September 26, 2024 • 46 mins
Explore the intricacies of gut inflammation management with naturopath, herbalist, and nutritionist Dan Sipple. Drawing from his personal battle with Epstein-Barr virus, chronic fatigue, and celiac disease; Dan offers unique insights into integrative health approaches.
This episode provides a comprehensive exploration of gut health, from dysbiosis mechanisms to the microbiome's role in autoimmune recovery, while delving into critical aspects of celiac disease diagnosis and treatment.
Gain valuable insights into streamlining the patient journey for gut issues through strategic intake forms, comprehensive patient history, and advanced testing methodologies.
Episode highlights:
- Celiac disease diagnosis and psychological impacts
- Patient intake strategies for gut issues
- Fecal calprotectin testing
- Diverse fibre sources for optimal gut health
- Nutraceuticals for gut inflammation: EGCG and HMOs
- Integrative approaches to autoimmune conditions
- Microbiome's role in long-term health recovery
- Dietary recommendations for gut health optimisation
About Dan
From a path of illness, to discovery and eventually recovery, Dan Sipple has ridden the waves of medicine and wellness first hand.
As a result of his personal experience and clinical expertise, he has a unique ability to recognise where to begin with every individual he works with. Dan’s method does not feature cookie-cutter protocols and recipes for wellness, but rather offers fully customised treatment plans for his patients which he considers the backbone of his approach and successful clinical outcomes.
Dan is a fully qualified Naturopath, Nutritionist and herbalist with a Bachelor of Health Science. He is a registered member of the Australian National Therapists Association (ANTA).
His multimodality approach features elements of both Allopathic and complementary & alternative medicine (CAM) and he regularly employs Western diagnostics in accompaniment with functional & integrative testing to help him reach the best possible patient outcomes.
Dan is passionate about the areas of gut & microbiome modulation, hormone optimisation, autoimmune illness, stealth infections, immunity and anti-ageing medicines.
Shownotes and references are available on the Designs for Health website
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DISCLAIMER: The Information provided in the Wellness by Designs podcast is for educational purposes only; the information presented is not intended to be used as medical advice; please seek the advice of a qualified healthcare professional if what you have heard here today raises questions or concerns relating to your health
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:20):
Music.
This is Wellness by Designs,and I'm your host, andrew
Whitfield-Cook.
Joining us on the line today isDan Sippel, a naturopath,
herbalist and nutritionist.
Today, we're going to betalking about gut inflammation
markers and management.
Welcome to Wellness by Designs,dan.
How are you?
Speaker 2 (00:38):
Very well.
Thank you, mate.
Thank you for having me.
Speaker 1 (00:40):
It's a pleasure to be here I wish I was there, where
you are down on the south coastof New South Wales.
It's a pleasure to be here.
I wish I was there.
Where you are down on the southcoast of New South Wales, it's
a favourite place of mine in theworld.
Speaker 2 (00:50):
Yes, yes, we're very lucky.
Down here in the south it'scold in the winter, but the
sun's been shining all week, sowe can't complain.
Speaker 1 (00:59):
Beautiful Dan.
Can I start a little bit withyour career?
What's your background?
How did you arrive at aninterest in naturopathy and
herbalism?
Speaker 2 (01:10):
Yeah, sure thing I'll give you the concise version,
andrew, otherwise we'd probablybe here all day years ago now
and I'll sort of do my best topaint the picture.
But it was the good old sort ofEpstein-Barr virus into.
You know, never will sensescenario for me.
(01:31):
So not uncommon, as you know,in our industry, but yeah, just
definitely that path of illnessto kind of discovery and then
eventually recovery.
So high school certificate year, year 12, lots of pressure.
High school certificate year,year 12, lots of pressure, hsc
and all the things.
And I come down with a prettyheavy case of glandular fever at
(01:53):
the time and two weeks laterthat sort of you know eventuated
and two weeks later I was backdoing my HSC.
So it was all quite fast andhappened very quickly.
But point being, I sort ofdidn't recover well after that
and for the next two years I wassort of doctor shopping, if you
like, and just kept gettingtold the same old thing that you
(02:13):
just need to rest your body,you're still getting over
Epstein-Barr.
And yeah, as I say, it got toabout the two year later mark by
the time I was about 19.
And I could just definitelytell that something else was not
quite right Just wasn'tthriving.
Lots and lots of upperrespiratory tract infections,
(02:33):
fatigue, brain fog, you name it,but certainly wasn't presenting
in a typical way that you wouldto suspect that there was an
underlying gut sort ofauto-inflammatory process
happening.
So I was eventually diagnosedceliac.
When we changed gears a littlebit and saw an integrative
doctor, she ran a barrage oftests and found those celiac
(02:56):
antibodies quite raised and sofrom there it was a big aha
moment and a lot of relief.
And you know, going down thepath of the GI specialist and
the okay, you need to be on agluten-free diet for life and
this is how we manage thecondition.
But you'll do that and lifewill return to normal and you
know we'll never hear from youagain.
(03:16):
Basically, everything will goback to normal within a matter
of weeks to months.
For me that was not the case and, uh, I, I, I guess over the the
course of the next few years,kind of worked that out and and
went on a bit of a journeybecause it was recovering from
all the damage that that I'dtaken.
