All Things Food Sensitivity and More with Cheryl Burdette

Wellness is a practice, not just a word.

Welcome to the Synergy Podcast where myself, Kelly Engelman and Lori Essery shed light on powerful tools and topics that nourish.

Your body and most importantly, feed your soul.

Welcome back senergy listeners. We're so glad you're here where we believe we're stronger together. Hold on to your seats because we have Cheryl Burdett here with us today and we are so excited to have her.

Cheryl Burdett, ND is the founder of Persona Logics Health Academy, an educational initiative designed to increase knowledge of integrative medicine for practitioners. She is the Director of Education and the naturopathic Residency program at Progressive Medical. She is the founder and educational director of a functional laboratory, Precision Point Diagnostics, for which she designs clinical profiles and trains clinicians with utilization. She is on the board of advisors for Zymogen & Inc. 500 supplement company. She is a partner of Theradura, a physician line distribution in Germany. She serves on IRB boards, is involved in study design and translational research and has lectured extensively worldwide. Her passion is teaching around the practices of integrated and naturopathic medicine to increase awareness of evidence based natural therapies. Let's get started with Cheryl Burdette.

So welcome to the Synergy Podcast. We are so excited to be back together. Lori Essery and Kelly Engelman hosting Cheryl Burdette today. And I have to tell you, I have been the most excited about this podcast than I have been about any podcast in a long time. Because if I could sit in one person's brain and absorb all of the information that she has up there, it would be Cheryl's brain. I have brain envy every time I'm around her. All of the biochemistry that swims around in there. I just wish I could soak it all up. So I'm excited that she's here with us today.

I'm going to second that. Cheryl, thank you so much for being here. I can't even say that any better. I feel like such a geek sometimes. Give me everything you got.

You guys are too kind, I think. I just. It's like company. So thank you for having me here.

Yeah, Cheryl's been in our world for a while. Lori and I are perpetual students since they were always in class. And Cheryl's been gracious enough to teach us live and virtually. And so we are honored to have her here to share her wealth of information. We're going to dig into all things food sensitivity, intestinal permeability. Those are big words. But we're going to break them down for you. We're also going to get into the whole idea of oxidative stress and how that plays out what you can expect to feel or see when you're experiencing some oxidative stress. We know if we have that, we're not winning our game. So, Cheryl, let's dig in. It's common. And I have to think back to when I first started doing food sensitivity testing. And I have to say, the first panel that I did for food sensitivities was a food sensitivity panel that looked at the response of the white blood cell and it tested multiple foods. And we would get that panel back and it would be, oh, my goodness, how in the world am I going to eliminate all of these foods? And so, at Precision Point, I absolutely love and adore the way that your panel is laid out so that as a clinician, we can look at that information through the eyes of a functional medicine practitioner and say, what is the immune system trying to do with this food source? And how do I take this information and help this patient navigate a diet that's going to lead to healing and not lead to further nutrient deficiencies and ongoing food sensitivities? So help us understand a little bit more about how that panel is laid out and the intention of that panel.

Yeah, so the panel came to be through Precision Point diagnostics, as you said, but the lab came out of a clinical practice. So I practice at Progressive Medical and my partner, Dr. Gazagoli. It's a large clinic, about 10 docs, 10 to 11 docs, all under the same roof. And so, but also PAs and. And nurse practitioners and acupuncturists and dietitians and naturopathic docs. And so a lot of patient care, Progressive's been around for 30 years, and so really getting to see a lot of data come through there. And historically, we used other food sensitivity tests as well, even the one that you mentioned and from other places. And we always felt like a little bit like Goldilocks, right? Like a little too hot or a little too cold. And I was like, ah, it's not exact what I want. And so we started a laboratory about 15 years ago for just this reason, because really, when you sit toe to toe with a patient, wanting to feel like you're giving the best and that you're really getting to the heart of the issue. And so it's difficult in this world of food reactions because there's a lot of disagreement and there's not consensus. And if you approach more standard of care, there's even the idea that there's only one way that the body reacts to foods, and that's an allergy IgE. And that's what's typically done. It can be done through a blood draw, but it's usually done in offices when that's the one that when people get stuck in the skin and then you wait and you see, does it turn red? And if it doesn't, then you probably don't have a problem, or you're told you don't have a problem, but you. Even the best allergy test out there, it's only positive 50% of the time when somebody has a symptom. And so what that tells us is 50% of the time we're reacting to foods in a different way. So the allergies are important. And we want to know if you're going to eat a strawberry and you're going to go into anaphylactic shock. That's an important thing to know. But it turns out also you can have lower levels of these immediate reactions that you might not even be noticing because they're more subacute in terms of the threshold of how you feel, they can still create inflammation in the body. And if you see a lot of reactions in terms of more allergies, even if you're not feeling symptoms from them yet, it can tell you that you're in more of what's called an atopic direction, an allergic direction. This is where we're more likely to get autoimmune conditions or eczema, things of that nature. But again, it's only part of it.

