SIBO vs IBS vs Leaky Gut: Tests, Treatments, and How to Heal Fast | Dr. Carolina Gonzalez

26:08And so many people are like, it doesn't matter if you eat organic or not. And I'm like, it is so unethical to me to say that when we know that many people, Central Valley of California, for example, really high rates thyroid cancer, other cancers. Why is that? Pesticide exposure. We know where that's coming from. But you act like, well, because you're not getting exposed to it in an apple, we are globally a community. and we are also in community with these microorganisms that inhabit the earth, the microbiome of the earth, like, and the animals of the earth. So anyhow, that's my, like, environmental.

26:47I think about, like, antibiotic resistance, but what's happening to the pesticide resistance, like, that's also something to be worried about as well. Yeah. So would you say that people need to be choosing 100 % organic or is there, like a middle ground here? Yeah. So, I mean, try your best, you know, honestly. And I know the cost comes into it as a factor as well. You can always try to follow the clean 15, dirty dozen, which basically shows you which foods are likely safer to consume if they're not organic. And usually those are the foods that have a thicker peel, bananas, avocados, those cantaloupe, those sort of fruits, versus other ones that have a thinner skin, berries, right?

27:33Those generally are more toxic, have more toxic levels of pesticides. So try to follow that list as best as you can, or just kind of use your judgment when you go. Try to go to farmers markets when possible. They're typically not using pesticides, I hope. You never know. So just try your best and maybe try to opt for the organic foods that have the thinner skins or they don't have peels. What you said about the farmer's market, usually farmer's markets are small farmers. And so they don't have, I want to say this, anytime we scale food production, we compromise the integrity of the entire process.

28:16So if we look at why do we opt, say opt for grass-fed beef, yeah, there's like, it's better quality for sure, but it's also smaller production compared to something, and I will call out Hearst Ranch because I just think they're the worst, huge feedlots where you just see cows for miles and miles and miles. Like, you're not only treating the animal bad, that's problematic, but the way you're treating the animal is impacting the quality of that animal and what we're consuming. And so that's why I'm always like dollar vote for the small guys because it's just inherently often going to have better quality because it's not being scaled to a level where they're compromising and cutting corners and doing things like what we call poor husbandry practices.

29:05Correct. Yeah. You are what you eat. I tell patients. Or what you absorb. Or what you absorb. Yes. Yeah. So we want to ask you, if somebody is waking up, they're feeling gassy, they're feeling bloated first thing in the morning, what's something that can help them with those symptoms, but also what should they be thinking about on a deeper level? Yeah. So if you're waking up gassy and bloated, I would definitely say put more time between your last meal of the day, the night before, and the time that you go to sleep. So generally, we want to stop eating three hours before bedtime to allow your body to fully digest that meal before you lay down, you're in a supine position.

29:42So yes, try to not eat too close to bedtime, I would say. After that, start your day with a glass of warm water, maybe a little bit of lemon, a little bit of apple cider vinegar. Drink that because actually that's a great way to wake up your digestive system, get the digestive juices flowing, and that can maybe help digest any food from the night prior if you ate too late, too close to bed. But if that's going on consistently, I would definitely ask yourself, are you not eating too close to bedtime? And then if you're not and you're still getting these symptoms, that's when you want to be looking into some other causes, right?

30:18So yeah, those would be my suggestions for that. You're a Latina. I'm curious, does your family really late? They do. And I yell at them. Yes. So it's like lunch around like, I don't know, one, two, and then our last meal, la cena, is not until like 9 or 10 p.m. sometimes. And I yell at them. I'm you doing this? Because it's also affecting your sleep, your sleep quality, right? And like your blood sugar and all these things. So, but they've been doing it for so long, they're probably resistant to that. Yeah, I blame it on Spain. I'm like, I really feel like it was Spanish influence because I don't know if you've been to Spain, but it's wonderful there.

30:56But I just can't hang with like restaurants not opening until eight people eat. Like it's like 10 o 'clock people are starting their meals. I'm like, it's 10 o 'clock and I'm already out. I'm sleeping. But it is the thing that like with with all of my mexican friends like they'll they'll dog on me sometimes because they're like oh i'm making dinner reservations for nine i'm like i what dinner earlier and they're just like you're latina like what's your problem like why are you eating so early i'm like science yeah right yeah so i had to ask that because it is very much a cultural thing so we have to also be um i think aware of that we make recommendations right of like well culturally that can be difficult.

31:36So what can someone do if they get invited out with a big Hispanic community and it's dinner at nine? What are some things maybe you can do if you are having late dinner to try to safeguard against that morning bloat? Chronic migraine, 15 or more headache days a month, each lasting four hours or more, can make me feel like a spectator in my own life. Botox, onabotulinum toxin A, prevents headaches in adults with chronic migraine. It's not for those with 14 or fewer headache days a month. It's the number one prescribed branded chronic migraine preventive treatment. Prescription Botox is injected by your doctor.

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32:45Why wait? Ask your doctor, visit BotoxChronicMigraine.com, or call 1-800-44-BOTOX to learn more. Yeah, that's where digestive enzymes and even bitters can be helpful. So bitters are bitter herbs that you take usually in the form of drops before your meal, and that can again simulate your vagus nerve, stimulate digestive juices to help you digest that meal better. And then after that, I would also take a digestive enzyme, honestly, a good comprehensive one to help digest protein, carbs, and fats, because that's going to make sure that you are digesting a little bit better before, again, you go lay down, unless you're going to be up, you know, mariachi-ing with your family until like two in the morning.

33:23So that would be helpful. And then, you know, drink some water and, you know, hope for the best. Yeah. What should people look for with a digestive enzyme? So a good quality digestive enzyme, well, let's start with what's a good supplement, right? A good supplement is one that is being third-party tested by an external lab that has no interest in the profits or gain of that supplement because supplements aren't regulated. So you want to make sure it's a good quality supplement. But beyond that, a good enzyme is one that has a good array of different enzymes to digest proteins, carbs, and fats.

33:54So hopefully it has things like amylase, lipase, protease. There's a question of should it have HCL or hydrochloric acid or not. If you're someone that doesn't suffer from gastritis or really bad heartburn or reflux, generally I would say try to get one that has HCL or hydrochloric acid in it just to further help digest that protein. But if you're someone that's a little bit more sensitive, try to get one that doesn't have it. So yeah, one that has a good quality, a good different amounts of digestive enzymes in there. Yeah. Well, that's fantastic. I appreciate you sharing that with people. How can someone quickly calm a gut flare after eating something that doesn't agree with them?

34:33Fast. Fast as long as possible. If you're able to, if it's safe for you to do so, try not to eat anything until your stomach has gone back to baseline, is feeling better. I'm such a fan of fasting. I think it's good for so many things. It's definitely good for digestive flare. So if your flare happened around 4 to 5 p.m., try not to eat anything until the next day if possible. Drink a lot of water, hydrate well, electrolytes. Tea is great as well because tea contains tannins, which help bind toxins. So if you happen to eat something that had some bacteria, it will be helpful for that. But in general, try to fast.

