The Overlooked Role of Nutrient Deficiencies in IBS and Gut Dysfunction with Amy Hollenkamp, RD

Welcome to The Perfect Stool: Understanding and Healing the Gut Microbiome. This is your host, Lindsey Parsons. Today I'll be speaking with Amy Hollenkamp, RD. She's a registered dietitian who has worked with IBS patients for the last 8 years in her private practice. Amy helps her patients overcome their symptoms without strict diets and intense protocols. Amy also has over 200 episodes of her podcast, The IBS Freedom Podcast, with her co-host Nicole Danetza. More recently, Amy has started a Substack where she hopes to share gut health insights and tips that will help you IBS-proof your gut for good. But before our conversation, if you haven't yet followed or subscribed to the show, be sure to do so now. And 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 recently updated free ebooklet, Finding Your Root Cause Through Stool and Organic Acids Testing, when you sign up. And if you haven't yet done my quiz on which stool or functional medicine 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 back to the show, Amy.

Yeah, it's been a long time. I feel like I was one of your early guests a long time ago.

You were actually my first ever guest back in 2018. And I am quite thankful you didn't hesitate to come on, especially given I didn't have a single listener.

Well, it's okay.

And you've had thousands of listens, so it's all good. But, uh, yeah, I've been following your blog lately and you've been publishing some really interesting posts. So I'm excited to have you back on and dig into some of these ideas you've been sharing.

Yeah, I'm happy to be back. Yeah, it's always fun. Hopping on pods and talking about gut health.

Yeah. So you wrote a long blog post on why you don't use stool testing much anymore and especially criticized the GI MAP in particular. So I was wondering if you could dig into that.

Yeah, I mean, I think, I think first and foremost, people oftentimes don't start with the foundations. So I feel like first and foremost, if someone's struggling with gut stuff, we wanna get back to the unsexy basics basically is, is how I would describe it. And I find that a lot of times people are very quick to test right out the gate. So I think in general, the philosophy behind it, I have some issues with cuz it, I think sometimes we kind of jump straight to the diagnostics and don't sort of look at, okay, we know that, you know, optimizing nutrition is gonna help with gut health to some degree. I know working on my sleep's gonna help with gut health. I know. So it's kind of going back to these basics cuz I find I'll work with someone who's done 4 or 5 stool tests and I'm looking at their nutrition and there's all these gaps, or I'm looking at their sleep and they're like, well, I sleep 6 hours, but it's fine. And I'm like, ooh, I don't know. Like we might wanna work on that and really focus on ways to improve sleep. And maybe they're having issues with sleep and it's not totally like something they've been able to hack, which is fine. I feel like that's That's a big part of it is I think that we get real zoomed in at like, ooh, this microbe's off. That means I have to do all this microbiome work when we might need to zoom out and actually do some other really key foundational work. And I find a lot of times people think they're doing, and they are doing maybe dietary restrictions and things that could help their gut health and help symptoms. But I think some of the bigger work, like optimizing nutrition as a whole really matters. So that's part of it. The microbiome testing is, is one of those things too, where there's this mindset of we know so much and there's still so much we don't know. So there's a lot, I think there are some things you could glean from a stool test, but we might not understand what a big chunk of your microbiome is. We haven't even figured out ways to identify certain microbes, if that makes sense. So like there's this whole part of your stool test that we might not even be able to identify. So having some humility of what, like what we don't know about the microbiome's also important too. So again, I think that those pieces are important. So working kind of on the, the key fundamental pieces and I think just understanding that like we're still trying to get an understanding of what the optimal microbiome even looks like. And I feel like sometimes the stool testing companies will come and be like, oh, we are very confident that this is the right range. For this microbe and this is certainly off and this means this. And there's just like this illusion of confidence that I don't know if we're necessarily there. So it's not like I totally don't use stool testing or like I don't think that there's value cuz I think there can be value. It's just sort of like how much stock you're putting into it and how you're using it and sort of maybe what the strati— what the, what you're implementing based on the stool testing. Cuz I also think sometimes the stool testing lends to a lot more of like a kill and clearance based mindset. I don't think you have to use the stool testing like that, but I think just a lot of the stool test companies sort of put that in a lot of their materials. Like, oh, you, we have the 5 Rs or whatever it's called where you remove and replace. I, I forget all the Rs, but basically there's kind of that, like, we look for the bad bug, we kill the bad bug, and then we move on to other things. And I, I haven't necessarily seen that need to be the case in practice. You can manipulate the microbiome and not be as kill-oriented. I think specifically about the GI-MAP, you know, I've had some providers that I've worked alongside who've done like split sampling and have gotten kind of weird results that weren't consistent between the split samples that make me a little bit nervous. Some, I find that sometimes the clinical markers are also a little weird and, and that aren't consistent with when we retest from other labs, like the elastase. Um, I've seen a a number of cases where it's been lower on the GI-MAP, but totally normal. And that could oscillate a little bit, but I've seen enough of a trend where I'm like, hmm, that's a little interesting. I also think the other, the other thing that always interests me too is podcast co-host. She had her like assistant put together a list of 100 GI-MAPs and look at all the data. Cause, cause she works with basically IBS, SIBO, like dysbiosis patients mainly. And what she found was really interesting is that there was only one with low bifido that was flagged as low bifido. So we're like, that's really interesting cuz like, seems like when we do other stool tests, like if we do a 16S or something, it does seem like a lot of our patients are low bifido. So like something's weird with that range GI-MAP-wise. Maybe again, it's just like the range is too broad or something. I don't know. But basically it does not flag bifido being low a lot of times, which is really interesting. To us in general. Similarly, I think Lactobacillus might have been like 7 out of the 100. It was another one that like didn't really register as low super often, but we've found in other tests that it is low. So basically again, it's just, that was one piece of it. And then I think she did some of the split samples would like have true pathogens on one split sample but not on the other. And so it would change like the clinical decisions, which Again, I, I think it's hard. I, I feel like basically I think there, these tests are imperfect, uh, in a way. And, and I just think we wanna understand that if we're gonna use them. I've generally moved a little bit more away from stool testing and have been really focused on, again, I think the, the factors that would shift the microbiome. I think sometimes the stool testing can be a little distracting, in particular when people are doing like a bunch of them. When they keep repeating it and they're like, oh man, like I have this marker. Like it just kind of causes that, oh man, I have it, basically this infection-based mindset, which, you know, isn't necessarily true either. I feel like we can kind of manipulate levels of certain microbes in gentle ways. It doesn't have to be this aggressive. I got this boogeyman. I just feel like, I don't know if I'm being dramatic, but this is how I feel like some of the discussions go with my patients. That, oh my gosh, like I have this bad microbe and like I have to clear it. It, it kind of creates this worrying mindset. I, I just feel like sometimes the stool testing does that in a way when it might not need to be that like intense or aggressive.