I don't want to interrupt, but I did have to ask this question for clarity. So what I heard you say is that 50% of the time that a person has a allergy to something, a potential allergy to something, they may have a negative test. Is that right? Or is it just the opposite?

Absolutely. Yeah. And the best allergy test out there, it's only predictive 50% of the time.

And that's for Ige, that's for immediate reaction. Right.

So we have people that have inflammation. I mean, they come into our clinics all the time. As you just said, they're clearly having some form of symptoms, inflammation, but yet they come in saying, I've had all these tests and they're negative. So this is why.

Yeah, it's just it's not the greatest test. And then research has been very stifled in this area, kind of because of how immunology gets taught and who knows? And maybe also because there's been a Reluctance on insurance companies parts to pay for some of these things, that does factor into it. So we got kind of left with a very inadequate way of looking at how people react to foods. And I'm sure you guys feel the same way. One of our most powerful tools in terms of what we deliver to our patients is around diet and dietary therapy. So if that's the case, if diet's one of our most profound tools, then what do we do to make sure that someone's on the least inflammatory diet possible? So we continued to work with other food allergy tests, food sensitivity tests, and like I said, oh, maybe this one shows everything all the time and this one seems to show no reactions. And so we really struggled. And so we thought, you know what, we need a test that puts together all in one test, multiple ways that the immune system reacts to foods. And so like you mentioned, the live cell analysis, that's helpful, it shows this innate immune system reaction and that's what part of it. But we also have this secondary immune system and a lot of autoimmunity and a lot of chronic conditions are more driven by that. When we think about something like rheumatoid arthritis, for example, we think about what's going on there. And so in a condition like that, there are antibodies that are confused and they're attacking the patient's tissue. Well, why did the antibody get confused? And often it's because it's reading a food wrong. That food has a similar amino acid structure. And so we create this antibody to a food that can cross react to our own tissue. So if the immune confusion is something like a cross reactive antibody, then you need to measure antibodies as well. That's what we do on the dietary P88. We look at antibodies not only, but I'll get there. So we look at those antibodies like in an IGE reaction, an allergic reaction. But what we've learned is that we also have these delayed reactions to foods three to 72 hours later, not immediate. So you're having a bad day, you feel foggy, your head hurts, and you go, God, what did I have for breakfast this morning? And it's really what you had for breakfast two days ago. And so this is why the sensitivities can be difficult to get from merely a history alone. It doesn't happen immediately, it's just that it's delayed. And so IGG is something that's often overlooked in standard of care. And I think the reason for that is because in a standard of care approach, you want to measure something that tells you about a diagnosis, an ICD10 code, a label, and that's important. We need a diagnosis that certainly helps us in a functional medicine paradigm as well. But IgG reactions, they don't create a singular symptom, they don't create a rash, they don't create hives, they don't line up with a particular diagnostic code. They create general inflammation that can make so many conditions worse. So in a standard of care world where you're doing testing for a diagnosis, it doesn't match what's generally being done here. We're saying we care about the diagnosis, we want to do the correct testing to get to that point, but we also care about the process behind the diagnosis. And that process is so often inflammation. And a large part of inflammation comes from what we eat. And so if the immune system is confused and now fighting foods, we have this increase in inflammation. And that can make almost any sign or symptom worse. So we said, okay, we need to look at allergies, but we need to look at sensitivities. But then as you dive into the immune system, it continues to be more and more complex. There are more and more pieces to it. So what we realized, and largely from the world of desensitization in terms of allergies, so if we know that we have an anaphylactic reaction to a peanut, we can seek out desensitization like injections or even sublingual immunotherapy that's done under the tongue. And when we do this, we take in a little bit of peanut and eventually become tolerant. And so the mechanism of action of that is that it increases another type of antibody, something called IgG4. And so many tests out there just looked at all IgG together. IgG is that sensitivity, that delayed reaction, three to 72 hours later. But there are four types of IgG. And so this was another kind of pushback. People would say, well, there are four types, they don't all do the same thing. In fact, igg4 does something completely different. It's not inflammatory, it doesn't contribute to headaches or joint pain or bloating or these type of issues. In fact, it blocks an allergic reaction. So when you do something like desensitization, the whole point of that is to increase this antibody, IgG4, and when we have enough of it, it will block ige, that thing that drives the allergic reaction. So true. They are all different. So pull it out, measure it. And this is very useful because now you can tell, have you become tolerant to something you are allergic to. And now when we're looking at IGG, we're looking at subtypes 1, 2 and 3 that do run in the same direction, that do behave in a similar way. They create inflammation. But then even that wasn't the end of the story, because it's not just IGG that plays a role in these sensitivity reactions. It turns out that there is an amplifier and it's something called complement. And when complement is there with this IGG antibody, it can amplify that reaction a thousand fold, even some say as much as 10,000 fold. And so out of that clinical practice, you, we would be looking at just IGG by itself sometimes, depending on what test we were using at the moment. And patients would say, you know, the ones that are high, I don't really get the most symptoms from that. But these medium levels, those tend to really kick in the headache or kick in the depression or anxiety. So what's going on there? Well, again, it's because it's not just igg, it's also this complement antigen. And when you have those together, it amplifies the reaction. So we say we need to measure that too. So we ended up with a test that looks at four independent ways that the immune system reacts to foods. Because again, if food is our most powerful tool, how do we create the least inflammatory diet for each person? And a great start without any testing is of course, to get the processed foods out and to eat more fruits and vegetables and focus on getting good quality protein and make sure you're getting good fiber. And so many people as they start to feel unwell, this is obvious, we all know, oh, I should eat better, I should exercise more. This isn't news to most people out there. And so they went out, they went to Whole Foods, they changed what's in their pantry, they ate more vegetables, but they still weren't feeling optimal. And so what else is going on? Well, unfortunately, we can feel inflamed from healthy foods. And so looking at each other patient's blood, looking at their levels of reactions allows us to individualize diet and take it to that even next step to make the most powerful tool more exact.

