Episode 199: GUT Zoomer Deep Dive - Functional GI Testing for Thyroid Patients - Thyroid Answers Podcast

Episode Transcript
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Adair Anderson (00:20):
Hey everybody,

Eric Balcavage (00:31):
it's Dr Eric Balcavage. We're back for
another edition of the thyroidAnswers podcast. We have a guest
today. Her name is AdairAnderson. She's a registered and
licensed diet dietitian,nutritionist. She'll tell us
what that means in a secondhere. But we're going to talk
about gut physiology, and we'regoing to talk about a test
called the gut Zoomer test,which is a test I use pretty

(00:52):
frequently, and there not onlyprobably uses this test in her
practice pretty frequently, butalso is kind of an advisor with
vibrant labs who's one of the isthe company who actually
produces the test. So Adair,welcome to the thyroid Answers
podcast. How are you today? I'mdoing all so I guess the place
to start is just to give everyhave everybody get a little bit

(01:15):
of background about you. Who areyou? What you do, and how did
you get into working withvibrant labs and being here
today to talk about the gutZoomer test. Yeah,

great question. So, you know, I'm a dietitian
nutritionist. Got the privatepractice, but also wanted to get
involved on the lab side ofthings, and one of the women
that I've looked up to in termsof educating people on evidence
based stuff. Dr MarybethAugustine worked at vibrant, and
there was an opening forposition on the clinical team,

(01:48):
and I jumped at the opportunityto learn more about lab testing.
So been with vibrant for overfour years now, and did such a
good job on the clinical team,they've taught me and brought me
over to the marketing teams, andI'm the Product Marketing
Educator, where anytime welaunch a new test, I get to
explain that test to not onlyeveryone internally vibrant but

(02:08):
also all of our clients, all ofthe healthcare providers who
order vibrant testing. So it'smy job to learn the ins and outs
of all the tests.

So let's talk a little bit about gi testing,
maybe why it's important. From amedical standpoint, we typically
think about the the GI track. Isthere a problem in the GI tract?
The testing that is typicallydone in a in a gastroenterology
practice is a bit different thanfunctional based testing. So can

(02:37):
you touch base? Hey, what's thestandard difference between a
gas what a gastroenterologist isgoing to look at versus what
some of these functional testslook at?

Yeah, so most gastroenterologists are going to
be trying to diagnose something.So they're looking for elevated
calprotectin to diagnoseulcerative colitis, Crohn's
disease, that there's actually achange the mucosa, and it's like
actively bleeding, you know, ifthere's like occult blood, for
example, you can also do aoocyte and parasite test in Omp

(03:08):
to look for actual parasite inthe stool, although that is
often falsely negative becausethey're stealthy and you can't
always find them. In contrast, afunctional stool test is going
to look at pretty mucheverything within the gut
microbiome, well, specificallywithin the colon. It's stool
test stools in the colon. And soin terms of vibrance, guts
humor, we're looking at 150commensal microbes, 76

(03:33):
pathogens, along with gutmetabolites, digestive markers,
gut antibodies. It's a reallycomprehensive look at exactly
what is going on within that,the whole gastrointestinal
tract, tube. So are youdigesting? Are you absorbing? Do
you have a good balance offlora? Does your is your gut
barrier intact? Do you haveenough Secretory IgA? Do you

(03:56):
have enough akermansia to helpbalance the mucin layer, the
mucus layer, that is part ofthat barrier. Do you have leaky
gut or not? Like you haveintestinal hyper permeability,
for example? So it gives you adeeper insight into, you know,
what's really going on, andgetting into the root cause of
what could be causing theeventual disease. But also in a

(04:17):
preventative sense, gives youinsight before that happens, you
can prevent that ulcerativecolitis or Crohn's disease from
actually manifesting.

Yeah, and I'll add to that a little bit to even
maybe from my perspective, justsimplify it for the for the
listeners a little bit more.When you're seeing a
gastroenterologist, as Adair wassaying, they're looking for a
disease, a pathology, that theycan cut out or medicate and say,
Okay, you have X disease. Andthere's things called the Rome

(04:47):
guidelines that they utilize forhow they evaluate, assess and
treat if you have no activepathology. That makes sense
based on the guidelines to cutout or medicate you. You will
typically get diagnosed withirritable bowel syndrome or
something along those lines.Your bowel is irritable. We can

(05:07):
see some ear we can see someredness, maybe on a pathology
based evaluation, but there's nopathology. There's no disease,
although we would say if there'sredness, inflammation, irredeem
like there is something but thedisease has not developed quite
yet, right? So when we do afunctional gi test, I should

(05:28):
finish that. If you go to agastroenterologist and they do a
pathology based testing, andit's all normal, you'll get
diagnosed irritable bowelsyndrome. You'll probably be
provided maybe some symptomaticsupport, and then you'll be told
to come back next year, andwe'll do another assessment, and
we'll keep looking at thesepathology based tests until we

(05:49):
find the pathology. And thenonce we have the pathology,
we'll either cut it out ormedicate you, and then we'll
manage the condition intoperpetuity. What we're doing
with functional medicine, orwhat we should be doing at
functional medicine is exactlywhat Adair said. Why wait for
the pathology to develop if wecan measure the functionality of

(06:12):
the GI tract, is thereinflammation? What inflammation
markers are elevated, and whatcan we learn from those markers?
Is there decreased digestivecapacity. And what might we
start thinking about as to whythe digestive capacity is is
reduced? Is there alreadypermeability starting to
develop, damage the intestinallining, the starting develop and

(06:35):
what can we do to intervene andthen, if what's going on with
the bacteria in the gut, and howmight that be related to your
signs, your symptoms, and whatwe might see on an exam, and not
just on a gut zoom or a test ora GI test, but how does that
reflect into like a good,comprehensive metabolic panel,

(06:58):
and especially because thePeople on here are people
typically struggling withthyroid related issues? I've
talked I talk about this all thetime, how gut based issues are
such a big problem for peoplewho have thyroid and immune
regulating, regulated disordersreduced t4 to t3, conversion.
People say we just woke up oneday and forgot how to do it.

(07:19):
Your cells and tissues did notforget how to do it. It's
usually an adaptive response. Anadaptive response to some type
of inflammatory process goingon, and we can dig into that fun
stuff later. But the importantpart here is, when you go to a a
gastroenterologist with yourwith your GI based symptoms,
they are doing a differentassessment than what we're doing

(07:39):
with these tests, I often do thetasks. And if I see something
that I think needs a physicalevaluation, a medical
evaluation, I'll say, hey, takethese results my notes to your
to the gastro. I think we needto get an evaluation done here,
just to be on the safe side. Andthey'll often say, I don't even
know what these things are. Idon't run these tests. They'll

(07:59):
do a pathology based test andsay there's nothing going on. I
don't know why you're here, butthese we don't want something to
occur, and that they're notrunning these tests on a regular
basis, therefore they reallydon't have a knowledge base
about what all these thingsmean. And so that's part of the
discussion today, is, why wouldwe do this test, and what do
these things mean? You okay withall of

that? Sounds great.

So functional gi test. There's lots of them on
the market, and I I've been inI've been in practice 30 years,
so I've seen lots and lots offunctional gi tests. But the gut
Zoomer is the test I runexclusively at this point, when
I when I want to initiallyevaluate what's going on with

(08:43):
gut and gut physiology. Whatsets the gut Zoomer test apart
from all the other functionalbased gi tests that are on the
market? Because sometimes peopledon't know they get they say,
Well, I had a GI test done. Ihad this one done, or that one
done, or this one done. Butwhat? What's your stance on why
this test is maybe the best testto run on somebody well, for

(09:07):
looking at the functionality ofthe GI track,

yeah. So the reason the gut Zoomer is sort of
a step above the others isbecause we use the most evidence
based gold standard methodologyfor identifying what is on the
test, all of the markers, forexample, for identifying
commensal bacteria andpathogenic bacteria, we use real

(09:33):
time polymerase chain reaction,or RT, PCR. And in addition to
that, we also do bead beatingand somatic and thermal
processes to get rid of anybiofilms, to really get to the
nucleic acids in order toidentify those specific
microbes. And we also use notonly 16 s, but 20 3s and also

(09:57):
proprietary Sections and. Um, ifyou only use 16 s, and you give
a company 20 different microbes,just running 16 s, you might end
up seeing 80 different microbes,whereas when you're using 16
plus 23 plus proprietarymechanisms, you could accurately

(10:17):
identify those microorganisms,certainly with pathogens like we
they're known things like with Ecoli, we know exactly what to
look for, and so you only need acouple of probes for pathogens.
But for commensals, there's somany of them, we have
proprietary ways of identifyingexactly that organism, so we
know it's very accurate andprecise. In fact, our gut
pathogen study showed 100% ohgosh, I can never remember

(10:41):
sensitivity or specificity. Wegot 100% specificity and a 95.9%
sensitivity, meaning no false nofalse positives. If you have it,