Um, throughout that period ofmisdiagnosis, with subsequent
(03:37):
antibiotics, just one after theother, boom, boom, boom.
So lots of antibiotic cocktailsand and by that time in my
early 20s, I was quite beat up.
So the gluten-free dietdefinitely helped initially, but
I quickly worked out that itwas kind of the end of the road
with the modern medicineapproach as far as celiac
recovery and management went.
(03:58):
This is where I started learningabout gut dysbiosis and the
microbiome and more sort ofintegrative approaches.
So that sort of evolved into areally keen interest and I
worked out by probably the ageof 23, 24, that, yeah, just that
that I had a really keeninterest in the science side of
(04:19):
it and learning about theautoimmune and gut connection
and so forth and eventuallystarted studying it in my
mid-20s, took up thenaturopathic degree through
Endeavor and did that over thecourse of the next five or six
years on and off, and I wasstill working at the time so
started practice at the age of30.
I'm 37 now, so this is myseventh year in practice and we
(04:42):
moved down from Sydney down tothe south coast when I started.
So what's that?
Yeah, seven years ago, and fastforward to 2024, and here we
are.
Speaker 1 (04:53):
Can I go back to the diagnosis?
What was it that twigged inyour doctor's mind to test?
Because you know you've gotthat age bracket.
You know the sort of late orsort of mid to late teens.
The high school certificate isthe classic, the hormones around
(05:15):
that era and the stress.
So that perfect storm is whenEBV just knocks people.
But how many get tested and howmany don't?
Speaker 2 (05:28):
so what was it?
where your doctor said, listen,we need to test, we need to find
out I can remember going in Iwas still under the care of my
my folks at the time and I canremember going in to to this
particular integrative doctorwho I maintained a great
relationship with for yearsafter, and doing the old
palpation on the gut.
It was probably the first timethat my mother was saying he's
(05:52):
not thriving.
There was that word and I waslike what does that even mean,
daniel's not thriving?
And it made sense.
It was like in all aspects itjust was like I hit a sort of
roadblock and prior to that,mind you, there were no signs or
symptoms to alert us toanything celiac related.
So I didn't have the classicpicture with gut symptoms and
(06:13):
that's probably why it wasmisdiagnosed for so long.
For me it was more fatigue,brain fog, extreme, extreme
brain fog.
So it was a very cerebralpicture, um, recurrent
tonsillitis, which was whyprobably EBV kept getting blamed
, you know, for the um, for theillness, and, and whilst that
might have been partially true,um, the celiac was kind of there
(06:35):
, you know, bubbling away in thebackground.
So malabsorption, you know,then ensued.
So it was eventually I had toget really, really low for it to
be recognized.
So we're talking about, youknow, getting to the level of,
you know, weight loss, grayingof the skin, not leaving the
bedroom, yeah, very, veryrecluse.
And so that, I think, tippedthe doctor off to the fact that
(06:57):
there could be an absorptionissue.
And that was the first timethose antibodies were run.
And sure enough they were skyhigh yeah high yeah yeah.
Speaker 1 (07:05):
So what's really interesting to me is, you know,
fatigue in in a teenager.
Obviously we think about ironfirst, but if there's
chronically low iron then you'dgo, uh, absorption celiac.
Was there any hint of low ironthroughout your earlier years or
any hint of like breathlessness, or you, you know,
(07:27):
underperforming when you didsports day or anything like that
?
Speaker 2 (07:31):
The latter Exactly.
So what, where I really knewsomething was wrong, was I was
trying, you know, with mylimited knowledge at the time to
quote, unquote get well.
So that meant for me liftingweights and trying to, you know,
build my body and just buildback.
But when I do that I would gocatabolic.
I would actually break down andsometimes for weeks, and then
(07:51):
I'd come kind of good again.
So I'd do it again and thatpattern kept happening.
So, once again, that's where,you know, I eventually had to
just keep pleading with theoldies.
Something is wrong, I'm tellingyou, and it's not just
glandular fever, you know.
With the oldies, something iswrong, I'm telling you, and it's
not just glandular fever, youknow, yeah.
So, like I said, I did have toget quite low for the
practitioners to think outsidethe box and I've always carried
(08:12):
that with me, even as anaturopath.
Now, to never I mean obviouslyI'm biased, being a celiac but
to never disregard theimportance of running that
celiac serology when you'reseeing that sort of not thriving
picture and the amount of timeswe've seen, you know, even low
level active antibodies and youwouldn't otherwise suspect it.
(08:33):
Then you get your classic caseswhere it's very, very, you know
, true to classic sort ofhallmark celiac symptoms.
Speaker 1 (08:38):
Yeah, can I ask you something you just mentioned
before and you said it as if itwas inconsequential, but it's
got to do with labels.
You said I'm a celiac versussomeone who has celiac disease.
Yeah, do you know that, thatyou know where, where the
disease becomes the person, ifyou like.
(08:59):
Does that bother you?
Speaker 2 (09:03):
it did for a long time.
It doesn't now, I think,because it's been so long, so
it's been over half my life andum yeah the awareness now is
very, very, you know, differentto what it was 20 years ago.
So it definitely did for a longtime.
Um, and I've it's interestingyou bring it up, because
sometimes I do say thatunknowingly and um, it's
something that I don't thinkabout anymore, but I often catch
(09:26):
patients saying it you know,I'll talk to them about that
that sort of that mindset andchanging their terminology.