Such a complex test, I mean, I mean, I think about what it took to get there, to figure all of this out. And, you know, I know that there was a lot of medical lingo in that and we have a lot of followers that listen to this, that, you know, or that are our patients. So I think between Kelly and I, we're going to go through and I have A couple of questions, and I think I heard you say there are four independent ways that you guys have figured out how to look at the immune system. Right. So you're not just looking at ige, which is that immediate reaction, but you're also looking at delayed food sensitivities that could be three hours to 72 hours. But on top of it, there's this layer of desensitization that can occur. Right. With you. You're able to look at that. Have you been in some ways desensitized to that food? But then do you also have a compliment that may amplifies something that may not be a big deal or look like a big deal with your immune system, but because of that, it amplifies that reaction? So it's a big deal. So that's a lot of information. And I can only imagine the difficulty of interpreting that test so as not to overwhelm our patients. Kelly, I know that you see that all the time, right?

Yeah. I have to say I have an example of a patient that had a test from another functional medicine provider a year ago, and she comes in to see me a year later. She'd been strictly following that elimination. These, you know, more significant elimination. I can't remember how it's worded on there, but the more restrictive diet on there, and a lot of those had eliminated her valuable oil sources, avocado and things like that. And so she'd gotten herself pretty nutritionally depleted with fatty acids, and she was having skin breakdown and having ongoing gut breakdown. Right. And so you can, without working with a trained clinician, if you're trying to do this independently, you can walk yourself into a worse situation. So it is a complex test. It is so unbelievably valuable to the clinician that can help someone walk through recovery from food sensitivities. But it does need to be respected in that this is not a forever way of living. Your immune system constantly changing and evolving as it should be. And as a result of that, we have to be careful in how we counsel our patients on taking action on that testing, correct?

Yeah. And this is why, like you said, it's very important to work with a clinician, because it's not just a piece of paper. That's a forever roadmap. And I like to remind patients that, in fact, the whole point of this test is not to restrict the diet more initially, maybe, but long term, the goal is actually to open the diet up even more than before and be less reactive to foods in general. So the benefit of working with a clinician is they're not just going to say, here's a piece of paper that says to remove foods. They're going to look at those foods, which ones are the most important for you, prioritize the plan and at the same time, do things to build the gut lining, do things to help the immune system become retrained so it's not confused by those foods when it meets them, and then guide the patient as to when they should bring those foods back in. That's one of the most important parts of the test, is that's step A. But you move and you progress. And the point is to be able to bring in more foods than before with less inflammatory reactions. Now, I don't mean Big Macs or, you know, sometimes we're probably gonna still keep things like wheat or dairy more to a minimum. But we can see these situations where people are inflamed from chicken or avocado, like you said, or spinach or things that they need. And that's not the state that we want them to stay in long term. We wanna open that diet back up.

And I think that's so important too, as we as clinicians are discussing that with our patients, because I think so many times they come into that going, you're just going to take more foods out of my diet. And I want to reiterate that that is not the goal. It's to give you the appropriate removals that you need in that time to heal and then understand how to also diversify and open it up to foods maybe you haven't been taking in. Right. And now you become nutritionally deprived. Right. So it's adding them in. So definitely important to address it that way.

I think, to your point, Lori, what usually ends up happening is people eat a different variety of foods. Like, when we look at a standard American diet, it's quite possible that you are getting wheat and dairy at every single meal. So now you're opening up to other grains. Almond or maybe tapioca flour or various blends. Like, I think in general, what we see is more diversification of the diet.

Yeah. And that's what we absolutely need in order for that gut microbiome to repair the gut lining. Right.

