's hardest for them to receive. So in both cases, I apply rules, but I take them to an extreme. I apply rules that I would use for people that have irritable bowel syndrome or other forms, other manifestations of dysbiosis, but with the acknowledgement that in inflammatory bowel disease, these are typically the people with the most damaged microbiome. So the rules are that I typically, when it comes to these types of foods, I will start very gentle and then I will slowly ease into it. So I tend to like in this context, a low FODMAP diet. And Lindsey, I know that your listeners are quite facile. So FODMAPs, is this something that I should explain or how do you feel about that? Do you want me to get into that?

Briefly. I'm sure they've heard about it in other podcasts.

Okay. Well, FODMAPs, F-O-D-M-A-P, it's an acronym. It's super nerdy. It stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. And basically what this is referring to is the fermentable parts of our food and specifically fermentable parts that are carbohydrate or carbohydrate-based. Now this doesn't make them actually bad. In fact, they're good. They're good because the vast majority of them, what we would describe as prebiotic, meaning they feed and fuel our microbiome. But that being said, anytime we use the word fermentation, it's never a human biological phenomenon. That's always our microbes. Microbes are what ferment things. So whether it be in a jar and we're making some kimchi or sauerkraut or pickles, or whether that be inside of our own intestine and our gut microbiome is processing and digesting these foods, Fermentation is process that's actually done by these microbes. So the point is that for people that have a damaged gut, their microbiome, those microbes, they're just not in a good spot. And by going low FODMAP, it allows us to actually give them the space that they need to heal and be gentle. We don't want to do low FODMAP in perpetuity.

Right.

But for a period of time you make this play and the intent is to sort of gently ease into feeding the microbiome as opposed to aggressively doing it and stuffing it. And so there's actually data, like there's been data for many years on irritable bowel syndrome. Anytime we talk about irritable bowel syndrome, if you have inflammatory bowel disease, you almost certainly also have irritable bowel syndrome underlying it. It's an overlap. So there's data with irritable bowel syndrome, but now there's also data more recently with people with inflammatory bowel disease, two things. One was a 6-week study where they had people with inflammatory bowel disease follow a low FODMAP diet, and they actually improved the measures of gut inflammation.

Mm-hmm.

So that's a beautiful thing. And then the second was among these people with inflammatory bowel disease, they discovered that they had improvements of their symptoms and improvements of quality of life. So the point being that if I were to take a person who has Crohn's disease and I look at them and what I see from my perspective is a person who has a damaged gut microbiome because their gut microbiome is damaged. Their gut barrier is broken and this has activated the immune system. Inappropriately. And the immune system is on the attack. And when the immune system goes on the attack, people think about things like autoimmune disease. What's interesting is that inflammatory bowel disease, I actually don't consider to be autoimmune. Really? Very similar, but I think worth pointing out, cause it's more than just semantics. It's, it's understanding what's happening in an autoimmune disease. Your immune system is attacking you. In inflammatory bowel disease, your immune system is attacking your microbiome. So it's a rejection of your own microbiome and your intestines get stuck in the middle.

Interesting.

And so the inflammation that manifests is the result of the inflammatory process manifesting in the lining of your intestines, but your immune system is not trying to attack your intestines. It's trying to attack the microbiome. And the way that we heal this broken, damaged gut microbiome, broken gut barrier, and confused immune system, the way that we ultimately want to heal this is by healing the gut microbes. Because if we can do that, if we can reverse dysbiosis and move back to a normal, healthy, balanced microbiome, which the term is eubiosis for that, eubiosis. If we can do that, then that balanced, healthy microbiome will allow us to repair and restore the gut barrier, which is like, that's how we accomplish that. And when you repair and restore the gut barrier, then you simultaneously are going to give the immune system the space that it needs in order to, to manage itself, to heal, to stop attacking.