(11:03):
you have it. If Scott Zoomersays you have this pathogen, you
absolutely have it. There's asmall chance we've missed it.
But if you if it says you haveit, you have it on the test. And
then terms of the othermethodologies we're using, LC
MSMS, liquid chromatography,tnms spectrometry, which is a
gold standard for identifyingsmall molecules. We are using

(11:24):
that for all of our, you know,bile acids, short chain fatty
acids, fecal fats, meat fiber,vegetable fiber, and then we're
doing our proprietarychemiluminescence microarray for
all of our gut antibodies, sotissue transglutaminase,
staminating, glad and protein,anti Gliadin, anti actin, anti

(11:46):
LPs, and also anti Saccharomycescerevisiae antibody or ASCA. And
I can totally dive into that,but at the top, that's like a, I

think it's still, look, yeah, that's a
little too we don't need to gothat deep. I think for some of
this, because it's a lot ofpeople are going, I don't even
know what those things mean. Sowe'll try, and we'll kind of
skip and we'll kind of scale itback a little bit. But there are
some tests that are available onthe market. I'm not going to
mention names, but people go andget these tests on their direct
to consumer tests, and they andwhen I have an initial
conversation with somebody,they're like, Oh, I had my GI I

(12:17):
had a functional gi test, andI'll get a test, and it's just a
bunch of bacteria on there, andthey're like, this is my gut
test. And here's and maybe it'sgot some genetics, and here's
the recommendations I was given.My challenge with those tests
is, A, I'm not sure how accuratethe information is. B, it's just
the biome potentially, right? Itdoesn't tell me what's how well

(12:41):
are you producing pancreaticenzymes to help break down and
kill the bacteria and the foodthat's coming in? It doesn't
tell me anything about FAT, FAT,FAT malabsorption or lack of
absorption of fats, right? Itdoesn't give me an idea of the
intestinal lining. Is thatstarting to become problematic?
There's a lot of things thataren't on those tasks, that are

(13:03):
from my perspective, arecritical to helping our clients.
Just looking at the bacterialbalance, looking at the bacteria
there, I don't know if itprovides me with as much
information that biome canchange pretty rapidly, many
times. And so it is sometimes Ithink the argument as to I hear
from people in in the allopathicworld, like the biome changes

(13:26):
all the time. This is, it's aridiculous test, but the biome
stuff that we see on the gutZoomer, we get information from
it, for sure. But I'm notlooking at only the gut biome. I
look at the gut biome and say,Okay, why is this the biome that
this person is developing, andall of those other functional
tests are important. So do yousee a challenge with some of

(13:50):
these direct to consumer teststhat are just providing bacteria
and then providingrecommendations based on just
the bacteria that's there?

Oh, absolutely, yeah, if you're just looking at
the bacteria, like, as you said,it can change rapidly based on
what you eat. For example, ifyou take a vacation to a
tropical place and they'reeating lots of pineapples and
guavas, like the fruit lovingbacteria will grow in numbers
because you are feeding them,and then as soon as you go back
home and start eating your meatpotatoes, like those bacteria

(14:20):
that were thriving on fruit willdie because you're no longer
feeding them fruit like it canchange very rapidly. And so when
you want to look at what's goingon in your microbiome and how
that's impacting digestion,absorption and inflammation in
the gut, you really want tostart top to bottom and look at
anything that could be going sostarting again, thinking about

(14:44):
the gut Zoomer from the top ofthe GI tract, from your mouth to
your anus, like first you wantto make sure, are you digesting
your food, right? The gut Zoomeris going to look at pancreatic
elastase. It's going to look atbile acids. It's going to look
at fecal fat. So are youdigesting your food, and are you
able to break it down in termsof fat? Fat breakdown through,

(15:06):
through vial after that you wantto see, are there a lot of good
bacteria populating your gut? Sofor example, is it easier to
build a house in Manhattan orthe middle of Montana, where is
there more real estate? Right?Probably in Montana, there's
more land available to build,maybe money aside, right, not

(15:29):
thinking about that piece of it,but the fact that Manhattan is
already populated, every squareinch is covered in some type of
concrete harder to build there.So we want a microbiome that has
lots of good microbes,commensals. We call them. We
want lots of commensals, becausethat way, if a pathogen comes
in, it's not going to find realestate, it's not going to find a
place to build to live, whereasif you have low commensals, if

(15:51):
it's like a barren wasteland,like there's nothing there,
anything can grow there. Anexample is that my friend went
on a camping trip and use alittle too much iodine to clean
his water and end up wiping out,wiping out, like all of the
microbes, and then got a clusterof difficile infection, because
there's nothing to compete andprevent that from happening, and

(16:14):
C diff is awful, so don'trecommend doing that.

Well, we'll touch base on that. It will get
we'll get back there. I do wantto touch on one other thing you
said regarding the testing, andit was regarding the biofilm
breakdown, and I think this isreally important. And years ago,
when a really one of the morepopular test, functional tests,
came out, kind of new on themarket, more markers than maybe

(16:41):
was out there on previoustesting, and I ran a test on
somebody, and then I provided aan enzyme, a systemic enzyme,
and then there was a problemwith the collection. We
collected a kit about a week anda half later, and we get the new

(17:03):
test results back, and thebacterial balance, there's a lot
of difference. There lots ofdifference there. And so I, I'm
like, What is going on here?And, you know, this is maybe
more than a decade ago. And so Iwas like, What the heck. And
then I I spoke with somebody. Ireached out to a biologist, and

(17:26):
I said, Hey, what do you thinkwould create this? Because I had
reached out to the company, andthey're like, I, you know, they
gave me a bunch of comments, butnone of them seemed to land
appropriately. And he he said,Well, you provide a systemic
enzyme. You probably broke downthe biofilm. You should be doing
that before every test anyway,right? I'm like, no, like, I

(17:49):
wasn't at the time. Nobody wasmentioning, Hey, we should do
this. And so it became the thingthat I started doing. I don't do
a lot of the other testingcompanies do what you guys do to
try and break down biofilm priorto collection?

Yeah, I can't speak to what other companies
are doing. I just know that wemake sure to do these thermal,
mechanical and enzymaticprocesses so the bead beating,
literally beating, like withbeads and a bead beater, like,
moves around, knocks themaround, so it breaks down that
biofilm. It breaks down biofilmis sort of like the microbes

(18:30):
building a home for themselves.It's like this little raft where
anyone can go and live, and thenthey have this community. It's
sort of like a commune. But youwant to, like, break that down
and pull it apart. So we canactually get and identify what's
in that, what's stuck inside thebiofilm. Otherwise it could be
things could be hiding in there,like geese, for example. So bead

(18:51):
beating mechanically breaks itdown, you know, literally pulls
it apart, sort of like chewingyour food. Mechanically breaks
down your food, and thenenzymatically, anytime you add
an enzyme, it's going to alsobreak down those those
compounds. And then thirdthermal processes is heating it
as well. So when you heatsomething, it can also break it
down, like it can softenvegetables when you cook them,

(19:13):
right? They're not crunchy nowthey're soft and mushy, like
that's what we're doing to thebiofilm. So it makes it a lot
easier for it to disintegrateinto a liquidy substance, so
that when we do the polymerasechain reaction, when we're
putting all the enzymes in thereto make amplification happen,
they can actually bind to thetarget, because it's not getting
stuck.

Yeah, and so this isn't for the listener.
This is really important becausethe or almost all the organisms,
have this biofilm. It's theirkind of protective coating. It's
like me sitting in my office.Nobody knows I'm in here, right?
They can, you know, they canhear me, maybe. But the the
immune system, if there'sbacterial overgrowth, the immune
system sometimes can't seethrough those biofilms to get at

(19:55):
the organism. So you could haveall kinds of signs and symptoms.
But if. Doing a test and youhaven't used some type of
systemic enzyme or biofilmdisruptor prior to testing, or
the lab that's doing the testingisn't going through that process
to mechanically break down orenzymatically break down that
biofilm. You may not see whatmight be contributing some of

(20:17):
the immune some of the immunebased challenges that are going
on, and maybe some of the signsand symptoms, right? Exactly. So
I want to talk about commensalsand pathogens. Okay, because
these terms may not be familiarto everybody, and the way I
explain it is, commensalbacteria aren't necessarily good

(20:38):
or bad, but they're like theneighbors. In my neighborhood,
there's 114 homes here.Everybody who owns a home here
deserves to be here, okay? Butif I've got one of my neighbors,
likes to party a lot, likes toinvite everybody over and their
party until, you know, all hoursof the morning every night, even
though they are part of theneighborhood, it is going to

(21:00):
potentially create a problem forme, right? And if I have another
neighbor who loves to live inhis their vacation home in
Florida seven to eight monthsout of the year, and that means
those seven to eight months outof the year, they're not taking
care of their property, itbecomes disheveled. It doesn't
look great. The grass is great,growing too high and it too can

(21:22):
become a problem, right? Sosometimes people think, I either
have pathogens and that's aproblem, that these commensal
bacteria, which are bacteriathat are supposed to be there,
can't be a problem. So let's,let me have you just kind of
break down. What do we considera pathogen? What are commensals?
Are there good? Is it or am Iwrong? Are commensals only good,

(21:44):
or can they also be problematic?