35:13And if you can't fast, just try to eat very blandly. Try to eat low fiber, low residue. So soups, broths, white rice, chicken, that sort of thing. Yeah. Yeah. I recently, I just had like food poisoning literally like five days ago. I got a smoothie somewhere and I think like, at first I started bloating and I will do that sometimes with pea protein. I joke that I'm like, I think vegan protein should be illegal. But that's just because with my gut, But if somebody loads me up on like a ton of like tea protein, and it's just like, I think it's more about how it's processed as well. But I bloated initially and I was like, oh man, it must have been pea protein.

35:54I thought it was whey. And then the symptoms came on and I was like, what do I have in the house? I was like, I have my women's probiotic, Saccharomyces boulardier. And then I was like, I have berberine in the house. And I hit that and we were going on a trip the next day. We're going to be up at 3 a.m. My husband's like, you're never going to make it. like you're so sick, like you're never going to make it. I'm like, watch me, watch me. But I'm totally with you because outside the supplements, I was like just drinking clear fluids, like just trying to like give my gut the rest that it needed.

36:26So I want to, I want to switch gears to parasite cleanses because this is like what you see. I roll. Everybody. I roll. Okay, here we go. Do most people really need a parasite cleanse or is this an influencer trend? So if we're talking about our side of the world, the Western side, the Americas, generally, no. We tend to live in a pretty sterile environment. Unless you're someone that's eating a ton of raw fish, sushi, or you're someone that works a lot with animals on a farm, then yes, I might think more about parasites in that instant. But I can tell you I've done hundreds of stool analysis, and out of all of them, maybe 5 % came back positive for intestinal parasites.

37:08So yes, they are hard to detect, but the type of stool testing I'm doing is actually looking at DNA level of the parasites. So if we're not seeing any DNA level, then you don't have a parasite. And the reason why this is all the rave is because most of the supplements that are being promoted as parasite cleanses are actually, number one, laxatives. And so if you're flushing out your gut, you're going to think it's doing something for you. And you might feel good, especially if you've been backed up for a while. You might think it's doing something for you, but really it's just flushing you out and further depleting your good bacteria.

37:44So I would say no, most cases it's not necessary unless you're showing obvious signs of a parasite infection or like I said, context, right? Well, and some of these supplements are irritants as well and people pass mucus. I don't know if you've had patients take photos and they're like, look at this parasite. I'm like, that's mucus. That's mucus. And that's supposed to be there protecting your gut lining. And so you just stripped your defense. And so I think that's another thing that, you know, people are, and it's the people who are promoting these supplement kits. I'm always like of the opinion of like adults get to make their own choices.

38:26You can educate people if they choose to do it. That's their life. I take issue with the kids when people are like giving some of these supplements because there's people who I believe they actually do know this and they're from a marketing perspective saying it's natural so it's safe. Antiparasitics can be incredibly toxic if at high doses like not every herb is safe and so that's another concern I have is that you have a small human I'm also like what if this this child actually has something else going on. What if they have celiac disease and you're chasing this parasite cleanse? And often I think that as doctors, it's really easy for us to like judge the individual.

39:09We always have to like go back at like the root cause, right? Why are they doing that? Because they probably went to a doctor who didn't listen. They probably went to a doctor who dismissed them and they were like, well, I'm desperate. I'm going to try this other thing that I see working for other people on the internet. Yeah, definitely. And some of the herbs, if you are doing an herbal antiparasitic, like warm wood, for example, at higher doses, it's actually pretty toxic to your liver. And so it's very important to be careful with that, especially when dealing with children. Yeah. And acute hepatic failure is nothing to mess around with.

39:47So what are the actual signs of the true parasite infection so that people can understand? Because really, I mean, I have people when I talk about my endometriosis and they're like, you have parasites. That's what's going on. I'm like, well, the predominant theory right now is that this actually happened in embryonic development, like in utero. They're like, then your mom had parasites. I'm like, cute. Okay. Right. Yeah. So actual signs. So they're pretty vague and nonspecific, and there's a lot of overlap with other functional digestive disorders like SIBO. So it's hard to really parse out, you know, is this a parasite?

40:24Is it SIBO? Is it something else? But in general, that's why it's important to get a good intake from the patient and, you know, see the context of everything. But other signs and symptoms other than digestive symptoms, bloat, diarrhea, cramping, you usually see weight loss, especially if it's a worm. A worm is going to be eating up your nutrients, all of that. So we tend to see weight loss. Sometimes we can see fatigue, we can see brain fog, but again, these can also point to SIBO, right? So other signs could be, actually a funny one is rectal or anal itching, especially one that tends to wax and wane with the moon cycle.

41:02It kind of goes in accordance with the feeding of the parasite. So that would be another telltale sign of something that makes me want to look more into parasites. Yeah. And if you have rectal anal itching, there's a little scotch tape test that you can do. Really fun. But we have people do this with their kids and you'll see the eggs from the, like this happens with pinworms. Yeah. It is. I want people to understand. I think that like we all have our things in medicine that we like absolutely hate. And parasites are one of those that I'm like, if you have one, we definitely, we definitely want to make it gone.

41:35I want to say, I appreciate you bringing up that, you know, if you're eating sushi, you're eating undercooked meats. If you are living in certain countries or traveling to those countries, I was actually just with a Brazilian doctor and we were talking about the internet trend of parasite cleanses. And he's like, yeah, like when I was growing up as a kid, we had parasite treatments every six months because of where we were at. He's like, is that what people are doing? I'm like, no, they're getting like boxes of like herbs and all this stuff. And he's like, what? Like they were taking like what ivermectin or albanzazole, like some medication.

42:07Yeah. And that's pretty common because if you're in an area where, you know, there is a lot of farmland, there's runoff, you're coming in contact with animals, maybe the meat isn't the highest quality. So there are definitely considerations. I don't want people to think that parasites are not a thing and they're not something that has to be considered. but I am curious, what we're talking about is these influencer-driven parasite cleanses, these supplement kits and boxes, I'm sure you've seen them. Are they doing more harm than good for gut health? I wouldn't say necessarily they're doing more harm than good.

42:42I just think they're not doing anything for the person. I think it's delaying proper treatment, actually figuring out what's going on with the person rather than just kind of flushing them out and giving them random herbs and laxatives. But if they're doing that consecutively or you know, weekly even, then yes, they're irritating their gut lining. They're depleting their good bacteria. And again, supplements aren't regulated. So we don't actually know the quality of the herbs, the supplements. So some of them actually can be doing more harm in that case, right? If they are laden with toxic heavy metals or anything like that, they're not being tested for purity.