Well, I know that Lucy Meiling did the split sample on the Calprote— and, and the calprotectin marker was off. And I've, I work with a, I have a mentee right now and I've been looking at a lot of the GI MAPs that she gets cuz the company she works with, that's their default test.

And yeah.

Calprotectin is elevated a lot of the time. I mean, maybe in that sort of yellow range, but elevated on a lot of people that didn't come in with gut health issues. These are like Hashimoto's people and such. And so I'm like, I don't think all these people have IBD.

I mean, yeah, no, that's, that's another one that gets weird. I, I remember specifically having a patient who I think it was like 900 and I was like, ooh, we might wanna like circle back to that, go to your GI, like, like another test. And I think it was a little elevated, but it was 100, you know, it was like, okay, this is not something I'd be extra alarmed about, but 900 would be something that I think you would need to take care of right away.

Right, right.

That's—

so yeah, I've, I've definitely seen that trend too. Yeah. Like sometimes more extreme examples like that. And, and again, I kind of wonder, is it, are they biting off like more cause there's so much in that test. It's like there's the clinical markers and the microbiome markers. Like, is it just too much in one test? Does that make it harder to make it accurate? I'm not like a scientist on stool testing, so yeah, it's hard for me to say. But yeah, I mean, I, I feel like it— the other thing that's a little weird about that test, and I didn't realize it as early as I maybe I should have, but my husband and I did a test, a GI Map. This was a long time ago, maybe like 4 or 5 years ago, like right when we got married. And I remember like he did the test and there's the line to fill it up, right? Like there's usually like a line, like fill to this point. I filled it like exactly to that point. He like filled it up to the brim and I'm like, how does this affect the test? I don't know. 'Cause the solution's supposed to like basically, I think neutralize and kill like, or like hold it in place. Mm-hmm. Again, I don't know the whole science behind it, but if the solution to like stool ratio's a little weird, like could that make the test wonky? It just kind of put an idea in my head because he got the results back and he had sky-high levels of every microbe. And I had kind of lower levels of every microbe. And I'm like, could that just be like a coincidence across, like between our tests? Maybe. I don't have the true answer to that, but it did create a, like a question in my head of like, even the amount of stool to like the solution that's supposed to be like stabilizing the stool, if that gets weird and isn't tightly regulated.

I mean, you'd imagine they must measure, right? Like put a certain weight of stool or whatever when they're—

Right.

Well, I mean, to me, the, the, the reference range is like, they should always be as a percentage of the total microbiome. Like, that's what I want. Cause like you do a tiny health pro, you're like, oh, okay. So 20% of your entire microbiome is this one bug.

Right.

And you do a GI map. If that one bug's not on their list of bugs, it's not showing up. Same thing for gut health.

Yeah. Right. That's what I put in the Substack article I wrote too. Like, it doesn't put anything into perspective if you're doing absolute values, which the GI Map does. It's like, okay, so I have this 10 to the 7th, like, oh my gosh, when it's, you know, it, it's, it doesn't put anything into perspective. Like that microbe might still be like in a, like in the context of your whole microbiome might be fine, but I think it creates this boogeyman mentality of, oh no, you have that Pseudomonas or whatever. And it's like, okay, maybe that's an issue, but I don't think we should just direct like the whole entire protocol because that is a little elevated on the test. Uh, when maybe you had like no other really other major markers, it's like there could be ways for us to like gently move that in the right direction if we're gonna like trust the test. So yeah, I, and, and I have had people, uh, I think the other thing that's interesting about microbiome tests is I've had some people with like fairly decent microbiome test and have crazy symptoms and you're like, okay, well there's other stuff at play here and and that's, I think, can, can be interesting too. Like people just sort of assume that the microbiome has to be like this big player and maybe it, you know, maybe it's not 100% there, but it's not doing anything crazy in terms of how the stool testing's coming out. Maybe there's something that we don't understand, like we haven't identified a microbe that's there, but nothing obvious is coming up. I think that that can be at play too. So yeah, it, it's a strange, it's a strange world to kind of maneuver through, but I think you're right. The absolute value versus the, percent of the microbiome, like looking at it in the context of all the microbes makes way more sense to me than the absolute values.

Yeah. So yeah. And the other, the other one, I mean, I use the GutZoober a lot because, well, for one thing I was using it a lot, especially when they had the deals for like 3 tests for $700. Yeah. But, but I hate their reference ranges and I've told them this, I've said 10 to 20 or above 20 or under 10.

I'm like, there's, this is completely outta context.

Like for this particular microbe, it might represent 0.01% of the microbiome and this other one, it might normally represent 5 or 10% and, and they're all in the same reference ranges so that if it's a little out, I don't know if we're talking about something that's completely taken over most of the microbiome or it's just a tiny little, a tiny little amount more than its tiny normal amount.

Exactly. And I, I do think the other thing too sometimes about microbiome testing is like usually I'm seeing people that have done a bunch of these tests. And I don't think it's just related to like this test not being the right fit or whatever, but basically it's like if this test was so useful, you would think that treating based on the test would yield results, if that makes sense.

Yeah.

And again, it's like someone, and it, it is, I think sometimes you're so like in the weeds with this stuff cuz I'll have people that'll come work with me and they'll be like, do I need to do another GI map? And it'd be like the 5th GI map. It's like, well, we've done, you've done 4 and nothing really has led to the right solution, or like it hasn't been that great from like a clinical standpoint. So, and there could be a lot of reasons for that, but you know, I think it just goes to show that the test isn't the end-all be-all. I think all GI stool testing isn't the end-all be-all. We want like a strategy that's going to push the needle and create a healthier microbiome. And there's a lot of other issues I think in this space that prevent people's microbiomes from getting better and from improving. But, you know, I, I do think there's probably an overreliance on stool testing to like direct clinical decision-making in my opinion at this point. And again, I think I still run stool testing here, here or there. It's not something I do on everybody, but you know, there's still value I think at, at certain points. But usually I would focus on the fundamentals pretty heavily before I would do any stool testing, which I think sometimes people do it in the reverse, which everybody has their own way, way to do it.

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.

So when you mentioned you're seeing gaps in nutrition, is there a common pattern? I mean, I know that obviously like the kind of people I'm seeing, there's certainly nothing I, most of them need to tell them to take out of their diet. It's usually I need what they need to put back into their diet.