Yeah, great. Thanks to break down a nuance
apart here so pathogens arethings you do not want you know,
for example, clustered indifficile, like it causes
illness in your body, it causeswhatever diarrhea or
gastrointestinal upset. Theseare things that don't provide
any benefit, and they shouldn'tbe there, right? They're not

(22:09):
supposed to be there. Sopathogen, when you get it, you
want to get rid of it most ofthe time, unless it's self
limiting. But that's anotherconversation. In terms of
commensals, you can have aprobiotic commensal which
provides benefit to its host. Sothese are probiotics like
akkermansia or plus or fecalbacteria and presni or roseberia

(22:31):
that create short chain fattyacids or create vitamins like V
12 that help us as a host togive us benefit. And then, as
you said, there's also justbacteria that live in existence,
like in the neighborhood.However, sometimes they can get
turned to be a more pathogeniclike strain, because of what

(22:52):
else is going on in theenvironment. So for example,
when someone is acting outpoorly, like in a elementary
classroom, like it leads morekids to also act out. And sort
of it sort of changes the themental, the mentality of those
microbes to be more on thepathogenic, not pathogenic side,

(23:15):
but like on the bad side, to bemore, more problematic.
Problematic. That's a good word,problematic, and also sometimes
when you have too much of aparticular bacteria, for
example, when you have too manylipopolysaccharide producing
bacteria, to me, the gramnegative bacteria from the
Proteobacteria phyla that causesmore inflammation in the gut.

(23:40):
Because LPS is inflammatory, itcan cause endotoxemia after
eating. It's actually whatcauses sepsis if you get an
infection like in an organoutside of your gastrointestinal
tract. So the balance ofmicrobes is also really
important,

yeah, and we call that the diversity, right?
That. And we see that there'stwo indexes on the gut, Zoomer
test and those two index give ussome idea of like, how many
different types of organisms, ofthese commensal organisms, we
have, and how how balanced theyare in between each other,
right? Exactly. And we won'tnecessarily break them down, but

(24:15):
that part's important. If we seethat you have lots of
commensals, but the diversity isnot very good, then that that
can be one of the reasons why wehave some signs and symptoms
correct. So in a standardallopathic approach, they're

(24:36):
typically not looking at thecommensal bacteria at all
correct, from my knowledge base,they're typically really just
looking at pathogenic organismsonly. And I think the reason,
from my perspective, that theydon't look at the commensals is
because they don't really have astrategy to address commensals.
So we don't, we don't addressthem. Mm.

Right, right, exactly.

So when we are looking at inflammation in the
GI tract, well, let's, let'skeep on the dysbiosis
standpoint. A lot of timespeople are, I think, confused a
little bit, like, how could Ihave bacterial imbalance, like,
where is it coming from? And weprobably need to talk about that

(25:26):
a little bit like, what is theprimary thing that leads to an
imbalance? Let's just talkcommensal bacteria. What's, what
are some of the primary thingsthat would lead somebody's
commensal bacteria? These arethe bacteria that should be in
the GI tract, most of them inthe colon. But what would cause
these bacteria to bedysregulated?

Oh, yeah, the number one cause is probably not
eating enough fiber, rich foods,not enough plants.

So there's a whole community that would argue
with you on that, right? Youknow that, right? So, but why
would plant based foods? Becausethat that community would say
plants have toxins. Toxinsdamage the GI lining, therefore
plants are bad. You should noteat plants. But let's talk about
why fibrous based plants couldbe beneficial to the gut and the

(26:18):
GI tract.

Yeah, I'm solidly in camp fiber over here
for sure. So come after me, ifyou want folks who believe the
other side. But yeah. So whatfeeds our short chain fatty acid
producing bacteria areprebiotics, fibers, polyphenols.
These all come from plants. Ourmicrobes will take these

(26:42):
undigested carbohydrates andthings and turn them into short
chain fatty acids. Short chainfatty acids are essential for
the gut lining. They heal andseal the gut. They help produce
new cells people, they actuallythere's a study that showed
people who had higher shortchain fatty acid levels had
better COVID outcomes like shortchain fatty acids are really

(27:04):
important. It is like the numberone source of fuel for your
colonocytes. And you don't haveenough of them, your colon cells
are literally starving. Andeating plants is what feeds
these good microbes, feeds these10 months old microbes,

yeah, and so I'm in agreement with you, but I'll
take the other side of it aswell too. Okay, so for the
listener, like, if you are, ifyou already have a lot of gut
based issues going on, you havea lot of signs and symptoms and
issues going on and a lot ofinflammation in the GI tract. It
is, it is, there is a truth tothe fact that plants have some

(27:41):
level of toxins in them, mybelief is that primarily, when
we eat healthy, properly raisedcrops, and we eat them in
season, when they're whenthey're at when they're ripe,
they have a lower level oftoxicity. That's probably not
problematic, but plants don'thave much of a way to defend
themselves. So having higherlevel of toxicity when they're

(28:04):
not ripe protects them. Innature, we have a tendency to
pull our our crops way beforethey're ripe, we force ripen
them in a factory somewhere, sothey look beautiful and we can
then we eat them. But thatdoesn't necessarily mean that
the toxicity of the plant is isgone because we force ripened
it. It may still have a higherlevel of toxicity, but even

(28:25):
those toxins in the plant have abenefit. In a healthy GI tract,
they are like exercise for theimmune system of the GI tract,
if you're not constantlystimulating the immune system to
some degree low level, theimmune system gets weaker over
time. So these plant basedfoods, healthy in season,

(28:46):
appropriately ripened, can havea positive effect in beefing up
the immune perspective, immunesystem, from my perspective,
it's like lifting weights, youcould argue, Eric, why would you
ever lift weights? If becauseweight lifting breaks your
muscle tissue down, correct? Itdoes. It creates, breaks it
down, creates low gradeinflammation, but that low grade
inflammation then helps me builda bigger, stronger muscle

(29:08):
tomorrow, so today, if I have tolift something heavy, I actually
have the ability to do it. If Inever did anything to strengthen
my muscles, I wouldn't be ableto do it, and I'd probably get
injured. Is that fair?

I think so. Yeah. So I think

there's a benefit to them, but I also
understand why. Sometimes, whenpeople already have a lot of
inflammatory processes going on,they go, Oh, I switched my diet
and I felt much better. Well, athat dietary switch probably
create a big change in your gutbiome. And if you are more plant
based, and that was and youalready had inflammation and

(29:48):
dysbiosis and other thingscreating disruption there,
minimizing some of those plantsand plant toxins might calm the
inflammatory process at leasttemporarily, but I do agree
that. Short chain fatty acidsare critically important, and
we'll talk that more about thatin a sec.

Then there's also the digestive piece and the
stress piece as well, becausesomeone can be eating the
perfect diet, but they'restressed all the time. And
anyone who studies stress knowsthat when we're stressed, our
blood flow is shunted away fromour digestive organs, away from
our fertility organs, into ourarms and legs so we can run our
fight, so we can literally fleeor fight and survive the

(30:29):
situation. Because if you'reabout to be food for a bear,
there's no reason to digest ourfood in terms of prioritization,
the goal number one is get ridof get out of the danger zone.
And so when that happens once ortwice a month? Like, no big
deal. But when it happens allday, every day, and I have lots
of clients who are stuck infight or flight,

yeah, absolutely. And I talk about, I
always look at somebody'sphysiology from the perspective,
is this a person in homeostasisor allostasis? And I talk from
the lens of the cell dangerresponse, and that's why, on
this podcast, in my book, andall the things I talk about, I
don't think thyroid physiologyis broken. I don't think the

(31:08):
immune system is out of control.I think everything is an
adaptive response. And so manyof our clients are under an
excessive stress load, andsomebody might say, but you
know, I had the same stressors.Then this happened, and now I'm
back to the same stress load. Ican't handle it right, because
you had an excessive stressload. You were managing it. You

(31:29):
were in homeostasis. But thenthat extra stressor pushed you
into cell stress response, andthat shifted you into Allostatic
regulation. You up regulate,start up regulating the
sympathetic nervous system.Brain gets more wired, more as
you said, more energy, moreblood flow goes to the brain and
the muscles so we can run. Whatgets down regulated, gut

(31:50):
physiology, sex hormoneregulation, detoxification
pathways, these sleep, like allof these things that make us
feel wonderful, get downregulated, right? And we ramp up
the the immune the defensemechanisms and the hormone that
helps us regulate the shift fromhomeostasis to allostasis is

(32:10):
thyroid hormone. By decreasingthe conversion of t4 to t3 in
the cells that are perceivingstress and danger, we actually
slow down mitochondrialfunction. We stiffen cell
membranes from a protectionstandpoint, and that doesn't
make us feel good, but thatallows that lower t3 state
actually activates the celldefense mechanisms inside the

(32:32):
cells. So we often look at thelow t3 and somebody's like, oh
my gosh, your body can't convertt4 to t3 anymore. That is such
nonsense, in my opinion, that isthe adaptive response and adding
more thyroid hormone in thatsituation, especially t3 Yes,
you can give a temporary hit ofimprovement, but actually can
increase the oxidative stress inthe inflammatory process that's

(32:55):
going on, up regulate thesympathetic nervous system and
down regulate theparasympathetics. So I fully
agree that stress, right, realor perceived, right? Everybody
thinks it's just emotional. Soit's what you think about, your
work, your relationships, right,your partner like what you worry
about, right on a daily basis.And so many of us, I think, are

(33:18):
in chronic perceived stress, andwe don't even realize it.

