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Back by popular demand is another powerful SIBO survivor story. In today’s episode, Shivan Sarna is sharing her experience of uncovering her root causes, from Lyme disease to mold exposure, and how she became the patient expert she is today.

Shivan is the founder of SIBO SOS, where she hosts monthly master classes to support others on their journey to understand, treat, and manage IBS, SIBO, and other digestive issues. Relying on her past as a yoga teacher and 20 years of experience hosting live TV, Shivan’s superpower is asking the questions SIBO patients have and then making that information easily understood and actionable.

For those of you who have been asking for a patients’ perspective, more information on underlying causes, how to vet practitioners to build your SIBO medical team, and navigate a SIBO diet as a vegetarian, this episode is for you.

A quick taste of what we’ll cover:
  • Mold and Lyme exposure and what that looks like as a root cause for SIBO
  • What it’s like to be a “canary” constantly reacting to everything in your environment
  • We talk about Shivan’s SIBO misdiagnosis and whether or not to believe your breath test results
  • The importance of uncovering underlying causes
  • The biggest mistakes people make when trying to eradicate SIBO
  • What products are essentials for your medicine cabinet and pantry for dealing with SIBO symptoms
  • How to navigate a SIBO diet as a vegetarian
  • And so much more…
Resources, mentions and notes:

Today’s episode is brought to you by Fody Foods, a whole array of condiments, sauces and spice blends that are low FODMAP and use real ingredients to promote digestive health. Everything is Gluten-Free, Dairy-Free, non-GMO, and most importantly, delicious. You can now purchase Fody Foods products at the regular grocery store! Keep an eye out for their purple logo on the shelves of Whole Foods, Sprouts, Fairway, and other grocers. Or you can head directly to fodyfoods.com to purchase online. SIBO Made Simple listeners in the US and Canada can get 15 percent off their order by using code SIBO15. Click here to learn more

Disclaimer: The information shared in this podcast is not meant to provide medical advice, professional diagnosis, or treatment. The information discussed is for educational purposes only and is not a substitute for medical or professional care.

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These falafel-style quinoa veggie burgers are brought to you in partnership with my friends Little Northern Bakehouse. As always opinions are 100 percent my own. Thank you for supporting the brands that make this site and all my gluten-free vegan recipes possible!

I often get my inspiration from places rather than publications.

When I’m cooped up in my Brooklyn apartment for too many consecutive weeks I often find my cooking getting a little stale. You know, too many rotations of this or this.

But the second I step foot on Martha’s Vineyard, it’s like an invitation to experiment. What time I spend in the kitchen outside work can sometimes feel like an afterthought. But during the summertime on my favorite island, it’s the main event for my creativity.

Usually, I let what’s fresh at the seafood market be the cornerstone for the meal. But my dad has been making an effort to be even more plant-based than usual, so I took it upon myself this year to create a new quinoa veggie burger that is both low FODMAP (for me) and full of Middle Eastern flavors (for mom). 

The result were these falafel-like quinoa burgers with creamy tzatziki sauce.

Though these veggie burgers are best crisped up in the oven to hone that falafel crunch, they are still perfect for summer entertaining. The batter makes 8 patties and since it’s completely plant-based, you can easily make the mixture a few days in advance of a party. They also freeze really well if you just want to have a homemade burger option on hand for when your vegan friends come to visit. 

As for the low FODMAP factor, you might be surprised to see these veggie burgers have a whole can of chickpeas involved. 1/4 cup of canned chickpeas is an acceptable low FODMAP serving, so as long as you stick with only one burger in a sitting, you will be good to go. Just make sure to opt for plant-based yogurt or 24-hour homemade yogurt for the tzatziki topping.

Now, when you’re going gluten-free vegan at your summer barbeque one of the most important choices you can make is what bun to use. I’ve searched long and hard for an acceptable option, but usually just end up eating my burgers naked or animal-style, since for whatever reason all my favorite gluten-free bread brands have buns that are just a touch too dense and clunky.

That was until I discovered Little Northern Bakehouse and their Millet-Chia Buns. The first time I had one was actually at a Met’s game earlier this summer and I was shocked by how fluffy and soft they were, even without a good toasting. I’ve since stocked up my freezer with both these quinoa veggie burgers AND a bag of LNB buns. 

If you’ve been around here for a while, then you know I’m a huge fan of what Little Northern Bakehouse does. Their products are sourced from gluten-free, non-GMO and whole-food ingredients, and feature fiber-rich seeds and grains for a boost in nutrition. Many are also 100% plant-based and vegan, appealing to a wide-variety of diets and food preferences. Most importantly, they are certified as Glyphosate Residue Free by third-party testing so consumers don’t have to worry about this cancer-causing substance.

Read on for the recipe for these faux falafel quinoa veggie burgers, courtesy of my MV kitchen inspiration.

With health and hedonism,

Phoebe

Faux Falafel Quinoa Veggie Burgers with Tzatziki

This recipe can be low FODMAP if made with plant-based yogurt or 24 hour yogurt, or you can always just swap out the sauce for something else you like in the Mediterranean family.

  • One 15 ounce can chickpeas (rinsed and drained)
  • 1/3 cup parsley leaves
  • 2 cups cooked quinoa (from 3/4 cup dry)
  • 1/3 cup almond flour
  • 2 teaspoons ground cumin
  • 2 teaspoons ground coriander
  • 1/4 teaspoon cayenne
  • 1 1/2 teaspoon sea salt
  • 4 Little Northern Bakehouse Millet Chia Buns (toasted)
  • Mint and/or parsley leaves (for garnish)
For the tzatziki:
  • 1 small cucumber (roughly chopped)
  • 1/4 cup parsley leaves
  • 1 tablespoon fresh lemon juice
  • 1 cup full fat plant-based yogurt or Greek yogurt (from one 7-ounce cup)
  • ½ teaspoon sea salt
  1. Preheat the oven to 425 degrees Line a baking sheet with parchment paper.
  2. In a small food processor, pulse the chickpeas and parsley until coarsely chopped. Alternatively, you can hand chop the parsley and use a fork or potato masher to turn the chickpeas into a paste. Transfer to a medium mixing bowl and add the quinoa, almond flour, cumin, coriander, cayenne, and sea salt; stir until well-incorporated.
  3. Lightly grease the parchment paper with oil. Also, grease a 1/3 cup measure and use it to portion the quinoa falafel batter into 8 mounds. With your hands, shape the quinoa into balls, then pat into 1-inch thick smooth discs and arrange an inch or so apart on the parchment-paper lined baking sheet. Transfer to the oven and bake until the patties have dried out and formed a nice brown crust on the bottom, 30 minutes. Flip the burgers and return to the oven for 10 more minutes, until firm.
  4. While the burgers bake, prepare the tzatziki. In a small food processor, puree the cucumber, parsley, lemon juice, yogurt, and salt until smooth but still chunky. Alternatively, you can finely chop by hand.
  5. Top the cut-side of each bun with 1 tablespoon of tzatziki. Add a falafel quinoa burger patty to the bottom half and top with another spoonful of tzatziki and a handful of herb leaves. Repeat with the remaining burgers and enjoy immediately. Or refrigerate each element separately for later.

These falafel-style quinoa veggie burgers are brought to you in partnership with my friends Little Northern Bakehouse. As always opinions are 100 percent my own. Thank you for supporting the brands that make this site and all my gluten-free vegan recipes possible!

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A lot of integrative medicine these days blends practices from Western science and ancient cultures. But rarely do we get to fully understand the principles of the Eastern approach and how we can apply them to our healing journey.

In today’s episode, I have one of my personal practitioners, Dr. Heidi Lovie, discussing the tenets of Chinese Medicine, including modalities like acupuncture, herbs, moxabustion and gua sha, and what they teach us about thyroid and gut disorders. Heidi is a member of the HashiPosse herself, so we go deep on how acupuncture, manual therapy and dietary changes can make up the secret sauce for Hashimoto’s healing.

If you’ve be wanting to try acupuncture, or are curious why it works so well for chronic conditions like Hashimoto’s and SIBO, this episode includes so much wisdom.

A quick taste of what we’ll cover:
  • How Chinese Medicine teaches us to live in harmony with nature and what this means in our modern world
  • What changes our bodies have undergone between 2019 BC and 2019 today
  • Why gua sha and manual work is so essential for thyroid therapy – all you need is a ceramic soup spoon!
  • The best diet for Hashimoto’s and why keto + a low carb approach isn’t the best fit
  • SIBO, parasites, and opportunistic viruses – the category they all fit into and how to treat them
  • When to use herbs and when to use acupuncture to treat a gut issue
  • How to detox properly according to Chinese Medicine and what the seasons mean for our diet
  • And so much more…
Resources, mentions and notes:

This episode is brought to you by my new e-book program, The Low FODMAP Summer Reset, a 4-week elimination diet meal plan with mouthwatering SIBO-friendly recipes using the best of the season’s produce. All the dishes are not only free of high FODMAP foods, but also gluten, dairy, soy, corn and refined sugar. This will help not only quiet symptoms of bloating and IBS, but identify the food triggers that might be lighting up your immune system and creating a cycle of inflammation in the gut. Plus, there’s a step by step guide for reintroducing these ingredients one at a time so you can design your best path forward. As a member of the SIBO Made Simple listener family, you can take $20 off by using the code SIBO20 at checkout. Just click here to learn more.  

WHAT IS CHINESE MEDICINE?

PHOEBE: Heidi Lovie, since you’re one of my favorite people in the world in addition to being a very smart and talented practitioner, I would love to start by hearing a little bit of your health story. You’re a member of the Hashi posse. All five die-hard fans of the wellness project book may remember you as acu Heidi and probably are just dying to hear more about who you are and where you came from and how you became an acupuncturist and such.

HEIDI: Phoebe, you’re the best. Thanks. I was thinking about this over the past couple of days preparing for this discussion. One of the questions that I always ask patients when they come in, and you may remember this, is when did you feel your healthiest? It gives us a baseline and it gives us something to aim for. If they’re coming to me, they’re not feeling good. It’s kind of like what do you remember in your system when you felt amazing? When I ask that question of myself, it’s an incredibly hard one to answer.

PHOEBE: I was going to say, I can’t remember what I answered for you, but it was a really long time ago. I’m not sure I can quite remember myself.

HEIDI: A lot of us with Hashi, they call it the catalyst event. That’s a time or something where it happened and it’s like I’ve never felt the same since X, Y, Z. That could be I’ve never felt the same since I had food poisoning in 2011 or I’ve never felt the same since my divorce or I’ve never felt the same since … fill in the blank. With most autoimmune, there’s a trigger that sets it off, but there’s a backlog of things behind that. It could be I’ve never felt the same since I had that sushi explosion that happened Christmas of 2017, whatever it is.

Before that a lot of people will probably notice that they weren’t feeling so well. A lot of the symptoms were things that could just be easily written off. I’m getting a little bit older. My joints hurt because I’m the ripe old age of 28, whatever these things are that we tell ourselves is. When I asked that of myself, I’ve never felt healthy. That’s not something I’m sure a lot of people expect to hear from their healthcare practitioner.

When I made my cameo on planet earth in the middle of a Minnesota snowstorm, my family still talks about my legendary colic. Then as I got older, the health problems didn’t clear up. Anything weird that would come into the neighborhood, be it pityriasis rosea, be it Lyme’s disease, I got it as a kid. All through high school I was sick. Then when I went to go get my college physical when I was 18, I can’t really tell you much about that appointment. I don’t remember the appointment, but I do remember the panicked phone calls from the GP.

I’m 18. I’m a kid, but technically old enough to be an adult. The college GP called, and all I remember from that conversation – this is 1995. The doctor called and all I remember is Synthroid. I remember thyroid disease, and I remember lifelong medication. Those were the three takeaways I had from that conversation.

Being 18, we came from a lower middle class family. I started working at 14, 15. I was already working, going to high school. I was on the ski team. For a lot of Hashi’s people, this is going to sound familiar. There’s a psychological profile that shows up that I call plate spinners that we seem to do everything in the world, and we do it in spades, and we do it well, often at a consequence of our own health. I was already doing this kind of behavior as a teenager.

You’re 18, and I had no idea what that was. It was one more thing to forget about because I already felt like shit most of the time. I wasn’t connecting that to thyroid. When I’ve gone back in retrospect and looked at my pediatric records, I probably had thyroid disease since 12 or 13. I’m now 42, so I’ve been dealing with it for a good 30 years, a good portion of that undiagnosed. I wasn’t formally diagnosed until I was 26.