43:17So yeah, just be careful with what you're getting out there. You want to make sure you're getting supplements from a trusted, reputable company or from a practitioner. are. So in context of this conversation, do you eat sushi? Sometimes. Yes. So pretty much like every podcast guest, I'll give them a list of places they want to go. And it's always the sushi restaurant that they pick. But I'm super picky about my sushi. And I have like, one of my kids is always like, I love sushi. We'll be like at a gas station. Can you get sushi? I'm like, no. Not from here. No. I'm like, no, no, no. I always tell my kid like, food poisoning is a really dumb way to die.

43:54Like it's a, it's a really dumb way to die when you are in a developed country and you have the ability to avoid those things. Like don't, don't mess around with it. That would be such an ironic way for me to die. No, thank you. Yeah. Well, it's like, you know, something of like, you know, and because this happens to everyone every now and again, like you make something like soup gets left out overnight. And that, I remember my husband, we were first dating and he's like, oh, should we just like put this away and eat it tomorrow. I'm like, do not know about botulism. What? No, that's trash. And he's like, we spent all this time making it.

44:28And I'm like, yeah, and we messed up. Like, that's a bummer. So when I talk about like, if someone suspects they have a parasite, maybe they're like, listen, I'm listening to these influencers online. They're making sense. What can they do to test? What's the proper type of testing to actually catch a parasite? Because the one-and-done stool culture. You're never going to see a parasite. You might, but you probably not. Yeah, it's really hard to detect parasites, especially if they're hiding out somewhere. But that's why I prefer doing something like a PCR microbiome stool analysis, which is looking at the DNA components of said parasite.

45:05So if you're suspicious of that, try to get in contact with a naturopath or a functional medicine doctor that can order this test for you, because that's going to be probably the most effective way to try to detect a parasite, especially if it's a more chronic one. Like you said, a lot of the ones that we're doing at Quest or LabCorp, they're just looking for the presence of the actual parasite in the stool. But if it's not coming up in that stool sample, it's very easy to miss. So again, if you are having acute symptoms and you think you have food poisoning or a possible parasite, definitely go see a doctor right away.

45:39And, you know, they might give you antibiotics or antiparasitics. But if it's something that's been more chronic, low-grade, long-standing, a PCR DNA stool analysis is what I would recommend. And the other thing, you know, you've said see a doctor a few times, I think it's important for people to understand is it's not enough to treat the organism. There's also a healing phase that has to happen afterwards. And in the case of parasites, certain parasites, they can trigger autoimmune disease. You want to make sure you're not missing that. They can also lead to nutrient depletion. So if you're like, oh, I'm fatigued and I think it's just because of the parasite, well, we want to also get a CBC, like at least a CBC and make sure you don't have iron deficiency anemia.

46:21So there's no one ever says you get to have just one thing. And in fact, most people do not have just one thing. And there are consequences of having infections that you also want to make sure are dealt with properly because just eradicating the organism is often not enough for people to truly feel better. So instead of going and buying an expensive parasite cleansing kit, what is an actual evidence-based way to treat parasites? Yes. So if it turns out you actually have a parasite, you've done the test, you come back positive for a parasite, definitely work with a naturopath or a gastroenterologist.

46:57Depending on the severity, you might need a prescription. You might need albendazole or mabendazole, even ivermectin, depending on the type of parasite it is. If it's not to that level, you can definitely work with a naturopath to get on a good anti-parasitic regimen where you're taking anti-parasitic herbs along with modifying your diet. So parasites do thrive off processed foods and sugars. So you want to make sure that you're limiting that and focusing mostly on a whole foods-based diet and that you're seeing the treatment through. Because sometimes the parasites can be shed in phases depending if they're actively feeding or if they're dormant.

47:34So you might have to do a couple weeks on of treatment, weeks off, weeks on, like that, depending on how severe the infection is. Do you not typically prescribe these medications? I can't prescribe in my state because I'm in Connecticut. So I don't prescribe prescription medications. But if it's a very severe parasitic, then I'm referring to infectious disease or a gastroenterologist. Yeah. And that's, I think, important for people to understand because there's different formulary scopes of practice, which means prescription rights. I didn't realize you were in Connecticut. I'm licensed in Oregon.

48:09I've got a full formulary and patients will come to me and they're like, wait, you're going to prescribe a pharmaceutical? I thought you were like anti-pharmaceuticals. And I'm like, oh baby, I'm all about how do we get you feeling better as soon as possible? Because I have been there with things where I've been, you know, I have a history of H. pylori. And that was something that I'm like, oh, yeah, I got to like, I've got to get rid of this. As we were talking off camera, I've had SIBO a couple of times. One time I used herbal treatment, totally fine. Another time I landed in the ER because the pain was so bad and the pain I was having was so severe that I was like, it's refuximant.

48:48Like I can't, I can't go through my days. So I have to have something. And that's what I really appreciate in this conversation of what you're saying is that it's not an either or, right? There's, there's always this division of, um, happening where people are like, no, you have to do everything all natural or only pharmaceuticals actually work. And really it's about looking at what is best for the individual. What are they treatment is medically necessary, when someone's like, okay, I'm going to pursue this, why should they know about treating parasites? Because it's not one of these things that when you start treatment, you just start feeling better overnight.

49:29Yeah. So you can definitely get a herxheimer reaction or what's called a die-off or a healing crisis, which is basically where you feel worse before you feel better. And so you can see a heightening of your symptoms, usually within within the first couple of days or first week of starting the treatment. That's typically when you're going to see die off. If you're going to have die off, some people don't have the die off and that doesn't necessarily mean the treatment isn't working, but I always do pride my patients with the expectation that that may happen. And if it does, as long as it's not too uncomfortable, you know, try to get through it.

50:02We support them symptomatically through that. But if it's something that's lasting, you know, weeks on, then we kind of just, you know, turn down the volume on the treatment and maybe support in other ways. Well, you have prefaced this many times saying like working with a licensed healthcare professional is important. But with that in mind, are there herbs and foods that do help with parasites? I know there's certain smoothies that I do, depending on where we're traveling. Yeah. So garlic, I mean, as long as if you don't have SIBO, garlic is a great one because it has a lot of antiparasitic, like antimicrobial effects, but it's high in FODMAP.

50:41So if you have SIBO, you don't want to be eating a lot of garlic. Other ones would be spices. So things like thyme, rosemary. So using a lot of the spices in your cooking. Papaya seeds actually are also antiparasitic. And those are a couple of ones that I can think of off the top of my head. What's in your smoothie? It's papaya seeds. Yeah. And I just think papaya is like the nastiest fruit to ever exist. um i'm it's very interesting because i had said that about papaya people are you just haven't had the right papaya like i have tried people were like you know you need to have a mexican papaya i'm like said from mexico i hate papaya turns out that um just like some people have cilantro issues some people have papaya issues i still make myself eat it i still like i'm like it's so good for you like i get in the mix but the seeds themselves that with um like pumpkin seeds.