Totally agree. Would you say that for the top
five things that cause the celldanger response, stress is one
of those top five? Well,

I look at stress as the big category. So, right?
So stress is stress, your cellsdon't really know the
difference. So I look atdefinitely mindset, like, What's
going on between the six inchesof my ears? Because you know
this too, right? I could getyelled at and I could be like,
Oh man, that person's crazy. Itdoesn't bug me, right? Or I

(33:54):
could get yelled at and I go, Ohmy gosh. And now I get angry,
and that changes my physiology,right? COVID, you mentioned
COVID. The COVID comes.Everybody goes inside, people,
some people stressed, worried,my oh my gosh, my money. What am
I gonna do job? Other people aregoing, This is awesome. I can
work from home. I'm moving tothe beach. I'm gonna start

(34:17):
investing in these differentthings where they need me and
that person under the samestress situation thrives, right?
So it's it's really not thestuff as much is, is, can I
manage it, and how do I perceiveit? That's so I always tell
people the mindset is one ofthose top things that create

(34:38):
stress. Number two, for me, issomebody's habits. What do they
do, day in, day out, right?Those things that their habits
Make, make or break them. Okay?Number three is sleep fitness.
To me, prioritizing Sleep,sleep, good sleep. Habits, good

(35:00):
sleep behaviors. Good sleepschedule is critical. Number
four, diet, what we eat feedsour microbes, right? We've got
more microbes than we got genes,so if we don't feed us, well,
we're not just feeding us fortaste and wow, that makes me
feel happy, but we have we'refeeding the microbes. So what we
feed them, determines whatgrows. And then my fifth, like

(35:23):
foundational, what I callfitness factor, is physical
fitness. Because we, I'm sureyou know this physical movement,
physical exercise at the rightamount, not excessive, but the
right amount can have hugeimpact on our overall
physiology, fromneurotransmitters, hormones and
gut physiology. So those are myfoundational five. I've got 13

(35:47):
other ones I work through withclients from, hey, what's your
relationship like? What's yourwhat's going on with your
finances, like those, all ofthose things create our body's
perception of danger

totally. Yeah, you can go into new ones from
all of those too, in terms oflike diet, also circadian
rhythm. Are you eating at thesame time every day? Because
your body will anticipate thefood and will actually start
getting digestive juices readyto go, which is why when you
wake up for an early morningflight, you're not hungry, and
when you eat, then you don'tdigest as well.

Yeah, absolutely. And so the key
piece, I think, for a lot ofpeople, when we're running these
tasks, right, when we're runninga gut test, is that the gut
Zoomer tests, or whatever othertests they run, it tells a
story, but it doesn't tell thestory, right? Some people like,
Okay, you got dysbiosis. I'mgoing to do my gut protocol for

(36:44):
the next 30 days, 60 days, andthey do, and somebody goes, I
feel better, I function better.And then two, three months off
supplement support, they'relike, having problems again.
What we see on these functionalgut tests is the result of your
habits, your behaviors, yourlifestyle and all those things.
So yes, we often have tointervene and help this kind of

(37:05):
reset itself. But we also, if wedon't change the environment,
the perceived environment, wedon't we don't wind up changing
the terrain. And if we don'tchange the terrain, why would we
expect 90 days after all mysupplemental support that the
problem isn't going to comeback. Would you agree?

I totally got terrain theory never present. So

let's talk the we want to talk a little bit
about the digestive capacity,and we can see problems many
times on the gut Zoomer taskwith reduced digestive capacity.
But if we had to give somebodysome guidance, they get a gut
zoom or test. They see decreasedpancreatic enzymes on there.

(37:49):
They see fat malabsorption onthere. Like, what are things
that somebody as a clinician ora client, if the clinician goes
over the test, what are thethings that might be they should
be thinking about, like, why?Like, I always say, Look, if you
have decreased pancreaticenzymes, I can give you
digestive enzyme temporarily,but we got to figure out why. So

(38:09):
what are the things that youwould suggest just generally,
when you see reduced digestivecapacity? What are the things
you want to help inform yourclients of like, Hey, here's
things we need to consider, orthat you're instructing a
clinician who's coming for you.Of like, hey, how do I interpret
this thing? Yeah,

so number one, just overall stress level. Are
you stuck in fight or flight ona more incremental segment, like
before meals? Are you takingsome deep, relaxing breaths to
get in to rest and digest. Andthen are you actually being with
your food and eating your food,enjoying your food, like when
you go to a nice restaurant, youhave a drink, you relax,
everything tastes amazing.You're really in the moment. But

(38:51):
if you're just eating food toget to the next thing, or you're
eating while doing somethingelse, like working or studying,
which is the worst, like, areyou really there with the food?
No, it's just going in thebody's like, I don't what are we
doing right now? Are wethinking? Are we working? Are we
digesting and so making mealtimea time to just nourish your body

(39:11):
and paying attention? Somepeople call this mindful eating.
So smelling the food, I don'tknow if your mouse ever started
watering after you smell cookiesout of the oven. Like that's
your body getting a head starton digestion, so smelling the
food, really tasting the food,noticing textures, eating more
slowly, putting the fork downbetween bites, if you have a
hard time eating slow, maybeeating with a non dominant hand,

(39:33):
or using chopsticks, eating withother people, having
conversation, anything to slowdown the eating. So it takes
longer, I know in a lot ofMediterranean countries, they'll
have like, meal time last twohours, and it's a social event.
Everyone's happy and enjoyinglife like that's what a meal
should be. It should be a timeto nourish your body. So if
that's not what your meal timelooks like, that would be a

(39:55):
great place to start. And thenthe other component is eating
about the same time every day,so you. Get into eating rhythm,
that circadian rhythm andalignment with when your body
anticipates food, so you havethe best ability to digest,
absorb and assimilate thosenutrients and utilize them for
repairing toward muscle tissueor restoring your your immune
system, for example. Yeah,

I agree with those things. The other thing I
would add to that is you gottachew your food. When we think
about what's going to start tocause acids and enzymes to be
released. Chewing your foodappropriately really sets the
stage. That's where the foodstarts to break down. In the
chewing process, we start to wehave enzymes that start to break

(40:39):
it down orally. Then from there,we start putting stuff into the
stomach, and the stomach acidthen gets stimulated, and that
should start to break it down.And the downstream impacts of
digestion are really based onthe acidity of the kind the
stuff that's leaving the stomachto come into the small

(41:00):
intestine. There's sensors therethat tell the gallbladder, hey,
you got to release some stuff.Pancreas, you got to release
some stuff here. If you're justgulping, gulping down, throwing
some water down on top of it.And that, I guess, would be the
other thing I would say is, hey,don't be drinking if you're
thirsty. When you're eating,you're probably not chewing your
food appropriately. So do youagree with those pieces as well?

(41:22):
Absolutely.

Yeah. And for people who have hard time
chewing, look at your teeth. Goto a dentist like get that fixed
as well. If you have pain inyour mouth, it's going to be
hard to chew missing teeth,anything like that,

yeah. And I would say too. If you got oral
issues and you're strugglingwith chronic hypothyroidism,
thyroiditis, reduce conversionof t4, to t3 what goes on in the
oral cavity can be be a hugedriver of your immune
inflammatory issues, and yourreduced conversion of t4, to t3

(41:53):
other lab, there's another labout there I like, and they do a
panel that looks at some of Themost common organisms that
trigger immune conditions andoral bacteria. I can't tell you
how many patients who I'veworked on my gut. I've done
this, I've done that, I've donethat, and we look at their oral
fitness through a questionnaire.I'm like, Alright, there's some
oral there. You're got someareas here. We should get

(42:15):
checked out. And then if we dorun a test and that, here you
go, oral bacteria popped up. Idon't have any tooth problems. I
don't have any pain. I don'tguess what. You got antibodies
to these oral bacteria, whichmeans they are creating a
reaction, and that also so theoral cavity becomes really
critically important.