So, yeah, it's, it's a quiteimportant thing to to raise to
people that feel that they've, Iguess, been, you know, dealt,
you know a bad card or you know,that sort of victim mindset.
Speaker 1 (09:50):
Yeah.
So I guess where I'm goingthere is because you're
proficient in what you do.
You have a level of comfort.
It doesn't define you.
You're quite fine with it.
But for somebody who'sinvestigating this along their
journey, they might be a littlebit touchy on the subject.
Is that how you felt and whatyou see in your patients?
Speaker 2 (10:09):
It was yeah, yeah, like I say, for a long time, and
I think it's more in the socialsettings that it becomes quite
apparent.
You know, at home it doesn'tbother you Quite often, the
whole household will just begluten-free and it's not
something that you tend to thinkmuch about.
Um, but it's sort of thosesocial settings where the rubber
meets the road, where you knowyou'll be.
You know, classic one is you'resitting at a a big, um, you
(10:32):
know dining table at arestaurant, you're doing the
order and it gets to you and allthe attention's on you and, uh,
you know you.
You say can I please have the?
The?
You know the item on the menuthat's marked chef?
Oh and, and, by the way, I'mceliac.
Can you let the chef know?
So that's where you getreminded, yeah.
Speaker 1 (10:49):
Yeah, but do you find there is a greater awareness
now that it's?
I mean, we should have had thisfor at least 10 years minimum,
but do you find that there's annot awareness, acceptance,
indeed care, by eatingestablishments, food
establishments that know nowabout what a celiac is?
(11:10):
No, you can't sneak that in.
No, it can't have a little bit.
Speaker 2 (11:14):
It's got to be zero it's definitely, it's definitely
improving, um, and I alwaystell people, um, despite that
and the awareness, you got toremember that you know the, the
waiter takes your order, it thengoes to to the kitchen, which
is, you know, a separate area,and that's.
You know something that youneed to be very confident in.
(11:34):
So pick, pick your restaurantswisely, stick to the same.
You know routine and um, yeah,you'll avoid trouble and
fortunately for me, it's been,oh gosh, probably over a decade
since I've been gluten poisonedtouch wood.
Speaker 1 (11:49):
Gotcha.
Yeah, let's go into our topictoday because it's quite broad.
When we're talking about seeinga patient first for any sort of
gut issue, where do you start?
Where does the patient journeybegin with you?
Do you begin with testing?
(12:09):
Do you begin with you?
Know family history, patienthistory?
Do you start on like a fewsupplements first before you
test?
How does it look?
Do you start on like a fewsupplements first before you
test?
Speaker 2 (12:21):
How does it look?
I'd say it's probably differentfor each patient, andrew, but I
make a very strong point in myintake form to be very thorough
so that by the time I'm jumpingon the call with them I've got a
very well-rounded understandingof where they're at, their
family history, their currentsymptoms.
My intake form probably takes agood 10 to 15 minutes to fill
(12:44):
in.
So, as I say, by the time wejump on the call I've usually
got a whole lot of pathology notalways, but most often as well
to go with it.
So that helps me, after theinitial 45 minutes of
questioning, to sort of work out.
Do we jump straight intotesting, or has this person
already been to three or fourpractitioners and they've got a
plethora of decent testing, butthey're just after a different
(13:07):
opinion?
In that case we usually justjump into treatment.
But generally speaking, I dolike to start with testing.
I feel like it's a goodinvestment.
Um, five years ago maybe Iwould have said something
different, but with what we cansee of the microbiota and the
ecosystem now, I feel like thatmoney is quite well spent.
And I always say to the patientif we don't have the funds to
(13:28):
test, that's okay.
It's not a prerequisite, but ifwe can test, I can be very,
very specific with theapplication of different
nutraceuticals or prebiotics orprobiotics, without the
guesswork.
So it's that whole thing oftest and don't guess, I suppose,
mind you.
You know, after seven years andmy own personal history and and
(13:49):
just being in the health andwellness space for a while, a
lot of practitioners would agreeyou get a pretty good sort of
understanding of what tools arevery likely to be useful versus
others.
Speaker 1 (13:59):
Gotcha.
Speaker 2 (14:00):
Even without testing yeah, yeah, yeah.
Speaker 1 (14:03):
So what tests do you tend to favour?
What do you employ?
Speaker 2 (14:08):
If we're looking at the, yeah, if we're looking at
sort of understanding, well,first of all we've got to
understand is the patient'sdigestive symptoms in the small
bowel or large bowel or both?
So in an ideal scenario, if thefeasibility isn't an issue,
we'll do testing for smallintestinal bacterial overgrowth
via a series of breath tests andfollowed by then the stool test
(14:31):
, to give us a really good,well-rounded understanding of
the ecosystem, where we're notjust kind of fixated on looking
at pathogens but we're lookingat the balance of the whole
ecosystem.
And I'm quite, you know, in thecamp of.
You know, yes, we want tounderstand what critters are in
there that are causing dysbiosisand inflammation and so forth,
(14:51):
but equally, if not moreimportant, we need to look at
the balance of the other guyswhich, you know, let's face it,
even 10 years ago we couldn'teven see half of what these guys
were doing or, you know, didn'tknow what roles they had, and
we can talk about differentspecies that sort of make up
that commensal ecosystem as wego.