Yeah. Well, I think that that's 100% what I'm seeing as well. Most of the time I try to work through like a hierarchy. A lot of my patients have dealt with like weight loss and this is like a sub-stack I'm working on today, so it's top of mind, but like they're under fueling altogether. And I think what people need to understand too is like, if you're not eating enough food, your body goes into this budgeted state. And one of the systems that gets hit really hard is the GI tract because the body sort of views it as like, oh, this is like less important than like breathing, like your respiratory system or your cardiovascular system. Like same thing with like hormones. Sometimes women lose their periods if they're underfueling. Not always. Like I've definitely seen people that are underfueling by a lot and still have their cycle, but you know, I think that's one thing you can see typically is like, oh, someone might lose their cycle or their cycle gets a little weird. So like that kind of takes a hit, but then your body sort of goes into budget mode and it's like, okay, we don't have tons of fuel coming in, so we need to really start downregulating things like thyroid hormones. A lot of times cortisol gets a little weird. One of its main jobs is to maintain blood sugar, so if like you're underfueling, and you don't have enough stored carbs, cortisol kind of comes in to bring glucose into the bloodstream and that does weird stuff GI-wise. So like all these hormonal patterns from undereating are pretty awful for your gut or just could make you feel awful. And I think what I try to, how I present it to patients is the, your body is trying to help you. It's trying to say like, ooh, she's not eating enough fuel. We're gonna not burn all that fuel. We're gonna try to save some of that or like store some of it. And not burn it as quickly as maybe we'd like to. Same thing if you're, if you lose your job or something and you have a certain amount of savings, you're not gonna go blow it like you have extra money. You might wanna be a little more, more cautious with how you're spending. That's what the body does. And so I think that's one of the biggest things I look for right out the gate is like, are you getting enough to eat or not? Because if you're not, it's gonna impact so much. And I would say like probably like 80% of my patients are not getting enough to eat. And they've worked on this, they've worked on diet, I think, with a lot of providers, but just never kind of looked at like, is the plate adequate? It's more like, oh, what's on the plate?

Is it because they're, they're trying to lose weight or is it because they're restricting their diet so much because of the gut symptoms or why is it that they're not feeling?

I think it's a blend of a couple things. I think big, one of the big things is like restrictive diets. So maybe they took out like pieces that were really huge in their diet and haven't totally found ways to replace them. Them. So sometimes that could be like gluten, all carbs, or yeah, carbs. Exactly. Carbs is a big one. All bread, right? Bread, that kind of stuff. And it's like, oh, they're eating whole foods now, which is great. But like they're also, maybe they're pretty active and it's like, oh, this is interesting cuz maybe they're just not totally fueling for their activity level. I think the other thing is sometimes I'm seeing people skipping meals for maybe they're fasting, like doing fasting windows. Uh, which I don't think necessarily is a bad thing, but you have to make sure that you're able to like make sure calories are sufficient if you're doing a fasted window. I think some people just skip meals because their symptoms are so high. So like some people are just having trouble eating enough and that becomes like a weird cycle that people get stuck in where they're kind of underfueling a little bit and then they're like digestive capacity and their motility goes down a little bit more and then they're like, ooh, that doesn't feel great. So they under— they continue underfueling and it's just the cycle that continues. Until they can find ways to get calories up and then their system kind of reboots a little bit more.

So constipation is, is how it's manifesting.

Yeah, I would say constipation's a big one. I still see people with diarrhea who are underfueling, but yeah, I, I think, I think a lot of things basically go wrong if you're underfueling metabolically, hormonally, nervous system-wise. It's just very stressful for the body. The, the other thing I would say is people that are underfueling, some people don't lose weight. So like that can be a little bit of a trickier one. Like, oh yeah. Where they're like, well, I didn't lose weight. And I'm like, well, I think it's just cuz your, your metabolism sort of met you where you were. Yeah. Whereas other people will lose a lot of weight and sometimes significant amount of weight. And I've, I have found in people that have lost weight, sometimes it takes restoring some of the weight for their metabolism to like kick back on. If that makes sense, like their body doesn't— they've lost like 40 pounds, maybe they're eating enough right now. If until they kind of gain maybe like 10 or 15 pounds back, they might not necessarily feel fully metabolically healthy.

Mm-hmm.

So I have seen that too. Sometimes it takes certain individuals to be, to be able to like increase their weight again a bit for their body to feel like safe to metabolically like run at an efficient rate. So I think that's interesting. I think like in terms of macros, I know you were mentioning carbs. I see sometimes carbs being a little bit low. That can do kind of funky stuff to the hormones as well. Similar to what I was describing, like thyroid hormones can get a little bit distort— like low T3 when there's too low carb. I think cortisol can get weird for the blood, blood sugar reasons I mentioned before if carbs are a little bit on the low side. So usually that's one area. I very rarely would say, I think a lot of my patients do okay with protein. There could be some people that might be a little bit more on like the vegetarian side of things or vegan side of things where they're low in protein, so that becomes a much bigger issue. So I kind of look at the broader areas first of like, okay, are we getting enough and is everything like fairly well balanced? And then from that point I will look at micros. I would not look at micros before then though, because if you're under fueling overall calories, your micros are likely gonna be a little low. As you increase more of the calories, the micros usually will increase unless someone has like a, a nutrient-related test that shows them that they're low in a nutrient, which has value too. I'll talk a little bit about that, but I like to assess like what someone's eating micronutrient-wise. What are their sort of like pain points? Are they really struggling to get certain nutrients in? And so that's usually something I'll, I'll get into a little bit later if we can get the first bigger pieces in place and we can get a much better baseline of the micronutrients. So I'll look at that and I will run more thorough nutrient-related labs in terms of things that I do with patients at this point. I, I don't run as much stool testing, but I do run way more micronutrient testing than I maybe have historically done in the last couple years.

Do you do full panels or are you doing like individual tests through their insurance or?

So it depends. I don't really care. I don't care how they do it, but usually I will recommend a certain, certain nutrients based on what I'm seeing. So like a lot of times I'll like do a little bit of review of what makes sense for them. So I'm doing like custom panels basically. So usually I'll just order them. You can order them now through Fullscript, but you could run them through Ulta Labs. Like there's a lot of options now to do it yourself, but if someone felt like their insurance could do it for cheaper. I'm all for that. I just have found like that's a whole nother animal in and of itself. I don't understand like the cost of labs. I was telling someone the other day, I ran B12, an iron panel with, uh, or an iron panel with ferritin and vitamin D through a provider. And I was like, oh, just run it through my insurance or whatever. I think I could order all those for like $50 or something fairly cheap. And they billed my insurance $800., and then I paid $200 and I'm like, what kind of racket is happening with blood tests? I just don't understand how like ordering direct can sometimes be cheaper. It's very strange to me, but I guess it's the nature of the racket that I don't understand. It's too over my head. But yeah, I'll, I'll order a number of nutrients and there, there are patterns that I've seen with patients in terms of like nutrients that can be fairly low.

What do you, what do you see?

I see vitamin A being fairly low.

I, I find that, do you test that a lot? Do, do you do beta carotene or retinol or both or?

Retinol mostly. So I'll look at retinol and I would say most of the time it's either low or at the very bottom of the range.

Oh, okay.