Hey, this is Lindsey here. Just letting you know that if you're tired of dealing with digestive issues, like bloating, indigestion, soft stool, diarrhea, constipation, reflux, IBS, IBD, or the numerous health conditions that come about when your gut is off, like brain fog, weight gain, UTIs, fatigue, mental health issues, or complex conditions like fibromyalgia and ME/CFS. That's my specialty. With my 3 or 5 session gut health coaching packages, we'll discuss different stool and functional medicine tests to find out the root cause of your symptoms. I'll interpret the results and provide clear explanations, empowering you to make informed choices for your gut and overall health. And together we'll develop a customized action plan based on your test results so you can find relief and regain your health and vitality. I come from a functional medicine perspective, trying to incorporate the latest peer-reviewed research and educating you on protocols used by functional medicine practitioners, but devoting lots of time and support to my clients the way a doctor simply can't. If you're interested in a 3 or 5 session Coaching package, you can sign up for complimentary 30-minute breakthrough session, or if you can only afford one appointment at a time, you can book an initial 60-minute consultation. Links for those are in the show notes. Now back to the show.

Yeah. And so are you using comprehensive stool testing to assess the microbiome?

So with Crohn's disease, I haven't actually found comprehensive stool testing to be something that I would allow to lead. I find it to be a complimentary piece. So I don't yet believe that these tests are in a position of like being ready for prime time in the sense that what I want to know, like with a patient with Crohn's disease, I want to know how they feel. The expectation is that symptoms are present as a result of their condition. And I mean, I should say like, it's not, it's not universally true, but generally speaking, symptoms are present in response to their inflammation. When the symptoms improve, it is because you are improving the inflammation. I want to get them into a symptomatic remission. That would be the first step. And then the second step is to get them so completely free of disease that you can't tell, that you can't tell them from another person who doesn't have inflammatory bowel.

And are you talking about interventions with diet or are you talking about using immunosuppressive drugs or?

So the way that I sort of see this interplay is, I guess, like, let me, let me put my sort of general philosophy as a medical doctor out on the table, which is that what I care about is people being better, right? And to the best of our ability, addressing the root of the issue and not just covering it up. Because I feel like when you just cover it up, you might get them better temporarily and then they get worse again. So with this in mind, the answer to your question depends a bit on the intensity of the, of the health condition. For people that have mild Crohn's disease and it's not severe in terms of the effects of inflammation or in terms of the symptoms, then we have more leeway. We have more give. Rebuilding and repairing the gut microbiome, it takes time. To me, what we're talking about here is not a 4-week process. I don't even know that it's really a 4-month process in my mind. Generally, people that have inflammatory bowel disease, to really get to where I would want them to be, we're talking at something on the order of like minimum of 6 months, most likely 12 months, somewhere in the range of 12 to 18 months, right? To truly get there. I won't sit back and have a person progress to the point of requiring surgery with Crohn's disease. While we're waiting for diet and these things to kick in. So when it's appropriate and medically necessary, absolutely, I would treat them with medication. My issue with medication is not the fact that they exist, because I'm glad that they're there and they can really help people. My issue with medication is that we have built a healthcare system that almost entirely is focused on providing the medicine with absolutely no acknowledgement that these other aspects, which actually are the root issue, are relevant. That to me is the problem. And I actually, this is an interesting thing, which is that I would have drug reps that would come into my office and they did not like me. And the reason why is because I literally said to them, I know that's not you, but your company has created a drug that they're charging people thousands of dollars per month. And you're asking me to prescribe this, but then you don't teach me or provide the clinical study necessary for us to know how to stop. And I don't think that's fair because you're making a ton of money. You should be not just funding a study to start the drug. You should be required to fund the study to stop the drug.

Yeah.

That's not their business model.

That's not what they're going to do.

Right. But that's the problem.

Because is that at the end of the day, like, I feel like that should be a requirement for approval of particularly these drugs. So the issue with Remicade or Humira, right? Infliximab, adalimumab, like those are sort of the two classics when it comes to treatment of inflammatory bowel disease. The problem with these things is that if you stop it and you're wrong, they will form antibodies. To the drug because the drug is a biologic. So the immune system can react to it once you withdraw it and then you won't be able to put it back on board. And it's a, that's a serious issue because the data are very clear that the first medication that you receive that's in this class is the best that you'll ever do. And then the second one will be not as effective. And so my point is that I understand why doctors don't want to withdraw these drugs because they're afraid of losing the drug and not being able to bring it back. But it's not fair because the drug companies are, they know how much money they're making.

Yeah. So as you're intervening in the meantime on diet, is there, how are you correcting microbiome? I mean, I know, are you familiar with the research of Mahmoud Ghanoum at Case about the plaques and Crohn's and the presence of Candida and H. pylori and some of these plaques and such.