So to answer the question, yeah, if we can do both, we'll get
(15:15):
an understanding of where theproblems are Sometimes it's very
classic that it is all smallbowel and we'll get a positive
breath reading for SIBO andyou'll usually understand that
from the interview with thepatient.
You know, oh, I eat, and it'sonly half an hour to 45 minutes
later that I'll get a lot ofsymptoms, versus the person that
says a lot of my symptomshappen in the PM hours of the
(15:38):
day, the back end of the day,you know, I kind of wake up, I
go to the bathroom, I do mybusiness.
The first half of the day isokay.
Later on in the day is when Istart getting, you know, quite a
lot of signs and symptoms.
Yeah, so we can tell.
You know, by questioning we canget a pretty good idea.
But ultimately the testinghelps us elucidate the specifics
(15:59):
.
Speaker 1 (16:00):
Gotcha, and so you know we're talking about
microbial testing.
What about other sort ofinflammatory markers, for
instance Calprotect?
And you know we can go and go,but what do you tend to rely on
most or what do you find is mostuseful?
What do you find is most useful?
Speaker 2 (16:19):
The testing I'm currently using.
I really love the fact that weunderstand the species you know
down to, you know, a reallyreally definitive level, so what
pathobionts and what you knowcommensals are in the gut.
But we also have an array ofdigestive markers and
inflammatory markers, like youmentioned, which is very handy.
And you know, even five yearsago that information was just
(16:41):
starting to be sort of, you know, more common, very handy, and
even five years ago thatinformation was just starting to
be sort of more common to a lotof the different reports that
we use.
And that's where thatinformation is really helpful
for me with patients.
So, yes, I love to know whatspecies are present in someone's
gut.
Equally important, as I saidearlier, is what the metabolites
you know are and what's sort ofwhat's being produced and
(17:03):
what's predominating.
So, for example, are we seeinglots of hydrogen sulfide gas
production?
Are we seeing lots of ammoniaproduction?
If so, what are the speciesthat are responsible for that
and what can we do about it?
And it's really interesting,andrew, when you interview
different patients that are ondifferent types of diets.
You know you interviewdifferent patients that are on
different types of diets.
You know you can usually tellby their biome reports how
(17:24):
they're eating and you know bywhat sort of species are
overrepresented orunderrepresented and we can get
into the specifics of that.
But you know, 2024, it's verypopular for people to be on
these extreme ends of the dietspectrum.
So we can, as I say, we can seea lot from the biome, the
impact of that, whether you knowsomeone's having issues with
(17:45):
breaking down all the proteinand the fat that come from a
more sort of paleo-esque type ofcarnivore type of approach,
versus someone who's on more ofa plant-based diet.
Speaker 1 (17:56):
Yeah, Do you ever use a particular food or group of
foods as like a challenge to seeif a particular forgive me that
the type of bacteria might besitting there quiescently and,
(18:18):
like you said, you know they,the patient tends to get
symptoms later in the day.
You might be seeing them in themorning, but do you ever say,
listen, why don't we challengewith this sort of food that you
ordinarily have at lunchtime,for instance, that you don't
have at breakfast, to see if youcan elicit a response with your
testing when you do the test?
Or actually, no, that doesn'tmake sense, does it?
(18:41):
Because the test is done by thepatient at home.
Speaker 2 (18:45):
It's interesting, it's a great question.
What I often do, andrew, is Isay to them I paint a bit of a
hypothetical scenario and I say,all right, I want you to
envision yourself eating a bowlof chickpeas for lunch today.
And you can usually tell by theexpression on their face the
folks that might have you knowthe presence of SIBA.
They usually say, oh no.
(19:06):
Straight away they startshaking their head no, that's
going to be disastrous.
Oh no, very, very soon.
If I tried to do that, the lasttime I happened to do that at,
you know, x, y and Z was quitedisastrous.
On the flip side to that, whenwe've done a lot of, you know, a
lot of treatment and we've putthem through various protocols
(19:27):
to balance out the ecosystem,one of the foods that I do use
as a bit of a proxy is blackbeans and I explain to them
these are, you know, probablythe most gentle out of the
legume kingdom, great prebioticcontent.
And I say start with a smallhandful, cook them really,
really well, soak them if youcan, and see how you react.
Give yourself a few daysbetween and then try again, and
(19:47):
we just try and build up thetolerance.
I've had patients come in thatyou know they've been through
all sorts of antibioticcocktails and told they've had
parasites and it's just kill,kill, kill for years and years,
to the point to where they're onliterally four or five foods
and bringing those patients backcan be quite challenging.
But those usually are thepatients where it's just a mess
(20:09):
with those metabolites.
So we're seeing elevated levelsof branched-chain amino acids,
hydrogen sulfide, ammonia,histamine and a lot of the
critters that sort of secrete.
These metabolites are quiteabundant and it's a slow and
steady process with those guysto get them back to normal.
Speaker 1 (20:28):
Gotcha.
Can we go through some of these, testing these metabolites in
greater detail?
Ammonia, for instance,calprotectin, but there's others
as well.
Speaker 2 (20:40):
It's calprotectin, but there's others as well.
Yeah, definitely, yep.