And, and granted things like diarrhea can lower vitamin A. I think getting the vitamin A up really helps with the immune function and inflammation in the gut and can help prevent infections. Like, I, I do wonder a lot about some individuals with post-infectious IBS. Like, I'd love to do like research on some of these areas just because there are some studies with vitamin A where they'll— they've looked at like, oh, you people recover better from like GI bugs if they have enough vitamin A in their system. And it's just a really interesting question as to, as to why some people get post-infectious IBS and then other people don't. It's like, whoa. I think there's multi-factors in there, so I'm not saying it's just vitamin A, but it is like an interesting variable, I think, is your nutrient status.

Yeah. Well, let's, we're, we're gonna dig more into that later, but, but tell me about other nutrients that you've, that you've noticed that tend to be—

yeah, I think zinc can be one that trends pretty low. You know, I've seen very, like, I've seen levels in the 40s before. I think sometimes people are kind of like right at the cut, like right at the cusp, sometimes in the 60s. So that one I think can also be really important for immune function, that kind of thing. Copper is actually one I see pretty low. I always run zinc and copper together because I have to figure out how I'm gonna like address the zinc. If someone has low zinc but they also have low copper and I'm loading them, them up on zinc, it's gonna affect their copper. But copper, I see low really regularly. You know, some of the Bs I look at, I've had a few patients with low folate, which is interesting, especially if they're maybe not eating some of the like fortified grains. Like they kind of remove stuff outta their diet and aren't like supplementing with anything would, would maybe increase the risk a little bit. I'm not saying you have to be eating the like fortified grains or anything like that, but I, I've had a few patients who have like pretty restrictive diets and then they have kind of some of these low B vitamins, folate being one. I look at B12 sometimes. Iron, iron's another one that I think can be pretty much low in most people.

Definitely, definitely menstruating women. But I tell you, I find a lot of people who are high as well. A lot of people.

Exactly.

And that's true. And that's my genetics for hemochromatosis. And that's, that's, that's me. I found out myself that I have that.

And yeah, that is very true. I feel like you get kind of both ends of the extreme, especially people that are like Obviously people that are more inflamed can have ferritin in the 300s.

Sure.

But yeah, I think that that can be a really interesting nutrient, especially if it's, I mean, if it's on the high side, you wanna obviously cor— do different things to help get the inflammation in the body down. But I find that low, low iron can be one that's just one, it's gonna maybe impact your energy level. So like people that just feel like, even if they don't have anemia, anemia yet, but their ferritin's low. Like I do see even just getting their energy back up a little bit being a super important part of them making progress GI-wise. I think it would— getting iron up is going to help GI-wise. You know, I've had even patients who've restored their iron and we think it was a bigger part in why their gut feels better. And there are studies specifically on how the gut's functioning, basically like a gut that has or when iron levels are higher, there's more permeability. If iron levels lower, there's actually more inflammation and permeability. So we need a lot of these mineral— and that's with most minerals. If you look at magnesium, that's also a mineral that when they've studied like actual permeability and like how the gut's functioning, if it's too high, it causes more permeability. If it's too low, it causes more permeability. So a lot of the, the minerals are very interesting when you look at— it's like a Goldilocks effect. But I think you could take pretty much any nutrient and link it to it affecting the gut-brain in some way. So that's why I like to focus a lot on these, these micronutrients and not get too in the weeds with some of these other things, because sometimes if you can just get like your nutrition up, inflammation at the barriers, barriers regulated so much better. And like a lot of these IBS-like symptoms start to kind of gradually decrease. It's not an overnight. Like shift. That's the problem I think with like nutrient diet related stuff is it takes time and there can be things you could do in the meantime that might help symptomatically. But in terms of building up the resiliency in the gut, I think it really takes optimizing nutritional status. I feel like it's a really hard uphill battle if your nutritional status is subpar. And so many people I'm sure that you work with, if you're dealing with restrictive eaters, there's, there's gonna be gaps. Somewhere. I mean, I don't think I can think of one patient where we didn't do something nutritionally to help them build resiliency and help with their gut-brain in some way.

So, in that same post that I mentioned earlier, you identified some common patterns of dysbiosis that people with gut issues tend to have such that you almost don't need to test cuz you kind of already know what it's gonna look like. And I agreed wholeheartedly with what you said, but can you, can you elaborate on that a little bit?

Ah, well I think I, I even think in general, I, I just released a post this week too. Like, I think there can definitely be interesting patterns GI-wise. I actually think a lot of the research tends to lean towards, especially with like SIBO, IBS patients, maybe having like more proteobacterial growth and that sort of stuff leading to a little more inflammation and having low levels of good microbes. Again, that's why the GI Map's so weird where it's like, okay, bifido and lacto and all these good microbes seem fine.

And they, and they don't, don't list proteobacteria amongst the phyla. You just get the two.

Right.

And you're like, um, well they're both low, so probably you have high proteobacteria, but I don't know. Yeah.

I think what's interesting about that is like the actual profiles that you see with dysbiosis in IBS patients is like a proteobacteria doesn't really love fiber. Do you know what I mean? Like that's always interesting to me is like this idea of, oh, let's starve out the microbes and then starve out the, the imbalance. I feel like Proteo is definitely gonna be more into sugar, into fat. And it's like, not that sugar, sugar and fat are inherently bad or evil, anything like that at all, but it's like this idea of demonizing fiber or ferment, fermentable fibers, I don't think really fits the hypothesis that like Okay, we can take this proteobacteria or this imbalance and starve it out. Like, I just don't think that that really— there's not tons of evidence to support that, which I find kind of interesting because people have kind of taken that and run with it. And I do think some dietary restrictions help symptomatically for sure. I'm not trying to say that they don't, but I feel like looking at the actual microbes that can be imbalanced in IBS, the recommendations dietarily, I think promote more of that in some way. So if the diet's restrictive and you're limiting certain fibers, I think you're gonna start getting overgrowth of certain microbes and that sort of thing. And it almost takes flipping that on its head. I think you could do restrictive diets to help lower symptoms, but that's pretty much the main thing that it does is it lowers symptoms. It doesn't correct an imbalance. And I feel like there's that idea floating around of like, oh, I can starve out these bugs. And it's like, we can't really starve out anything without like something else popping up. It's like whack-a-mole almost. It's like, okay, there's just no evidence that we can kind of really manipulate the diet in that way and cause like shifts to happen where we're starving out only the bad bugs, but the good bugs we're feeding in some way. I just feel like it's gotten a little bit misinterpreted and misused. Low FODMAP, I think, has a lot of evidence for lowering symptoms and it has a time and place, but the more that you can kind of maybe get symptoms under control and then like flip the script almost of like, oh no, now I need to add diversity in to feed all my different microbes that can do all different types of jobs for me is the main way to go when you're looking at these microbial patterns. So I think in the end you could get real locked in on like what microbes are growing and that sort of thing. And there's some relevance. And if you're targeting certain things, if, if a microbe is really overgrown or something, there might be value in that. But I think in general, we really wanna focus on strategies that help diversify the gut, which kind of gets lost, I feel, or is kind of an afterthought in some way of like, okay, eventually we need to do that, but right now we need to kill, kill, kill that micro— that Pseudomonas or something. Yeah, it gets— I think some of that's the targeting of certain microbes gets really skewed and some of the actual interventions that are popular don't really fit that model either.