So I am familiar with Mahmoud Ghanoum. And so, and to me, when it comes to Candida, and I believe that he would agree with this, it's been a couple years since I talked to him, but he and I used to be in contact. I think that he would agree with me saying that when it comes to fungal infections, this is at least what I see in the data, that when we empower the healthy bacteria, They suppress the inflammatory yeasts. And we can see this quite readily because for the vast majority of people, thrush, which is Candida infection in the, in the mouth or esophagitis from Candida or vaginal yeast infection, these sort of manifestations of yeast, they are number one, when the microbiome is weak, right? And classically occur number 2 occurring with antibiotics, which of course the antibiotic is not the microbiome is non-existent in that moment because you've suppressed it. So, and then they come up and they flourish. So from my perspective, the solution is not necessarily to attack the Candida. I believe that the solution is to focus on building, building the beneficial bacteria. Because when we do that, like, I, I believe that the key to inflammatory bowel disease and many of these dysbiosis-based conditions is ultimately to restore healthy microbes and then feed them with prebiotics and allow them to release the short-chain fatty acids, butyrate, acetate, and propionate, because then those are what actually help to suppress inflammatory microbes, help to suppress inflammatory yeasts. Rebuild and restore the gut barrier. And also simultaneously they have direct effects on the immune system.

And so at what point in the Crohn's healing process is it safe to add in fiber?

So I believe that it's very early in the process, but I think that there's a strategic approach. So I guess, let me, let me talk through this. Let's pretend that we have a person for a moment who has moderate to severe Crohn's disease. All right. If they're actively flaring right now, I am not trying to put out their flare with fiber.

Right. Right.

And because they're actively flaring, the addition of fiber is going to be a mess and may actually make their symptoms worse because they're just not in a position to keep being capable of handling that. So ultimately we need to get this person into remission, which may require medication in order to do that. When they get into remission, this to me is when our process of healing begins. And the analogy that I would actually make, Lindsey, is, gosh, and I feel so weird even saying this. I hadn't even processed this until just now, but like, we obviously have the fires that are happening in California. So I hate that, but I feel like this is still the best analogy for me to describe this, that, so please forgive me and let's separate from that if we could. But if you have a fire that's burning, you don't plant new trees in the midst of a fire, right? You have to put the fire out, right? That's step one. You put the fire out. And then when the fire is put out, there is damage that's there. And the forest has been reduced down to not much, but there's also an opportunity to regrow, acknowledging that that opportunity to regrow does require time and patience, but it's possible. And so you put the fire out and then you replant the seeds and you allow those seeds to grow and mature, which takes time. So with that analogy and applying it to Crohn's disease, a person's having an active flare. I want to use medication when appropriate, Put the flare up, whatever is the least medicine necessary. Once they're in remission, that to me is when we really start to introduce the fiber-based approach. And my preference would be going back to what we were discussing a moment ago. I would generally start with a low FODMAP diet and then over time progress. So go from low FODMAP to moderate FODMAP. And then working our way up to less restriction over time. And simultaneously, from a fiber perspective, I would absolutely use a fiber supplement within that context. And so, as you know, Lindsey, I started a company called 38Terra, right? And I'm happy to talk about 38Terra supplements, but I think there's also this broader conversation that ignoring for a moment that I have a prebiotic supplement, just acknowledging like, what is the role of a prebiotic supplement within this setting? The answer is that it's targeted for the microbiome. It's not the same as food. It's not meant to be the same as food. It's not meant to be a replacement for food. It's meant to be a way in which you can confidently influence the microbiome and have control over that dial. So you can start with a very small amount and then you can work your way up slowly over time. And what I would opt for within that setting is I would absolutely opt for a low FODMAP prebiotic because low FODMAP, once again, still is prebiotic, still feeds and fuels the microbiome, but it's going to be more gentle to this person who has a damaged gut.

Yeah. So in terms of foods, you were talking about smoothies and how, you know, if they're blended up, the fiber is not so difficult for somebody. Is that like an early way of introducing fiber? So would higher FODMAP foods that were in the context of a smoothie be acceptable where they might not be otherwise?

Ultimately it depends on how they feel.

Yeah.