PHOEBE: What does that mean, formally diagnosed? Do you mean that you got an ultrasound?

HEIDI: Yup. What happened was I had lived in Japan in this interim. That was when I first had acupuncture. I just had acupuncture on a fluke because a friend of mine was going, and I was like it’s a bigger part of this Japanese experience. It’s just weird voodoo. I have no idea what this is.

The acupuncturist I really liked. He was this tiny guy that you could put in your pocket. He was the cutest, most humble, to this day the most gentle soul I feel like I’ve ever come across. There are some of us that we would take the last appointments of the day and the practice was in the front part of his house. We would just go have dinner with him and hang out until midnight and do whatever.

I was really going more because I liked this guy. I like his wife. I liked the social scene. Acupuncture was a side piece to that. All of a sudden my cramps went away. At this point I had gained an additional 50 pounds from what I was in high school. My weight started to stabilize. My mood started to stabilize.

My whole health profile completely changed. If I have to think about my healthiest, it was when I was regularly getting acupuncture and living on the healthier side in Japan. I moved back to New York afterwards, and my health just crashed. It went back to when I was in high school and it was just awful. I was telling a colleague about it, and she goes this sounds familiar. Go see my endocrinologist.

I go to see the endocrinologist, and I walk in and the guy just does a sonogram on my throat. He goes, “That’s classic [00:06:30]. You have Hashimoto’s.” I started crying. I started balling. He was like, “Oh, my God. Why are you crying?” I finally have a name to this. I finally have a name.

When I was first diagnosed, this was pre-internet. There was no Doctor Google or WebMD or anything like that. You just kind of had to lean into people if you could find them that had the experience. I was diagnosed in 2004, 2005, something like that. I got on Synthroid. Then with all of this you would think I started feeling better. I started feeling worse.

They put me on Cytomel. I’m sure this is going to sound really familiar to a lot of people. They put me on Synthroid and they put me on Cytomel. They were just like your blood work is fine. I’m like great. Why am I 210 pounds and I’m eating 1,200 calories a day and I’m going to booty boot camp class and I’m not losing weight? I can’t get up in the morning, and my hair is falling out.

They said, “Go see a nutritionist.” I go see a nutritionist. I give the guy my food journal for the week, and the dude literally flips it back at me and said, “If this is how you’re actually eating, I have nothing to teach you.” I was like, “Yes, you have nothing to teach me. Screw you.” I walked out.

It took a couple years to get my ducks in a row, but I went back to an acupuncturist, and all of the sudden my health profile started changing again. I couldn’t explain it. I didn’t understand why. I just knew that I felt better when I did it. I decided to go to Chinese medicine school, thinking it was going to be all unicorns and intuition. I really didn’t know what I was getting into.

I was like I’ll take classes here and there. It’s actually a four-year full-time degree where you go through 4,500 hours of both Eastern and Western medical training. I wound up doing rotations at St. Vincent’s HIV Center. I was at St. Vincent’s Cancer Care Center. I did the VA Manhattan Veteran’s Affairs Hospital. I went right into private practice after that thinking I was going to be the HIV queen of New York.

I loved treating HIV. I loved treating the LGBTQIA community. I loved being an ally, but you treat what you know. What started coming in was a lot of Hashi’s patients. Since then I can’t even tell you how many Hashi’s patients have been on my table; a couple thousand easily. You sit with that many of us and start hearing the same stories over and over again.

My story is really not that unique. It’s part of a bigger conversation. I do consider thyroid disease to be a feminist issue 100% because 8 times more women than men suffer with it. It’s not just that men don’t have Hashi’s, but I can count on two hands the number of male patients with Hashi’s that have come to the table. The treatment strategy from a Western standpoint has not changed in over 50 years. The treatment strategy is mostly just hormone replacement therapy, meaning your body is attacking your thyroid. Your thyroid is not producing hormones. Therefore, we’re just going to replace it with either something synthetic or more natural cousins like Armour or [00:09:57]or something.

That doesn’t actually resolve the issue. Through my work in Chinese medicine, I’m working with a lot of functional medicine practitioners. I’m convinced it’s an antibody game. You start to get the antibodies down, you start to bring the attack down. I’m also convinced that it’s a scar tissue issue.

Those of us who our thyroids have been under attack for that long, the thyroid gland itself starts to swell, starts to adhere to tissue next to it. She just can’t breathe. When I work with patients, there’s a lot of manual work. There’s a lot of soft tissue work we do. Diet is the number one thing, and I have gotten into pissing matches with MDs over this. Diet is the number one thing. That’s one of the things that I pulled from Chinese medicine.

PHOEBE: I actually thought you were in Japan studying medicine when you were there. I didn’t realize that was earlier on in your story. I would love to know the Chinese medicine side of your training. I think it’s now a buzzword that comes up a lot in the “wellness space.” I don’t think a lot of people really understand it, myself included, being a patient of yours of Chinese medicine for many years. I don’t know that I really understand what makes it different from other ancient healing and other cultures and what the classic central tenants of it is.

HEIDI: That’s a beautiful question. My time in Japan, I was just teaching English, drinking a lot, just generally causing mayhem.

PHOEBE: Important life skills that led you to where you are today.

HEIDI: Thank God. We all need that experience. I actually had an opportunity to go back and study in Japan, but I decided to do my studies here in New York for a couple reasons. One, at the time we had St. Vincent’s. This is before integrative medicine was this huge buzzword. The college was able to get us into rotations next to MDs and Western practitioners.

I really wanted that experience because I think that’s where we shine. I think when we’re in crisis, we need a team onboard to help us with things. That was one reason. Another reason was that the program I chose was a California-based program, and in California we’re licensed as general practitioners. We’re GPs. The training was very different. It was a very higher caliber of training than I would have gotten abroad. That’s one reason I chose to stay in the US to do that.

I was at this integrative medical conference about a year ago. I sat through three days of lectures. There were mostly MDs, but some nurse practitioners and other people speaking. Every single person referenced acupuncture, but they didn’t have a Chinese medical person who came up to speak for the medicine itself. I wound up talking with the organizers of the conference afterwards. I was like this hurts because I think there’s so much cultural appropriation around it and myths around it. There’s a little bit of racism tinged with it as well.

Even the word Oriental medicine is not good these days. The tenants of the medicine, we can go back about 4,000 years for sure. There’s talks that it goes back 10,000 years, but that has yet to be verified by medical anthropologists. The beauty of the medicine is we have this long tradition of historical writings and case studies that go back. Our tenant book is called The Yellow Emperor’s Classic, the Huangdi Neijing.

The book is actually a conversation between a student and the teacher. The teacher’s name is Qibo, and the student’s name is Huangdi. Huangdi starts off the conversation by saying, “Oh, teacher, teacher, teacher, why is it in the olden days people lived to be 100 and they were so much healthier?” Even 4,000 years ago they’re like why is it that a couple generations ago we were doing better? Qibo, the teacher, answers, “Because the sages of yore were able to live in concert and harmoniously with nature.” The rest of the book is a conversation how to do that.

There’s addendum books that have been written over time to be like when you don’t live in accordance with nature, when you don’t rise and set with the sun, when you don’t eat seasonally, all these things that we’re talking about now, this was codified in the Huangdi Neijing. It talks about where the breakdown in the system happened and what the intervention to that is. When I introduce myself, I very rarely introduce myself as an acupuncturist because that’s not really what we do. As a Chinese medicine practitioner, we actually have eight pillars to the medicine, five that we talk about and three that we don’t talk about because we sound fucking crazy when we talk about the other three.

These are all interventions that we can do with people. The five main ones are acupuncture. I think that would be one of the number one things. Because it’s so weird, that’s the one that gets the most attention out of everything we do. It’s the one that’s the least understood as well.

PHOEBE: Acupuncture is Chinese medicine. It originated there as a concept and practice.

HEIDI: It’s a branch of Chinese medicine. We have acupuncture. Out of these five pillars, acupuncture is number one. What falls under that, 1A, 1B, 1C are things like cupping, moxa, gua sha, all these other weird things that we do with our hands, the modality of it. Acupuncture is number one.

Number two would be dietary intervention. We know how or when to intervene in the diet, so it’s right diet, right person. I love the keto thing. It’s right diet, right person. You’ll find that even though keto is the big new thing, I know plenty of people that have had tons of issues resolved on keto. I find very few Hashimoto’s patients can tolerate it just because the way our bodies need carbs a little bit differently.

We do acupuncture. We do diet. We do herbal therapy. That’s basically prescription intervention. We do something called tuina, which is medical massage. We’re doing hands on work in addition to the acupuncture. That’s hands on work in addition to the acupuncture. That’s our hands and not using other tools.

Then the fifth branch would be movement. I do a very specific type of yoga. I do Kundalini yoga because it’s basically Indian qigong. A lot of practitioners will do qigong. They’ll do tai chi. They do these things. Again, these are different levels of intervention that we are able to offer to people.

The three that we don’t talk about, the secret ones are meditation, feng shui, and astrology. It’s how you move in meditation. It’s how you move internally. Feng shui is how you move locally. Astrology is how you move globally.

Those are ones that I like to refer out. I know where I’m strong. My feng shui, I’m good enough to be dangerous, but I’m no master any stretch of the imagination. A lot of people will say I’m an acupuncturist, but that’s really a misnomer because we’re doing all kinds of other things.

HOW TO FIND AN ACUPUNCTURIST WITH PROPER CREDENTIALS

PHOEB E: Do you think that today in America most acupuncturists are just trained in acupuncture and not Chinese medicine? What should someone look for in terms of letters or title that they say when looking for a practitioner who actually understands Chinese medicine and was trained the way that you are as a general practitioner?

HEIDI: Me as a licensed practitioner, the California based school, I had 4,500 hours of training. Up until recently we were one of the few healthcare degrees that had that many hours without having a doctorate title. The field is now changing a little bit. I went on to get my doctorate. I’m a DACM, so that’s a doctor of Asian and Chinese medicine. I just did a little bit of extra training to upgrade the title with that.

What you need to look for is the letters at the end of anyone’s name. You have to see LAC. That stands for licensed acupuncturist. That’s somebody that did go to school. They trained in Chinese medicine. They have the license. We’re the only license to move qi. We have a very unique license to us.

You want someone who’s licensed. You’ll see sometimes a certified acupuncturist. What a certified acupuncturist is, that’s an MD who did 200 hours of additional training. You can already see 200 hours versus 4,500 hours is something completely different.

The other thing that we’re seeing in the field, and there has been a lot of fights over this, is something called dry needling. There’s a lot of chiropractors and PTs that are not trained in acupuncture. If I were to offer as an acupuncturist, a licensed healthcare practitioner, as a non chiropractor adjustments to people, I would lose my license. However, the chiropractors and the PTs have taken on this “dry needling.” Wet needling would be hypodermic where it draws blood. The name dry needling comes from the type of needles that they’re using, which are just acupuncture needles. They’re going in with one-eighth the amount of training and trying to do muscle releases on people.

We’re seeing really egregious and harmful treatments. I’ve seen everything from pneumothorax, which is a collapsed lung. We’ve seen infections. We’ve seen all kinds of things coming from this practice. You know this. I’ve said this before. If a PT or a chiropractor wants to do it, run like hell. I refer out. You know this.

When in doubt, refer out. I refer out all the time. I have no problem referring to a chiropractor or a PT or a functional medicine doctor or a parasitologist. I have no problem with that, but the acupuncture is something that other professions have started to pick up without the training with deleterious effects that just aren’t good.

PHOEBE: I’m so glad you gave us a good primer on what actually to look for. Do you want to use that as a segue? First of all, I want to understand why acupuncture allowed you to feel the best that you’ve felt and how it can potentially allow our listeners to feel the best that they’ve ever felt. I also know that you do work in conjunction with body workers sometimes. There is something to that if you have the license to do the acupuncture segment of it. Just take us from the beginning about the power of acupuncture and how it works in improving movement in the body alongside someone who does more traditional manual work.

HOW DOES ACUPUNCTURE WORK FOR HASHIMOTOS AND THYROID ISSUES

HEIDI: We don’t know why the hell it works. Let’s be very clear about that. Unfortunately, acupuncture doesn’t lend itself very well to the Western scientific method. Another fun cocktail party argument I get into with MDs, they’re like how does it work? I’m like explain anesthesia. That usually shuts them up pretty quick because we can’t explain anesthesia.