Yes, it is complicated, but then there is a page that says, stay away from these foods and eat these foods. So it does get boiled down a little more simply. But it's always best when there's an interaction between patient and clinician. Because you're going to be able to take that to the next level.

Absolutely. So timing of doing a test like this. Right. Because the timing of the test in working with the patient is important into knowing how to implement. Right. So to your point earlier, you mentioned, you know, we want to eliminate processed foods that are inflammatory. If you've got a patient that's complaining of inflammatory symptoms, headaches, muscle aches, fatigue, insomnia, you know, the list goes on and on. Brain fog. Right. Those are inflammatory symptoms. We want to get the obvious foods out of the diet first. Right. So I love the fact that you're a clinician and in the lab, you know, you get both sides of the equation. When do you recommend that a food panel be done on a patient? Like, what's in the perfect world? If you could have a perfect world of timing, of testing in relationship to working with the patient, that's pretty naive to making food changes, where would that fall?

So when we first meet with a patient, and like I said, there's a team of dietitians that I'm lucky enough to work with, we will start on some dietary change pretty immediately. That's done at the first visit. And we often use something that we label it a detail diet. But I think that it could equally be called a detox gut microbiome diet. And so we do. We have people come off foods that tend to be more inflammatory as a trial, we take them off the wheat, we take them off the dairy. Caffeine goes, alcohol goes. We talk to them about hitting targets with fiber, making sure you're getting 15 to 20 grams of fiber, which even the best of us can struggle with, even when we have vegetables and all through our diet. So really working on that piece. And then from there, when people come back at the next visit, if they are still experiencing some symptoms, that's when we'll say, okay, now let's do a food sensitivity test. And many times people really want to do this because they want to transition from that. In general, here are things that are often inflammatory to people to exactly what is going on in my body, where's the inflammation in my system? So they're often eager to do this to know what's going to be most appropriate for them. But I do lean on this test a lot. And so, you know, I've had patients come in that say, oh, I had a friend who was here, you know, last week or the week before. And you ran this test on them as well. Do you just run this test on everybody and. No, not everybody, but many people. And again, the reason is because I want every patient to have the the least inflammatory diet possible. And one of the major ways we can retrain boost the immune system. Retrain is a better word because if it's overactive, put it back into a normal zone is by working through the gut. And if we are eating foods that we're sensitive to, you will continue to degrade the gut. This is where we house 85% of our immune system. And even the part that isn't there in the gut, the immune system that starts in the gut communicates with the rest of our immune system as well. So if we're thinking about any condition where there's an immune imbalance, any condition where there's gut based distress, any condition where there's inflammation, then working with gut and foods becomes an important part of that. So I do run this test quite a bit because like I said, I want every patient to have the opportunity to have the least inflammatory diet it possible.

So what I hear you saying is very similar. Kelly, you and I in our independent practices working with patients to what we call a reset diet. Right. So it's deloading their body, removing those common inflammatory foods, those common food intolerances and or allergies out of the diet, giving them time to really get used to and get their body kind of offloaded as you will, and then meeting back with them. And I think from a timing piece that's great because then you're kind of like if they already begin to feel quite better in that time, I think that, you know, excites them to see that food alone helped them make a change in how they felt. Right. So I think that that kind of makes them first more curious and I think that makes them more motivated to okay, what's next? You know, what can I do next? So I did hear you say something that I wanted to kind of circle back to too. You had said, you know, because I think we all throw around the boosting of the immune system and I heard you go back and you corrected that. So I kind of wanted you to go back and explain what you meant by that for our listeners.

Yeah, so we all are familiar with being under more stress and didn't quite eat right and then that cold happens and we'd go, yep, our immune system was down and so got this infection not feeling quite well. But also the case of the immune system being over reactive. And this would be like in an autoimmune condition like rheumatoid arthritis or even Ms. Or Crohn's disease. And this is the case where the immune system has become Confused, it's hyper reactive, it's going off to foods and to even maybe bugs in the gut. And so now rather than too little immune function, we're in overdrive. So there are also immune cells that help to put the immune system back in balance. And they have a good name for what they do. They're called T reg cells like regulator. When we quit eating foods that we're sensitive to, it helps the gut lining to repair. And I always think of that as a barrier. And as that barrier gets stronger between the foods we eat and the immune system reacting, it helps those Treg cells to improve their function as well. You know, if we look at a standard of care model in the world of autoimmunity, what is done are to take various medications that are immune suppressive and then you have to deal with those side effects. It'll say right there there's an increased risk of colds or flus or catching various bugs because, because of that immunosuppressive part. But the nice thing about natural therapies and working on normalizing gut health and working on normalizing tissue is that it puts the immune system in balance. So we're not stuck with, we can either suppress the immune system or boost the immune system. When we work on gut based inflammation, it helps all these immune cells to work together. It helps these Treg cells to gain ground and put the immune cell system back in balance. And I love that about what we do because we don't just have to suppress or move the body all in one direction. When you make the system healthier, it begins to do what it should do more naturally. And so if something, if parts of the immune system are high and parts are low, then we can move them all back to the middle to be more functional. And that's what we're trying to do, is restore that function.