So, uh, what do you think about breath testing?

Do you use it at all? Yeah.

So breath testing. Oh, this is another can of worms. Breath testing. Breath testing is an really interesting one just because I feel there's almost like two camps in my head of like, I feel like the researchers are not super hip to breath testing at all. Like the actual scientists doing a lot of like the GI research. But I also think like some of the MDs and some of the conventional, like big MDs are very big into the breath test. So it's like this weird dichotomy in a way. If you look at some of the research papers, they're like, oh, this test isn't great basically. But then you hear certain proponents of the breath test being like, this is the best test ever. So it's a weird one to wade through seeing kind of both sides. And I think it, it, it does kind of stink because in terms of like a te— a true, a truly good test for SIBO. I don't think we have. I don't, I think the breath test isn't great. I think the real, there's a couple real big problems with it. Probably the biggest being there's no real way to figure out if the increase in gas is coming from the small intestines or the large intestines. Basically the, if you're not familiar with the breath test, you take a solution and you breathe into these bags and they collect gas. And the theory is that if you have SIBO, the gas kind of happens before like the 90-minute mark or whatever, or the 60-minute mark, wherever the cutoff is for that particular provider's test, then you have SIBO because the gas that's being produced is supposedly in the small intestines because it, it happened before this cutoff. But I think in the studies, the cutoff, people's orocecal transit time, so the time it takes for them to get that solution from their mouth to the to the start of the large intestines varied from like 10 minutes to like 220 minutes or something like that. So like if you're someone with really fast oral cecal transit, maybe that 10-minute mark, that solution's hitting the large intestines at 10 minutes. Well, all you're gonna have tons of gas and it's not related to SIBO, it's gas from your large intestines. There are probably some issues going on there if your transit's that fast too. Like maybe you do have some issues with transit. Being too fast. But then on the same token, if your transit's really slow, like maybe it's the 220-minute mark, like about that 90-minute point, the solution has not reached the, the large intestines. And so like maybe you've had some gas increases, but you, you're maybe the solution's moving so slow down the small intestines that it's not gonna show spikes. So it's really, it's a really weird test, I feel like, to try to interpret when you don't have that data. And most of the, like, researchers at this point who have reviewed a lot of the breath testing will try to say, like, you should do basically a transit study alongside— I mean, this is not being done in practice at all, but like, watch where the solution actually is and then do the test so that you know, like, okay, that lactulose solution is in the small intestine, we see it, and you're getting a spike. That looks like it could be SIBO, basically is what they'd want to do. Because what they found, especially if you use that 90-minute cutoff, the 90-minute cutoff seems too long. I think they said it should be maybe like 77 minutes is the cutoff. If we're getting really like into logistics, that's, I think what some of the research papers show it should be a little bit, especially for lactulose, should be a little bit sooner. But like I've seen people use 90 minutes. I've seen people use 120 minutes. You know, I'm seeing people use like a broad array of different endpoints there and it can really, really skew like the interpretation of the data. So I think when you even use the 90 minutes, I think they were, it was maybe like 88% of the tests. I don't think it was a large study, but when they looked at people doing the breath test and they, they actually monitored where the solution was in the system, that 80, 88% of them were blowing basically false positives. I believe it was around 88%. Don't quote me on that, but it's around there. It's around the 90% mark are like false positives basically, which like, that's alarming because people who get diagnosed with SIBO get really locked into that diagnosis and then they're like, oh man, like I have to clear everything out, which I totally get. I had SIBO, was in that same state of like, I have this overgrowth, I gotta clear it out. I think it's okay to maybe like use a breath test and be like, okay, this is kind of interesting. Let me see if it's like consistent with symptoms. Like I still think you need to work with a provider if someone did do a breath test and try to figure out if it makes sense to pursue treatment for SIBO. I think if you can kind of put the breath test in the right, like, frame of mind, like, I typically would not spend money on it at this point, but if like a provider really wanted to use it or if they, they were like wanting to explore that and they, that's like their process of running it, running that test. I think the way I would think about it is like, I'd also wanna match it with my symptoms. And like make sure things seemed like it could be SIBO. And I think there— it's okay to maybe try treating it if you've done other things and nothing's worked and see what happens with treatment. If you try to treat it and it— nothing happens, like maybe you could try one other option, like either antibiotic or herbal or however you wanna treat it. But like, I find people will go down that SIBO road like over and over and do tons of herbals and maybe the first round was helpful, but like none of the other rounds were helpful. And that's really hard psychologically too. Like if you took Rifaximin or something one time and it felt amazing and you're like, wow, this is awesome. But then you do it the second time and it's not helpful. And then you're like, oh, maybe it'll be the third or fourth time's the charm. And, and I think it's just usually some of these like clearance-based options, like have their, have their season of helping, but then, and if it doesn't help, don't continue. Cause I, I find some people will get into that boat. Some people it never helped and they're on like their sixth round of something and it's like, okay, we this never helped before, we probably shouldn't keep doing it. Like, more is not better. And there's a whole range of people that have been diagnosed with SIBO who try treatment and it does not help, and they feel like, oh my God, I have like this insane SIBO case that's just like untreatable. Like, it's the, the rifaximin's not touching it. And I really kind of wonder if those people don't actually have SIBO or that like the typical SIBO protocols are not gonna help. Like we should probably maybe think of some other why your gut brain's breaking down beyond just like SIBO. Let's kind of zoom out again and see like what other variables are at play. You might not be someone that's going to respond to SIBO because maybe you don't have SIBO. Maybe there, maybe you just have dysbiosis, which also tends to be more linked to what the research says too. So I feel like SIBO is definitely real. I feel like sometimes people are like, oh, are you a SIBO denier? Which I'm not at all. I think SIBO is definitely real. It's just like, it's overdiagnosed with the breath test. And I think that you have to have fairly high levels for it to be, for it to be like the main issue. I think what most people have who are like put in the SIBO camp is dysbiosis of the small intestines seems like most problematic. There's that really cool 2019 study. From Nature where they looked at that, where they looked at like, it was SIBO linked to functional GI symptoms basically. Um, which there's a bunch of different diagnoses that fall under functional GI, but like IBS is the big one. I think like GERD, that kind of stuff. And what they found was that SIBO was not linked to the symptoms, that dysbiosis was linked to the, to the symptoms. So like the actual balance of the bacteria likely matters way more than the abundance. I think what the caveat to that is like how abundant is the bacteria. So like I think if the bacteria starts to get pretty high, old school SIBO, how they used to test for it, like in the 2000s, early 2000s, like late '90s, that's when you're going to have like a lot of symptoms that look like SIBO and where you get like people starting to have nutrient deficiencies and kind of some of these, the, the cluster of symptoms that we hear SIBO causes. So yeah, I think that a lot of people get sucked into the SIBO framework of like, ooh, I have SIBO, I gotta do all the SIBO-related things. And I think you, if you are in that place now, like how have you done with that type of work? I think some people do great with certain rounds of herbals and that's still good. Uh, that's great. I'm glad that those things help, but I think there's this whole cluster of people that haven't been helped and then they feel like, oh my God, I'm just this like lost cause SIBO case and SIBO is so hard to treat and they just sort of go down that mental rabbit hole. And in reality, I think maybe they're just looking at their situation wrong that maybe SIBO isn't like, it's something that they can kind of like keep in their orbit a little bit, but release a little bit and say like, okay, that path didn't help. Maybe I just really focus on some other things and like zooming out again and seeing like where, where's my gut brain at? As a whole, that sort of mentality and kind of going back to the drawing board versus kind of thinking that they're like broken in some way. Like, I just think that the protocol might have been broken for them, not that they're like some really difficult case.