Yeah, I decline. What a cavitation. She addressed
it, and all of a sudden she losta bunch of weight and was able
to, sort of like, totally excelin her physi physical, like,
performance. Yeah,

I have a client 20 years ago. I think she had a
wisdom tooth pulled out. And weworked on a lot of different
things, and we then we ran thattask, and I'm like, Yeah,
positive for oral bacteriabecause I don't have any, I
don't have any root canals. Idon't have any cavities. I don't
think else. I'm like, Well, goget a comb. Well, go get a cone
beam X ray done. The firstdentist, I think, just did a
regular x ray. The seconddentist did a cone beam. And

(43:08):
sure enough, in that pocket wasa whole bunch of infection in
there. And I'm like, That's whyyou can't get your immune
systems stable. That's why yourthyroid gland is under attack.
That's why you can't convert t4to t3 Well, what do we do? We
do? You got to get cleaned outlike this. And so it's been a
process to do that. But thingsare oftentimes hidden, even

(43:30):
where we don't have signs orsymptoms. I don't want to, I
want to stay on this kind oftheme so we're chewing and we
need to have appropriate stomachacid. The gut Zoomer doesn't
have a an assessmentspecifically for stomach acid
production.

It does not but

we do have the next steps and for the for the
listener, if you have aclinician who's looking at
general blood chemistry labs andlooking at your signs and
symptoms, we can pretty muchgive you an get an idea that you
have low stomach acidproduction, but it's not on on
this test, because this isreally more a functional test
further down the GI tract, butthere are markers of let's take

(44:12):
pancreatic elastase one. Let'stalk about what that is and why
might it. What should it? Whatshould the range kind of look
like, and if it is low, what arethe common strategies and what
are your thoughts when that whenthat value is low?

Yeah. So pancreatic elastase, one is an
enzyme released by the pancreas.It does not get to grade it when
it goes through your GI tract.So when we measure in the stool,
it's a good representation ofhow much pancreatic juice your
pancreas is releasing inresponse to a meal. So it's a
stand in representation of howwell your pancreas can release

(44:51):
enzymes to help you digest breakdown and somatically break down
your food in order to betterabsorb it. So when it's low,
that's indicating. To mean thatsomething is not allowing the
pancreas to release the amountof digestive juice it needs to
break down your food. So why isthat usually stress? Maybe
something's going on with theimmune system in the pancreas,

(45:15):
or

I'll jump in there and give you some more.
One of the things that's reallyimportant is there's this thing
called a sphincter of ODI, whichis where the pancreatic duct and
the bile duct come together, andthe sphincter opens up to allow
the digestive capacity, thesedigestive pieces to come into
the into the small bowel, if youhave low stomach acid

(45:42):
production, that may reduce theamount of release that's coming
in. That's number one. Numbertwo, that sphincter muscle is
controlled by the amount of Tavailable, t3 so if you have low
t3 in the GI tract or and orcirculation, that sphincter
muscle may not open up as wellas it should. And if you have

(46:04):
estrogen, excessive estrogen,estrogen metabolites, estrogen
dominance going on, estrogenwill also cause that sphincter
to be tighter, so it reduces therelease of enzymes into the GI
tract. The amount of circulatingt3 also plays a role in how much
pancreatic enzyme is going to beproduced in the first place,

(46:27):
because you need t3 to supportthat. So there's lots of
mechanisms there, and there'sone other one that I I've
consider, and that is, ifsomebody's in a cell stress
response, and they've gotglucose resistance, and they're
struggling to produceappropriate levels of insulin to

(46:47):
regulate it. There are there isresearch that what can happen is
some of the pancreatic cellswill become insulin producing
cells, even though their primaryfunction is to make pancreatic
enzymes. The pancreas will say,Look, we we can't deal with the
glucose in the that's in thesystem. Now we need more insulin

(47:11):
to deal with it. And so sincefood, more food coming in isn't
a priority, let's hijack some ofthese cells and we'll make them
insulin generating cells. Andwhat goes down is the pancreatic
enzyme output. So those are someof the things from my point of
view.

Oh, I can tell you're the third expert, Dr
Balcavage. Like I did not knowthat hormone like estrogen
dominance, can slow downdigestion, because that happens
so often. And the guy has thismarker called beta
glucuronidase, which also couldbe contributing to estrogen

(47:47):
access. If you're not making toomuch, you might just not be
eliminating it.

Yeah, and so, but it's, these are the things
like, when I'm going through thetests, and it's, I think it's
important when you're when, whensomebody's running this test,
right? We can't just read it. Wehave to interpret it, right,
just like blood work. Peoplelike, oh, it's outside the
optimal range, therefore youneed this or it's inside the
optimal range, so therefore it'sgood. Well, no, it's not. If you

(48:12):
have hypothyroid signs andsymptoms, your TSH is normal.
That's totally inappropriate foryou, right? There's reasons why
that TSH means be suppressed.Same thing when we look at these
tasks, right? And we look atthis gut Zoomer, and we see
these things a lot of thosepatients, and I'm guessing you
would do the same thing. There'sdecreased pancreatic enzyme
output. Let's support with apancreatic with a digestive

(48:35):
enzyme right now. But that's notthe long term strategy. The long
term strategy is to get thepancreas to actually release
this stuff more appropriately.Absolutely,

it's short term symptom reduction mechanism. And
then meanwhile we support inorder to return you to
homeostasis.

Exactly what about the bile physiology
component of this in the fatmalabsorption? Can you talk
about that a little bit?

Yeah. So vibrance guts. Zoomer measures
several bile acids, two primary,two secondary, and then it gives
you the ratio as well. So we'relooking to see, are you properly
converting the primaries intosecondaries? You know, are you
able to reabsorb bile, becausewe utilize it multiple times. It
gets recycled. Is thathappening? And then we also look

(49:26):
at fecal fats to see and affirmlike if there's fat, if there's
elevated fat in your stool, ifyou have floaty stools and oily
stools, it indicates you're notable to digest and absorb your
fats, your fat soluble vitamins,your omega three fatty acids,
the stuff that helps with properlike healthy skin and eyes and
brain development. So it looksat all of those things as well.

(49:51):
So

the when we if somebody has on a on the gut,
zoom or test, they've gotmultiple markers of fat
malabsorption. Hmm, but theirbile acid percentages, the
metabolites are normal. Do theydo they still have a potential
bile gallbladder, liver issuegoing on? Oh,

good question. So they could have just had a
really high fat meal, and theirbody just couldn't handle it. Or
you know, the percentages may beokay, but it's percentage. It's
not actual amount. So it's nottelling you if there's enough of
it or not just showing you theratios of primaries and

(50:35):
secondaries.

Correct. That's what I would say, too, because
I've had patients that I've gonethrough the test with them,
they're like you said, I had aproblem with bile and physiology
and fat, but this the bile acidmetabolites are, are normal,
right? Those are percentagesthat doesn't tell us total
circulating. And my opinion, youcorrect me if I'm wrong, we're
looking at the primary bileacids are what you're when you

(50:59):
eat, your liver releases bileacids that are already ready
from your gallbladder, and thenthose bile acids are being
recycled five, six times throughthe meal. And most of those
primary bile acids are beingcycled through the system. We're
looking at the primary bileacids on there are ca and CDCA

(51:19):
that are on that form, there's avery small percentage of primary
bile acids that make it to thecolon, about 5% of the bile
acids. And then we're looking atthe secondary bile acids. And to
me, what this really gives ustonight, idea when we look at
the bile acid metabolites is,how well are those bile acids
being resorbed? Am I getting toomuch moving down that track and

(51:42):
getting into the colon, and thenit gives us a little bit of a
story about what's happeningwith the colonic bacteria and
how they might be convertingthose and there's another little
nuance that's important here,and I won't get too technical on
it, but I write hormone plays arole in which bile acid

(52:03):
percentages we see on there. Sowhen I see somebody based on
their medication, I might see analteration in the percentage of
ca or CDCA, and that's beinginfluenced by the amount of t3
that's getting to the liver,because that changes those a
bit. So that's how I look at it.So when patients say, but my

(52:23):
bile acids metabolites lookgood, I'm like, that's part of
the picture. But the thing thatI were more concerned about to
say, hey, is there fatmalabsorption issues here, and
bile issues and pancreaticenzyme issues, is we look at
those fecal fats, right? Becauseif you're if you're eating fat,
sometimes people say, Well,maybe I just eat too much fat. I

(52:44):
don't know if that's necessarilythe case, but a lot of people
just don't have great bile flow.I mean, just and if we look on
that test and we see lowpancreatic enzyme output, then
there's a good chance that we'regoing to have some fat
malabsorption, correct? Yeah,

and it takes bile to move bile, so sometimes,
if you have sludgy bile, justgiving a bolus of like pudka
Toro Deoxycholic acid, that canget it flowing again.