51:34I will put in there. I will grate turmeric, ginger in there, try to put in. So looking at polyphenols and bringing that in, which is what you were talking about with this, the spices, the herbs, thyme, rosemary. Those are also rich in polyphenols, which we know are absolutely essential for your gut microbiome. I'm also going to link to the episode. Do you know Dr. Kara Fitzgerald? Heard of her? Yeah. I think her clinic is in Connecticut. She's a researcher as well, though, did fantastic research. We did a whole episode together about polyphenols in the diet. And her diet, they did a study in eight weeks, was able to reduce people's biological age by about four years.

52:18And a lot of it comes down to the microbiome. So for everyone listening, take care of your gut because it literally can take years off of your life in either direction, right off of your biological age, which we want to be younger or years off of your life because you're not having the nutrients that you need and you're having this chronic inflammation. Yes. We've talked a lot about SIBO and IBS. You have said anyone before they get diagnosed with IBS should be worked up for SIBO first. What is SIBO and why is that your stance? Yes. So SIBO stands for small intestinal bacteria overgrowth and the name describes what it is.

52:58So you have too much bacteria in your small intestine where it should be relatively sterile compared to your large intestine, which is where your microbiome actually resides. So I think up to 70 % of patients that are diagnosed with IBS actually have SIBO, which like we were talking about, it's a very treatable condition. And so why wouldn't we want to rule that out right before diagnosing someone with IBS, which is basically just a collection of different digestive symptoms, an umbrella term, if you will, when we don't really know what the cause is or the cause is not known. But if there is a cause that can be tested for and treated, I think everybody should have that before just being diagnosed with IBS.

53:42And essentially IBS, then that's a chronic condition that is going to be managed with either medication, lifelong by the way, and diet changes. But if you can treat it, then you can definitely put your symptoms into remission by 90 % or more and feel better. Yeah. 90 % is no joke. Yeah. So why is it so often that there's this misdiagnosis? People are told they have IBS when in fact it's SIBO. Yeah, I think it comes down to the provider that you're working with. So some gastroenterologists, they're not looking for it. Maybe they haven't been trained in that. There's also testing availability. So if you only have one SIBO machine per hospital, you might have to wait three plus months to have access to that test.

54:31But practitioners can actually sign up with other companies to actually drop ship SIBO tests to the patient directly so they don't have to wait so long to test and then treat for it. So I think it comes down to knowledge and then testing availability. Mm-hmm. So with IBS, we see this as common. I think it's like the gut diagnosis that's synonymous to anxiety in women, right? We see a lot of women get handed that diagnosis. Outside of SIBO, what may also be looking a lot like IBS, but it's not actually IBS. Yeah. I mean, so anxiety for sure. And it's interesting because it's not just anxiety, like fix your anxiety and you're done.

55:13Because if you've been anxious and you've been in this fight or flight, like we were talking about earlier for a long time, that can actually alter your microbiome to the point where now you're getting SIBO. So anxiety can definitely be a cause even of SIBO. But then there's also something called SIFO or what we used to call just candida or candida overgrowth. But that candida is also occurring in the small intestine. In fact, 20 % of patients that have SIBO also have SIFO along with that. And so I can get into the testing for that if you'd like. So with SIFO, the testing isn't as promising or as telling as the SIBO test.

55:49The SIBO test has high accuracy and specificity versus a candida or SIFO test. There isn't. So what I tend to do for patients is I order something called candida immune complex in the blood, and it's basically an aggregate of antibodies. And if it comes back high or positive, then you're more likely to have SIFO. You can also order arabinose in the urine, which is not one I do readily. That's often seen in an O test, but O tests are costly and I'm not ordering them on every patient. So I'll do the candida immune complex and I'll also look at the other symptoms that the patient is showing up with.

56:22There's a lot of overlap with SIBO, with SIFO, but typically they're also showing signs of oral thrush, of hives, of itching, chronic vaginal yeast infections, dandruff. Also recent or frequent use of antibiotics is another telling sign that they might have SIFO. So I'm screening for both at the same exact time for patients. And if they have both, I'm typically treating both at the same time. What is making people susceptible to developing these? So definitely stress, unfortunately, is a very common cause because again, it does deplete your stomach acid, which is an antimicrobial peptide against bacterial overgrowth.

57:02So then you're getting that bacteria, you know, translocating into your small intestine. It's also slowing your gut motility. So food isn't moving as efficiently as it should down your digestive tract, allowing bacteria to come in and feed off of that. So stress, medications, antacids. So I can't tell you how many of my patients come to me that have SIBO that have been on PPIs or H2 blockers for decades, right? And so that's bad. Anything that slows gut motility, honestly. We talked about stress, but also things like hypothyroidism, diabetes, Lyme disease, anything that's affecting the neurological wiring of your small intestine to slow things down.

57:42And yeah, antibiotics, birth control, antidepressants, all these medications, obviously don't stop them. If you think you have SIBO, work with a doctor on that. Poor diet, excess consumption of alcohol, caffeine. So, yeah. And we know food poisoning can be a big thing as well. Totally. Yeah. So that's when you get something called post-infectious IBS, which basically ends up turning into almost an autoimmune condition where your body creates antibodies to try to, you know, fight off the infection. But those antibodies actually affect your gut motility as well. And so as you can see, there's primary and secondary causes of SIBO.

58:21And so that would be a primary cause, right? The secondary cause would be that it's slowing down your gut motility. And that's actually really hard to treat because those antibodies, we don't know how long they're going to hang around for. And so in those instances, we're really doing a lot of work with patients to enhance their gut motility. So yeah, whether it's herbal or prescription-based. Now, we started this podcast and you said lactulose breath test, worth it. Can you explain what this test is and why you feel like it's worth it for SIBO? Sure. So the lactulose breast test is a test we use to test for SIBO.

58:59So lactulose is a non-absorbable sugar, so it doesn't get absorbed, but it does feed bacteria that may be lingering in your small intestine. What will then happen is bacteria will feed off that substrate and then release gases, either hydrogen gas, methane gas, or even hydrogen sulfide gas. And basically the way that we're detecting that is you're blowing, after drinking the lactulose, you're blowing into a bag every 30 minutes for three hours. So it takes three hours because that's how long it takes that substrate, ideally to get, you know, from drinking it all the way down to your digestive tract.

59:30So within 90 to 120 minutes, if you're having elevated hydrogen gas or methane gas, then you are positive for SIBO. And the lactulose breath test is ideal because we're able to see which gas are you testing positive for? Because that will actually determine which treatment we do for you. When the very first time that I self-diagnosed SIBO, because I did a lactulose breath test, my husband, I was like, you have SIBO. I know it. You need to do the test. He's like, I'll do it if you do it. I'm like, fine. Okay. We're going to do this home test. We'll just be here for three hours. I was so bloated during the test that I was like, okay, I definitely have it.

1:00:06And then I was aggravated. Like I, it was, it was so aggravated. I was like, I can't wait for the test results. I need to do this now. Um, and I think that's important for people to understand is that this test can definitely make symptoms worse, but also that I had no symptoms. I was like, no, I have no gut symptoms. Um, and then it turned out that it was positive. So whether it's hydrogen or methane, what is your approach to resolving SIBO? Yeah. So again, because I work in a state where I can't prescribe, unfortunately, I tend to work with herbal antimicrobials, whether that's berberine, oregano, thyme, rosemary, different formulas of different herbals, along with a low FODMAP diet and a lot of patient education around meal hygiene.