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Well, I think it also helps to maybe distinguish between SIBO and EMO because EMO I have seen can be very recalcitrant. Like yeah, sometimes very hard to dislodge those methanogens. And I, I, I'm almost to the point where somebody comes and they've said, I've already failed, failed either antibiotics or herbals, then just take straight to the elemental diet. Like that seems to be like a pretty successful treatment for EMO and it's just that, you know, it's expensive off the bat and of course you're not gonna be eating, so people don't think so much about like, well, there's no grocery bill, but, but it is, yeah. You know, one of the more successful too.

Yeah. Yeah. I, I agree. I, I think like with emo too, sometimes I find, you know, things can be sort of stacked on top of each other as well. I've generally found too, I really liked PHGG doesn't work for every single person, but PHGG, I think can help with emo. I like to pair it with the Biogaia and PHGG. I like that for emo as well.

Okay. Gastris.

Yes. It might not do like the heavy lifting if someone needs more heavy lifting, but in terms of like if they've done some clearance and they're still kind of struggling a little bit, it can be helpful.

Post-infectious IBS. Let's talk about this because that, that's what I have had for all these years and Yeah, I've had positive antibodies. I've subsequently had negative antibodies, but honestly, I can't say that anything has really changed symptom-wise. Like, I still feel like I'm on that sort of treadmill where, you know, things start to get a little overgrown, gotta knock things back a little bit. And then, I mean, overall though, I'm not, I'm not bloated. I'm fine. Like, I'm, I'm generally good most of the time, so. Right.

Yeah. Well, I take two, like. Sometimes I think it's helpful too when you've had like post-infectious IBS. I find sometimes people will like try to compare their gut to like pre-infection of like, I have to get back there. And it's like, well, let's kind of maybe like turn the page a little bit and like the circumstances have changed a little bit. That doesn't mean that we can't like have you be mostly symptom-free most of the time, but like The fact is like maybe your symptoms have changed and they may, they like, I would not necessarily think that you're not a success if you can't get back to this point of like pre, like extreme. And I had a patient too who had like, he had 3 GI infections at one time. It was kind of wild. And he had, he's had a pretty gnarly case of post-infectious. And I feel like, again, like, ooh, that is like, he had C. diff. I think he had rotavirus and then Giardia all at the same time.

Oh gosh.

And so it was like nasty and it took, oh, and it, and he had kind of longstanding issues from it. And I'm like, well, we really can't compare. Like we can't necessarily say like, oh, we, the goal is to get back to this point of like pre, and that could happen. I think sometimes with post, post-infectious issues, it just does take some time for like things to kind of slowly get more calibrated and maybe you get back to that point. But I think there can also be like, okay, maybe I have like a little chink in the armor, but I can mostly still function normally and maybe still have like pretty normal days, but the goalpost shifts a little bit. I think having a mindset like that can be helpful. And I think about that too, like even with my, I had some postpartum, like OCD anxiety stuff. And I remember a therapist saying like, the goal isn't for you to have like the mental health state of like no pregnancy. Like, that's just not necessarily a realistic goal. Like, you're probably gonna be someone that has more anxiety and OCD postpartum, and that's fine. Like, we can move through that and like strategize how to do with that. But like, it's almost a page is turned, which I think it's helpful to like compartmentalize in that way. But I think with post-infectious, um, IBS, the immune system sort of takes on a threatened state and it's like, well, we had like this invader come in and like shake stuff up and we're not gonna let that happen again. It's kind of like what the gut the, the stature that the gut goes into post-infection. You know, I, I think there can be different things to consider and it's, it's something that I, I think there's so many variables, it's hard to totally understand, like again, why someone could have an infection and immediately be fine and someone else can have an infection and be thrown off. It could be the timing of that, like maybe it's mixed in with some other stressors and it just hit the immune system in a weird way. There could be genetic pieces, but I think again, it, it, it's one where I think you still have to zoom out and kind of look at the full picture. The gut might still be a little more sensitive to stressors in the gut-brain, but you can still look at different ways to, you know, support the gut-brain. Same would go for people with SIBO that don't have post-infectious issues or, or that just have dysbiosis. I think we still wanna zoom out and look at the full picture, gut-brain standpoint-wise.

So what are you talking about when you're, when you're talking about support for the gut?

Yeah, like nutrition optimization, what I talked about before, lifestyle factors, movement, sleep. And I, when I say these things, I don't think they need to be like A++. Like, I don't think you need to be like the best sleeper or the best mover or something like that, but like you need to be covering that base, like doing B work. You need to be doing B sleep. You need to be doing kind of like, you know, that type of work. So I think those things would still help someone with post-infectious IBS. It might not be the only thing, thing. I think the, the thing I would consider more so if someone had post-infectious IBS would be motility support would probably be more important. I think it's something you still have to play around with, with the individual and like figuring out what option would be best. I think there's certainly people that take like low-dosed pharma meds if they feel like they need to do that and, and that it's beneficial. I think a lot of people that I work with do well with different herbs. I don't necessarily think that has to be a supplement either. Uh, some people I think with like more mild cases of post-infectious IBS can do okay with like ginger tea a few times a day and chamomile. I, I like those three together. I think can be interesting if you consistently do it. Some people can manage just with that.

What was the third?

Chamomile. So like two ginger teas during the day and a chamomile. So kind of like taking those before bed. Yes. So I like those. Blends is like kind of like a, a mild way. Or if someone gets to a point where like they feel like they don't need the prokinetic supplements anymore, maybe they can do like a maintenance of like one ginger, one chamomile.

Yeah. And I mean, in terms of, of like herbal supplements, do you feel like there's any that are more successful as prokinetics? Because I mean, I've tried every last one of 'em and I can't say any of 'em made a huge difference in SIBO not coming back for me.