So boost versus suppress versus balance.

Yeah, yeah, exactly.

Yeah. I want to talk about the gut lining intestinal permeability. We're blessed also to be able to look at that. So tell us a little bit more about how that plays into food sensitivities and how we can assess for that.

Yeah, it's a podcast, but so it's hard for me to refrain from using my hands. So now I've got some hand gestures going on here, but. And so with patients I used to draw the picture, but now I act it out more because it's a little bit faster. So as we think about gut based permeability, it even sounds weird. Leaky gut, it sounds weird, right? I Remember when I first Learned about it 20 plus years ago, I thought the same thing. That sounds weird. I'm gonna go look it up in the scientific journals and I'm gonna see if I can find some stuff about leaky gut. And if I can't, then this isn't real. And when I did that 20 plus years ago, there wasn't a lot of data, but I couldn't make it out of naturopathic medical school without having to realize that probably there was something to this. And so I was working with an ulcerative colitis patient, she was having 20 plus bowel movements a day. She, she couldn't leave her house, she couldn't go out to eat. And what they had suggested her next move be would be, well, we'll just remove part of your colon and for sure that's going to decrease the inflammation. But I'm going to guess that most of us would like to hold on to our body parts and there would be some other issues there when we remove the colon. So instead we got started doing things that treated this phenomenon of leaky gut, gut based on permeability, and changed her diet and figured out foods that were inflammatory to her. And as we did that, her bowel movements went back to normal and she wasn't having 20 bowel movements a day and she didn't have to remove her colon and she was able to go out to dinner with friends and family and she got to that point of being able to even expand what she was eating. And this was because we were working on this concept of leaky gut. And so now if I go to the literature and I look up gut based permeability, I can find thousands of studies. And not only can I find lots of data that supports this and connects leaky gut to things like depression, connects leaky gut to things like insomnia, connects leaky gut to things like cardiovascular disease and neurologic conditions. Not only can I find the data, but now we've even figured out biomarkers, things we can measure in the blood that tell us about this is going on. And so 20 years ago, we didn't know these biomarkers existed. So we couldn't measure it, we couldn't tell where someone was at. But now we have the opportunity to do so. And so Alessio Fasano is instrumental in this story. He's a researcher. He was at Boston, now he's at Harvard. And he popularized this marker, zonulin. And Zonulin, you can measure in the blood, it can also be measured on stool testing. And it is what tells those that gut lining to open up. So there are these little things called tight junctions. And think about kind of legos or linking logs locking together. That's how the gut lining works. And this zonulin tells those locks to open up. And when the gut opens up, now things get into the body that shouldn't be there. Your food doesn't get broken down as much as it should. Little bits of bugs, bacteria. Because we have more bacteria in our gut than there are stars in the Milky Way, Little bits of this bacteria begin to leak through into our body. And our body goes, that's weird. That shouldn't be here. I'm going to create immune reaction. And boom, we develop these sensitivities and it creates this inflammation that can be part of something, like I mentioned depression or even neurologic conditions. So historically, we would treat this, we would see people get better. We called it leaky gut or gut based permeability. We knew that it worked, but we weren't really able to measure it or define it. Now we're able to actually measure markers in the blood. Some go up, some go down, but that change direction from normal when the gut is more leaky. And zonulin is one of these, so we can measure it in the blood. And the lithio fasano went on to say, he said, you know what? This is the environmental trigger that causes autoimmunity. You're not born with rheumatoid arthritis. You're not generally born with Crohn's disease. We get there eventually. So what caused that gene to express itself? Well, he went on to show that zonulin goes up before the onset of autoimmunity, before the onset of things like celiac disease or even Crohn's disease. And so what he said was, this gut becoming leaky is what causes the immune system to run crazy, run wild, run amok in terms of being overly inflammatory. And he said, also, the good news is once it's high, if we do therapies to lower it, we can put that genie back in the bottle. We can keep the immune system from being overly reactive. And so once, once we could measure it, then it became much easier to diagnose, it becomes easier to treat. Our patients always rightfully want to know, well, how long do I need to do this treatment? How long will I be on these particular supplements? And now we can say tilzonulin is normal because that tells us the gut is no longer leaky. But it gives us a way to really rule these things in and out more appropriately. And it gives us some benchmarks to know if our treatment is working or not. So it's fascinating. The science really caught up to what we were doing. We've been doing treatment of leaky gut for decades and decades, and now the science says, yep, that's a known phenomenon. We can measure it, we can treat it, and we can see health conditions improve when we do so.