1:00:54So slowing down when you're eating, chewing your food thoroughly, trying to get in that calm, restful state when you're eating, and also spacing out your meals four to five hours in between is really ideal for enhancing your gut motility as well as not eating too close to bedtime. So that's typically my approach. And I do that anywhere from four to six weeks for one round. And then we kind of reassess and see how the patient is feeling. My goal for the patient is for them to be feeling 90 % or better at the end of the treatment. If they're not, we go ahead and do another round of the treatment.

1:01:24Another option would be something like the elemental diet. So the elemental diet is a meal replacement liquid only shake diet that you do. And it's completely SIBO safe, it's hypoallergenic, but you only drink this shake every day for two weeks on end. And then we kind of reassess and either repeat the SIBO test or see how you're feeling. So that elemental diet is meant to starve off any bacteria in your small intestine while feeding you and giving you the calories and nutrients that you need during that time. And so that's typically where I start. And if patients typically don't respond to that treatment, then I'm referring them to Zyfaxan or Neomycin with that.

1:02:01Luckily, I do work in an integrative practice where we have prescribers on our team. So in that case, I would refer them to them if they're not responding to the herbal or natural treatments. And what are you using for motility support? So I'm using a combination of ginger, 5-HTP, artichoke root. So that would be, I don't know if I can say brands, but there's a motility activator, modal pro are common ones, gut motivator, using that in severe cases. If patients actually have been diagnosed with gastroparesis, then they have to go on a prescription. I also have been using LDN often as well with patients, low dose naltrexone, because it is a nice, gentle anti-inflammatory, but it's also a great gut motility agent as well.

1:03:18Mm-hmm. busy. See terms. And are you leveraging the low FODMAP diet at all? Yes. So we're doing the low FODMAP diet during the herbal treatment, not during the antibiotic treatment. So it's not necessary to do it during the antibiotic because you do want the bacteria feeding around for the antibiotic to be more effective. But the herbal intermicrobials are not as strong as Zyfaxin. So in that case, I do recommend low FODMAP diet. And I recommend it even after finishing the treatment. I recommend it upwards to a month after finishing the herbal antimicrobials, elemental diet, or the antibiotics.

1:03:53Because when you stop the treatment, you're feeling amazing. But right after is when you're the most vulnerable for a relapse. You're actually most vulnerable for a SIBO relapse four to six months after treating it. But we don't want to keep you on low FODMAP that long. We want to, during that time, we want to continue supporting your gut motility, your digestion, your eating habits, and then going in and healing your gut lining, and then reintroducing the beneficial bacteria again. How long does it typically take for someone to heal from SIBO? So typically weeks to months. Yes. I've had chronic patients where it's been more difficult and it's taken longer.

1:04:28It's taken up to six months. Sometimes patients don't fully heal, but they're a lot better than when they first started and they're usually happy with that. And if they're not and they want to keep investigating, honestly, that's when I would bring in maybe a parasitic cleanse, anti-parasitic cleanse, because it could be something that we're missing or that we're not detecting. So, yeah, weeks to months. When it comes to SIBO compared to SIBO, how does the treatment approach differ? Yes. So definitely the diet, you know, it's focused on limiting processed foods, limiting sugar, refined carbs anyway, which is what we want to be doing.

1:05:06With candida, I don't always have people go too strict with taking out all sugars like fruits because then it gets really, really strict and impossible to follow. But I'm also adding in things like antifungal herbs such as monolaurin or caprylic acid. In some instances, I'm giving them liquid nystatin, which is an antifungal. So it is a prescription, but we coordinate care with our prescribers because it just works so well and it gets people feeling better much quicker than some of the herbal antifungals. What are some of the mistakes people make when they're trying to treat SIFO? Eating too much sugar, not watching their sugar consumption, not treating long enough and not taking probiotics during that time.

1:05:47And so I know I mentioned that I treat both SIFO and SIFO at the same time. The probiotic that I give is Saccharomyces boulardii because it's actually a yeast-based probiotic. So it's not likely to aggravate if you have SIBO like other probiotics would. So with SIBO, we're not giving probiotics or prebiotics during the treatment that comes after we treat it. Yeah. And for people listening, we started talking about parasite cleanses. Those are the thing, that's the current trend right now. Several years ago, it was anti-candida diets. Everybody had candida. Everybody had fungal issues. That was the trend in things.

1:06:24And as we're talking about this, we're talking a lot about what does the individual have and what is the best treatment for them. And I think that's important just to underscore and highlight here for people is that it is possible that you have candida. The problem is, is there's no difference between a doctor who's like, it's IBS, it's IBS, it's IBS in everyone, and the influencer that it's like, it's parasites, it's parasites, it's parasites in everyone. That's the same methodology. And that is not the bio-individualized care that patients need to actually get better. So I just, as you're saying all of this, I'm like, I just really want to highlight that because you can't have any of these things, but, uh, you know, as in, I know I've, I've, I'm older than you, been around a lot longer than you.

1:07:12And I just watched these trends and I'm telling you in 10 And here's going to be candida's back again. Like that's what people are saying again. And so it's really important to work with a provider to understand these things. Now, you have been exploring peptides for gut health. And I think that's a really interesting avenue for treatment. What are some of like the highlights of what you've been discovering in clinical care and in the research? Yes. So peptides are basically sequences of amino acids that are strung together that are meant to elicit healing. And so the one that I've been working a lot with patients is called BPC-157.

1:07:51And that one has been shown to actually stimulate healing and regeneration of the cells in the small intestinal lining, which actually is really great for healing leaky gut. So I give it to patients orally because right now I think the FDA has done a pushback on the injections of BPC-157. So the oral BPC-157 I'm finding is really helpful. We are seeing zonulin come down and symptoms improve drastically. It is a little bit more costly because it's still, I think, something that's newer on the market. But hopefully over time, you know, it will come down a little bit. So yeah, these peptides are incredible, but you want to be careful because it has the ability to regenerate the cells of the lining.

1:08:34It does so via angiogenesis. And so if you have any cancer cells or if you have a diagnosis of cancer, you want to be very careful because that can potentially increase the cancer or the spread of it. So I'm very careful with who I'm giving it to. I'm doing a lot of screening with the patient. So it's not something you want to just kind of pick up off the market and try yourself. You want to make sure that you're doing your due diligence. Yeah. And that goes for a lot of these peptides that are being used. I mean, I don't think peptides have really become that mainstream as of yet. They show a lot of promise and you're seeing a lot of people using them in the anti-aging community.