So if they, if they were to do a higher FODMAP and they feel totally fine, cool. You're good. And if they struggle with that, then we have to back it down and move towards something that's more simplistic and what, and lower in FODMAP content.

Is the struggle gonna look like pain in the context of Crohn's, or is it gonna be like loose stool or diarrhea or constipation? Like what are, what are the primary symptoms that people are gonna be suffering from?

It really depends on the individual. And it depends cuz the, the issue is that the disease can manifest in so many different locations, but varying degrees of intensity. So small bowel disease manifests in a rather different way. Like for example, the discomfort with small bowel disease will typically be felt around the belly button. So if you have small bowel Crohn's disease and you're having intensification of discomfort around your belly button, you know what's going on there. Whereas colonic Crohn's disease, the colon basically frames the abdomen around the outside. So right lower quadrant, right upper quadrant, left upper quadrant. These are different places depending, like that could manifest. And again, I think it's understanding your own disease where you typically manifest it and how that, and what sort of symptoms you experience. The lowest, most common symptom is bloating. Anytime the gut is struggling to process and digest food, you get bloating. So, and it's not to say that the smallest amount of bloating should be something that scares you. That's not the way that I feel about that, but it's the acknowledgement that ultimately what we're trying to do is get you to a place where you're comfortable and then grow from there. Because if we can start with you being comfortable, then we have our baseline. And then from the baseline, we'll continue to push over time.

So you mentioned the crossover of IBS with IBD. So in some of these cases, this bloating could be caused by SIBO, conceivably.

Definitely.

Right. So are you, are you testing for SIBO then and treating that?

Potentially, but SIBO, so I guess the thing with SIBO is I'm a bit sensitive when it comes to SIBO. And I'll just admit that my fear is overtreatment. Because typically the treatment for SIBO is antibiotics, right? Bacterial overgrowth. Therefore, we must reduce the volume of the bacteria. We must cut them down. And antibiotics are a routine part of care with these people that have inflammatory bowel diseases, including Crohn's disease, and they're highly effective. But the issue though, is that ignores the root of the issue, which to me is dysbiosis, a damaged gut. I believe that dysbiosis is at the heart of Crohn's and other forms of inflammatory bowel disease. I believe that it's at the heart of irritable bowel syndrome. And I believe that SIBO is quite simply a manifestation of dysbiosis. It's just a form of it. And so, so my, my concern with, with this particularly is that I don't want to rush to be put into a position where I feel that I have to treat a person with antibiotics because the test is positive. So there are people who need antibiotics. There is no doubt. There are people who definitely have SIBO and that's like, ultimately we have to get there. But my fear is that we're paying a price where in the short term they're better, in the long term, not making them better.

Yeah.

But I mean, there's definitely approaches that don't involve antibiotics like serum bovine immunoglobulins or herbal antimicrobials that are more selective, like the pomegranate husk or gosh, there's, I mean, there's heaps of them. Turmeric, Andrographis, lots of things. So how about those approaches then?

So those approaches, it depends on, like, to me I would have to get, take a look at the specifics of what we're talking about. So an example, oregano oil, I would have concerns about.

Oh yeah.

So, because it's like we're talking about, you know, broad spectrum antimicrobial. And I understand like it's not an antibiotic, it's the same thing from my perspective, right? Whereas when we're talking about something that's more on the spectrum of raw garlic, or you mentioned pomegranate husk, or you mentioned turmeric. Okay. Well, the thing that's interesting with these things is that that's not an isolation antimicrobial that's in combination with prebiotics. So curcumin is a polyphenol. And so the, the health benefits that we receive from turmeric are the result actually of the gut microbiome and the effects that turmeric has on the gut microbiome. All right. And the same is true with pomegranate in terms of ellagic acid and other prebiotic polyphenols that exist naturally in so my answer to you is I have less concerns about those things because basically what we're talking about here is a prebiotic being packaged with something that we talk about being antimicrobial, but more selectively.

Yeah.

And I'm, and I'm seeing this not as an antimicrobial. I'm seeing this as a prebiotic building.

Right. Right. Okay.

Because my fear is that we're not building. That's, that's my fear.

We're just cutting.

Yeah.

The building process is ultimately going to take care of the cutting process that they're going to sort of, you're going to feed the good microbes and they're going to outgrow the bad ones without having to break down the bad ones.