So let me ask if we can measure it in different ways, like stool or blood, is there one that's more preferred over the other, or should one be used at different times than the other? You know, what is your philosophy on that? What is your belief on that?

Yeah, there's a lot of overlap there. So when you're measuring it in the stool, you are measuring the largest pool of where zonulin is created, because most zonulin is created in the gut. If you measure it in the blood, you're capturing part of other places where we make zonulin and we make zonulin in the liver. We make zonulin at the blood brain barrier. And the blood brain barrier is just what it sounds like. It's this tissue that separates the rest of our body from the brain to protect it. So, interestingly, zonulin made in the liver can be a reason for an increase in lipids like cholesterol and triglycerides. And zonulin at the blood brain barrier can be a reason for things like brain fog. In fact, I was fascinated when I read that one of the things that is causing brain fog in Covid long haul is a leaky blood brain barrier governed by zonulin. And so there's a lot of overlap. I would say there's about 80% overlap between the fecal or a stool zonulin and a blood zonulin. But the blood zonulin will capture those other places as well, and those contribute to pathology too. So if you already had it on a stool test, I wouldn't bother retesting it in the blood until you've treated it. But if there are symptoms that have to do with like brain fog or depression or anxiety or even cardiovascular issues, then the serum might be preferable because you're going to capture zonulin that would be related to those places in the body and can be contributing to those things.

Excellent.

So you mentioned some symptoms of leaky gut. So if I'm a patient and I'm wondering, is it possible that I have leaky gut, you know, as a clinician, I have found those symptoms May be just those traditional inflammatory symptoms. So what do you see?

Yeah, and it's a little bit tricky. And this is why measuring can be useful at times as well, because we would think, okay, leaky gut, that must mean that I'm bloated or I have constipation or diarrhea, that I have pain in the gut. And often that's true. Often there will be some bloating or, you know, you eat certain things and you don't feel right and kind of thing. So gut based symptoms, of course, but even ankylosing spondylitis, so a condition where bones fuse in your back, the part of how that starts is when the gut becomes leaky, when zonulin goes up. And so there's a, this association between leaky gut and even that. And so in that scenario, somebody might not have been having lots of constipation or diarrhea, but they could still have leaky gut that's contributing to symptoms that they're feeling. Maybe an even more common one is depression. You might not necessarily have diarrhea, constipation, gas or bloating, but you're depressed. Well, gut based permeability, or the gut being leaky, creates inflammation that's hard on the brain. That inflammation even impairs our ability to make certain neurotransmitters like serotonin that make us feel good, make us feel less depressed. And so now being able to measure these markers of leaky gut can be really important then because you're like, no, it's in my head, I feel blue. I don't have any problems with things I eat. But it's the leaky gut that creates the inflammation that causes the depression to express itself. So when someone's gut is leaky, there's inflammation that's created from that. And inflammation kind of washes over our genetics and causes probably our areas of weakness to more expose themselves. So we can have symptoms that aren't even related to the gut that can be a direct result of that gut based permeability.

So what I heard you say brain symptoms are very common with leaky gut. Right? Brain symptoms are very common. And your areas of weakness having exacerbations in challenges that perhaps joint pain, skin issues that may or may not be gut related or gut related symptoms at all. You may not have any gut related symptoms and still have full blown leaky gut. And that's hard for patients to conceptualize because we say leaky gut and they're like, but I have a bowel movement every day. And I don't have any bloating. Right. So that can be difficult for them to kind of put those two and two together.

Yeah. So it's nice when the science catches up and we can measure these markers to say, yeah, this is a part, because let's go back to the example of depression. Maybe Zonulin's making the blood brain barrier leaky and this is causing depression. And that's one way to get there. But maybe you are producing less of certain neurotransmitters. Maybe it's serotonin, maybe it's dystopian dopamine. Those both being low could either or cause depression, or maybe you have issues in terms of something called methylation. And so we have to methylate our neurotransmitters to turn them on and make them more active. And so that can be another reason for depression. So the fact that we can measure these markers of leaky gut to say what is your cause for depression? Is very useful because now we can treat more accurately.

Absolutely. So in the way of intestinal permeability panel, because one of the markers that I absolutely love on there is dao. I see so many histamine related challenges because of that Microvilla in the small intestine being damaged, they're not able to make enough dao. And as a result of that they'll have histamine symptoms which drive them bananas. Itching, insomnia, anxiousness, oftentimes that come with lack of dao. So tell us more about that.