Yeah, and let's talk about, we're going to talk
about intestinal permeabilityhere in a bit, but this right
here we talk about where we'reat with this fat malabsorption.
We're talking about bile that,too plays a role, and when we
can where we're going to talkabout permeability and
intestinal permeability, right?So the I don't know if you want

(53:35):
to touch base on the role ofbile acids in maintaining those
tight junctions, or do you wantme to take that?

Why don't you give it a stab? I

absolutely so bile acids, just so everybody
knows bile acids, these thingsdon't just break down fats. Bile
acids are anti microbials.Direct anti microbes at top end
of the GI tract. They startkilling the bacteria that makes
it past the oral cavity, makesit past stomach acid, it starts
entering into small intestine.Bile acids are there. They start
breaking down biofilms and doingthat stuff. As those bile acids

(54:08):
move down the GI tract and areabsorbed through the intestinal
cells. That bile acids actuallyhelp maintain those intestinal
tight junctions. We're going totalk about something else that's
really important on this task,that helps us get an idea of
intestinal tight junctions, butthose that bile helps regulate
healthy tight junctions. So ifyou don't have good bile flow,
and you have fat malabsorption,more than likely you're going to

(54:30):
start breaking down theintestinal barrier and leading
to potentially what we callintestinal permeability, or
leaky gut. Those those bileacids at the end of the GI tract
also activate some of the thingson the inflammatory panel, the
beta defenses and other thingsto help deal with the bacterial
overgrowth and prevent it. So ifyou don't have good bile flow,

(54:51):
you don't kill bacteria comingin from your food or your oral
cavity at the top end of the GItract, and you can't control the
bacteria as well at the bottomend of the GI. Eye track. Did I
miss anything? I think you gotit all right, fantastic. So
let's talk short chain fattyacids. What are these things and
why are they important?

Yeah, so short chain fatty acids are going to
be the post biotics made by yourcommensal bacteria. So they're
turning mostly carbohydratesinto these short chain fatty
acids. You can also haveputrefactive, not short chain
fatty acids, but the proteolyticversions, where it's breaking

(55:35):
down protein, like fermentingprotein, and those are not as
good, but the short chain fattyacids from carbohydrate sacral
lytic fermentation that's goingto create these byproducts that
are very beneficial to the body,and helps heal and seal the gut,
helps repair the gut barrier,helps signal to the immune

(55:56):
system. Just in general, reallygood things.

Yeah, the short chain fatty acids really
important for the people withimmune dysregulation. You're
about 70 we think the literaturesays maybe about 70% of the
immune system surrounds the GItract. And that's why we're all
kind of look at the GI tractwhen we're saying, hey, there's
immune inflammatory problems. Wegotta have a healthy gut.
Everything's gotta come in, inthrough the gut. Everything's

(56:21):
gotta come out through the gut,and there's such a signaling
mechanism to the immune system.Interestingly, there's a direct
lymph connection from gut tothyroid for everybody, just so
you know, if problems in the gutcan directly impact the thyroid
from a lymph perspective, notjust a blood perspective, but a
lymph perspective, but the shortchain fatty acids are a huge

(56:44):
driver to Reg, to up regulatewhat are called the T regulatory
cells. So if you have an immuneinflammatory process that gets
started, we want that to happen.We want the immune system to
defend us. But if you don't havehealthy short chain fatty acids,
the off switch may not be thereto calm the whole process down.

(57:04):
So once that thing gets turnedon, if you don't have the right
bacteria, you don't have theright diet, the right bacteria
to produce these short chainfatty acids, you may initiate
immune response, but it may behard to turn that off. You okay
with that? You saying that? Yep,that

all makes sense, perfect.

So what is if somebody has there's a lot of
times when people say, I eat alot of plant based foods, why
would my short chain fatty acidsbe low? What? What's your take
on that? Huh, good

question.

So my take when somebody tells me that I'm like,
Look, there's couple pieceshere. What you put into your
body is going to have an inputand an impact on the bacteria
that grows. If what you'reconsuming, even though you eat a
lot of plant based foods, ifthey are more processed based
foods, or more alcohol or moremore sugars or other things that

(58:02):
actually prevent these bacteriathat take these short chain the
fibers and convert them intoshort chain fatty acids. If
those are down regulated, youcould eat all the plant matter
in the world, and you're notgoing to produce the appropriate
short chain fatty acids. Are youokay with that?

Yeah, so when you said plant based, what I'm
thinking of is Whole Foods, likeI went to best year University
School of holistic medicine. Sowhen I hear plant based, I think
of like carrots and apples andalmonds and black beans and
brown rice and quinoa. I don'tthink of like a vegan thing

(58:40):
that's full across, like, theprocessed food. Like, yeah,
totally. It's, it's, you have toeat real food. You have to eat
food that's from nature. Like,you can recognize it. Your
grandma could, you could cook itin your own house. Like, that's,
that's the food that fuels andfeeds us. It's not the
convenient stuff that lives on ashelf for 12 years. And

is it fair to say that the life perception of
life based stressors couldpotentially change the bacterial
balance. So therefore, even thatwhole food based diet is great,
but it the bacteria are beingaltered by the stress response.
So they're not there to reallyat a high enough level to
produce these

things, absolutely, absolutely, and we
know that stress reduces yourSecretory IgA as well, which is
part of that barrier. It's partof the defense. It's like the
guards around the castle whenyou have low Secretory IgA, it's
like they're sleepy and theydon't really protect you
anymore.

Yeah, so that's another that's another thing
that's on here on this test, andI think it's an important
marker. So let's talk about whatSecretory IgA is. I think it's
important that people know whatit is, and then, if it's low,
what should that be telling us?And if it's high, what should
that be telling us?

So Secretory IgA. A is a type of
immunoglobulin. So we're lookingat the immune system, and
there's a sweet spot in themiddle where you want it to be.
If it's too low, it means yourimmune system isn't able to
fight against a pathogen. Itisn't able to fight against the
neighbor that's doing naughtythings. But if it's too high,

(01:00:19):
that means it's actively tryingto fight against that pathogen.
It's actively trying to fightagainst something that's causing
dysbiosis in the gut. So we wantit optimally to be at that
normal level and not on eitherside, although it's probably
easier to treat the high side,because you identify what it's
fighting against and then getrid of that or adjust the diet,

(01:00:41):
lifestyle, all the things tobalance it back. It's a little
bit harder to bring it up ifit's low, because that's usually
indicating you've been understress for a long time, and it
takes a while to bounce back.

Eric Balcavage (01:00:51):
Yeah, I want to come back to that from a testing
perspective, but I I see this aswell. Like, I think the same
way, like, if we see dysbiosisand inflammation, I'm hoping
that the secretory IgA iselevated, right? Somebody be
like, Well, why would you wantit high? Listen, if somebody's
breaking into your home, I wantthe cops. I want lots of them,

(01:01:14):
right? I want them coming. Thattells me that your immune system
is appropriately responding ifyou have a lot of inflammation
and you have low Secretory IgA,I'm worried that you don't have
an immune system that's capableof dealing with it, and we
really need to help out. And notonly does the secretory IgA
influence your gut physiology,but all of your mucous

(01:01:37):
membranes, so all systems, nasalpassages, oral cavity, eyes,
pelvic area, right? Likeeverywhere where you have these
mucus memories, these coatings,these protective coatings of
that kind of as a barrier fromoutside to inside. The Secretory
IgA system is the police forcethere, right? So if they're

(01:01:59):
weak, you're more susceptible tochronic organisms getting into
the system and becoming latentor active or acute or
replicating infections. But moreoftentimes, what we'll see is
that these are people withchronic, latent infections.
They're not in a replicatingmode where, like, oh my gosh, I
got a fever, I got chills, I gotall that. But they have chronic

(01:02:19):
health, low grade health issues,because this the organisms are
like, nobody's stopping us.Let's go. I would do the same
thing, right? Well, there's nonobody to stop me from walking
on the private beach. Great. I'mgoing to go on the private
beach. Why not? Right? SoSecretory IgA is critically
important from an assessment,when we assess that, because
that really does tell us, like,the state of the immune system,

(01:02:43):
right? It does, yeah, there's,we're going to come back to
maybe rechecking this and maybesome strategies here. But
Zonulin, there's a lot ofdiscussion about Zonulin, fecal
Zonulin versus Zonulinantibodies. Some people say
fecal Zonulin is not a goodmarker of intestinal
permeability. They say you gottarun blood tests and antibody

(01:03:04):
tests. Other literature saysfecal Zonulin can be used what's
vibrant stance. I would say theywould believe that it has, that
it's can be used as a potentialmarker of intestinal
permeability. But why did they?Why do what's the, what's the
general thought processregarding fecal Zonulin? Let's
start with what is fecalZonulin, and if it's elevated in