Yeah. And there's healthy, there's healthy foods as you've already pointed out. And then I would put my stamp on that. There's healthy foods that do have antimicrobial or antiviral effects that have been demonstrated. Yet that's not in isolation. We wouldn't characterize them as an antimicrobial. We would just say that they have that effect. It's in combination as part of a package that also is, is many times prebiotic and therefore good for the microbes.

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So tell us about your supplement and what's in it and then, and how it's helpful. And it, is it helpful in, in particular in Crohn's or was that, in your mind as you developed it, or was it just generally developed for building up good microbes?

So the way that I was thinking about this is, I guess, you know, to, to frame the context, I have had incredible success treating people with prebiotic supplements for many years. But the thing that always troubled me is that the standards that I hold, I'd never felt like the supplements were there, never fully. Like fulfilling those standards. And so this led me to want to create my own because I, with confidence, believe that there is a role that this exists for optimizing the gut microbiome and then receiving the effects and the benefits that come from the production of short-chain fatty acids. So to me, that was the general approach, was I wasn't necessarily thinking about a specific disease state per se. It's more so to say that, okay, what we know with 100% clarity is that when you put prebiotic fiber or resistant starch or polyphenols in the mouth and swallow, we know where they're going to go. We know what they're going to do, right? It's the, because there's no place else for them to go. They are going to come into contact with the microbes and then those microbes will ferment them and create short-chain fatty acids. But what I felt was missing is that many of the fiber supplements that exist are monofiber, one single type. And in some cases, people advocate for using them at ridiculously high doses, 15 or 20 grams. And so what happens when we only consume one type of fiber? Well, you only feed certain microbes and there is such a thing as too much. And this is part of my concern with, for example, inulin. Is that does inulin have studies to say that it's beneficial for our microbiome? Yes. There's also studies that say that it can be inflammatory and problematic if you do too much. So I wanted to create balance. I wanted to create something that had multiple different forms of prebiotics, different types of fiber, also resistant starch, and also polyphenols. And I wanted them whenever possible to come from something that has been clearly studied in humans with randomized controlled trials demonstrating that number one, if you take this product at this particular dose, here's the effect that it's shown to have on your microbiome. Mm-hmm. Number two, it will affect your bowel movements, right? That to me is part of the proof that we're actually achieving something of benefit is if your, if your bowel movements are not the same, like the proof is in the poop. And then number three, benefits beyond this. So such as the improvement of gut symptoms like bloating. So as I pieced together the formula, there's 7 different prebiotic ingredients and they include resistant starch, which comes from potatoes. By the way, that's a, it's a bit of a unique thing. It's not the same resistant starch that you get by heating and cooling the potato. This is the resistant starch RS2 that's innate to the potato if it's uncooked. As well as kiwi fruit, mango, beets, lingonberry, and acacia and baobab. Acacia and baobab. I almost forgot those.

So, all right.

So it's 7 different, and again, it's a combination of fiber, resistant starch, and polyphenols. And I see these as being synergistic together. So we actually have clinical study that's occurring right now. That we should have the results in the next few months. And part of what we're doing with this study is to demonstrate the synergy that exists when you take resistant starch and you add fiber and then subsequently polyphenols, because my expectation is that this is like priming the pump, getting the microbiome organized and prepared to basically create these short-chain fatty acids. So, all right. Now, as it relates to Crohn's disease or these different health conditions, irritable bowel syndrome, or even small intestine bacterial overgrowth, a few of the things that we did specifically and strategically, number one, it's low FODMAP. So this is uniquely and strategically formulated and it's certified as low FODMAP. It's intended to be gentle on the gut. Number two, it is certified glyphosate-free. But it's also taken much further than that. One of my concerns with, for example, gluten-containing products or oats, or many of the things that people worry about is maybe it's not the actual plant itself. Maybe it's what we're putting on the plant, like glyphosate. Because to me, if you go to Italy and you can eat the food, which a lot of people say this, It's not the actual wheat. That's the problem. It's the way we're treating the wheat. So the product is certified glyphosate-free, but then beyond that, I'm actually really proud of the fact that we have extensively tested every single batch for more than 50 different pesticides. And it's been negative every single time on every single test.

Hmm.