So secretory IgA I alwaysexplain to folks is an
interesting marker that's madein the mucin.
It's kind of like the policetask force and we're looking at
levels between sort of 500 to2000 micrograms per gram as
being sort of the normal range.
If we see it quite low andunderneath and underrepresented,
(21:02):
it's kind of that immunedepletion picture and you do see
that it's probably rarer thatyou see that.
Quite often what I'm seeingmore commonly is the elevated
presence of secretory IgA andwhen we see that we're usually
correlating that with adysbiotic picture or an
auto-inflammatory picture.
So the task force are just onhigh alert.
(21:23):
Essentially that's how Iexplain it to people.
In line with that, faecalcalprotectin is a great marker.
That's the one that mainstreamGI specialists will often use to
look at IBD patients andmeasure different interventions
and pharmaceuticals and whatnotto see if it's active or in
remission.
But as naturopaths again,that's kind of a great marker
(21:46):
that we can utilize to look atwhether people are kind of in
the clear for very full-oninflammation or they're in that
borderline kind of area which is, I think, around 50 to 100.
So when there's that borderlineresult, sometimes it is useful
to send them off to a GIspecialist for an opinion,
certainly when it's over 100,we're doing that regardless of
(22:08):
what we're doing as naturopaths,to explore the underlying cause
there, sort ofauto-inflammatory IBD kind of
case where there is very overtinflammation.
But even then, you know, asnaturopaths I like to think that
there's a lot of nutraceuticaltools that we can use to
(22:29):
intervene or add, as you know,adjunctive therapies there to
help drive that down.
And I've seen that quitecommonly, even with just good
old curcumin at the right dose.
Speaker 1 (22:39):
And Dan, what about ammonia, for instance?
Speaker 2 (22:43):
Yeah, ammonia is an interesting one.
It's an emerging metabolite andI always sort of make a point
when I get a patient throughthat is on a more.
I mean, yeah, athletic diet,carnivorous diet, paleo sort of
diet, however you want to referto it, but a diet essentially
where there's, where there's notmuch of that fermentable
carbohydrates coming in and itis quite protein and fat heavy,
(23:06):
which can be great short termfor metabolic reasons, but long
term, for the microbiome canstart to tip the balance.
And this is where branch chainamino acids, ammonia and
hydrogen sulfide and histaminecome to think of it.
The four of those can be quiteelevated and it's an interesting
one because the patient doesn'tnecessarily have a whole heap
of gut symptoms always in thatcase, and it can be quite
(23:27):
different.
And what I mean by that is forsome people high ammonia can
just mean brain fog, for anotherperson it can be chronic
fatigue, for another person itcan be achy joints, and so that
sort of highlights theimportance.
For another person it can beachy joints, and so that sort of
highlights the importance aboutlooking at these metabolites
and understanding that themicrobiota isn't just simply the
composition of what speciesmake it, it's how your diet is
(23:49):
interacting with those speciesand then what compounds they're
producing, and I always explainto patients those compounds that
they're producing can either beanti-inflammatory and driving
your health, or pro-inflammatoryand driving your health, or
pro-inflammatory and degradingyour health.
And, of course, there's alwaysgoing to be a balance.
It's an ecosystem, after all,with hundreds and hundreds of
species, um, but looking at thatdata is quite valuable.
(24:13):
Um, I've said it already on thepodcast today, but even five
years ago, uh, we, we weren'table to see much of that in
terms of the metabolitesproduced and therefore it was
more just focusing on whatspecies were present and whether
we had enough good guys andquite unquote bad guys in a
balance.
But I do use that data when Ifollow up and do another repeat
(24:35):
test, which I usually recommendeither six to 12 months later,
if the budget's there, and it'sreally interesting to see what
interventions work to balancethat out.
Speaker 1 (24:45):
Great Anything else that we need to be aware of with
regards to the metabolites,because these are really, these
are interesting to me, reallyinteresting.
Speaker 2 (24:55):
The other one is hexa-LPS, so lipopolysaccharide,
and you, it's, it's thecitrobactors and the e-colis and
uh, klebsiella's and thesetypes of pathobionts that, when
they get too high, make thisthing called endotoxin or
liposal lipopolysaccharide, andit's.
It's not something where thebugs are trying to to harm us,
it's just how our immune system,um, you know, surveys them and,
(25:18):
in response to them, if they'retoo high, will produce more
inflammatory compounds as aresult.
But elevations of thesepathobionts is, you know,
typically what we see drive thesort of Western dysbiotic gut,
and then from there you can thenargue, you know, we're seeing
offshoots to various diseaserisk conditions such as obesity,
type 2 diabetes, parkinson's,you know, and a plethora of
(25:41):
other conditions that wouldn'tever been linked to the gut
microbiome 10, 15 years ago.
Even so, it's quite exciting tosee that sort of space, you
know, evolve.
Speaker 1 (25:52):
Can I ask you, with people who are neurodivergent
for instance, they tend to havean overabundance of the
clostridiaceae Are there anythings that we need to be aware
of, apart from identifying thatoverabundance, for instance,
(26:13):
metabolites, particularmetabolites they may throw out?
Is there anything that we needto be aware of with regards to a
?
Um, these people who have theseconditions and their gut
scenario, if you like, but alsohow we intercede with them?