There are certain things we just don’t know why they work, but they work. Acupuncture does fall into the category of what we say is EIP, so evidence informed practice. A lot of times when people hear EIP or they hear evidence informed practice, that’s the kind of thing that you find in PubMed or things that are well researched. Another category of EIP is clinical experience. Because in this grand tradition of Chinese medicine they’ve had written tones of this in case studies in teachings going back thousands of years, we actually do fall into EIP.

The kind of bodies that we’re inhabiting in 2019 versus the type of bodies we were..

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This paleo pancake recipe is brought to you by my friends at Bob’s Red Mill. Thank you for supporting the brands that make this site (and my healthy breakfast cravings) possible! For more delicious recipes, coupons and stores near you visit BobsRedMill.com.

Yesterday was my first wedding anniversary, something that 359 days ago I wasn’t sure I’d ever be saying.

People don’t believe me that the idea was seeded only 5 days before we actually dove in head first and tied the knot. I talked a little bit about my reasoning in this post. But here’s how it actually went down.

On July 2nd, I met my friend and mentor Debbie on Martha’s Vineyard for a quick breakfast and long catch up. It was the first time I’d seen her since her husband Rob had been diagnosed with stomach cancer, and the previous few weeks had left them both discouraged and heart broken. That morning we cried into our scrambled eggs and talked about how they were preparing for the worst while trying to savor each sweet moment, which included a lot of the island’s finest quiche.

Over the course of our conversation, it came up that Rob had officiated an intimate wedding ceremony for their goddaughter a few weeks prior, just the four of them in their living room—the same spot where they themselves had been married almost twenty years prior in similarly intimate circumstances.

As someone who never wanted a wedding in the traditional sense, for the first time, I could feel with such clarity that this was not only something I could get on board with, but that the scenario was IT.

I asked Debbie if Rob would have the strength and willingness to do something like that for Charlie and myself. Her eyes softened, as we both already knew the answer. And then, as if reading my mind, she said: “Oh, Phoebe. If not now, when?”

Later that afternoon, like many men before me, I asked Charlie to go for a walk to get him out of the house, away from the prying ears of family members, and proposed.

He didn’t say yes, just “ok.” Which was not a measure of his love, just his understandable confusion.

Anyway, you know how the rest of the story goes.

For our first anniversary, I was a little thrown by the paper assignment. Couldn’t year one just maybe be pancakes? Like, really good paleo ones with date caramel?

If there is any one of the earth’s materials that sums up our first year, it would definitely be pancakes, specifically ones made from Bob’s Red Mill gluten-free pancake mix. As many of you know, Charlie’s dedication to these gluten-free pancakes, and his insistence on making them every Sunday, have earned him the nickname Pancake Man on instagram.

His secret is that he follows the recipe on the back of the Bob’s Red Mill package exactly as written. But he’s also added his own spin with ghee and oat milk.

Gluten-free pancakes are the one food group I cannot compete with him with in the kitchen. Paleo pancakes, on the other hand, are another beast entirely. And those, I must say, I have mastered.

My secret? Following the recipe on the back of the Bob’s Red Mill Paleo Pancake Mix package. And in this case, adding all the flavors of a banoffee pie by mashing up banana into the batter and topping the stack with a dairy-free date caramel, coconut whipped cream and chocolate shavings.

Perhaps I will print this recipe on some nice cardstock and give it to The Pancake Man as an added gift? Does that count??

Read on the for the banoffee paleo pancake recipe and a video showing how to make it!

With health and hedonism,

Phoebe

How to Make Paleo Banoffee Pancakes with Date Caramel - YouTube

Paleo Banoffee Pancakes with Date Caramel

This paleo pancake recipe takes all the flavors of banoffee pie – banana, whipped cream, caramel, chocolate – and turns them into a healthy breakfast.

  • For the date caramel:
  • 1/2 cup pitted Medjool dates (about 10)
  • 1 tablespoon 45 mL smooth almond butter
  • Pinch sea salt
  • 1 teaspoon vanilla extract
  • 1/4 – 1/2 cup almond or coconut milk
  • For the pancakes:
  • 2 large eggs
  • 1/4 cup almond milk
  • 1 tablespoon melted ghee
  • 1/2 teaspoon vanilla extract
  • 1 cup Bob’s Red Mill Paleo Pancake & Waffle Mix
  • 1 banana (mashed)
  • For garnish:
  • 1 sliced banana
  • Coconut whipped cream
  • Chocolate shavings
  1. In a medium heat-proof bowl, cover the dates with boiling water. Allow to sit for at least 10 minutes until soft. Drain and add to the bowl of a food processor or high-speed blender along with the almond butter, sea salt and vanilla extract. Puree until a thick paste forms. Stream in 1/4 cup of the almond or coconut milk and pulse until smooth, adding more liquid as necessary to get a pourable consistency. Set aside.
  2. In a small bowl, beat the eggs together with the almond milk, ghee and vanilla until smooth. Add the Bob’s Red Mill Paleo Pancake and Waffle Mix, and mix until just combined. Fold in the mashed banana.
  3. Heat a small nonstick skillet over medium heat and brush with coconut oil or ghee. Add 1/4 cup of batter to the skillet, using the back of your spoon or cup measure to flatten the pancake into an even circle. Cook on the first side until bubbles form in the center, adjusting the heat as necessary so that the bottom doesn’t overly brown, about 3 minutes. Flip and cook for about minute or two on the second side. Repeat with the remaining pancakes.
  4. To serve, divide the pancakes between plates, drizzle with the date caramel, and garnish with the sliced banana, coconut whipped cream and chocolate shavings.

This paleo pancake recipe is brought to you by my friends at Bob’s Red Mill. Thank you for supporting the brands that make this site (and my healthy breakfast cravings) possible! For more delicious recipes, coupons and stores near you visit BobsRedMill.com.

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CBD has become a big buzz word in the wellness world, as a salve for everything from anxiety to gut issues to period pain. But what is it and how does it actually work? In today’s episode, I’m joined by Chloe Weber, a trained herbalist, acupuncturist and founder of Radical Roots, which combines the power of Chinese herbs with full spectrum hemp.

Chloe got into the world of hemp because of her son Remy, who has been using various CBD formulas to ease a neurological condition. She’s a wealth of knowledge about how the endocannabinoid system works, what deliveries best serve digestive disorders, and how to use both hemp and cannabis as part of your SIBO plant medicine cabinet.

If you’ve been wondering whether hemp-based extracts are worth all the anti-inflammatory hype, this episode has so many incredible takeaways!

A quick taste of what we’ll cover:
  • The difference between CBD and THC
  • How to use CBD and THC to treat anxiety, insomnia, SIBO, neurological issues and epilepsy
  • The best formulas and delivery methods for gut health
  • Why smoking hemp or cannabis might be a better choice in certain situations than taking an oil or edible
  • Product terminology to beware of and what you want to see on a package to ensure its therapeutic grade and not snake oil
  • And so much more…
Resources, mentions and notes:

This episode is brought to you by Epicured, a low FODMAP meal delivery service that understands that food is medicine. Each menu is created by Michelin star chefs and honed by doctors and dieticians at mount sinaii to restore digestive health for those with IBS, SIBO, Celiac and IBD. Everything they serve is 100 percent low FODMAP and gluten-free, with no cooking required! My favorite part about their dishes is the healthy spin on takeout gems like shrimp laksa and PAD THAI! Their version had a great balance of fresh veggies mixed in with the noodles that left me feeling both satisfied and completely free of my usual carb coma. Listeners to this podcast can get 20% off their order by using code SIBOMADESIMPLE. Just click here to learn more. 

THE DIFFERENT BETWEEN CBD AND THC, HEMP AND CANNABIS 

PHOEBE:  To get going, you have a very interesting story in kind of how you started to incorporate hemp and CBD into your medicinal toolkit.  Why don’t you tell us a little bit about your background and then some of your own personal turning points.

CHLOE:  Cool, yeah. So I’m an acupuncturists and an herbalist. My son, Remy, who is now almost five and just took his first steps about two weeks ago – I’m still starting to wrap my head around that – was diagnosed with a rare neurotransmitter disorder when he was two and a half, which also causes lots of seizures and all sorts of global delays, Parkinsonian-like tremors. It’s a really complicated disorder and since it’s so rare, there’s really no Western research into it.

I started looking as an herbalist into CBD and see how that might be able to help him. Remy and I were trying all the CBDs we could possibly get our hands on, and some would help me with my sleep, some would help him with his seizures, but the research was really there, and as an herbalist I just sort of felt like it wasn’t a one-size-fits-all model, which is what everybody was using, so I combined Chinese herbs with CBD to potentiate the actions. Either way, everything that I’m studying, when it comes to endocannabinoid system and CBD and THC, it just really is such a remarkable medicine, and we’re just now scratching the surface of the possibilities of what we can do with it.

PHOEBE:  Very cool. I know they’re both becoming real buzzwords in the wellness world, so for those who are just coming at it from square one, who have maybe heard the buzzing about CBD versus THC, can you just give us the endocannabinoid system for dummies? Explain the difference between hemp and cannabis, in terms of medicinal plants, and then the difference between the compounds CBD and THC.

CHLOE:  Okay. So, basically, about 25 years ago, researchers found that we have an endocannabinoid system in our bodies. Throughout our entire body, we have different receptors for cannabinoids, and the main receptors that we found are CB1 and CB2. Actually, it turns out that we make our own cannabinoids, which are called anandamide and 2-AG – which is a really, really long technical term, so we’ll stick with 2-AG – but what’s interesting is that our body not only responds to the cannabinoids that we make, but it responds to the cannabinoids that are made by plants.

The two best-researched cannabinoids from plants are THC and CBD, as we all know. THC works directly on the CB1 and CB2 receptors, particularly in the brain, so that’s why we have the psychoactive aspects of THC. CBD works in a different pathway. While it affects both of those receptors, what it does is it sort of locks the natural “homemade” cannabinoids from being reabsorbed quicker, so it increases the amount of anandamide and 2-AG that’s available. It’s sort of like an SSRI in how that works.

Hemp versus marijuana; basically, as somebody recently said, it’s like a different breed of dog. Everything is under the cannabis plant, but hemp is legally classified as hemp as long as it’s less than .3% THC, so that’s really the only differentiation. There are ways to grow it in different ways, but it’s sort of like you’re breeding out the pit bull, or the psychological effects.

PHOEBE:  Got it. So hemp doesn’t have THC involved in its makeup at all?

CHLOE:  It has to have less than .3% THC in order to be called hemp.

PHOEBE:  Got it. So for products where you’re seeing ratios of THC to CBD, are those primarily in the cannabis camp, or do you find those at all for hemp as well?

WHY FULL SPECTRUM HEMP IS A POWERFUL GUT HEALER

CHLOE:  So full-spectrum is going to be anything that’s going to have a little bit of THC in it. Most research studies have shown that full-spectrum CBD extracts are more effective than isolate extracts. We’ve only really started looking into CBD and THC, and now we’re looking into other cannabinoids, so getting that full range of cannabinoids that are in the plant is most important and more effective than just getting the isolate of the CBD. There’s going to be THC in all hemp, but if you’re moving to a higher level of THC, then that’s going to be more considered cannabis.

PHOEBE:  Got it. When you buy a full-spectrum CBD product from hemp, it’s assumed that there’s just a lot of other things going on besides the isolate, as you said?

CHLOE:  Yeah, there’s going to be a full range of cannabinoids normally. There’s been a lot of research into CBN and CBG, which have both been really interesting, and there’s more research coming out every month; it’s really fun. There’s also a full range of terpenes, which are like the volatile oils that you smell. When you smell marijuana, hemp or cannabis, it always has that very pungent smell, so those are terpenes, and those are sort of essential oils. You’ll find terpenes in lots of plants. Also, hemp is very mineral-rich, which is really interesting because those provide important co-factors to potentiate the actions of the plant.

PHOEBE:  Obviously, cannabis is not legal everywhere in our country. Is there any example of a case where you would not want to use cannabis, and you would only want to use hemp as a plant?

CHLOE:  I mean, not as an isolate. I don’t think that the isolates are nearly as effective, and I think that that’s show in a lot of research across the board when we’re looking at pharmaceutical isolates of chemical compounds, as opposed to the plants they’re derived from. Most often, the research shows that the plant is more effective; the whole is greater than the parts. I think I would almost always want there to be some level of THC. Remy’s on CBD – he’s on a really high amount of CBD – to control his seizures and to help with his tremors and development, so that he can now walk.