(01:03:27):
the stool, what does that mean?And how does that maybe differ
from blood testing, if you're ifyou're good with that,

Adair Anderson (01:03:33):
yeah. So I like to think of Zonulin as, like the
key that unlocks the tightjunctions. So when there's
Zonulin present, it means thetight junctions have been told
to open up. It's like Opensesame. There's actually a study
by Dr Alessio Fasano that talksabout this. It's called Open
sesame. So Zonulin opens a tightjunction. So when you see
Zonulin in the gut, it meansthat sometime when that stool

(01:03:54):
was formed, Zonulin wasreleased, the tight junctions
opened. So there was recentlybeen depending on how long it
takes you between stools, itrecently has been leakiness in
your gut. The reason we wouldalso do a blood based test is
because we look at Zonulinantibodies, and Zonulin

(01:04:15):
antibodies provides a snapshot,or, sorry, a report card of how
long and how often Zonulin hasbeen elevated. So whereas, like
Zonulin, just Zonulin, and ablood test will tell you if it's
actively elevated, like afasting blood sugar, like, what
is it right now, a anti Zonulinis going to give you a report

(01:04:37):
card. If it's IgA, it's like thelast week. If it's Iggs, maybe
the last couple of months, it'lltell you how often it has been
elevated over that time period.It's like hemoglobin a 1c it
gives you a past perspective,yeah, and they can both be
helpful in hand, but if you haveelevated Donald in your stool,
it means you had elevated Danielin before you in creating that.

(01:05:00):
All, yeah,

so I think, like, I see both sides of the
argument, but it's on here whenwe start to see it elevated,
like, if you don't haveantibodies yet, that doesn't
mean we don't have a problem,right, right? We got an issue we
need to address. We gotta, wegotta reduce the inflammatory
process. We gotta deal with thedysbiosis. We've got to support

(01:05:22):
appropriate bile flow and shortchain fatty acids so that we
have less breakdown of thebarrier. If we don't do that,
whether you have a positiveantibody test or not, you're
probably going to have one,right? Is that fair?

Yeah, I mean, and lots of things can trigger
Zonulin release. So there'sevidence in the literature
showing gluten exposure cancause it, showing LPS bacteria
can cause it, alcohol causesleaky gut. Don't

tell everybody that, no, no, but there's, there
are so many things that do it.That's why we promote like,
whole food, anti inflammatory,low process style diet, right?
Not necessarily restricted diet.My opinion is restrictive diets
are short term, temporaryoptions, but long term, yeah, we
want to be whole food based.Mediterranean style diet is

(01:06:12):
probably a good, great place tobe, if you had to think. But
whole food based, low processedfood based diet is, is really,
my opinion, the gold standard.And I think it's 8020 I try to
explain 8020 80% good habit, 20%bad behavior. If you do that
consistently with all what if Italk about all the fitness
factors, you're probably goingto be fine. If you have 20% good

(01:06:36):
habit and 80% bad behaviors,you're in trouble. You're going
to have problems. So fecalZonulin, if that's elevated,
that tells us we're running therisk to develop more intestinal
permeability. And let's talkabout what that might mean for
activating the peripheral immunesystem or inflammatory system,

yeah. So usually your tight junctions, or your
the cells in your gut are reallyclose together to provide
provides a barrier. So things inthe gut lumen, the stool,
doesn't get into the bloodstreamwhen the junctions are leaky.
That means things in the gutlumen get towards the lamina
propria, where there's immunecells, and the immune cells get

(01:07:20):
activated more often, and whenthe immune cells are activated
more often, that means you'regoing to have more inflammation.

Yeah, and the other thing, yeah, go ahead and
it's systemic

in it, and it will manifest wherever you're
most genetically susceptible. Socould be joints. Arthritis could
be hashimotoitis. Could be, youknow, dementia could be just
brain fog could be fatigue,

yeah, those inflammatory molecules are going
to set the stage for problems.Right, tissue damage we get up
regulation of the immune systemwhen those tight junctions
become more permeable. Poorlydigested food matter. When we
eat food, we break it down,especially the proteins from the
big structure to a smaller stockstructure we call a peptide.

(01:08:06):
From the peptide into what wecall amino acids. And the amino
acids are really what's meant tobe absorbed across the GI
barrier. But if we get higherlevels of peptides crossing the
barrier, that can start totrigger more immune type
reactions, if we have LPs, youtalked about, that's the coding
of gram negative bacteria. Youhave gram negative bacteria,
it's supposed to be in the GItract, but the gram negative

(01:08:28):
bacteria, if particulate of gramnegative bacteria, or the
bacteria itself, crosses thatbarrier, the immune system is
going to become activated. Wecall those pimps, pathogen
associated molecular peptides.If there's damage to the
intestinal tissue, and part ofthat enters into the
bloodstream. We call that damps,damage associated molecular
peptides, and those thingsactivate the immune system. The

(01:08:49):
damps say, Hey, it's me the gutthat's damaged. The immune
system goes, Oh, we gotta go tothe gut. If there's tamps, they
go, those bind to the immunecells and say, Hey, this is the
thing we're looking for. Go findit and kill it. From a thyroid
perspective, I want to make sureeverybody hears this piece. We
think that a lot of timesthyroiditis, you'll see it
written up because it's gluten,and you eat gluten and it causes

(01:09:12):
cross reactivity or molecularmimicry. But what we would often
not talk about, I talk about ita bunch, is that the thyroid
cells themselves have patternrecognition receptors. That
means not on immune cells.Immune cells, these PAMPs and
damps, these danger particlesattached to the immune system,
to immune cells to activate theimmune system, to tell it what's

(01:09:33):
the problem and where the damageis, so they can help. But the
thyroid gland has patternrecognition receptors, and this
is why I said I said I don'tthink thyroiditis is a mistake.
I think it's a, it's a it's anadaptive response, because if
those camps or damps bind to thethyroid cells themselves, the
thyroid cell now becomes animmune like cell and initiates

(01:09:56):
the release of inflammatorycytokines, inviting more lymph.
Sites into the thyroid gland andcreating more damage. It's not
broken physiology, because itcan that process can turn back
off. But if you think about itfrom my perspective, if the cell
that's under stress and dangeris trying to down regulate its
metabolism, it can do itlocally. If there's lots of

(01:10:18):
cells and tissues in a systemicinflammatory or danger
perspective, how does the bodyslow down the metabolism? You
slow down the production of theprimary hormone that drives
metabolism and that occurs atthe thyroid gland. And this is
why I say thyroid physio,thyroid gland hypothyroidism,
and is oftentimes recoverable,but we have to address the

(01:10:39):
things that are creating thisimmune activation. And you're
right, those immune inflammatorychemicals, those damps, those
PAMPs, they can create othertissues to be damaged in time.
But a lot of times, I don'tthink of it as just like, okay,
the immune system is going todamage the tissue. I think it
has something to do withalterations of the local

(01:11:00):
proteins, structures because ofsome of these things, damage
being done. And then the immunecells kind of scooping up a
debris field and going, oh,there's an organism here, or a
piece of something and a pieceof tissue. I knew what the
tissue was. I don't know whatthese two things are combined.
And now, because that leaky gutand that LPS being out, now the
immune system says, Well, I'mgoing to react to what, what was

(01:11:23):
connected to that piece ofmaterial. Yeah, totally. So
we're going to wrap this up,because I'm sure you've got
other things to do than listento my boring voice, right? But
there's, there's one more thingI want to cover on the test, and
that is fecal anti Gliadin. Mm,hmm, okay. Now a lot of people

(01:11:48):
are who've already been in thefunctional medicine space, are
gluten free, dairy free, andthey get a test done like this,
and it is positive, and they'relike, I am not eating wheat. How
can that be? How would youexplain that to somebody, why
their fecal anti Gliadin mightbe elevated despite not

(01:12:11):
consuming it? Because that insome people's mind, until I
explain it to them, they thinkthe test can't be valid because
I don't need it. Oh,

totally. This happens all the time. So one,
there's a lot of crosscontamination. If anyone eats
out, you have no idea what'shappening in the kitchen. Most
fried things, there's crosscontamination. French fries,
they're probably also fryingcorn. Dogs covered in wheat.
You're getting gluten exposurethere. Like it just happens all
the time. Vegetables, they'llfry those too that'll be covered

(01:12:43):
in gluten. So you really have toask, Do you have a dedicated
gluten free fryer if you'regoing to eat anything that's
been fried out, period, fullstop. Also, just things can
happen in a kitchen, like, ifit's not your kitchen, you
would, you don't know. Youreally don't know. Other times
there's just lack ofunderstanding of what is gluten,
what's not gluten. And then wealso, you know, I've had a

(01:13:05):
client who, I had a client wholived just down the road from a
wheat field and was inhalinggluten antigen all the time.