We third-party test far beyond this. This is a big part of what I was hoping to accomplish by creating my own brand. Is that we've run over 100 different tests. That includes heavy metals. It includes microbes and pesticides. It also includes unique things that like I literally have to get the laboratory to figure out how to get this done, like histamine and salicylates and methyl salicylate. So in essence, what we're doing is we're basically looking at things that can cause food intolerances that are specific to people with gut health issues. And for any batch that you purchase, you can find on the packaging, on the bag, here's the lot number. You go to our website, you enter that lot number, and an entire report is downloadable for you to actually see the results specific to that batch.

Yeah. Well, I've been trying it since you sent it to me and I will, I will vouch for the fact that it is light and fruity and you add it to some water and it just makes sort of a light fruity beverage that tastes good and doesn't, isn't overly sweet. Is, is there, what kind of sweetener is there in there? Is there like stevia or something or?

It's got monk fruit.

Monk fruit. Okay. Cuz it did. Yep. I normally don't like monk fruit. Like monk fruit to me can be overbearing and, and sometimes weird, but it doesn't, to me, I didn't detect any kind of bitterness or bad aftertaste at all. It was just sort of light and pleasant and not too sweet. Like a lot of, a lot of these things like the electrolyte formulas and whatever, I'm just like, eh, way too much. It was not like that. So I will, I will vouch for the taste and also the fact that it, it didn't gum up. It wasn't like, a typical fiber supplement.

Yeah, it dissolves pretty well. You'll see a little bit of white granular powder and that white granular powder is actually the resistant starch.

Hmm.

So, and that's because resistant starch is unique because it's not soluble fiber yet. It's still prebiotic fiber.

Yeah. One thing I was wondering about though, on the, on the label it says, I think, was it maybe 5.9 grams of fiber? Per 2 teaspoons, but then it breaks it down and it says 2.6 grams. So I was sort of confused, which is it?

Yeah.

Yeah. Yeah. So the actual serve is 5.6 grams.

5.6. Okay.

All right. And when you dig into the amount of actual fiber, it's less than this, which by the way, to me is reassuring. And the reason why is because these are whole food ingredients. So like this is taking whole food ingredients, deriving a powder, and then putting it into the formula as opposed to some sort of chemical extraction process where you are isolating the fiber and nothing else. So what you end up with is that you end up with less than the 5.6 grams as actual grams of fiber. But the key from my perspective is that to me, it's like addressing our fiber deficiency is not about grams. To me, it's about a variety of different foods and feeding and fueling the microbiome to an adequate level. So what we have, for example, is we have two ingredients that have human clinical trials to show what they do. And the cool thing about it is they both have been shown to improve the health of the microbiome. So like an example is Solinol, which is the resistant starch increases acromantia levels by 317%.

Wow. At what dose?

At 3.5 grams per day, which is the dose that is in a single serve of this product. So basically like we wanted to meet the standard of that trial. So we included that precise amount.

Okay.

The Actazin, which is the kiwi fruit, a very small dose has a very powerful effect. So 600 milligrams of Actazin per day, because the kiwi fruit fiber is quite powerful, is able to achieve an improvement in fecal bacterium.

As in the CI?

Fecal bacterium as a, a genus, not necessarily Prosthesiae specifically.

Mm-hmm.

Yeah. And then they also more recently published a paper discovering that it also increases Akkermansia levels. And so now Akkermansia, like I, I'm sure that your listeners have heard about Akkermansia, but this is a powerful anti-inflammatory bacteria that protects people from inflammatory bowel disease. And there are companies that are selling probiotics and those probiotics may be alive or they may, they may even be dead and they're extremely expensive. And my argument is, I mean, nothing against those companies. If they help you, they help you. That's what I care about. But my argument is that if we could actually feed, target and feed our own Akkermansia and help that to grow, that's ultimately what we want. We don't want something from the outside that just passes through us. We want something that sticks.

Yeah. And I, interestingly, I have seen clients and you see on a, on a stool test or on a metagenomic sequencing that they have no Akkermansia, no Faecalibacterium prausnitzii. And then it'll come back. And sometimes this will be having not, I mean, of course having not taken a probiotic for, uh, for Presynitzia, but sometimes, and sometimes not having taken the Akkermansia probiotic, but it can come back just by feeding it. So that whole below detectable levels, it doesn't mean it's not there somewhere. It's hiding up in there, maybe in the appendix somewhere, right?