PHOEBE: Yay!

CHLOE:  Well, almost – but I would obviously prefer not to have my almost 5-year-old on THC, but THC is really important to activate those CB1 receptors in the brain to help with that function.

PHOEBE:  But there’s so little in these full-spectrum hemp products that you’re not really going to experience any of the psychoactive effects, right?

CHLOE:  Oh, not at all. Yeah, no. I mean Remy takes probably four times more than I would recommend most adults to take, no problem whatsoever, and I’ve played around pretty hardily and I’ve had no issues either.

PHOEBE:  Very cool. We’re going to talk about gut health down the line in this conversation, obviously, since that’s what our show is all about, but can you tell us a little bit about the various ailments or maladies that people are using CBD and THC for these days, or I guess just hemp and cannabis for these days?

CHLOE:  It’s been pretty incredible to see the vast array of ailments that CBD is being used for, or cannabis; I really think of them pretty interchangeably. Obviously, epilepsy is one of the things we got a lot of exposure for. The Charlotte’s Web strain and their story with Charlotte Figi and their mission has really revolutionized the field and brought so much more research and opportunity to get this medicine out there.

USING CBD FOR EPILEPSY AND OTHER NEUROLOGICAL CONDITIONS

PHOEBE:  Can you tell us a little bit about that story?

CHLOE:  Charlotte’s Web is a company out of Colorado. It was started by a bunch of brothers who – they have a really great Ted Talk – started making hemp salves for pain management, and then they were trying to figure out how to get this medicine out into the world. Then this little girl, Charlotte Figi, who I believe was having about 150 seizures a day, contacted them, started taking their CBD, and – she apparently was really sort of on death’s door, was really remarkably revived by this medicine. That’s the case with so many of these children with intractable seizures.

It’s really such a life-changer for these families. I can’t even express to you how horrendous it is to watch your child have seizures; I cannot imagine watching Remy have hundreds a day. That would – ugh! So they’ve been really active in getting a legislation passed and pushing the field forward overall. I really have nothing but respect for those guys.

PHOEBE:  What exactly is happening in the brain that this endocannabinoid system is kind of heading off the seizures before they start?

CHLOE:  That’s sort of a tricky question. There’s a lot of research going on right now to find out exactly what’s going on. We know that it works on certain biopathways, so it definitely works on the sodium pathways; it works on the tripB1 pathways; it works on the serotonin pathways, but, really, it also regulates the vagus nerve, the vagal tone. I’m sure we’ll be getting into the gut brain axis and how important that is.

PHOEBE:  Oh, yeah.

CHLOE:  But it’s really just bringing the body and the brain into homeostasis at the most basic level, but the chemical compounds and how that’s all working is still sort of being sorted out. There is some really cool research on it coming out now.

PHOEBE:  Amazing. Yeah, I know a lot of friends who take it for sleep and anxiety. I don’t know. I’m kind of – I haven’t been – I’ve been very loosely using it, I’d say, for the past two years, so I haven’t been a true guinea pig to really see what the affects are. It’s also, you know, expensive, so I haven’t been that compliant.

I’m assuming that the sleep, the anxiety, and even, I guess, the gut health – which we’ll get into a second – it’s all because of that regulation of the brain, yes?

CHLOE:  It’s all because of the regulation of the brain, but, also, you can sort of think of CBD as an adaptogen. It’s like if you need more energy, it gives you more energy. If you need more sleep, it’ll help you sleep. You know what I mean? It just sort of balances everything out. The receptors are literally throughout the entire body. The CB1 receptors are mainly found in the brain, but they’re found throughout the rest of the body as well. Whereas the CB2 receptors are mainly found in the immune system. So it’s regulating the immune system; it’s regulating the gut; it’s regulating how the neurotransmitters are communicating. It has an anticholinergic effect. It’s really, truly pretty remarkable. It’s pretty fun.

While I was sort of doing a little bit of studying up on the gut and CBD, I would be like, okay, CBD in the guy microbiome, CBD in leaky gut, and it was just research paper after research paper saying, yes, it help this, yes, it helps this, so that was pretty fun.

PHOEBE:  Okay, so let’s dig in! Tell me what you found. Let’s tackle, I guess, the microbiome as a whole. There’s research about it improving various beneficial populations. How does it work?

CBD FOR MICROBIOME HEALTH, MOTILITY AND DIVERSITY

CHLOE:  So CBD has been shown to regulate your appetite, which can help with regulating the microbiome, and it also just helps with inflammation, which helps regulate the microbiome. One of the things that I found most exciting and super nerdy was that it potentiates – so there’s a research study on how CBD affects the microbiome and how that affects treatment for MS. One of the bacterias that it potentiates, Akkermansia municiphila – I can send you the research so you can post it if anybody wants it.

PHOEBE: Yeah, I’ll put it in the show notes for sure.

CHLOE: CBD potentiates this one specific bacteria to help with MS, which I thought was super interesting because I had just read a research study about the keto diet potentiating the same bacteria in order to help with epilepsy, so I was super stoked on that. Yeah, CBD helps balance microbiome and helps reduce inflammation in the gut, and it helps strongly with the tight junctions so that it helps prevent leaky gut syndrome.

PHOEBE: What happens there? How does it help that permeability?

CHLOE: It seems to help activate the immune system. Again, a lot of these things, in terms of the specific biomechanisms, are still being worked out, but it helps activate the immune system and reduce inflammation in the area, so that they can sort of reform those junctions so things aren’t getting out. It also down regulates leukocyte infiltration at the area, so that way it prevents adhesion and migration, so it’s pretty cool.

PHOEBE:  For someone who has SIBO, a strange subset of general microbiome issues, also leading to leaky gut, what have you, what kind of application would you recommend? Do you think CBD would be something that’s interesting to incorporate during the recovery process after someone goes through treatment? How would you incorporate that into the toolkit.

CHLOE:  I definitely think CBD would be helpful, especially in terms of balancing the microbiome, healing the gut, and its affects on motility, since SIBO has so much to do with motility as well. I was sort of thinking about it today, in terms of would I prefer somebody taking it under the tongue, which is one of the most common administrations of CBD, or whether it would be better taking it in a capsule. I think either would really be effective because if you take it under the tongue, you’re still swallowing it, and it’s getting to all of those rich capillaries under your tongue, so you’re getting an effect really quickly. Some of the affect that the CBD is having on the gut is through its effect on the brain, as you mentioned earlier. You want to get both of those going on.

If you take it in a capsule, it’s sort of getting closer to what’s the heart of the matter, so that might be better for some people depending on where they are. That’s one of the tricky things with CBD, is you sort of have to play around with it a little bit because it’s not one size fits all.

PHOEBE:  I would think some people’s digestion is so messed up that like capsules are even hard to get the most out of.

CHLOE:  Exactly, yeah.

PHOEBE:  So I think having something that’s kind of built-in in liquid form is kind of a benefit, I think, for some people with SIBO.

CHLOE:  Definitely. I’ve even had patients use suppositories for certain disorders, not really with SIBO but for Crohn’s, IBS, or endometriosis.

PHOEBE:  That’s really interesting.  Back to something you said before about appetite. When we think about these plants and appetite, I automatically go to the munchies from smoking cannabis. How does just the CBD affect appetite?

CHLOE:  It seems, again, that it’s more of a regulatory mechanism. It seems like it acts upon the vagus nerve, to tell the brain when you’re hungry or not, and when you’re in a fasting state, anandamide, the endocannabinoid, is increased, so it seems like it helps with brain signaling, in terms of whether you’re hungry, whether you’re not, or whether you’re actually full. Yeah, again, it’s strain-specific and it depends on probably how much THC is in it. THC tends to make you hungrier than CBD does.

PHOEBE:  It’s really interesting. I think, obviously, there’s a lot of things at play for SIBO people with appetite. If you’re extremely distended and bloated, it can make you feel full faster. Also, I think there’s just like a whole emotional component with the strict diet and starting to feel like food is the enemy. It’s nice to have something, potentially, that loosens your grip on that and potentially forces you to nourish yourself at the appropriate times a little bit more. I don’t know; just something that popped into my head.

CHLOE:  No, definitely. Again, it’s really about balancing homeostasis action that it’s always looking for. If you’re using it to increase appetite or decrease nausea, it’s incredibly effective. Also, if you’re starving for nutrients, it’s going to tell your brain, like, you need to go and get food, so that’s really helpful.

PHOEBE:  Yeah. So for hemp, if I’m understanding this correctly, you want to look for a full-spectrum product, but for cannabis – I mean, I basically just know as a casual consumer, the once or twice a year I visit Oregon or California – there is kind of a whole array of different products out there now, in terms of edibles, that advertise various ratios between CBD and THC. How do people navigate that who are in the states that are able to do so? Are there certain ratios that are better for certain ailments? Specifically people with SIBO or gut issues, what is the ideal there?

WHAT HEMP AND CANNABIS PRODUCTS ARE BEST FOR SIBO

CHLOE:  Again, a lot of it’s down to personal preference and how your body responds, and how much THC, and thus psychoactive effects, you’re interested in having. A lot of people do 1:1 now because you’re getting a higher THC activation, but less of a high, so that’s sort of better for a lot of people who aren’t looking to sit on my couch and play video games all day. In terms of strains, there are so many different ones. You want to look at the terpene profile. Those can help. You want to look for terpenes like myrcene, which is really clovey and musky, it’s sedating, but it’s also antibacterial, anti-fungal and helps a lot with inflammations, so that might be a great one for SIBO – cumalin, also.

PHOEBE:  Where do you find that kind of information? Is it on the back of most edible or oil packaging?

CHLOE:  It should be on the back, or if you go to any of the company’s websites, they should have certificates of analysis, which should have all that information on it. Right now, it’s such the wild west out there; there’s so many products that really are just mass-produced and really not well-tested, don’t have good quality ingredients or have fillers. You really do want to do your homework and make sure that you’re getting a product that has what it’s listing on the label, especially if you’re spending $100 a product.

PHOEBE:  Totally. We’ll get to that question down the line, of how to distinguish the snake oil from the real stuff.

CHLOE:  The other thing is, also, CBG is one of the cannabinoids that’s not being further researched, and it’s coming out in more and more products, but that one’s been shown in research to be really effective for irritable bowl disease, and decreasing inflammation in the gut and potentially inhibiting colorectal cancer, and it also works as an appetite suppressant; it’s antibacterial, and there’s a really awesome research study about using it for Huntington’s Disease, which is obviously a debilitating neurological disorder. I think in the coming year to two years, you’re going to start seeing more of these other cannabinoids play a role in the industry as we get more and more research on them.

PHOEBE:  So interesting. How are these being incorporated now? Is it in addition to both the CBD and the THC, or are people kind of starting to use that – I don’t know – on its own? How do people look for those types of products with CBG?

CHLOE:  If you’re getting a full-spectrum product, you’ll probably be getting low levels of CBG or CBN in there and a bunch of other, sort of, undiscovered cannabinoids, which are all really exciting, but they’re working on genetics to increase CBG and CBN. I know that we were looking into getting some seeds for our crops next year that had an increased amount of CBG so that we could start developing products with that, for that reason.

PHOEBE:  Very cool. I assume that Radical Roots does an oil. Let’s talk, just for a second, about, I guess – I don’t know what you call it – method of delivery. What are the different benefits between just an oil under the tongue, chocolate or gummies, or miscellaneous edibles, and then smoking?

CHLOE:  Smoking, you’re going to get the fastest response to it, obviously, as we all know. That’s a benefit if somebody’s in acute distress and needs something to change, whether it’s anxiety or whether it’s visceral pain. Smoking can be really helpful for that and you can totally smoke..

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This is a sponsored post written by me on behalf of NeoCell. All opinions are 100% mine. Thanks as always for supporting the brands that make my free leaky gut health resources possible! 

Leaky gut (like adrenal fatigue) is a term that gets thrown around a lot in the holistic health space, despite its controversial place in mainstream medicine. It’s also one of those terms that might make you cringe a little, as no one wants to be told any organ or orifice is, er, leaking.

While intestinal permeability is a real thing (and for the sake of this post, I will use leaky gut interchangeably with this term), many practitioners argue that it is more important to look at other aspects of the digestive system to uncover why your gut might be damaged in the first place, rather than chalking up everything that ails you to this one syndrome.