1:09:13But that sometimes gets translated to like, again, it's natural. It's safe. Just go for it. Like, just use it. And I think that you're right to caution people of like proper screening. And also, when these things are costly, you want to make sure that it's the right thing for you. Yeah. Yeah. And so that's just one thing that I'm using to heal the gut lining. Other things I like, collagen is a very effective one that a lot of people can have access to, and it's generally safe. Glutamine is also really effective. So glutamine, we normally think of taking that for our muscles, for muscle recovery, but also great for it's a fuel source for the cells of the small intestine.

1:09:52So that one is great. Bone broth, aloe vera, demulcin herbal teas, like licorice root, marshmallow root. These are all great things that help heal the gut lining as well. BPC is just one of our stronger hitters, but we are also using the other things as well. You brought up bone broth. It makes me think of histamine. and everybody who, so histamine intolerance is a big topic and it is, a lot of people are impacted by it. Not everyone, like the being touted online. So bone broth can be definitely a trigger for people with histamine. Often people think like, okay, the only thing I can do is go on a low histamine diet, start restricting.

1:10:32But we know many of the histamine problems actually originate in the gut. Can you speak to that? Yeah. And so going on a low histamine diet can help if you have histamine access in your gut, but why all of a sudden are so many people histamine intolerant or have MCAS or mast cell activation syndrome? It's because of the dysbiosis. We have, there are bacteria in the gut that can either directly activate mast cells to secrete histamine or they themselves secrete histamine. And so if you have an overgrowth of these bacteria, well then sure you're going to have histamine access. So the goal is never I think to restrict the diet and have that be the answer.

1:11:10It's to get to the root and the root could definitely be that bacteria overgrowth. I was recently reading a study. So for years we've heard moms say the food dyes affect my children's behavior. And I was recently reading a study where they did genetic testing regarding genes that help with clearing histamine because we do know so often when we talk about this food dye conversation it's again very split of like everybody has behavioral issues with food dyes every child will have problems or nobody right and it tends to be the more conventionally minded doctors who are always like in the nobody camp they're wrong so often um when they take that stance i think about how like right nobody has SIBO nobody has SIFO nobody has leaky gut.

1:11:57That's not the thing. And nobody has HPA dysregulation. And then we have just like mountains of studies now. And I'm like, yeah, it's always better to be like, let's be curious. Why would a patient say this? But this study actually showed that there's several food dyes, one being the red 40 everyone talks about, that they actually cause the immune system to release histamine. And in the population that has this genetic polymorphism, they're not clearing that histamine and they did in fact see behavioral changes and so it's even you know even really another point of saying what you've been saying all along of like this ultra processed food like paying attention to that if you're someone with histamine issues certainly if you can afford to get genetic testing and then you know like yes it's me but i think paying attention as you were saying with food sensitivities as well you eat something you don't feel right, that might be true for you.

1:12:53Bring that data to a clinician who's willing to be curious and not just shut you down because they haven't happened to read the one study that has existed at this time that's pulled together the aggregate of other studies saying there's something to this. We need to dig deeper. Yeah. And I would say it's not just bacterial overgrowth. It could also be not enough of the good bacteria because the bacteria also play a role in degrading histamine, specifically bifidobacterium. And that's the one that we see tank the most in the setting of antibiotics, right? And so we live kind of in a world where antibiotics are given pretty freely now.

1:13:29You have a cold, you go in and you get an antibiotic. And so the good bacteria will suffer as a result, and then they're not around to help degrade the histamine. Then you have the other bad bacteria that are just spewing histamine. And sure, some people can have an issue breaking down histamine, and they can take enzymes to help with that. But generally, that tends to be more on the rare side. It's usually more an imbalance in their microbiome, I'm seeing. Yeah. And this is something that, so I've worked with a lot of PMDD patients over the years. I personally struggled with PMDD. And I find so often that in addressing the gut, we can get symptoms better.

1:14:06For myself, personally, I was able to resolve them all. I never like to make promises of like, we just have to fix your gut and we'll fix everything because we're complex and that's not always the case. But it is something that as we look at more of the research coming out with some of these issues that women struggle with, we know that with neurodivergent women, there could be more histamine issues, those with PMDD. We also see it with endometriosis as well. And so I think this conversation around the gut is really important. I would love for you to share with listeners, how do you approach someone when they're dealing with histamine intolerance.

1:14:39Yeah. So you can temporarily go on a low histamine diet. And so let's talk about what that would look like. So definitely limiting anything that's fermented, that's aged, aged cheeses or meats, anything like that. Anything canned, honestly, and leftovers are big ones as well. So like you're not a fan of leftovers and it's also, it's not great if you have histamine intolerance because the longer foods are left out, the more they tend to build up the histamine. So I think temporary low histamine diet can be helpful, obviously, while you're getting to the root of that. But then you can always take things to help degrade histamine a little bit more.

1:15:15There are enzymes specific for that. Natural antihistamines can be helpful, things like quercetin, vitamin C, stinging nettle. So just kind of helping your body clear the deck of any histamine as much as possible would be my advice. Yeah. And for people listening, I find with, I'm not a fan of doing low histamine diets overall, because I just find that people who are struggling with histamine, they're struggling with like mood dysregulation, nervous system dysregulation overall. Like they're, it's one more thing to do that can feel really, really overwhelming. But I do find sometimes that, so in cases of PMDD, if we do that, if we're like, okay, not doing leftovers the week before your period, Like we're going to start modifying some things while we're also, you know, working on the underlying issues, bringing up the vitamin C.

1:16:04You mentioned some great herbs as well. I think those drinking nettle tea is like definitely in. We want to be doing that. But the other thing with PMDD is actually using H1 and H2. So we're going to use something like loradidine, claritin, and yeah, pepcid. and doing that. Typically, I'm doing Claritin like 10 milligrams twice a day and then Pepsid once a day. You always want to check with your doctor if that's right with you because even though these are over the counter, that doesn't mean they don't interact with other medications. They can't have side effects, that they're not right for you.

1:16:39But this is where it's that integrative approach of like, how do we get you feeling better as soon as possible? And in some people though, a low histamine diet is going to be the way to go for a period of time. I just think that, you know, as much as you were saying as well, you know, the low FODMAP diet, like we just have to be cautious of like taking too much away because food, I think very much within North America, people are like, food is just fuel. It's just nutrients. It's just information. But we come from a culture where food is pleasure, food is community, food is how you connect. And so we have to be really aware of how we're approaching these things in people because being super restrictive and robbing someone of the joy of their life is going to cause gut dysfunction.

1:17:25If you're miserable every time you eat and you're like, I hate this so much, or as you said, you're afraid every time, we're going to have issues. You can literally make issues in your mind that can happen. That is a real phenomenon. I'm always cautious in saying that though, because I just feel like some male practitioners run with that in women and they're just like, oh, you just manifested this with your brain. Your pretty little head caused all your problems. And it's like, it can happen. But I see that more as often a manifestation of influence, outside influence, teaching people to be afraid of food.