Um, that's a bit of a broadsword, that question, isn't it?
(26:36):
How, um, what can we see if wedid testing on neurodivergent
people?
Is it plain as day or is itnuanced?
Speaker 2 (26:46):
When you ask that, I think straight away back to a
case I saw about a year agowhich was an autism case and I
don't treat that presentationclinically often.
It has obviously cropped upover the years a couple of times
but it's certainly not my areaof specialty.
But I do recall when we didshotgun metagenomics testing on
this particular case I think itwas the prevotella species or
(27:09):
the e-coli was making on its own, I think, almost half of the
microbiome.
So the abundance of thatspecies or that genus, the
microbiome, so the abundance ofthat species or that genus, was
that represented um, which wasthe highest I've ever seen.
I've not, I'm not aware of youknow, whether that's a classic
finding for that sort of, youknow, neuro archetype, but I
(27:31):
just remember thinking that thatis very significant and and
it's quite likely that that isadding you know, degree of you
know what would you call itinfluence on how that sort of
condition plays out.
Speaker 1 (27:48):
Gotcha Any other metabolites that we need to be
aware of.
Speaker 2 (27:53):
The only other one I think about is mucin degradation
, and that's again a newer sortof kid on the block.
But the gut obviously, as weknow, makes mucus, it sows and
reaps mucus and there needs tobe a good turnover and balance
of that for protective reasons.
But when there is a lack ofthat fermentable fibre, the
critters in the biome will go tothat as a fuel source and thin
(28:16):
the gut wall and therefore makethe walls of the gut in the
large intestine more thin andleaky.
You know, and as we know, leakygut is kind of uh and
permeability is a is a precursorto a lot of these.
You know western, you know typeof conditions that we're seeing
.
You know massive amounts of.
So, um, I think that does comeback to the conversation about
fiber.
But then it's from there.
(28:37):
It's like fiber isn't just thethe one thing.
It comes in all differentshapes and sizes, as um one of
my mentors, jason horlach, likesto quote all the time.
It's so true I I use that oftenin consults, even today.
Get people thinking about youknow, away from thinking that
fiber is just this thing thatcomes in cereal, uh, which we
all grew up in the 80s and 90s.
Thinking of.
You know the kellogg's fiber,uh that.
(29:01):
You know thinking aboutpolyphenols and you know blacks
and purples and blues and thecolors of the different skins on
various fruit and veg asmicrobiome feeders.
So you know that's getting backto the 40 plants a week, 50
plants a week type ofconversation and I always make a
point to say you know, I'm sonot a practitioner, who's is
more plant geared.
(29:21):
I believe in the power ofanimal protein as well, but
there just needs to be a goodbalance of both at the end of
the day um, so that was going tobe my next question.
Speaker 1 (29:29):
It's sort of you know , we always talk about when.
When we're talking about goodbacteria feeding good bacteria,
it is always an only plant food.
But there is a balance.
We are omnivore, omnivores,sorry, vegans, I'm gonna get
lambasted, I know, but but ifwe're talking that, then surely
(29:53):
a there's obviously thatcritical balance.
But surely bacteria that arefed by meat, proteins and fats
are not in and of themselves bad.
It's just this abundance,correct.
Speaker 2 (30:11):
Exactly right, exactly right, bad, it's just
this abundance, correct, exactlyright, exactly right.
And I mean the reality is thatin non-civilized, non-western
nations, hunter, gatherersocieties, when they looked at
the, the biomes of these people,um, who, by the way, when they
make a kill, are going to gorgeon animal protein, um and and
preference it, yes, that said,they're not going to make kills
every day and have meat forbreakfast, lunch, lunch and
(30:33):
dinner.
So that comes back to theconversation about well, there's
these fallback foods, which arethe plant foods, and the tubers
and the berries, and the nutsand seeds and that sort of thing
.
So if we try and reflect that,which I look at everything
through an evolutionary lens,when it comes to health, that
makes sense that the dietideally is somewhere between,
(30:54):
you know, perhaps 60% to 70%plant fibres versus that 30% of
animal proteins.
Speaker 1 (31:02):
Yeah, yeah, I often describe to people who are
wanting to investigate the paleodiet, wanting to investigate
the paleo diet, and they thinkit's all protein I would say
hang on.
Cavemen didn't eat mammothsalong the way to killing the
mammoth.
The mammoth was the prize atthe end of it, but along the way
they had to eat tubers andberries and nuts, things like
(31:25):
that.
Speaker 2 (31:25):
That's a statement, sometimes for days on end.
Speaker 1 (31:27):
Lauren Cordain.
In fact, when he presented at asymposium, who was it?
Pete Evans.
Pete Evans begged to do themenu for that symposium and when
you go out there to lunch itwas largely plant food,
(31:48):
absolutely spectacular plantfood, with some you know
obviously generous amounts ofmeat.
But I wonder if part of theissue these days is not so much
what we're eating but how much.
Speaker 2 (32:04):
How much we're eating , how changed it is from its
natural state when it'sharvested, how it's stored,
where it's travelled from,what's added to it.
Yeah, all of those things, forsure.
And the abundance, yeah, theintake.
Speaker 1 (32:18):
Yeah, yeah, which is obviously my demise.
But, dan, can we go into alittle bit more depth about what
you use with most merit?