I’ve had plenty of interviews on the podcast so far that cover various sides of the conversation. So in today’s post, I’m going to dive deeper into what impact leaky gut actually has on the body, the aspects of modern diet and pill popping that can contribute to increased intestinal permeability, and some easy changes that can reverse its course fairly quickly. I’ll also be covering some supplements you can add to your routine, including NeoCell Super Collagen + C, which I’m currently loving for healing my gut on the go.

Read on for everything you need to know to heal leaky gut and tie it together with other pieces of your health puzzle.

WHAT IS LEAKY GUT SYNDROME? 

When people talk about leaky gut, they are really referring to increased permeability in the small intestine.

For those of you who might have missed the basic anatomy lesson in my SIBO 101 series, the small intestine is where the majority of your nutrients are absorbed. It’s a more delicate section of the intestinal tract, responsible for allowing vital vitamins and minerals to pass into your bloodstream to keep your body fed, alive and well, while protecting you from some of the other junk that needs to be contained in the digestive system and eliminated via the colon.

The keepers of this barrier are called tight junction proteins, and they are responsible for making sure migrants have the right passport for entry. When the lining of the small intestine becomes damaged, either through degradation of the mucus that protects it or from local inflammation, the result is an increased permeability. Meaning, the fine mesh sieve formerly in place now allows through larger particles.

These foreign invaders, once in the bloodstream, can fire up the immune system, creating systemic inflammation via an unregulated, on-going immune response. The difference between local autoimmunity and system is something that’s explained really well by Dr. Susan Blum in this episode.

WHAT CAUSES LEAKY GUT?

Like many complicated gut-related conditions, leaky gut suffers from a lot of “chicken or the egg” ambiguity.

It’s thought that food sensitivities that trigger local autoimmune responses can cause damage to the intestinal wall. When our body is attacking something it doesn’t want around, it’s not uncommon for our own tissue to get caught in the cross-fires. (If you’ve read up on the connection between Hashimoto’s and gluten, then you know what I’m talking about.)

Since those tight junctions are proteins that might look similar to certain foods (the same way our body can’t tell the difference between a gluten protein and a thyroid protein), they become damaged during an attack.

Of course, once the barrier is damaged and members of that unwanted food group (let’s say soy) migrate from the small intestines into your bloodstream, it will cause an even more pervasive immune response. And that response will only further the feedback loop: now every time you eat soy, an even bigger army is sent to greet it in your small intestines, which only further damages your gut.

Food sensitivities create a vicious cycle, as do other causes like Small Intestine Bacterial Overgrowth.

Since your small intestine isn’t meant to house very much bacteria, their presence means competition for your food sources. When they aren’t getting enough carbs, they turn to the next best thing: you.

Unwanted bacteria can also feast on the mucus that protects your tight junctions, which is why increased intestinal permeability is one of the big downwind consequences of SIBO.

There is also a wide array of medications that can cause damage to the protective mucus layers: NSAID’s like aspirin and acetaminophen, antibiotics, steroids, chemotherapy and birth control pills.

For more information on why the pill creates another feedback loop of gut damage, listen to this episode of the podcast with Dr. Jolene Brighten.

Other causes of leaky gut include toxin overloads like mercury and other heavy metals, chronic stress, and gut-related autoimmune diseases.

Those with Crohn’s, colitis, and celiac disease have a higher risk of permeability since the gut is constantly under attack.

WHAT ARE LEAKY GUT SYMPTOMS? 

Signs of leaky gut can include any number of inflammatory symptoms.

Something we’ve discussed regularly on the podcast is that every individual has genetic shortcomings. Those with neurological weaknesses may experience the fog of inflammation as migraines, moodiness, or irritability. It might manifest as depression, anxiety, ADD, or ADHD.

Those who are already “gut people” may notice an increase in food allergies or IBS symptoms like bloating, constipation or diarrhea, since with leaky gut, damaged cells mean less enzymes for proper digestion. Another downwind symptom is nutrient deficiencies, which can then lead to hormone imbalances and thyroid issues.

Some may experience those imbalances through rashes and skin ails, sleep issues, brain fog, and memory loss.

Others who are predestined to joint issues might feel the inflammation as arthritis.

The list goes on!

HOW TO DO A LEAKY GUT TEST

The leading test for leaky gut measures levels of two indigestible sugars, mannitol and lactulose, in your urine. The idea is that you drink a premeasured amount of those sugars and the permeability or malabsorption is reflected in the levels recovered in a urine sample collected over the next 6 hours.

Some practitioners think this test is bogus and it’s better to rule out other things first. I had an interesting conversation with Dr. Patrick Fratellone on the podcast about this. His argument is that you need to test for intestinal permeability—even if you know the root cause of it—so you know how to treat the patient properly.

If you have severe intestinal permeability, it’s going to be much harder for you to digest capsule pills and you might be better off using powders, tinctures or teas to begin healing your leaky gut or treating your SIBO (which might be a big root cause).

WHAT IS THE BEST LEAKY GUT DIET? 

Discovering your root cause of leaky gut is going to be the best method of healing it, and often that trigger is a hidden food sensitivity.

The best way to uncover the culprit is through an elimination diet. This post will give you an overview of which food groups are most common to remove and for how long. I also have a 4-week Elimination Diet meal plan with recipes that will walk you through it.

Many people talk about removing lectins for leaky gut. This is a more extreme therapeutic diet approach. Personally, I would first try the bigger culprits. Next, focus on removing grains and legumes to give your gut further time to rest.

If you think SIBO is one of your root causes, it might be worth exploring a low FODMAP diet. If you find that these fermentable carbs are irritants, it could be a sign that there’s an overgrowth of bacteria in your small intestine that’s contributing to the leaky gut.

For more guidance on an elimination diet or a low FODMAP version that reduces legumes and easily fermentable carbs, check out my meal plans here.

As for what else to remove, it can’t hurt to take away additional irritants like alcohol, caffeine and sugar. This is something I do whenever my gut is feeling off for any reason.

Finally, focus on eating plenty of leafy greens, healthy fats such as fish, olives, avocados and coconut oil, and rich stocks and broths made from responsibly-raised animal bones.

WHAT ARE THE BEST LEAKY GUT SUPPLEMENTS? 

Collagen: The reason why bone broth is such a salve to the intestinal wall is due in part to their wealth of amino acids. These are the big workhorses for rebuilding tissue, fortifying your hair, nails and teeth. When my gut was still recovering from SIBO treatment, I used powdered collagen and added it to my morning tea, soups, smoothies and baked goods. Now that my gut is in better shape, I often take it in pill form for maintenance. This NeoCell Super Collagen + C supplement has been a recent favorite when I’m traveling or don’t have time to make bone broth. I bought mine in bulk at Sam’s Club so the bottle lasts a while. (You can buy NeoCell Super Collagen + C at Sam’s Club today here)

Probiotics: If you’ve read this post or listened to this podcast episode, then you know there’s more and more fascinating research on the roles of specific probiotic strains. For leaky gut, improving motility is going to be a key component. Click here for my favorites.

Digestive enzymes: When your gut is damaged, you want to make sure that you’re helping break down your food as much as possible before it enters the intestinal tract. That means first and foremost CHEWING. Like, really well. Second, you can take digestive enzymes to aid in the process and make up for the ones your body is too inflamed to make.

L-glutamine: This is another specific amino acid that rejuvenates the lining of the intestinal wall. You can buy it in pill or powder form, but as I mentioned earlier, if you’re in bad shape, start with the latter.

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Is it possible that the most potent medicine in your bathroom is what’s getting flushed down the toilet every day?

Fecal Microbiota Transplantation (FMT) – taking stool from a healthy person and using it to recolonize the colon of someone with a dysbiotic microbiome – has been one of the most exciting areas of medical research in the last five years.

The simple power of poop has been found to be 92 percent effective in treating the opportunistic and antibiotic resistant bacteria C. difficile, with patients reporting dramatic recoveries within 12 hours.

Though these “ick factor” therapies remain experimental, having not yet received full FDA backing, hundreds of trials are underway across the country to determine their future in treating IBD, SIBO autism, obesity and other inflammatory conditions. And plenty more people have taken matters into their own hands to try their luck with fecal transplants at home.

Today on the podcast, we talk about all things stool transplants: how they work, who might benefit most, and what we still don’t understand about their efficacy within the whole microbial ecosystem in all its complexity. Joining me is Dr. Andrea McBeth of Flora Medicine, who is one of the leading experts in the field.

Make sure to listen to the end of the episode as she also addresses the recent controversy over the FDA halting several trials using fecal transplants and what the future might hold for Big Pharma and every day sufferers.

A quick taste of what we’ll cover:
  • How FMT works and the best mechanisms for delivery for various gut issues
  • Why all the other matter in your poop is equally if not more important than the bacteria when recolonizing your microbiome
  • SIBO, IBD, autism, obesity and other inflammatory conditions that are being explored right now with FMT treatment
  • Methods for doing a DIY fecal transplant or fecal therapy
  • How to choose and properly screen a donor
  • The difference between a therapeutic dose for shifting an ecosystem and what you might need to eradicate a pathogen
  • Risk factors and why we still need more safety precautions
  • Why FMT could help certain SIBO cases
  • What lifestyle and diet strategies you need in order for the FMT to work long-term
  • And so much more…
Resources, mentions and notes:

This episode is brought to you by Epicured, a low FODMAP meal delivery service that understands that food is medicine. Each menu is created by Michelin star chefs and honed by doctors and dieticians at mount sinaii to restore digestive health for those with IBS, SIBO, Celiac and IBD. Everything they serve is 100 percent low FODMAP and gluten-free, with no cooking required! My favorite part about their dishes is the healthy spin on takeout gems like shrimp laksa and PAD THAI! Their version had a great balance of fresh veggies mixed in with the noodles that left me feeling both satisfied and completely free of my usual carb coma. Listeners to this podcast can get 20% off their order by using code SIBOMADESIMPLE. Just click here to learn more. 

Disclaimer: The information shared in this podcast is not meant to provide medical advice, professional diagnosis, or treatment. The information discussed is for educational purposes only and is not a substitute for medical or professional care.

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Sometimes I put off watching great food TV because it feels like work.

Such was the case with Salt Fat Acid Heat. Believe it or not, I arrived only recently to that party, thanks to an afternoon appointment at Shape House, where you get to watch television while you bake in their sauna sleeping bags, and where I felt just a little too guilty mid-workday watching Younger reruns.

So instead, I opted for Samin and am so glad I did.

The show makes her book come alive in the most sensual way. I wanted to taste everything she tasted. And go everywhere she went. Instead, I tried to make everything she made, starting with this Chicken Escabèche recipe.

This Yucatan-style sweet and sour chicken is traditionally made with a specific type of tart oranges from the area. Naturally, it was something that Samin included in the Acid episode, which centered around Mexican cuisine from this region. It’s also the dish and episode that my close friends might have guessed that I liked the least, since I have a bit of an orange phobia.

But after watching, when left to my own devices, I had an idea to use either limes or Meyer lemons to create a similar acid base for my version of Chicken Escabèche. And since there were so few other ingredients besides hot peppers and onions, I decided to omit the latter and make the dish a low FODMAP taco filling.

In this version, the shredded chicken comes together quickly in the oven, where it braises with a mixture of carrots, jalapeno, lime and a little sugar for sweetness. A handful of fresh mint for garnish really compliments the spice. I also love topping the tacos with crunchy radishes and cabbage, but you can add avocados or any other accouterment you like if you’re not following the low FODMAP diet.

And speaking of that…those who subscribe to my newsletter got the good word yesterday that I’ve finally created a low FODMAP version of my Summer Reset Elimination Diet Meal Plan! You can find out more about it here.

There’s a version of this Chicken Escabèche in the book minus the tacos, since in addition to removing high FODMAP foods, the recipes are also gluten, dairy, soy, corn and refined-sugar free so you can layer a traditional elimination diet on top of your low FODMAP elimination. There’s instructions on how to do this of course, and it’s a really rare thing to find a plan that will help you dual path, so I hope it’s very helpful!

For launch week I’m giving you $25 off with the code TAKE25, so get on it! It expires on the 24th.

In the meantime, you can get a little taste with this Chicken Escabèche recipe!

With health and hedonism,

Phoebe

Chicken Escabèche Tacos (Low FODMAP)

These chicken tacos are made escabeche-style with the perfect balance of sweet and sour from the Yucatan. Instead of orange, I use lime juice with a little sugar. But if you like orange you can add some fresh juice to this recipe. Meyer lemon would also be great. Though there are normally onions, this recipe has been adapted to be low FODMAP.