Oh, I totally agree.

Yeah.

That's a great point on the appendix. I hadn't even thought specifically of that. That's a good point. In my mind, the way that I thought about, I've thought about these things is that just just because it's not detectable doesn't mean it's dead. Right. Doesn't mean that it's totally gone. That is just, is below the, the ability of our tools to detect, which have their limitations.

Yeah. So are there any other lifestyle or supplement or non-conventional interventions that are your regular go-tos in Crohn's?

So I think that there's other supplements that can be beneficial in Crohn's disease. I, you mentioned turmeric, so I'm of the belief that turmeric is something worthy of consideration for all people that have inflammatory bowel disease. The starting dose can be as gentle as 500 milligrams once a day, but that's a starting dose. And then we start to ramp it up and quickly get to 1,000 milligrams a day and potentially more than that, potentially up to 2,000 milligrams per day. I also am a believer in vitamin D. Hmm.

Yeah.

And the beauty of vitamin D is that it can be a test-informed and targeted approach. So you're not blindly taking the supplement that actually you test and then you address the level. Yeah. And the goal for people that have Crohn's disease, typically for me, I would target numbers of 40 to 60. And my observation is that vitamin D levels are consistently low in people that have dysbiosis because there's actually a connection. Between vitamin D and gut barrier function?

My observation is that they're consistently low in anybody who's not supplementing because nobody gets enough sun.

Yeah, that's true. Most people don't get enough sun, but I also think that we are living in an epidemic of dysbiosis these days. And I think that that, that's part of what feeds into this as well. So the other thing too that's kind of interesting about vitamin D is it's a, it's a fat-soluble vitamin. So vitamins A, D, K, and E are fat-soluble vitamins. So what that means, a few things. Number one, when you take your vitamin D supplement, take it with fatty meal. It will improve absorption. But number two, in the context of obesity, you can actually have lower vitamin D levels as a result of obesity, because basically it spreads out throughout the body and it can end up in fat cells where it's not even functional. It's not helping you. Yeah. So vitamin D, again, I would target 40 to 60, but if a person were not doing testing, then I would probably, most people talk about 2,000 international units per day. I'm more of the belief that we need to go higher and harder than that cuz I don't think that's adequate. So I typically would probably go at 5,000 and as high as potentially 10,000 if there were a need.

Mm-hmm.

Per day.

Yeah. And then testing every, 6 months, every 3 months? How, how often would you test it if you were supplementing at that level?

Well, if I'm trying to get them up to goal, then I would test more frequently. Probably 3 months would be the, the target there. Yeah. Once I have them at goal, then it, like, you make an assessment, like how hard was it to get them there?

Yeah.

If it was hard, then you might test them a little more often just to make sure you're maintaining it. Mm-hmm. But like over time you hopefully settle in, you find the, the amount that you need and then you just stick with it.

Yeah.

So anyway, I like that. And then I also am a believer on some level on the importance of adequate omega-3 intake, specifically EPA and DHA.

Yeah.

And, you know, unfortunately the vast majority of people, like, this is again, another one that you can test. It's the omega-3 index and the omega-3 index basically is a percentage and it tells you what percent of the total body fat that's detectable is actually made up of these types of omega-3s. So a few things on omega-3s real quick. Omega-3s are anti-inflammatory fats. They're polyunsaturated fatty acids, PUFAs. When people, when I hear people trashing PUFAs, I get a little bit bothered because omega-3s are PUFAs. They're good for you. Whereas omega-6s is a different story. And we can talk about that if you want to. We get plenty of omega-6s. Most people don't get enough omega-3s and it leads to an unhealthy balance between those two fats. So we want to reduce our omega-6 intake, but we really want to increase our omega-3 intake. There's three main types of omega-3s: ALA, EPA, and DHA. And the issue is that if you eat just seeds, which by the way, can be a source of omega-3s like chia seeds, flaxseeds, hemp seeds, and walnuts. It gives you ALA, but the conversion rate is extremely poor.

Yeah.

And so ultimately I'm of the belief that, look, if you can get your omega-3 index up to goal, which for a normal person is 8 to 12%, and if you have Crohn's disease, I would want you 10 to 12%. If you can get there up to goal without a supplement, I'm happy for you, but a lot of people cannot. So this is where the choice that's on the table is we want an EPA and DHA supplement, and you can do fish oil, which is less expensive, or you can do an algae-based supplement. I tend to, when possible, opt for a high-quality algae-based supplement. And the reason why is the purity.