Yeah, I mean, I think there's some I don't love. One that I don't love is Motopro. That one just generally causes a lot of symptoms. Like it can cause ginger burn. It's just not— it on paper, it looks great. You're like, oh, it has chamomile, it has 5-HTP, it has all these things in it. But I just think the ginger can be a little rough in that one. Ones like Motility Activator, I, I would say I see people responding well to and liking one that that again, I wasn't on my radar that my podcast co-host uses. It's not really marketed as a prokinetic, but I've had some patients really like it is Acetyl CH Active. It's like an acetylcholine booster, so it's a little bit different. I kind of, sometimes it's interesting to me cuz I think a lot of like the motility activator tends to be more of like a bile supportive supplement, which bile increasing can help increase motility. But like acetylcholine, CH active's more of like an acetylcholine booster. It's like more of a neurotransmitter shifter. So some of these have like slightly different mechanisms of how they're increasing motility. So that can be interesting. I, I use that one a lot.

Is that, is that one that's good for constipation or diarrhea? Yeah. Or either?

I've used it for both. I think that one too, I've used a lot for people that can't tolerate ginger cuz that's something too. Motility Activator is usually pretty gentle. It's much more gentle than MotilPro.

If you swallow it with enough water.

Yeah.

All of these, that's, that's the secret. Don't, don't try and just one-sip it.

Yeah. Yeah. They'll get like lodged in your throat and a burning sensation. Yeah.

I can't tell you the number of times I've had that like stuck in it kind of feeling.

It's like, what the heck is happening in there? Yeah. It's like the worst feeling. I hate that feeling. I know exactly what you're talking about. But yeah, the, the Seedle CH Active is one again, wasn't on my radar. That I've used a lot and have liked and good for people that have like GERD or like reflux or just don't tolerate ginger. Another one I've used again more regularly lately, not as much like early on in, in working with people, would be chamomile as a, as a tincture or like a stronger dose of chamomile. You can play around with the dose of chamomile too, like taking fairly high doses is safe with chamomile. The only thing I would be careful of is if you're on like an SSRI or any sort of antidepressant, just because it can cause serotonin syndrome. That would be like my only caveat, uh, for chamomile. But you know, I do like chamomile a lot. That one, that one wasn't really on my radar. I mean, this was a long time ago when we talked to this guy, but we talked to an herbalist on our podcast. He was basically making an argument that like peppermint gets so much press. For IBS, you know, he'd be like, our IB Guard is like, off— even conventional docs I've seen give IB Guard. But he was saying, you know, chamomile is way better for gut-related things that like IBS-related stuff. And I was like, oh, that's really interesting. Then I started digging into it a little bit more and there is some like interesting data on chamomile and gut stuff and it has prokinetic properties. I find that it helps with hypersensitivity as well. So people that have a little more hypersensitivity, sensitivity, I think do well with, with chamomile. But that one can be an interesting one too. Again, they all maybe have a little bit of a different slant on like how they're affecting motility and sort of like the pathways that they're acting on. And, and sometimes that's the case, I think, with prokinetics. Sometimes it does take playing around with different ones. Sometimes too, it just like, maybe that's not the fit. Maybe prokinetics aren't gonna be the answer. To help with motility stuff. I think the other thing I would mention about Prokinetics, I feel like one of the biggest symptoms that gets helped with Prokinetics would be bloating. So I think a lot of times people think like, oh, the motility piece is gonna be the biggest thing, but I would look out for blo— how it's affecting bloating more than anything else. So again, like I just feel like some of these motility aids, it's like, oh, they're gonna like for sure correct my constipation or something like that, and maybe they help with constipation, but I would say the biggest symptom to look out for is like, how's it affecting your bloating?

Yeah. So I got on my Motegrity, but I, a quarter pill is about as much of 1 milligram is about as much as I can handle, but I feel like it's made a big difference compared to using herbal stuff. I don't know if you've found the same with your patients.

Yeah, I, I agree. I, I think that, that you should be open to the pharma prokinetic and again, I think dosing can vary, but like I find that a lot of people do well with like half a milligram or kind of a lower dose of prucalopride. So yeah, I, I've liked prucalopride. I haven't, I would say I haven't loved many of the other pharma prokinetics. Mm-hmm.

Yeah.

I've never tried any of 'em, so I, I mean, I think things like LDN or something could be helpful for other things.

Oh yeah, I'm on that, but that didn't make a lick of difference for me.

Right, exactly.

I think like I didn't hear anything.

Right. It's like, okay, that can be helpful for like immune system stuff. Stuff, but sometimes people are like, well, I'm on a prokinetic and it's LDN. And I'm like, yeah, that's not really, that's not really prokinetic. So yeah, I, I feel like it, it's with all this stuff, I think approaching it from the mindset of like, okay, I'm gonna experiment and kind of see like what works and what doesn't. I think maybe picking the options that I would tell people, like the options I see being the most effective herbal-wise would be a motility activator. Acetyl CH active and chamomile. And I really like that, those three. So like if you were gonna do an experiment, you could try each of those out for like 2 to 3 weeks and kind of see like, am I noticing shifts? Maybe you don't get all the benefits in that period of time, but like I think you should notice some shifts happening. So yeah, I think that's the hard part about some of this stuff is it does take some like twiddling around. It's hard to know like exactly who's gonna benefit from one thing. You know, this is motility active is a the purpose, the perfect one for you and not for you. It's like, it's just hard to know.

So, yeah, no, I just generally steer away from anything with 5-HTP for people with loose stool. That's sort of, that's sort of my general rule. Ah, but I hear for me people have liked Modalpro if they were on the constipated side. Like I've, I've seen that.

Yeah. I mean, again, I, I still think Modalpro could be someone's favorite, so I'm not like totally against it. I would just say it's not the one I would start with. Yeah. Um, typically just because it's, can be a little bit more of the ones that I would say cause symptoms. So yeah, I, I think it, it, it still takes some degree of experimentation no matter what. Like on, on paper this might look like the best option for you. It's like, okay, I wouldn't get too locked in.

Yeah. What about Iberogast? Have you seen much, uh, success with that?

Yeah.

You know, I, feel like Iberogast was a really weird one cuz it like disappeared for a while.

Yeah. And then new formulation and, and then that was so funny last year.

It was like on TV. I don't know if you've seen like there's actual commercials. I was like watching them. I know.

I'm just like, wow.

Right. I was watching an NFL game. You buy this at Walgreens. I know. I was watching an NFL game and it was like a commercial and like all of a sudden it was like Iberogast and I was like, what? Like I, I like almost I almost fell outta my chair. It was just so random. So I would say like Iberogast was a weird one because it was just like not there for a while. Sometimes for international patients it was like a little more available. It was just a weird one. But generally I have seen some people like it. I, I think like with every prokinetic, it can be one of those ones that, you know, some people it might fit the bill. One thing about Iberogast that's interesting and I haven't explore this like at scale, like with lots of people. Something that Jason Horolak told us, he was on our, our podcast and he was saying that he uses Iberogast a lot for hypersensitivity. So, but you have to take it like fairly regularly for like 6 weeks or something before you see more hypersensitivity changes, which I found was pretty interesting. Again, I have not done like tons of work with Iberogast in that way. It's not one that I use really regularly. Like it's kind of one where there someone's like, oh, I tried it and I like it. And I'm like, well, stick with it. You know what I mean? That's usually how I've seen Iberogast. But yeah, I think it's a, it's an interesting one. I just haven't recommended it a ton, but I have seen so many people on it and some people do like it.