  • 2 tablespoons olive oil
  • 4 garlic cloves (smashed)
  • 2 pounds boneless skinless chicken thighs
  • 1 teaspoon ground cumin
  • 1 teaspoon ground coriander
  • 1/4 teaspoon ground allspice
  • Sea salt
  • 2 medium carrots (thinly sliced)
  • 1/4 cup sherry vinegar or red wine vinegar
  • 1/4 cup lime juice
  • 2 teaspoons organic cane sugar or clover honey
  • 1 bay leaf
  • 1 jalapeno (thinly sliced)
  • 1/4 cup roughly chopped mint leaves
For the tacos:
  • 12 corn tortillas (warmed in the oven or charred stovetop directly on the flame)
  • 1 cup shredded cabbage (for garnish)
  • 1/2 cup mint or cilantro leaves (for garnish)
  • 6 sliced radishes (for garnish)
  • 4 lime wedges (for garnish)
  1. Preheat the oven to 400 degrees F.
  2. In a large oven-proof skillet or saucepan, heat the oil over medium heat. Add the garlic and cook, turning occasionally, until golden brown on all sides and very fragrant, about 3 minutes. Remove the cloves and discard.
  3. Meanwhile, season the chicken generously with salt and sprinkle the cumin, coriander and allspice over the meat.
  4. Raise the heat to medium-high and add the chicken in a single layer, spice-side down. Cook until nicely browned on one side, about 4 minutes. Remove to a plate.
  5. Add the carrot and vinegar to the pan, scraping up any brown bits that may have formed on the bottom, followed immediately by the lime juice, honey, bay leaf, 1/2 cup water and 1/2 teaspoon salt. Bring to a simmer and reduce for 2 minutes.
  6. Remove from the heat and return the chicken to the pan, seared-side up. Scatter the jalapeno over the top.
  7. Transfer the pan to the oven and bake, uncovered, until chicken is fork tender, about 15 minutes. Let rest 10 minutes, then roughly chop or shred with a fork, top with mint, and serve alongside the tortillas, cabbage, mint or cilantro, radishes and lime wedges.

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Research shows that so much of what sets us up for good gut health later in life happens during early childhood. And yet, it’s often when we take our biggest missteps. In today’s episode, we go beyond SIBO to talk about the rules of greater gut health, why our detachment from the earth is making sick, and how by simply getting dirtier we can correct some of the microbiome mistakes from our youth.

I’m joined by Dr. Maya Shetreat, who is a pediatric neurologist, herbalist, urban farmer, and bestselling author of The Dirt Cure: Healthy Food, Healthy Gut, Happy Child. In our chat, we discuss what’s happening in a developing gut and how some of the popular ills of childhood – like ear infections, fever, rashes, colic, hyperactivity – relate to food sensitivities and a damaged microbiome. More importantly, Dr. Maya gives us some concrete advice on natural alternatives to conventional over-the-counter drugs that might be damaging your kid’s microbiome further.

If you’re someone who is still putting together all the pieces of your health puzzle (or a child’s) this conversation will bring a lot of aha moments, and offer plenty of suggestions for moving forward. 

A quick taste of what we’ll cover:
  • How the genetic vulnerabilities we’re born with play out via our lifestyle and environmental triggers
  • What being out in nature does for our nervous system and biodiversity
  • How the microbiome interacts with the microvirome – our body’s ecosystem of viruses
  • Why childhood fevers are so important for immune development
  • How gut health impacts the nervous system and why certain children present with neurological issues like ADHD or Autism, and others will get an ear infection
  • Why early childhood emotional or physical trauma can affect gut health later in life
  • Cranial-Sacral Therapy, reiki, chiropractic adjustments and how you can expand your child’s wellness toolkit
  • How to approach an elimination diet for children
  • Natural tools for your medicine cabinet to fight common childhood ailments like fever, rashes, etc.
  • What dietary culprits could be behind chronic ear infections in children
  • How we can apply the rules of greater gut health in adult life, even after imperfect childhoods
Resources, mentions and notes:

This episode is brought to you by Epicured, a low FODMAP meal delivery service that understands that food is medicine. Each menu is created by Michelin star chefs and honed by doctors and dieticians at mount sinaii to restore digestive health for those with IBS, SIBO, Celiac and IBD. Everything they serve is 100 percent low FODMAP and gluten-free, with no cooking required! My favorite part about their dishes is the healthy spin on takeout gems like shrimp laksa and PAD THAI! Their version had a great balance of fresh veggies mixed in with the noodles that left me feeling both satisfied and completely free of my usual carb coma. Listeners to this podcast can get 20% off their order by using code SIBOMADESIMPLE. Just click here to learn more. 

CHILDHOOD GUT AND NEUROLOGICAL DEVELOPMENT

PHOEBE: Dr. Maya Shetreat, it’s so nice to have you on. I’m going to call you Dr. Maya like the kiddos, even though we’ve met in person. Maybe I could just say Maya? I don’t know. Actually, I should tell people how we met.

I had emailed you probably five days prior to podcast guest, Jolene Brighten, being in town, and we were supposed to have tea. She texted me the day of and said, hey, I don’t know if you mind, but my friend Maya is going to come, and I was like, oh, my God. I guess fan girling a little bit since I had just reached out to you. We ended up meeting. Discovering that we are not only both Scorpios but have the exact same birthday, and yeah, here we are now. Thanks for coming on the show.

MAYA: Definitely a fated meeting.

PHOEBE: A fated meeting. All right, so for those who aren’t as familiar with your work, tell us a little bit about your story. You’re a pediatric neurologist. Why neurology? Why children? Go.

MAYA: When I was deciding what to do, I – actually, I like the idea of solving puzzles. That was really what I think got me really into neurology. It’s very logical and also, at the same time, very intuitive. In the nervous system, you localize everything based on the symptoms someone’s having. I like problem solving, puzzle solving, like detective work, and I decided I wanted to work with kids because – well, two reasons. One is because children’s brains are so plastic, so there’s just so much capacity for recovery, or at least that’s what I thought at the time. Now I know that, really, everyone’s brain is plastic and that our bodies are also. I’ve seen amazing recoveries that I never could’ve imagined back then with the work that I do, but at the time, that’s what I thought.

The other reason was that I had a mentor who gave a lecture in my second year of med school about autism, and I was so compelled by this mystery of autism. I decided to do research with her and really got connected with a lot of families and worked with the kids. It became a passion of mine, so that was how I got into my initial field of pediatric neurology way back when.

PHOEBE: Awesome, and then your part two, your next chapter was how you came to write TheDirt Cure, which stem from something that happened with your son. Will you tell us about that?

MAYA: Throughout my training, I got married, and I had three children. I had my daughter in med school, my son in pediatrics residency, and my second son in my neurology fellowship. My second son, my youngest, when he was about a year old, he started to have asthma symptoms and, also, a neurologic plateau or even regression where he’d been an early speaker. He stopped gaining words. He got clumsier. He started falling more, but he wasn’t catching himself, which is a normal reflex. He would hit his face into the ground, and he was just agitated a lot of the time. Coinciding with that, he had all these breathing issues, which looked like asthma. He went in this cycle of being on antibiotics and steroids and inhalers.

I took him to different doctors because I was like why did this happen all of a sudden? Nobody was that bothered. They were like, well – I took him to allergists and pulmonary doctors and neurologists. It was like, well, he’s a reactive kid. He’s going to be fine, this kind of thing. After ten months of him being – literally, every other week being sick and being on nonstop meds, I finally got to the bottom of it myself by looking in the scientific literature and ending up connecting with not the most well-known doctor in the world for food allergies or that kind of thing but, actually, a local allergist.

We discovered he was allergic to soy, which probably happened due to a mold exposure, which is a deeper story. He was allergic to soy, and when he stopped eating soy and, in his case, drinking soy because he was having soy milk – which at the time, I thought he was reacting to dairy. I thought, well, soy milk is a great option. We stopped that, and he stopped having asthma after ten straight months. Then we saw him really improve in his neurologic symptoms over time, but what took a long time was actually to recover his gut and his disruptive microbiome. That from all the medications was pretty much a mess.

PHOEBE: Yeah, I mean, one of the many reasons why I really liked your book is that I found that it wasn’t just a great read for parents because I’m not a parent but, really, anyone who is in adult life and suffering from unexplained symptoms. I think back to all the puzzle pieces from, I mean, certainly my own childhood health history, and I know people listening at home probably are people who have been through the ringer with mysterious symptoms for a long time. First off, what’s happening, really, in the early stages of development with children’s guts? How do some of the popular ills of childhood – like your son’s asthma, ear infections, rashes, colic, hyperactivity, how do these all tie in?

MAYA: It used to be – I’m going to start with birth, really. This I will tell you actually applies to everybody. I wrote my book for families, and that includes kids and adults. I’ve had a lot of adults read the book who are not parents. Even going back all the way to birth, it sounds crazy. What happens in the womb and at birth, our own birth meaning, and through childhood actually does affect our lifelong health, so it’s relevant. Really, we imagine that in the womb we’re completely in a sterile environment. This is what we were told for a long time.

It turns out even the womb and the amniotic sac has its own microbiome with its own unique set of bacteria that maintain that environment or help to maintain that environment. Then, when we’re born – so there are all these factors that impact. When we’re born, generally, we’re intended to go through the vaginal canal. This makes people squeamish, but if we’re talking about SIBO, we’re talking about poop I know, so at least we get to talk about all the different places in the body. Basically, part of how we seed – the baby seeds its microbiome, it’s swallowing vaginal fluids. Actually, even around the perineum right as it’s coming out, it’s getting this exposure to the vaginal microbes. That is what actually is like the initial probiotic of life that basically creates a beautiful diverse microbiome, hopefully, for the baby.

What we know, for example, is that if a baby is born by C-section, they don’t have predominantly vaginal flora, but what they have is actually predominantly skin flora. That changes the makeup of the microbiome. This doesn’t mean if a baby’s born vaginally that all their problems – that there are going to be no problems, or that if they’re born by C-section, they’re running into problems. Probability-wise, statistically speaking, they’re more vulnerable being born by C-section. Now, I will say I had my son vaginally, and he was a home birth for that matter. He still ran into some of these problems, so it’s not foolproof. We’re talking, again, about these different things of having healthy flora. Also, if a mom is given antibiotics around birth or before birth, or she’s gotten lots and lots of antibiotics in her life, her flora’s going to be different. The baby’s flora is going to be different and even getting antibiotics around birth or right after birth, so these are some of the issues that can come up.

Now we know that there’s not just a microbiome that contains bacteria but actually a micro-virome where there are actually viruses that maintain the tasks, let’s say, of the flora in the gut. For example, there was a study done, and it was published in Naturea few years ago. It was really like seminal study that showed that when they did these experiments with germ-free mice – and germ-free means that they wipe out all the flora of the mice using antibiotics. They actually gave a controlled group – they got nothing, and then another group got a certain relatively benign virus. The ones that had the benign virus, were given that, were ingesting that, those viruses totally took over for the bacteria. Literally, everything went without a hitch whereas, normally, in a germ-free mouse, there’s gut breakdown. There is all kinds of disruption that goes on physiologically because our – we are dependent on a healthy microbiome.

Things like steroids and Tylenol and vaccines and all these different kinds of exposures that we have that are normal in our lives, they change up the microbiome and the micro-virome in ways that we really don’t totally understand and can’t anticipate the kind of impact it has. When someone has a disrupted microbiome for any number of reasons and there are many possible reasons, what we know happens is that there could be gut symptoms, and moreover, there’s actually immune symptoms very commonly because the immune system and the microbiome are in close communication and then, in addition, neurologic symptoms.  We can actually see all kinds of issues relating to, let’s say, migraines, or seizures, or ADHD, or focus, or mood, or all kinds of neurologic symptoms that basically come from a disrupted microbiome.

PHOEBE: Yeah, I mean, it’s fascinating, and I think it’s something that a lot of people don’t understand is why maybe you could even not be experiencing any digestive symptoms but be someone who gets the ear infections, the rashes, and what have you. Why does that happen? Why does it get expressed in different ways, and specifically, with the gut-brain connections, how does that work?