You've spoken about curcuminpreviously.
If we're talking about gutinflammation, you know you've
got classic things like fish oil, for instance, but even things
(32:41):
like food, like I've been keenlyinterested in these for years
and forgive me for rabbiting onabout them, but they're called
p-dens now.
So plant derived exosome,exosomal, like nanoparticles,
right, p-dens.
And the original one that Iinvestigated with gin was ginger
(33:04):
, so back then it was gingerexosome, like nanoparticles or
gilms.
What basically the message isthat the ginger plant, when we
eat it they butt off this littlevesicles packages that contains
(33:26):
RNA.
That RNA talks to the bacteria,the genes in the bacteria.
The genes in the bacteria thentalk to the genes of the human
to say settle the hell down.
It was really interesting.
Well, that was my mouse study.
They're now investigating theseplant-derived exosome-like
(33:47):
nanoparticles, p-dense, for drugdelivery and what they found
was that they dampenedinflammation.
They made an anti-inflammatorymedication safer and more
efficacious.
I'm keenly interested in this.
So you mentioned before aboutJason Horolak talking to you
that fiber isn't just the cerealfiber, that it's in a heck of a
(34:11):
lot of other foods.
Do you find that you selectcertain foods to elicit certain
responses at all, like youmentioned, endotoxins, lps.
Speaker 2 (34:29):
Yeah, yeah.
So look, I'm one of thosepractitioners where I like to
use a combination of of,obviously, diet and, and the,
the medicines, and, but I Ialways try and place more
emphasis on what they can do inthe diet, because everyone not
everyone I should say, but mostpeople are very much geared
towards the what's the latestand greatest, you know what's
(34:51):
the silver bullet.
But I always say to people,when it comes to microbiome
resolution or balance, there'sso much that you can achieve
with just dietary changes, andit's actually the doing part
where people fall down.
So the education can be theretill the cows come home.
You know, I've got all thesecharts of here's your black
foods, here's your red foods,here's your purple foods.
When you're doing your shopping, just simply try and add more,
(35:12):
you know, and just work your wayup slowly.
But being conscious of that ona day-to-day basis and then
being consistent with that isthe challenging part.
But for the folks that do it,we can see massive changes in
diversity, for example in thegut microbiota.
But to answer your questionspecifically, one of my
favorites and again I have tothank Jason Horolak the Big Mac
(35:34):
Horolak as I like to call himfor this one, but it's the
pomegranate peel.
So the peels of the pomegranateand there was even a time where
I actually broke them down andgot a big delivery of these
beautiful biodynamicpomegranates, saved all the
peels, cut them up, you know,put them in the blender,
dehydrated them and I wentthrough two you know, huge tubs.
(35:56):
It took me about two years toget through them, mind you, but
not everyone has to go to thatlength.
But you can purchase thatonline, you know, quite easily.
So that's one example.
The black beans, which wealready mentioned, and I think
it comes down as well to sayinghey, you know that sweet potato
you eat.
Yeah, try and get the purpleversion.
Hey, you know that rice thatyou have three or four times a
(36:16):
week, try and get the black andred version as well.
And you just get them thinkinglike that, just to diversify the
colour palette coming in, andthe effects are quite good.
Another one is the EGCG fromgreen tea, such a basic thing
that you know just gettingpeople sold on.
If you just have a very strongcouple to daily of green tea,
(36:37):
that goes a long way, not evenjust with the biome but outside
of the biome.
So those are my favourites fromthe sort of culinary, dietary
perspective.
In terms of the nutraceuticals,I'm very jazzed and excited
about the non-dairy serumderived immunoglobulins, um the
(36:58):
the people that come throughthat are dairy sensitive, that
their faces light up when youtalk to them about a dairy-free
colostrum alternative and itworks wonders.
I've seen great results beforeand after with leaky gut testing
using the lactulose mannitoltest and just in those patients
like we're talking about earlier, like myself a long time ago,
(37:18):
that are just not thriving, thatjust have a really beat up gut
and you're pretty sold on thegut permeability as a core
factor there, such a greatgentle.
Additional tool In addition tothat again, something I'm
playing around with more andmore these days is the human
milk oligosaccharides, 2-fl or2-fucosyl lactose, which is
(37:39):
naturally occurring in mother'smilk.
Using more and more of that Inthe prebiotic kingdom, which I
do more and more of once againand it's not that I don't use
probiotics still, but I kind ofhave a limited range of single
strain probiotics that I kind ofstick to.
I could probably count them onone hand, but outside of that
it's more about the prebiotics.
(38:01):
Inulin is one of the favouritefor the folks that can tolerate
it, and coming back to thosemarkers we were talking about
earlier Andrew, great forattenuating that.
Calprotectin, even when that'sborderline or raised, does a
great job.
Secretory IgA, when that'selevated.
There's good research withgalacto-oligosaccharides or GOS.
(38:21):
Partially hydrolyzed guar gumis another favorite and that's
the one that I usually go inwith prior to knowing what the
biome looks like.
Irrespective of that, we sayget your sample sent off and,
regardless of what comes in,let's just get you started on
this guar gum stuff and we'lljust start you off nice and slow
and gentle.
Speaker 1 (38:42):
Can I ask about tolerability?
So, patient compliance I guesswe're talking about here.