1:18:02Yeah, for sure. And that's why I'm not a fan of keeping patients on restrictive diets, low FODMAP diet for more than six months. That's like the absolute max. And then we take a break from treatment. You know, like, let's chill out. Like, let's take a break. And I say the same thing. You know, we do want to, I say these foods are good. They're great for our microbiome, our good bacteria. We've dealt with the SIBO. The SIBO is gone. Now we want to reintroduce the good foods that are going to maintain the good bacteria to keep SIBO at bay. So I try to frame it in a way that is more of a positive and where we're introducing for a reason so that patients aren't so scared and they see that it's necessary to bring these foods back in and not stay off them.

1:18:40I mean, I have patients that come in on low FODMAP for years. They've gone out for years. And sure enough, we do a microbiome test. Their good bacteria is nowhere to be found. And that's what's keeping them from getting better. You mentioned the vagus nerve earlier on. What is that for people who are not familiar with it? And why does it matter for gut health? So the vagus nerve is the 10th cranial nerve, and it's the direct communication between your brain and your gut. So actually 80 % of the fibers in your vagus nerve are actually going from your gut back to your brain. So we're constantly getting signaling from our brain to our gut and our gut to our brain.

1:19:15That's what's responsible or comprises the gut-brain axis. So the vagus nerve is responsible for getting us in that rest and digest mode. And there are ways to activate the vagus nerve, such as deep diaphragmatic breathing, humming, gargling, singing, anything that causes vibration here because that's where the vagus nerve travels over will help to activate that vagus nerve. And so it's good to be doing these exercises in the morning when you're getting ready for work, in the car, on your way to work, or just whenever you want. And definitely before meals, we want to be making sure that we're activating this nerve because it's responsible for the secretion of your digestive juices, for your saliva, right?

1:19:57Your saliva actually contains enzymes that help you digest your food as well. And it's also really important for peristalsis or the contractions of your esophagus, your stomach and your small intestine. And so we want to be optimizing how much we're actually activating that nerve while we're eating and thereafter. What do we know about the neurotransmitters that the gut produces? You mentioned the gut-brain access. We often hear people say, your gut makes the majority of your serotonin. So if your gut's not happy, then your brain's not going to be happy. But what do we actually know about what's going on there with neurotransmitters?

1:20:31Yeah. So bacteria actually help make neurotransmitters, not just serotonin, but think like GABA as well. And so if you don't have the bacteria around to help create GABA, which is a neuroinhibitory neurotransmitter, so it helps decrease excitatory neurotransmitters, which make you more anxious, then you're going to probably be feeling more anxious, have trouble falling asleep. And so this is not a case where you would want to just take GABA, you would want to replete the good bacteria, specifically bifidobacterium. That one is my favorite guy because it plays such a role, again, in breaking down a histamine, but also in the production of GABA.

1:21:08So it's cool because there are some probiotics that target the gut-brain axis. I believe it's called gut-brain axis, which contains predominantly bifidobacterium species to help create more of the GABA. The probiotics called gut-brain axis? I believe. Yeah. I like very literal talk. Me too. whenever we're like it mainly we're like formulating a new um supplement now and i'm just like why can't we just call it focus and mood yeah and i and the team we came up with radiant mind they're like no it has to be something that like people are like oh like it feels uh good but i'm just like just like it's for focus and mood though like that's what we're doing here um so i'm like i very much appreciate that naming invention do those neurotransmitters cross the blood-brain barrier though?

1:21:54Yes. So there is controversy with that. Does the serotonin made in your gut actually make it to your brain? I think so. Again, I don't know exactly, but I want to say yes, because I can tell you that when my patient's gut is functioning more optimally, they're feeling better. They're less anxious. They're maybe less depressed. They have less brain fog. So my assumption is that they are, and same with the GABA patients, when they have optimal flora. They're feeling less anxious. They're able to sleep. Their sleep is better. So my assumption would be yes. Some of them are, maybe not all. Yeah. Well, and we also know that serotonin that's being produced there, that's why you use 5-HTP for motility because that helps with gut motility as well.

1:22:35And what I've seen in terms of the research is that it may be the neurotransmitters interfacing with the vagus nerve that actually then is helping modulate how the brain is functioning or responding. And we also know that there's been research to show when there's intestinal permeability, there can be a leakiness of the brain barrier. And then we're having the same kind of inflammatory response happening as well. Yeah. And then we didn't get into postbiotics, but I actually did a gut hormone episode and I'll link to that. And I talked a lot about postbiotics from the concept of how they impact your hormones.

1:23:12But let's talk about post... but we'll first tell people what postbiotics are and how do they actually help keep your gut healthy? Sure. So postbiotics are substrates that are made by bacteria and they serve a role. So these postbiotics can include things like butyrate, acetate, even bile acid, things that can break down the bile acid. Postbiotics are substances that are made by bacteria that help actually, they play a role. They play a role with our immune system, with maintaining the integrity of the gut lining with feeding beneficial bacteria. So some of these postbiotics include butyrate, acetate, substances that actually help break down bioacid as well or bioacid producers.

1:23:53So they play a really important role. So some of the postbiotics actually feed more of the beneficial bacteria. They play a role in regulating inflammation and also maintaining the integrity and health of your gut lining. So as you can see, it's really important to have good bacteria around. And some bacteria also produce nutrients, predominantly vitamin K and some other B vitamins as well. How can people ensure that their gut bacteria are working for them in making this postbiotics? So you can always do testing for this. There are special tests like the BiomeFX test, which actually does test for postbiotic amounts.

1:24:30So you can always do a test. But generally, I treat the patient, not the test. So as long as they're feeling well, they're having regular bowel movements, brown forms, not floating, they have good energy levels, good mood, no uncomfortable symptoms, then that's great. That's good for me. Those are all good signs that your gut is working optimally. And are there certain foods that people can be consuming that will help promote the postbiotic production? um well any fiber prebiotic rich foods will feed the good bacteria which will then allow them to help create those substances but um i'm actually a big fan of green tea to be honest green tea another polyphenol yes and it helps actually uh feed bifidobacterium and other species to help produce those postbiotics so green tea is a great one um black currant cacao like all the polyphenols we think of, cherries, pomegranates, dragon fruit, anything that's richly pigmented, purples, reds, pinks, that sort of thing.

1:25:33Not red wine, everyone. Sorry. So when it comes to fiber, what are some of your fiber-rich foods that you're incorporating on a daily basis? Yeah. So a variety. The key is variety and diversity in your diet. You don't want to always be eating the same fruits and vegetables every day or every week. You want want to change it up and it's best to eat in season when possible. But right now I'm really enjoying, I'm in Mexico, so I'm enjoying a lot of the fresh fruits here, the mango, the papaya, kiwi, definitely fruits and berries, the tropical fruits, right? And then beyond that, quinoa, sweet potatoes, regular potatoes, brown rice.