MAYA: For one thing, we all have different vulnerabilities, genetic vulnerabilities. We all come to the table with genetic vulnerabilities. This is when you say, oh, this runs in the family. My dad has it. My grandfather has it, that kind of thing, so therefore, I have it. That’s not a given. It’s very rarely a given that just because other people in your family had something that you have to express symptoms. You may have that vulnerability for eczema, or you may have that vulnerability for seasonal allergies, or food allergies, or migraines, or whatever, whatever it may be. What it comes down to is what are the circumstances? What are the environmental exposures? What are the triggers going to be that are either going to reveal that vulnerability, which means you’re going to have symptoms, and you’re going to express it, or that are going to keep you resilient?

Having a really biodiverse microbiome, meaning lots of different kinds of bacteria – and not too much of any particular kind but lots and lots of different kinds, so we call that microbial diversity. If you have increased microbial diversity, that’s protective, and that actually protects you in a lot of ways. One of the ways is simply by – that’s what your immune system wants. Your immune system wants to see lots and lots of different flora, lots of different microbes. Actually, it becomes more comfortable with lots of different things like different kinds of foods, different kinds of flora, all different kinds of compounds. Things you might find in nature, right? Nature is so biodiverse with lots of different compounds that your immune system becomes more comfortable with all different kind of things, and then it’s less likely to freak out when it sees something strange, which might like a certain kind of cat, or it might be a peanut, or it might be something else. It’s not to say that that’s foolproof, again, but this is the kind of thing that all this diversity is what our body’s evolved with in nature.

Now we’re in a much more sterile way of living in houses where we scrub it down all the time with bleach. We wash ourselves with soap. Not all of us. Some people though or a lot of people. Yeah, I think being clean and being sterile and being hygienic is what we aspire to. Actually, it doesn’t mean we all have to walk around like pig pen but really getting dirty and being exposed – like coming home with – going outside, getting dirt on our clothes, and sitting down in the grass and being in nature and having even a pet. We hear these scary stories, oh, like sponges that you wash your dishes with. They’re filled with bacteria, but the irony here is that you’re less likely to develop allergies if you use a sponge because you’re getting that microbial diversity whereas with a dishwasher you’re not getting that microbial diversity.

Same using bleach, there’s all this data that when kids are in schools or homes where bleach is used really regularly, they’re more likely to have chronic respiratory infections and bronchitis than if they don’t have bleach exposure, so it’s interesting, right? I mean, it could be the bleach, the chemical, all that, but I think it’s also very likely that it’s related to, again, the microbial diversity that we need that. That’s part of what keeps us healthy. These things that we aspire to do and felt like, wow, I want to be clean; I want everything to look just so, it’s actually being a little dirty, or a little messy, or having the pet, okay. Again, pets also increase your microbial diversity because you’re sharing the microbiome of your pet.

WHY SOIL IS THE BEST PROBIOTIC FOR KIDS

PHOEBE: I have a question about this. As someone who lives in New York City with a pet, who already has a compromised immune system – I have Hashimoto’s. I always wonder. I could, of course, walk to the park and, of course, lay down in the grass and roll around and what have you, but I just worry about the fine line between dirt in a city like ours and toxins. What advice would you give to someone who lives in a sterile apartment without a backyard, who has a dog who is often times walking around on pavement that’s not filthy in a good kind of way? How does someone like me get more comfortable with the idea of getting dirty?

MAYA: I think that, if you’re in an area where you think there could be massive heavy metals or something in the soil, that’s the kind of thing that you can just sample soil, and that’s actually not expensive to do. The city generally will come and remediate if there is a significant heavy metal problem, and of course, there could all kinds of toxins. It’s true, even pesticides and other things, but to me, in general, they don’t outweigh getting outside. That could be as simple as going and taking a walk outside. No one says you have to literally coat yourself in the dirt of the city, although I do recommend on a weekend taking your dog and renting the car or hopping on the train and getting out of the city. I do think that that’s something that people can prioritize, or there’s all kinds of clubs you can join or different things where you can go on little hikes, not far. It’s an incredibly healing thing just to get out of the city first of all, period. I think that it’s really regulating to our nervous systems and our immune systems and all of those things, so I think it’s worth doing that regularly.

Then the studies that look at soil microbes – because it’s interesting. There are different soil microbes that have been studied and have been shown to enhance mood, increase focus, improve cognition, so they make you smarter. You feel less anxiety when you’re exposed to these. One of the ones I’m thinking of is called mycobacterium vaccae. There’s a lot of data on that particular one. It’s a soil microbe. Basically, in the studies that were done, what they said was there’s basically – they called it a superhero effect from when you get exposed to that, and you’re exposed to it though light gardening, or being in the dirt, or in through cuts in your hands, or you inhale it, or you eat a little bit because you’re touching the ground and touching your mouth. I mean it doesn’t have to be very much, but the benefits last for three weeks.

We don’t have to live in a rural area or go off the grid in order to get that benefit, but we do have to show up. We have to go connect with nature. Personally, in the city, I mean, go to Central Park. Go hug a tree. Go have a picnic. You can sit on, literally, a blanket. Again, nobody is saying roll around if that’s not your jam. I do think it’s like – in one teaspoon of soil are as many organisms as there are people on the entire planet.

This is like here we are worrying about microbial diversity and how many billions of CFUs are in a particularly probiotic and stuff like that, but there’s a lot of CFUs in soil and just traces of it. I mean, go to the farmers market and get your food there when you can so that it’s not all power washed vegetables. You’re going to get, again, little traces of soil. You don’t have to eat mouthfuls.

PHOEBE: I’m totally onboard with all that. To go back to the fearmongering side of my brain/society’s brain, what you’re saying is that we shouldn’t worry as much about the idea of city grime equaling toxins per se. Real toxins like the mold, the heavy metals of the world are found in other areas of the city, sometimes your home, but not necessarily you’re going to be affected by those from petting your dog and letting him sleep on your pillow.

MAYA: Yeah, I mean, look, these are the things that can happen, and I think we have to have awareness around it. Honestly, I mean, I think two things. One is whatever traces you might be exposed to, in most cases, they’re not going to impact you in that dramatic of a way. Sometimes they will. I also think by showing up and being out in nature and thinking of nature as us being in relationship with the natural world, that means also that, if they’re going to spray New York City parks just for example, we’re going to show up and say don’t spray my park. I want the microbes that are here, and I don’t care if there’s some wild plant growing that isn’t as nice or might cause an issue. Let’s think of another way to deal with it, which there are other ways to deal with it. Stop spraying poison in my park. One other thing I’ll say about toxins in soil is that, actually, there is some research that shows that the more microbial diverse the soil is, the more the microbes themselves sequester toxins like heavy metals. That means that, if you have really beautiful soil that’s biodiverse and composted and we’re not spraying pesticides on it, it’s less likely if there are toxins in that soil that you’ll even be exposed to them because the microbes deal with them.

PHOEBE: Hmm, that’s really interesting. All right, so going back to the whole category of symptoms , I really loved how you talked about this in the book. Just about how so many kids go through the revolving door of doctors’ offices and just become overmedicated to treat the symptoms and become even more overmedicated to treat the symptoms of the first medication. I’m curious, though. In a lot of your examples, the various symptoms, be it ADHD, autism, rashes, what have you, were a result of a food sensitivity, and a food sensitivity is usually caused by some sort of either toxic burden like maybe in your son’s case with the mold or a gut imbalance. Are those the two main root causes of this plethora of different symptoms? Is that safe..

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SIBO breath testing has been the subject of some pushback in the wider medical community. Today’s episode discusses some of the controversy around the effectiveness of breath testing, when it’s worth doing, how to make sure your results are accurate, and what other tests might be better at getting to the bottom of your gut issues.

Joining me is Dr. Patrick Fratellone, a functional cardiologist and herbalist who used to practice with the late Dr. Robert C. Atkins. He takes us through how he does his gut detective work as a functional medicine doctor, including what comprehensive tests on genetics, vitamin levels and intestinal permeability can tell you about your bigger gut picture.

If you’re someone who’s been debating whether or not to get a breath test for SIBO, this episode might help you weigh that decision.

A quick taste of what we’ll cover:
  • Whether doing a SIBO breath test is worth your time, money and energy
  • What other tests are necessary to determine how your small intestine is functioning
  • Why vitamin D levels are great indicators of your gut health
  • How Dr. Fratellone goes through his process of elimination (hint: SIBO is not the first condition to rule out)
  • MTHFR genes and what they tell you about your health picture, including SIBO
  • Genetic origins of IBS and how to test for them
  • Candida versus SIBO: how to tell the difference
  • Testing for leaky gut / intestinal permeability and why it’s important
  • How to prepare properly for a SIBO breath test so your results are accurate
  • IGG reactivity testing and what it actually tells you
Resources, mentions and notes:

This episode is brought to you by Epicured, a low FODMAP meal delivery service that understands that food is medicine. Each menu is created by Michelin star chefs and honed by doctors and dieticians at mount sinaii to restore digestive health for those with IBS, SIBO, Celiac and IBD. Everything they serve is 100 percent low FODMAP and gluten-free, with no cooking required! My favorite part about their dishes is the healthy spin on takeout gems like shrimp laksa and PAD THAI! Their version had a great balance of fresh veggies mixed in with the noodles that left me feeling both satisfied and completely free of my usual carb coma. Listeners to this podcast can get 20% off their order by using code SIBOMADESIMPLE. Just click here to learn more. 

ALL ABOUT SIBO BREATH TESTING

PHOEBE: Thank you so much for coming on the show, Dr. Fratellone. To get people acquainted with your work and your practice, I know you’re a cardiologist by training but also practise internal medicine. Just tell us a little bit about how you got into more the integrative side, and how you’d describe your approach today?

DR. FRATELLONE: It really dates back to when I was a kid because I was born with a heart defect and I was a blue baby, and how my parents, in the late ’50s surgery wasn’t that great, my grandmother and my mother gave me a lot of herbs since I was a kid. I’ve been using herbs, unknown to me, from a young age. I always wanted to be a doctor, and I actually wanted to be in infectious disease, so I sought out to do an internal medicine – after medical school, internal medicine. I went to medical school in England, which I think advanced my knowledge of that they take a better care of the patients because they actually talk to the patients. I went to school there, came back to the United States, did internal medicine, infectious disease, cardiology.

My first medical partner was the late Robert Atkins of the Atkins Diet. We worked together for a number of years, and even though people know him as a diet doctor, he was the one who told me, or taught me about supplements. We wrote a couple of books together. He had a book called the Vita-Nutrient Solution. We had a radio show, so doing this kind of podcast, it’s not new to me because I’ve been doing radio with Dr. Atkins all those years we were on WOR.

He introduced me to a doctor on one of the shows named Andrew Weil. When Dr. Atkins passed away and I inherited his practice, I then went to do a fellowship with Dr. Weil, the first fellowship of integrative medicine. I stayed in Arizona, I met him, and just like I did a fellowship in cardiology, I now did a fellowship in integrative medicine. I learned more about the topics we’re going to talk about, but I also met someone there who change my life, Tieraona Low Dog. Do you know here?

PHOEBE: I do. Not personally, but I know her work. She’s amazing.

DR. FRATELLONE: She’s great. She was one of my – she was the professor of botanical medicine and a socio professor at the school, and she convinced me when I finished this fellowship that I would be great being an herbologist. I then did a lot of herb courses, and through her and through another herbalist named 7Song in Ithaca, I applied to The American Herbal Guild professional member to get a registered herbalist degree. Not only am I fellow of cardiology, a fellow of integrative medicine, I actually am more proud to say that I’m a herbalist.

From that I did other courses, but I would say I use a different approach, including SIBO and heart disease, using herbs more than medicines. That was how I started.

PHOEBE: Yeah, you’re not alone there, certainly for SIBO. Today we are going to focus on the topic of testing. I know some of your patients. I know you do a very thorough job of testing! I wanted to first of all just answer the question that I get asked from a lot of people, which is why is it even important to test for SIBO in the first place? Some of these people are getting practitioners who think it’s better to just skip immediately to treatment. I want to just talk about what the testing options are later, but first, what is the argument to even start with a test?