How to Move? Is it possible that somebody with
poor digestion and permeabilityand eating other grain like
foods could have their immunesystem that has become reactive
or responsive to Gliadin or anyof the Wheat peptides see a

(01:13:39):
piece of UN poorly digestedplant protein, let's say Corn
Protein. And say, You know whatthat looks close enough in this
chaotic situation, I thinkthat's wheat.

It's a good question. I suppose it's
possible.

This is where they talk about molecular
mimicry or cross reactivity. SoI don't know if the gut Zoomers
test is more specific that itfactors that piece out.

I know that our blood test is because we
manufacture the exact peptidesand proteins on our amino chip,
on the silicone semiconductorwafer, and so I know it's
specific to that thing. And Iknow antibodies are very
specific to this thing they'reattacking. But yes, absolutely,
molecular mimicry can happen. Itdoes happen. That's how we get

(01:14:36):
Lyme arthritis, for example.That's how we get rheumatic
fever. I think it is where youget a anyway. So, yeah,
possible. Oftentimes, whensomeone is reactive to the non
gluten wheat peptides on vibrantwheat Zoomer, they also have
reactivity to other grains likecorn, rice, etc,

and the antibodies on this test. Test
their Secretory IgA

antibodies. There are not. It's just looking
at the level of Secretory IgA.

No. So the Glee, anti Gliadin, which antibodies
are being tested? A Gliadin,right? Is it IGA antibody
testing or IgG? It would be IGA.

It's gotta be IgA, because that's what's made
on the mucosal surface, right?

So, because that leads to the next question,
right? Which is, I eat gluten,I'm within the reference range,
therefore I'm not reactive toit. And I always tell people,
Look, it all depends on whereyou're at and it depends on what
that Secretory IgA level is. Oh,yeah, so if you're 100 but your

(01:15:50):
Secretory IgA is 300 and reduceand suppressed, then we're not
really seeing your full responseto Gliadin. And I could be
totally wrong, but that's how Iexplain it is, does that make
sense to you? Yeah.

I mean, I would test total immunoglobulins in
the blood look at total IgA,total IgG, total, IGN, total
IgE, because that's going togive you a better snapshot.
Secretory IgA is similar, butdifferent. It's a different than
a total like than an IGAmolecule, but, yeah, they
should. I mean, sometimes theycorrelate, sometimes they don't,

but if they're but if we're looking at fecal
anti Gliadin, we're looking atantibodies to Gliadin. Yes,
right? So if, if their immuneresponse, and we're just looking
at the test and in the Gliadinis with, if it's within the
reference range, but thesecretory IgA is weak.

Does, does it? I mean, if it, if it correlates
clinically Absolutely, you couldindicate that for sure. I mean,
even just a slightly like, ifit's in the green, but it's high
green, that means something too,sure.

Yeah, you're still responsive, right? Yeah,

it's not zero. It's not at the very low end. It
means there's some reaction. Andis it a some reaction, but would
have been higher if your immunesystem was more robust, or is it
right? What's the reason for itto be a high green, high normal,
right?

I agree, and that's where it comes down to
the interpretation piece, right?Not just saying, Oh, it's in the
green, you're good, but saying,How much do you eat? I don't eat
much, and it's this high in thegreen, hmm. And you're seeing
maybe your immune system'scompromised, you might be, and
you guys are only testing onepeptide on here, correct? Yeah,

(01:17:41):
right. And there's multiplebreakdown products of wheat. So
the important part is, if youfeel wheat reactive, but this
component is normal, it doesn'tmean you're not reactive, right?
We'd look at, right? Might bebetter to look at an antibody
test, yes. And we'd look atmaybe the breakdown, all the

(01:18:03):
breakdown products, and see, areyou reacting to other components
of wheat, but not this Gliadinpiece that you're looking at
here, like

when there's scattered thunderstorms, you
might be in a sunny spot,doesn't mean it's not raining
somewhere else in

your body. Yeah, perfect. Alright, so let's wrap
this up. Let's do two things.What if you wanted to give some
final insight into the benefitsof the gut Zoomer test, maybe
over some of the other teststhat are out there, and then
maybe three tips for somebodywho's struggling with chronic GI

(01:18:37):
issues, should they run a test?Should they not run a test? When
did they run a test. Yeah,

so vibrant. Gut Zoomer is just very
comprehensive. It includes moremicroorganisms and more of these
extra markers to look intodigestion, absorption, immune
response than pretty much everyother test, any other test on
the market, in terms of whetheror not to run a test, I'd say
everyone could benefit from gutzoom or testing. Everyone can

(01:19:03):
benefit from knowing what'sgoing on in the microbiome. And
then in terms of when to test, Iwould definitely not do it right
after a colonoscopy, becausethat will wipe out everything in
your gut, so wait at least twoweeks for the microbes to grow
back. And as a side note, aftera colonoscopy is a great time to
feed your microbes, all of thehealthy things, so they grow

(01:19:25):
back in the way you want themto, as opposed to eating a poor
diet, which then would continueto decimate them. So not right
after colonoscopy, and then Iwould do it, eating your normal
diet. Some people, someproviders, will say, avoid
anything that could possiblycontribute to a change in the
gut. But you want, you want todo a baseline, or you want to do

(01:19:45):
like in your normal, like, youknow, like washout, or just like
eating your normal. What doesthat look like? So I would say,
maintain your normal routine,what you're currently doing. I
would not change anything.Personally for my clients, they
just eat normal. Um. And thatwill give you the best insight
into what your current diet,lifestyle habits, what impact
that's having on your gutmicrobiome. And

I agree with that, like, I don't want to test
you on your like, two weeks on aAIP diet that doesn't tell you
were struggling with on yournerve, on your on your diet. I
want to test you on your diet.Last question, so many people
taking supplements? Okay, sothey're taking lots of
supplements. How do yourecommend? I I give different

(01:20:32):
answers here based on the on theindividual. But should somebody,
if somebody's testing, they'redoing the test. Are there
supplements that are going tointerfere with the test that
they shouldn't take? And ifsomebody's coming in, I'm taking
this probiotic, that probiotic.I'm taking this. I'm taking
that, taking this. Do you havethem stop those things, or do

(01:20:55):
you have them take those things?I'd like to get your opinion on

that. Yeah. So if you want to know if your gut
needs a particular supplement, Iwould say test without the
supplement to see what it'sdoing baseline. I think baseline
information is more helpfulbecause if you're taking you

(01:21:18):
know digestive enzymes, ifyou're taking pro kinetics, if
you're taking probiotics likethat's going to impact the
results. And it might say itlooks great, but that means
maybe you need to be ondigestive enzymes the rest of
your life, or taking that proprobiotic the rest of your life.
But that's really notsustainable. We want you to be
in homeostasis without the needfor extra stuff. It's a

(01:21:39):
supplement. Because it'ssupplements. It's not a long
term thing you have to do allthe time. So I love, like, just
baseline, no supplements.

Yeah, I agree. So I'll do the I'll tell most
people listening, I don't wantif I can get them all. My
starting point is, usuallyyou're on 30 supplements. If you
need 30 to feel this awful, youdon't need any of them. Let's
wean you off of them first. Butif I have somebody who says,
Listen, I this is a really goodprobiotic. I'm taking this. I
need my digestive enzymes. I'mthen I may. If they're not

(01:22:12):
willing to not do those things,I'm like, Great, take it,
because I want to show them thatwhat they're doing isn't having
the intended impact. I Theythink it is right. And so
typically I'd say, Look, don'ttake anything week or so, and

(01:22:32):
then we'll get the stool testdone. Just eat your normal diet.
We don't need all the extrasupport in there. And let's just
see where you're at. But ifsomebody says, I can't live
without it, great, take yourstuff. Let's see how it changes.
See how if it makes the testlook perfect, then we know
there's problems, and whatyou're doing is managing it. But
then we have to talk aboutwhether you want to recover, you
just want to manage but manytimes, the reason they're coming

(01:22:55):
to you or is because theythey're managing their symptoms
with supplements, but it's notreally restoring a functional,
healthy,

functional state. No one goes to a doctor
if they're feeling right.

Yeah. So, Dara, I want to wrap this up. I want
to respect your time. We gotlike two minutes left, so tell
everybody a little bit about youand where you're located. So if
they want to hear more about youand what you do, they can reach
out. Alright,

so I'm located in Washington, DC. My private
practice is called eating withintegrity. The website's www,
dot eat honest.com. You canschedule a free consultation to
learn if my program is right foryou and I resolve functional gut
disorders like idea. So helpingpeople be able to live a normal
life again after suffering fromall that digestive issues,

awesome. Well, I appreciate you coming on the
podcast. We got through a lot ofthis test and some of the
markers on there and theimportance, but I appreciate you
coming on and sharing yourwisdom with us. All right,
thanks for having me. You

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Episode 199: GUT Zoomer Deep Dive - Functional GI Testing for Thyroid Patients

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.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}Episode 199: GUT Zoomer Deep Dive - Functional GI Testing for Thyroid Patients