Yeah, I love that one too. And because it is such a game changer for people, when that's the marker that's off and you identify it and you treat it, you can see a lot of improvement in quality of life, interestingly. So diamine oxidase, it's the enzyme that degrades histamine and we make it in the gut. So this is another thing that gut based work does for us. Not only putting that barrier in place so that our foods and bugs are separate from our immune system, but as you repair that gut lining, as you plump up the microvilli, as you said, they produce what are called brush border enzymes and also diamine oxidase right there in the gut lining. So the gut lining makes the process primary enzyme that degrades histamine. And that's great news for like this time of year when the spring and pollen and we're like, ah, how could I degrade more histamine? Well, your gut based strategies help with that. But what's fascinating is that this is not the only place histamine affects us. We have histamine receptors in the brain, we have histamine receptors on the heart. And so when diamine oxidase is low and people aren't degrading historically like they should, this could be a major reason that they are having headaches, those histamine receptors in the brain. In fact, 83% of people with migraines have low diamine oxidase. And you know, we think about migraines, they're horribly painful. The medications that are utilized are given in small amounts because they can be addictive. So it's hard to get that particular medications that pull you out of pain. And yet 83% of people could have benefit in terms of gut based work and degrading histamine more. And so when we see diamine oxidase is low, we can treat it, we can give it. And for example, I'll use supplements that have diamine oxidase in them even at the onset of a migraine. And I've seen great success, success with this in terms of not even needing to use something more invasive, not needing stronger pain medications to break the cycle of pain. I've seen arrhythmias turn around with increasing diamine oxidase levels. And again the heart has histamine receptors. And so even helping the heart stay in rhythm more gets back to how well we degrade this historical histamine. But histamine can make us not just itchy, but again it's your area of weakness. So for some people, histamine might make you really agitated. For some people, histamine might cause a headache. For some people, histamine causes an arrhythmia. And so if we can identify your ability to degrade histamine, then we have another way to treat that's very low invasive. That's back to that gut based work, that's back to building up that lining and keeping you from needing more and more medications over time. And so yeah, you're right, this one is just really nice tool to have. Often the picture is that person who's kind of non specifically reactive to so many things, they can't quite figure out what the trigger is. And it's even confusing from foods because they'll go, oh gosh, but I ate this food two days ago and I didn't get the symptom. Well, that sounds like a food sensitivity first of all could be that. But the second thing is as food sits, it degrades. And part of degrading is it starts to have more histamine in it. So you're thinking, well, it couldn't be this food. I ate this exact same thing the other day and had no problem. Well, now your leftovers have more histamine. And if you can't degrade that histamine, there are a number of ways that that can affect people, but it's so treatable, and so it gives us another avenue to pull people out of a highly inflammatory state by using more natural therapies.

Yeah. So, Cheryl, I want to go back to what you said about histamine and headaches, because oftentimes we'll see premenstrual headaches. Right. I mean, I know that histamine's a part of that, but I never even considered adding DAO just during that time of month to see how to help them navigate that. Right. I just hadn't put that together until you just brought that out. So thank you for that.

Well, yeah, and you're right. Progesterone will work most of the time for most patients that have that presentation, because as we know, progesterone drops. That's what causes the lining to shed. This is why we have a period. And for those patients, it's probably dropping too much, and progesterone stops swelling around the nerves in our brain. And so progesterone even binds to what are called GABA receptors that are the major way we rest and relax. Progesterone has a very calming effect on the body, and. And it's a great therapy. But now and again, you'll have those people that you'll use progesterone for a headache before their period, and they're still getting a headache. You test, and their level looks okay. So actually, diamine oxidase drops off around our period, too. And so when people are non responders to progesterone therapies, using diamine oxidase can be a really great thing for keeping people from having headaches.

Well, I could spend the whole entire afternoon talking to you.

I know, right? We could spend all day here. I want to spend a few minutes talking about oxidative stress. We produce oxidative stress as we do life as we should. But oftentimes we have a burden of oxidative stress that we're not taking care of in a healthy way, and that causes oxidative damage. So you guys have a way to measure oxidative stress burden. So tell me about that.