Yeah.

I'm kind of surprised to hear for hypersensitivity, cuz I think of the hypersensitivity usually coming in conjunction with hydrogen sulfide SIBO and then I would never do anything bile promoting in that scenario.

Yeah, I, I think again, it could be just some of the mixtures of the herbs. Cause he talked a little bit about peppermint and caraway, and I believe peppermint's in it. I don't know if caraway is in Iberia.

I don't know what the new formulation is. I, at one point though, when it was out of stock, I went and I bought all of the bottles of all of the things that went into it and tried to recreate it.

Yeah.

There was one of them, one batch I made, and it was like, there was this one overwhelming herb that was so terrible and I was like, oh my God, I gotta throw this out and start over. But I had to add a little like stevia to make the whole thing even. Yeah.

Oh my gosh. You're braver than me. I, that, that's impressive that you, you tried to recreate it.

It's a problem.

Bottles now. Yeah, you're right.

I might have a bottle of chamomile. I should check that out.

Yeah.

So have you found anything in your experience that lowers the vinculin antibodies?

I, I've had some people run it before. It's not a test I run super regularly to, to where I can say like, okay, here's their anti-vinculin before and then here's it now. Like, I feel like I don't really have that data. So yeah, I, I would say. But generally speaking, I think focusing a lot on like immune type, immune system stuff, I think also helps, which like to me, I always go back to the nutrients. So like A to D to zinc. But I think most of the nutrients play a role in how inflammation's regulated in the, the gut. So like I, I do a lot of work there and I think, you know, slowly working on diversifying the gut, I think is important for, uh, post-infectious stuff. It's just hard. Again, it, it gets a little squirrely if like motility's being disturbed and that's leading to like more stagnation and that kind of stuff. So I still think like such a big part of it could be trying to find some sort of prokinetic that helps and then sort of working on a lot of the fundamental pieces of building the system back up, but I do think the immune system piece matters a lot too and could be interwoven with some of the stuff necessary for, uh, post-infectious stuff. Like some of the very anti-inflammatory stuff, GI-wise, can help, especially if it's pretty close to when the infection happened.

Oh yeah. Yeah. I don't get that very often. I usually get, this has been happening for 10, 15, 20 years. I know.

Yeah.

I know.

Know, my story. Well, I, for what it's worth, I, I did 2 rounds of the Prolon fasting mimicking diet and my antibodies normalized.

So cool.

Yeah. Very cool. I don't, I don't know if it's, I, I kind of don't trust it cuz I did the, uh, Candida plus IBS profile with Vibrant. So now I'm doing the IBS Smart to make sure those results are real.

Yeah.

But I also, I, I had elevated cdtbs ironically when I had normalized pink lipids. Yeah.

You're like, wait, what? One goes up, one goes down.

Right, right. Whereas it'd been the opposite previously.

So who knows? Right. And like the, so ironic, I feel like when that stuff like that happens.

Yeah. We've gone overtime. You've been very generous with your time, so I will, I will wrap it up. Let people know the name of your podcast and where they can find you and all that.

Yeah. So the podcast is the IBS Freedom Podcast. I don't know if we've, we're kind of off schedule right now, but we should be back up and running soon. But we've done over 200 episodes of that, so we've Lots of topics there. Mainly I would say I'm writing in the sub— my Substack is sort of the main area that I post on. I am on Instagram, but I don't know that Instagram's a whole nother animal. I feel like, I don't know if you've ever run into this or dabbled in Instagram, but the algorithm is just rough in terms of like my skillset.

I don't even bother. I mean, I, I post, but that's it. I post and, and, right.

It hurts. I just enjoy my My, my skillset is like usually like long conversations or just like writing at articles that are more long-form content than like, you have to do something engaging with the, within the first 2 seconds or the post doesn't matter. It's basically like Instagram's model. So I do post on there a little bit, but I feel like I've like, not that it's all about who's watching, but it's like, okay, it feels like I'm posting into the ether on Instagram.

Yeah.

So, but you can find me at Amy Hollencamp, Amy_Hollencamp_RD, and I think it's a similar Substack.

I'll link it all in the show notes. And then your website?

Yes. You can find me at a couple websites. I pro— I need to clean things up a little bit, but I, I think I've provided a link, like if you were interested in working with me. But I, again, I think the Substack and the IBS Freedom's probably the most most useful resources. Man, Instagram, what are we going to do with it? Yeah, it used to be so great. I used to love Instagram and I feel like a lot of people engaged. And then again, I feel like it's, it's like this whole, we only have time for like the first 5 seconds matter the most. And then you're like, what can I do with that 5 seconds?

It was never my medium. So I have no, I I have no idea. Honestly, I, I never even check how many people look at my posts. I just have my interest posted and that's it.

Yeah. Anyway, I had a, I did have a girl, another dietitian who like started posting like really like weird things for like 3 seconds and then being like, now that I got your attention, I was like, well, I can't do that. It was like something very weird, you know? I don't know. I don't even remember what it was, but yeah. You know, like a cow's butt or something. And then it's like, oh, now I got your attention. I'm just like, I'm not playing these games on Instagram. I'll just go back on Substack and write articles and hopefully someone reads them. So yeah.

Well, I was reading them, so I appreciate it.

Good. Awesome. I'm glad. Yes. I've liked Substack a lot more. I feel like there's like people actually see your stuff and comment on things. So it's, it's good.

Yeah.

Yes.

Well, thank you so much for your time. I appreciate you coming on.

Yeah. And no problem. It's been really fun.

Well, that may have gotten a little bit inside baseball, but I think the main message was pretty clear, which was look for nutrient deficiencies, have a well-rounded diet and a healthy lifestyle in all the ways before wasting your money and time on stool testing or antimicrobial herbs or repeated rounds of that. So you can 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. Herb, which is available worldwide, or Amazon. And just a note that you can use my Amazon link to buy anything, so I'd appreciate it if you'd bookmark my link and use it not just for supplements but for gifts and everyday items to support the podcast. If you'd like to connect with me online, you can follow my High Desert Health Facebook page, join my Gut Healing Facebook group, or join my newsletter list at highdeserthealthcoaching.com, as well as follow me on Instagram, TikTok, Pinterest, Mastodon, and X. Links for those are in the show notes. Thanks for joining me today, and here's wishing you all the perfect stool.