DR. FRATELLONE: I’ll take a step back. You start with the test, but you really have to find out – since the gut is the gateway of all disease, you have to find out how the gut is working. When I say gut, I’m talking about the small intestines. You have to do some preliminary blood work before you test for SIBO to see if the gut is leaky, leaky gut, or malabsorbing. Though there’s many diseases, such as sprue, celiac, irritable bowl, Crohn’s, ulcerative colitis, you still have to get the basic physiology. I think physicians miss that they have to find out if the basic physiology of the small intestines is working.
When a patient comes here, and although they think they have SIBO, I want to find out is the gut inflamed, and what is the insult to the gut? The first thing I do is simple blood tests, examination of the patient, good history, and blood tests. The first blood test that gives you a clue is the vitamin D level. Once you get a low vitamin D you know that the three functions of the gut are compromised. One function of the gut is absorption, second is vitamin D, making vitamin D3, and the third function of the gut, which is [04:48] SIBO, is neurotransmitters.
We know that 90% of neurotransmitters are made in the gut and travel to the brain, so this is the gut–brain connection. I think you have to know that before you start treating SIBO because they’ve now found out that certain bacteria are prime – you need certain bacteria to make these neurotransmitters, so I do that first.

WHAT VITAMIN D LEVELS TELL YOU ABOUT YOUR GUT

PHOEBE: Could the vitamin D be low for any other reason than a damaged gut?

DR. FRATELLONE: Yeah, well, low, when I mean low – everyone thinks that vitamin – we all have a low vitamin D in the northeast where I live, and that’s about 35 to 40, but there’s not many reasons where vitamin D is in the 9s, 10s and 12s. That means there’s an insult to the gut. My job, if you get a D that low, before thinking of SIBO, which I’m going to think of anyway, I want to heal the gut from any insults first.

Now, if all those things that are insulting the gut are negative, that’s when you think of SIBO. I think we go – I don’t go to SIBO right away because I want to go to heavy metals, I want to go to autoimmune, I want to go to EBV, which is in the news a lot today, I want to go to Lyme disease. If I get all negative results for that, then I’m saying, oh my God, this is a SIBO problem that we have small intestinal bacterial overgrowth, maybe because the patient’s been taking the same probiotic for 20 years and not rotating it.

PHOEBE: In terms of testing for all of the things that you just listed, is that just a very comprehensive blood test, it’s all done through blood?

DR. FRATELLONE: Yes, they do a comprehensive blood test looking at vitamin D, B12, folic acid, but the other test that should be part of every workup is to check if the person has a methylation problem. I do methylation blood testing because if the person has a methylation problem of MTHFR, whether it’s the 677 gene of the 1298, that means the person cannot detox. That means definitely something is toxic in the small intestines causing the low vitamin D that could be SIBO, but then also I want to rule out other things.

I always get a methylation initial test on patients, all the time, because it is present in 40% of the population. I don’t think a lot of doctors think of all that. I think they go – some doctors, the GI – well, now the GI – the gastroenterologists are now trying to get on the bandwagon, where me as a functional medicine person have been doing this for a long time. My patients are educating their own doctors to treat SIBO.

PHOEBE: If SIBO could cause some of these issues, like not detoxing properly, why not start there? Why look into all of these reasons that could be downstream damager effects?

DR. FRATELLONE: SIBO could cause all this, but what happens if we treat for the SIBO and the person doesn’t get better? I rather do a comprehensive approach from the beginning, include all the stuff and SIBO, just not go directly to SIBO because people, if they have methylation problems, that means they have heavy metals. If they have a methylation problem they never got rid of their Epstein-Barr. All of this plays a role in SIBO.

I know you’re trying to differentiate it, but to me it’s all the – my job is to find out why the gut is insulted, and repair and restore the gut. Mine is a more comprehensive approach that will include SIBO testing although it’s not that good.

PHOEBE: Great, we’re skipping to the controversial questions that I had written down as well!

DO SIBO BREATH TESTS WORK?

DR. FRATELLONE: Well, no, but we know – look, I think only recently due to some – testing in medicine, whether I talk about SIBO testing or Lyme testing, we’re missing some things, but let’s get to the basic thing. If I told you the gut is the gateway of all inflammation, we should really be comprehensive. I think every physician who treats any disease should start in the gut first.

PHOEBE: Besides the blood test, what are some of your favorite other tests for getting a good idea of other types of dysbiosis? Do you like some sort of stool test? I’m curious.

DR. FRATELLONE: Yes, I do, and I don’t just pick a stool test from a lab. I’ll pick Genova Diagnostics because it’s a comprehensive stool test. I will pick – I’ll do an H. pylori breath test or a stool analysis. If I don’t find – I do parasitologist analysis. If I don’t find a parasite but the person has all the symptoms of parasite, I will send the person to get a rectal swab for parasites and actually look at the stool under the microscope.

PHOEBE: Do you ever use a GI-MAPs test, something that can – I don’t know how that stacks up to other tests?

DR. FRATELLONE: No, I don’t use that because the thing is I think that makes it too cook-book.
PHOEBE: What does that mean?

DR. FRATELLONE: I think you have to do different kinds of tests, so right now Genova’s a good one, but there’s other stool analysis tests by Metagenics that are good. There’s one coming out by Thorne Research which is called [One Genetics]. It’s a better analysis right now for SIBO than what we already have out there.

PHOEBE: Is that one you have to get through a doctor or is it one of these at-home kits?

DR. FRATELLONE: No, you have to get it through a doctor. It’s looking at genes, microbes, metagenes, and the pathology of irritable bowel by doing one stool sample versus three from Genova. It is costly. It’s about $395 dollars. The thing I don’t like about it, it takes six weeks to get the result back, so that’s the only thing, but I think it’s a really good assessment.

PHOEBE: I think this is really interesting. I think a lot of people, I wouldn’t say get misled, but run into issues down the line because they’ve been diagnosed with SIBO and then no one even thinks to investigate further into what the root causes are. I think it’s great that you’re starting with what all the possible root causes could be, and then eventually, once you have the full picture, getting to SIBO.

DR. FRATELLONE: I include SIBO, but I don’t want to be one of these doctors, and there are some GI people out there, that when they can’t figure it out because they didn’t feel like doing the work, automatically they go on treatment. Our functional medicine model is the triggers of foods. When you think about it, is there genetics associated with all this? What has been their diet? What food allergens do they have? What toxins do they have? What are biological mediators, like [cytokinin]. This test gets everything.

PHOEBE: How does that tell you about SIBO? How do the genetics –

DR. FRATELLONE: These are the triggers, so when you think about IBS as a functional medicine model, you first look at genetics, then you look at the triggers, and then when you look at the biological mediators, whether you’re looking at cytokines, neurotransmitters, free radical, all of this is the cause of irritable bowel. The basic lab work we get. You could do the fecal occult blood, you could do a breath test, you could do lactulose, but to do gut microbiome by DNA sequencing, that tells us what’s going on in the system. That’s what this test is all about.

PHOEBE: Would you go as far as to say is that the breath tests are a waste of time for people for those who maybe can’t afford to have a functional medicine doctor doing as in-depth testing as you are? What can people take away from just a simple SIBO breath test?

DR. FRATELLONE: I think a simple SIBO breath test could help us make the diagnosis, but what it’s not telling you is that there are 60 or more genes that are involved in IBS which is affecting SIBO, such as serotonin, [12:32], so it’s only giving you a little picture. I think the breath test just gives us a diagnosis and a little picture, it’s not expanding the whole role of the gut. I think it’s good for the person, you’re right, if you can’t afford going to see a functional medicine doctor, we have to start somewhere. You start with the blood test, you start with a simple breath test, and maybe you’ll do some stool testing, but that does not give you the full answer of what’s going on with the gut.

PHOEBE: You’re number one recommendation right now is the Thorne Onegevity test for the one-stop shop, but if you can’t get that, for sure the blood work and the breath test?

DR. FRATELLONE: Blood work and testing, there we have it. You know what, everyone does not have the ability to get this kind of test, and gastroenterologists are not going to use this because they don’t have time to do gene work and looking at what bacteria produces what neurotransmitter, so they will get the basic testing. That’s good enough, that’s good enough. I think we’ve missed SIBO over these years because no one thought about it.

PHOEBE: That’s actually getting back to the controversial side of things. There are some people who think that the breath test isn’t actually measuring SIBO and it’s creating a precedent for this fad that may not actually exist.

DR. FRATELLONE: I agree with that because I think that’s… You’re giving a disease to people based on a test that is not specific for SIBO.

PHOEBE: So what is being measured? How does it work?

HOW TO TEST FOR GUT OVERGROWTH AND OTHER FORMS OF DYSBIOSIS

DR. FRATELLONE: You’re making a diagnosis of overgrowth, but you’re really not getting into what bacteria, and you’re not getting into the basic pathophysiology of SIBO. You’re just saying, okay, you have SIBO, we’re going to treat you. I feel it’s like a cookie-cutter thing, the test is cookie-cutter. It gives you a diagnosis and you treat. I know people who have gone to gastroenterologists, got the lactulose test, got treated for SIBO, did rounds of antibiotics, and three months later they feel just as worse as they did after they finished a whole round of treatment.

PHOEBE: I think that’s very common. What’s happening in that case?

DR. FRATELLONE: The test is just treating it, it’s not looking at the gut microbiome. It’s not looking at the metabolic variables and the clinical phenotypes of all the bacteria. I think it’s just treating. It’s sort of like, you have thyroid disease; treat with Synthroid – which is not what I do, but I’m trying to make an analogy. You have heart disease; let’s treat the cholesterol. You’re not looking at the whole picture.

PHOEBE: In terms of getting the breath – the argument of getting the breath test to figure out if you’re hydrogen or methane dominant, do you think that’s a worthwhile thing to do as a step one?

DR. FRATELLONE: I think that’s a basic test to start because it gives you an idea. I’m just thinking, since this test has come out – and I really didn’t mean to talk about it, I forgot the topic was on SIBO, but when you think about it, that is the beginning, but if you have something else, then we should use something else. Because that we know the hypothesis is that an imbalance in the gut leads to dysbiosis. We know that. That leads to activation of the gut immune system and low-grade inflammation. I think we know that, but right away we rather give a treatment, or let’s say oh, it’s due to whether you’re producing methane or not, and this is SIBO.

I think the gut is more complicated than that. Let’s face it, we’re talking about 50 billion bacteria here, so how are we going to blame it on one thing? I think it’s multifactorial. There’s a lot of data to suggest that even fungi play a greater role in SIBO than the actual intestinal pathogens.

PHOEBE: I’m glad you brought that up because I’ve talked about it on other episodes with other physicians about how do you distinguish between SIBO and SIFO or Candida.

DR. FRATELLONE: This is why I think this test should be done because this will tell you – without doing five different tests. The problem with testing is that certain states do not allow it. For instance, Onegevity is not licensed in the state of New York and New Jersey. It’s only licensed in Connecticut. Well, I have a Connecticut license and I just opened a practice in Connecticut, so I’m bringing the Onegevity kits into New York and I’m going to get it done, but I have to mail them from Connecticut.

PHOEBE: You’re already citing so many hurdles that people have to jump through just to obviously get the ideal comprehensive testing, which is why I do think I do want to get back to just the simple SIBO breath test for a second!

DR. FRATELLONE: Look, I think in all fairness, the simple breath test is a place to start. Give the doctor a clue that there is a possibility of small intestinal bacterial overgrowth, it’s commonly accepted by insurance, it’s covered, and you start there. I agree with that 100%.

PHOEBE: Let’s dive in further for maybe someone who’s trying to DIY at home, which is obviously never recommended but is a reality. Do you have a position on whether to use lactulose or to do other substrates as well, or is lactulose you think the best starting point?

DR. FRATELLONE: I think lactulose is the most commonly used and it’s the one that we – there’s more studies with it, but you could do a lactulose or glucose, and decide if you’re going to [do it for] hydrogen or methane SIBO production, but that’s that. I think you need to do the lactulose:mannitol test for testing of permeability.

PHOEBE: That’s the test for leaky gut?

DR. FRATELLONE: Yeah. I think you not only need to do a breath test – say we do lactulose, it’s very common, it’s covered, do it, but then you have to do an intestinal permeability test.

PHOEBE: What additional does that tell you, since I know a lot of people’s thinking is if you have SIBO you probably have leaky gut, you’re going to want to fix that anyway?

DR. FRATELLONE: You do, but I want to know to what degree. Listen, I’m a cardiologist doing this! I know more about gastrointestinal disease now than I did in medical school. The thing is, yes, you’re right, people will say well, why are you going to do another test? I want to find how bad your dysbiosis or leaky gut is. And leaky gut is thrown around too much, that term. By me doing the lactulose:mannitol test, I’m finding out the degree of intestinal permeability and how bad this so-called leaky gut..

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