1:26:14So I always tell patients, try to steer clear of any white foods because they're typically void of fiber. So you want to maybe instead of white rice, opt for brown rice or quinoa. Yeah, any brown rich whole wheat is what we want to be aiming for for getting more fiber. Oats as well. Yeah, what are some of your favorites? So I actually, I have a toddler who just loves to just keep me on my toes with food, but he's like a chocoholic. That kid will always eat chocolate. And I made this pudding and it's cottage cheese that I whipped up with chia seeds in it. And then I used cacao powder and like a little bit, I think either honey or maple syrup.

1:26:57And then I just put like some chocolate chips on top of it. And he's been eating that. That's been like a little like hidden fiber. The other thing is that he went on just like, I'm only going to eat pita butter sandwiches for that. And so I would grind up chia seeds, a little bit of psyllium husk. I like psyllium husk. I just think you shouldn't overdo psyllium husk because sometimes it can have heavy metal contamination, which is like a lot of our food supply, which is another reason why variety is important. So I'll mix sometimes flax seeds in there and I mix it with the peanut butter, the almond butter, whatever butter we're using.

1:27:34And then I will actually make, I have to make a little pocket sandwich, just like a whole thing to get this kid to eat. So there's a lot of like stealth ways that I have been experimenting with in putting fiber into my toddler that I think also works well for people when they're like, oh, I'm having a smoothie. Also this like chocolate, I should write down this recipe actually, because it was so good. We were eating it and like the whole family was like, this is so good. I'm like, so much protein and fiber. You guys don't even know it. Mama got you again. But I think like thinking of ways that you can incorporate fiber, I'm a big fan of this.

1:28:13Like right now, raspberries are in season and artichokes. I need my protein, but I could literally just eat three artichokes for dinner and just be like so happy. But, you know, I love the idea of like pursuing what's in season. And then I have this thing that I say to patients, I say to a lot of people is microdose your microbiome. So when we have really picky eaters or even we're the picky eater, especially like a lot of the neurodivergent communities, like, ew, artichokes don't want to eat that. I don't like the fill of it on my teeth. Or, you know, there's certain things that they're like, no, I'm adverse to that.

1:28:47I talk about microdosing your microbiome. So if you're like, yuck, I don't want to eat that, like mushrooms, right? Can you just have like, can you just have this much with the tip of your finger? Can you just have that much. You can swallow it whole if you have to. If you cut it up like super, super tiny, you just want to swallow it whole. But I love this concept because your gut will see it. And we often think like, oh, if I'm going to eat chia seeds, it's going to have to be like a tablespoon or two of chia seeds. Well, what if it's just a pinch? Could you just do a pinch and put a little bit in there?

1:29:24And so in this concept of getting variety, can we just do it in a way where maybe you're adverse to that food. But it's always like, the way I always gamify my brain is like, I can do anything for five minutes. I actually just said to my husband when we were picking the world's worst flights of getting up at 3 a.m. and then coming back home at 1 a.m. within two days. I'm like, I can do anything for two days. And then I was complaining about it. He's like, you're the one that was okay with it. You said like, I can do anything for two days. And I was like, oh, that is something I say. But that is something with like the approach to the microbiome.

1:29:55Like anyone can do a pinch. Anyone can do anything. And if you give yourself that permission, it's a way to start diversifying what's coming into your microbiome and then start building up your tolerance to something. We all like to act like we were once toddlers and then we're never toddlers again, but we're perpetual toddlers for life, right? And just like with adults, when we tell them like, hey, I like to go to markets and pick up the weirdest routes I can find where I'm like, I don't even know what this is. I don't know what to do with it. I'm like going to Google it, like figure it out. But sometimes, times, you know, so with that, if I bring that home for my kids, I'm going to have to show my youngest that like 20 times before he's going to eat it.

1:30:32That might be true for you as well as an adult. Sometimes you just have to eat the little tiny bits at a time. Maybe you stick it in your freezer for later. Um, and then, you know, move forward and try to actually bring those foods in. The other thing I would say that, um, you were saying the getting the whole grains, the high fibers, if you are somebody who's like, especially like within the Asian community and you're like, but I love my white rice, put it in the fridge and eat it the next day. We can start getting some resistant starch. So there's ways that we can also gamify our food. And the other is you brought up butyrate.

1:31:07I love ghee. I feel like every time I read a study about butyrate, I'm like, we need to be cooking with ghee more. So for people listening, that's a source of butyrate. It's the only, you're only going to get it from dairy or your gut is going to make it. But butyrate is like such an unsung hero. Yeah, definitely. That one is like fuel basically for the good bacteria. And it's also really important for maintaining that integrity, right, of the gut lining. So that one is really important and really helpful too if you're battling with constipation. Sometimes I just get patients a little bit of buterin and they're more regular with that too.

1:31:45Yeah. And the anti-inflammatory effects can be really beneficial if you're somebody, I think especially in cases of like endometriosis, PCOS, autoimmune disease, when your baseline is like, we want to be inflamed. Like your immune system is like, yeah, let's be inflamed, like having butyrate. And of course, we always want to work through the gut first when possible, but sometimes supplementation can be just really lovely for people as well. Yeah, definitely. Especially the pick your eaters. Yeah. And going back to like the microdosing of the pre and probiotics. Think about when you're taking a probiotic, it's mostly bacteria, but it's in a prebiotic base, but it's a tiny, tiny amount.

1:32:25And that tiny amount is information and fuel for the good bacteria as well. So yeah, I don't think you have to go out and eat in like crazy amounts of prebiotics or fermented foods even. I can't stand fermented foods. I'm not a fan. I'm not a fan. I know. I need to eat more. But I'd rather get my fiber in other ways because but that's good enough for me to feed my good bacteria. Yeah. Fermented pickles are always the ones I recommend when people are like, I hate fermented foods. And I'm like, most people are like, do you only fermented pickles? I can't do it. I hate the vinegar. That's what it is.

1:33:00Like the vinegar base. Yeah. The small amounts maybe. We all have our thing. Like I can't eat teriyaki or any sweet food. I was out with friends recently and I don't know what they did to the steak, but it was sweet. And I was like, oh, I don't. I don't like sweet food at all. So for you as a vinegar, for me, it's my yogurt too. I could do yogurt. Yeah. Yeah. There you go. You can do yogurt as well. And I think that's actually a lot of people are going to be comforted hearing that. But that's another thing with like, you know, I'll have people like salmon salad. I'm like, can you, if it's not fermented pickles, can you just do a pinch of like red cabbage in there, which that one tends to go over well with kids when it's like, I, my kids are really into Halloween.

1:33:43So we're doing like spooky stuff where I'm just like, ooh, this is like bloody guts. And they're like, ooh, okay, I'm going to eat these fermented beets, mom. I'm like, yeah, okay. Just don't make a mess. But I think it's comforting for people to hear that because there's people who don't like fermented foods. Find what works for you, like what you can, because there's so much. Like there's a lot of different variety and it doesn't have to be just one thing or the other or all of it. Like pick what works for you and stick with that. Yeah. Well, this has been a wonderful conversation. I really appreciate you taking the time to chat with us today.

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