Yeah. And so oxidative stress maybe might sound foreign. I could call it a reactive oxygen species. And make it sound even more biochemistry. Weird, but really, people are very familiar with this concept. It's really simply, are you getting enough antioxidants for your body? And we all know antioxidants. We know that that's what's in fruits and vegetables. And we know this is why we should eat them, because they're good for us. And antioxidants squelch free radicals. And so another name for free radical is a reactive oxygen species or oxidative stress. And so we're familiar with the idea that if we don't get enough antioxidants, that we'll have too many of these free radicals. And that can even do things like damage our DNA. And this is how we get those mutations that could eventually become a cancer. But. But reactive oxygen species or free radicals, they can muck up a lot of things in the body. It's not just a cancer. They interfere with enzymes that will help us in terms of making our more active thyroid hormone, or they can interfere with our ability to produce neurotransmitters, or they can create pain in the body, or they can damage our lipids, our ldl, and make it even stickier. And more plaque forming. So these reactive oxygen species or oxidative stress is really at the heart of much chronic pathology out there. And you know, you probably had this experience, like you go in, you do your once a year wellness exam, and then you go, now what on here tells me if I'm at risk of cancer? And there's really not a marker on there that does that. It tells you that your kidneys are functioning and that your liver is functioning, and those are good things, and that you're not anemic. And those are good things for us to, to know. But you know our number two causes of death, cardiovascular disease and cancer. And so it's interesting that routine screening doesn't really do something to assess this. Well, some of those markers of oxidative stress that we look at, again, have funny names. AdoHDG is one of them. But it is a marker that goes up when there are more free radicals, when there's more free radicals than your body can handle. And it goes up when DNA is being damaged. And as it goes up, we have more risk of cancer. If it's elevated and you get a cancer, it's likely that your cancer will be more aggressive, it's likely that you'll have more metastasis. And so we do have very validated ways to measure are you getting enough antioxidants to control inflammation or reactive oxygen species in your body. And these markers are of oxidative stress. Again, are associated with, yes, risk of cancer, but also risk of cardiovascular disease when you have more oxidative stress, like I said, this can impact your ability for your neurotransmitters to function. So it can interfere and cause things like depression or anxiety. It can certainly contribute to more pain. So if we wonder, are we getting enough from our diet to control what's going on in our body to keep. Keep us in the best state of prevention? Well, we don't have to just wonder. We can very easily measure these markers and we can get a snapshot of, yeah, what I'm doing dietarily is enough, or no, it's not. I'm sure you've had this experience where maybe we'll recommend maybe something that has, like green tea or has broccoli sprout extracts because they're so helpful in terms, they're very potent antioxidant. And someone will say to you, yeah, but I eat broccoli. Broccoli. And then like, well, but is it enough to control your pathology? And if they're sitting there with symptoms, then we already know the answer is no. But again, how much? Like, every time you read there's a different antioxidant, there's, you know, different studies, different amounts, well, how much and how many should I take? Well, we can answer that pretty simply by measuring your level of oxidative stress. And that will tell us, are you getting enough antioxidants to control signs and symptoms that you're experiencing?

Yeah, I oftentimes find that tests can be really eye opening for patients. That to your point, think they're getting enough? And I'm like, okay, well, let's check and see. Let's see what your level of oxidative stress looks like. Let's see what your level of glutathione looks like. Are you able to have enough reduced glutathione? You know, those kind of questions we can have answered by looking at that oxidative stress panel. So that has been a game changer for people that, to your point, think they're good enough.

Yeah, it can really help those lifestyle things hit home. This younger gentleman who worked in the lab who exercised, taught tai chi, ate really well, but was a cigarette smoker. And I'm sure that he knew cigarettes were not good for him, and he did this on himself. And he saw that 8 ohg was so high, and he would always try to cover up the cigarette smoke. But if you're if you're not a cigarette smoker, it's very hard to cover that up. So I could always tell it. He just smelled like cigarette smoke and cologne when he came. So anyway, he was asking, well, what could that be? And I was like, well, there are various lifestyle things that can contribute. Cigarette smoking is an example of that. And anyway, so a few months later, he showed me his result again. Now it was very low. And I was like, oh, what did you do? What did you change? And he said, oh, I changed some lifestyle things because he was, you know, he didn't want to talk to me about the cigarette smoking and that's fine. But. And again, I'm sure he is a very smart human being. I'm sure that he knew that cigarettes were not good for him. But seeing it there and seeing the damage it was doing to his body and you know, he was in his early 20s and so already that happening. So it was eye opening for him and motivating to make the lifestyle shift he needed to make.

Great story. Well, Cheryl, we could spend the rest of the day here together. Go ahead, Laurie.

Yeah, that's what I was going to say. We could. And I just want to personally thank you not only for your contribution of being here today with us, but your contributions not only as a clinician, but in the lab developing tests that help our patients and our community live better and live optimally. I mean, we covered three tests today and it was a lot. We didn't even get to go in the nitty gritty of all of them. But we Talked about the P88 test, we talked about the intestinal permeability test. We talked about the oxidative stress test as well. And I think we could have probably spent an hour or more on each of those, but it was very, very enlightening. I just really appreciate that you've carved out time and just what you have contributed. You know, years and years and years of practice. We call medicine, obviously the practice of medicine, but also getting in there in the lab and being a pioneer and being. And willing to put yourself out there. I know that it's taken countless hours and ongoing.

Well, I want to thank you guys too, because I think lab tests and all that, the most important part of medicine is education. And so things making something like this available so people can just understand more about what's going on in their body is really the primary thing that we need to do. And like you said, we've known each other for quite some time, so I know, like, you're out there giving up your weekends. You guys are at every conference constantly trying to learn the next thing and how to help the next patient and so very lucky to be here today and spend some time with you and thank you for all that you do to help each patient feel better.

Thanks so much for listening to today's episode. You can find more information about Synergy at Synergy for Life. That's S Y N E R g e e the number four life.com and.

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