You're saying allergy?

Algae. So A-L-G-A-E. Algae.

Oh yeah. Yeah.

Like algae from the ocean.

Right. Right. Okay. Yeah.

Yeah. So I tend to favor the algae-based supplement for purity reasons. So you can create that and it's just, just the omega-3. And the problem is that when it's fish oil, it's not The fish is creating the omega-3, it's storing it, but it's also storing other stuff. So unless we know that it's pure, I have concerns. Anyway, the, the dosing for a person that has complex inflammatory conditions like Crohn's disease is very high. Typically we would start off in the range of 500 to 1,000 of EPA plus DHA. But with these complex inflammatory conditions, you work your way up to 2,000 or 3,000.

And are we talking about krill oil now at this point, or what is the algae-based one?

Krill oil could suffice. Like basically all of these things come from the ocean.

Yeah.

So there's the long-chain omega-3s, but algae-based is krill. Krill is an animal and it's its own unique thing. Like whales eat a lot of krill. Algae though is the plant and it could be grown in a farm. And still produce high quality EPA and DHA.

Yeah. So, but I know the, the vegan sources are, it's really hard to get much EPA or DHA without taking tons of it. Like they're like, it's really expensive to get there.

So I think it's, it's becoming increasingly available. The ability to get the, the vegan long chain again, like what I'm looking at is I'm going to turn the label. I'm going to look at it and I want to see, How much EPA and how much DHA?

Yeah.

And I'm gonna add those two together.

Yeah. I mean, is there one that you are familiar with that's Thai? Cuz I've, I've looked for this for clients who are vegan and I'm like, I can't find anything that's, it's more than like, you know, 300 of the two of 'em in a whole, in a pill.

I mean, I don't know the brand off the top of my head.

Okay.

I, I have seen them that are about 1,000.

Oh really? Okay.

Yeah, no, I think it might be two, it might be two pills per serve and that gives you 1,000.

Yeah. I use the Pro Omega 2000 a lot because One pill, 1,000 EPA and DHA. It's like, yeah, done. Yeah.

No, that's great. And for these people, so 1,000 EPA and DHA for the vast majority of us is a sufficient amount.

Yeah.

But for people that have complex inflammatory issues, you're looking for an anti-inflammatory dose.

Yeah.

And so that's where you have to push it a little bit higher.

Yeah. Yeah. Okay. So this has all been super interesting, but unfortunately we're kind of running out of time. So I do just want to ask, number one, where can people find your supplement? And mention that they did make a discount code for my listeners that was PERFECTSTOOL, all caps for 10% off.

Yep. The code is PERFECTSTOOL and caps or not caps, it should work either way. Okay, thank you. If you have trouble, just let us know. Yeah. If anyone's looking to, to try out 38Terra, just use that code. You'll save 10%. Our website is 38Terra, so it's 38TERRA. And, and you'll find it there. And, you know, on, on our website, like we have a ton of resources. If you want to check it out, we have a science page, we have laboratory results. We also have a product guide that kind of walks through people through the specifics of how best to get the most out of our product. So, but nonetheless, go to the website, check it out. And honestly, I hope that it helps people and, and if it doesn't, just let us know.

Awesome.

And I will put a link in the show notes. It is my affiliate link. I don't know if the, the code is also gonna attach to my affiliate account, but if people wanna support the podcast, I love for them to use my links.

Yeah, absolutely. People should. And, and in the process of doing that, save 10%. That puts money in your pocket. That's the way to be.

Awesome. Well, thank you so much for coming here and sharing your knowledge with us.

Thank you, Lindsey Parsons.

That was great. So if you're interested in trying out the 38Tera, you can use the link in the show notes to support the podcast and use the discount code PERFECTSTOOL ALL CAPS or possibly not for 10% off. You can also support the podcast by buying supplements at a discount from my Fullscript dispensary, ordering tests at a discount from my Rupa Health Labs store, or using 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 me on X, Instagram, TikTok, and Pinterest. Links for those are in the show notes.

Thanks for joining me today.

Here's wishing you all the perfect stool.