But when we're talking aboutsome of these fibres, like, for
instance, banana fibre, there'sa sugarcane fibre, really hard
to mix, they're hydroscopic,they float on top and as soon as
you put the spoon in they gopoof.
So, with regards to patientcompliance, do you ever talk to
(39:06):
them about?
Listen, you know, this is howyou take this sort of fibre,
whether mixing it in with a food, or indeed, well, mixing it in
with a food on their plate, ormixing it in with, like a
condiment, like, for instance,applesauce or something like
that.
Yeah, do you ever employ thesetactics?
Speaker 2 (39:24):
Absolutely.
The first one that comes tomind and I happen to have it
right here in front of me forthose folks watching is the
inulin and the cell.
That I say is it tastes likefairy floss, and it actually
does.
And um, that's, that's what Isay to the, the mums and the
dads for the, the kids that Isee.
You know, you can literally getthem to just spoon it straight
into their mouth and it doesn'tnecessarily require that water,
(39:45):
um, although it can go in water,but the compliance has been
great with that.
I mean, you can just get itstraight into the mouth and it's
got that really nice, naturallyoccurring sweetness.
So inulin is great for that.
With the guar gum, I usually saythat's quite seamless, so it'll
go into everything To yourpoint.
The resistant starch, that's aharder one, a trickier one.
So smoothies are great.
(40:06):
You know, if we can get thepatients doing three or four
smoothies a week and get agenerous dose of the, the rs, in
there, um, which which is aprebiotic that you you can go
quite high with, or or you getquite better outcomes.
I find when you go like morearound the sort of 10 to 15 gram
mark, even for some folks andwith some of those patients.
(40:28):
It's important to note too thatsometimes with prebiotics the
needle doesn't move until youget up to those sort of levels,
and that's something that overtime I've had to get really
comfortable with and sort of goout on a bit of a limb.
So three or four years ago itmight've been let's just start
you on five grams or a teaspoonand just kind of leave you there
(40:49):
for weeks to months and seewhat changes, as patients come
back and say that they'retolerating it, though I'm each
time now getting them to up itand push the envelope to that
level, to just below where theremight be a bit of discomfort,
and for some patients it'salmost like they just turn a
corner at that 10 gram mark withinulin or partially hydrolyzed
(41:11):
guar gum.
It's quite interesting.
Speaker 1 (41:14):
Right, I know this is going to be a multi-pronged
question, forgive me, but withregards to other things that you
might employ, if we're talkingabout healing an inflamed gut,
you've got things like zinc,obviously.
You've got the zinc carnosine,for instance, which has its own
action with healing lesions.
Let's say, um, we've got tothink about even, you know,
(41:38):
liver herbs, for instance,helping with digestion, with
bile flow.
And then the second sorry aboutthis double prong thing is, if
we think about the effect ofstress on the gut and we think
about how it can be deleteriousto healing the gut, how much do
you employ, let's say,anti-stress herbs or the, you
(42:00):
know, the nerve ions, theadaptogens, in helping somebody
to cope with the stressors oflife while they're healing their
gut?
Speaker 2 (42:10):
I'm glad you asked.
It's huge.
Speaker 1 (42:14):
I think you're going to hate me.
Speaker 2 (42:16):
Not at all.
Not at all, because it's one ofthose things that it's very easy
to overlook Mindfulness,nervous system balance,
parasympathetic versussympathetic, the role of the
vagus nerve between the brainand the gut, which you know over
the years I always think ofyour conversations with Mark
Donohoe that you guys havetalked about that ad nauseum,
(42:39):
and it's so true.
You know that the power of thevagus nerve and what the nervous
system can influence in thesecases, that was very, very like
specific to my healing too,andrew.
So you know there were periodswhen I think back to my journey
where I'd come good and then I'd, you know, get poorly again and
then come good, and if I hadhave known about the nervous
(43:01):
system back then, I think Icould have done a lot more.
Um, very easy to say now inhindsight, but uh, yeah, just
the power of you know varioushealing modalities, even just
you know walking in nature 20minutes a day, something so
simple, the breath work, and I'msure we're preaching to the
choir when we go on about this,but I concur 100%.
(43:24):
You know the amount that we canachieve just by you know the
mindfulness and these sorts ofyou know parasympathetic
practices, equally important asjust the medicines that they're
recommending?
Too Sure.
Speaker 1 (43:39):
You mentioned retesting earlier.
Can you just give us a littlething about the benefits of
managing somebody'ssymptomatology, tracking their
progress of therapy versus thecost of therapy?
How do you sit?
Speaker 2 (43:54):
Yeah.
So it's something that I don'tentertain, like if someone says,
oh Dan, I want to jump back inthere and have a look at what
we're doing and see if it'schanged.
I say, listen, we can do that.
It's probably not worth doingthat in terms of the invest, the
financial outlay until aboutthe six-month mark.
You know, realistically andthat might differ from patient
to patient slightly, but how Isort of approach that
(44:18):
conversation, I suppose, as Isay, although it is quite a big
investment doing that, retestingat the six-month mark or the
nine-month mark, that mightallow us to cut down your
supplement intake by half.
So then it's like you work outwhat you're paying in
supplements.
You know whether there's six orseven things that we started
with.
We might only need two of them,you know.
But ultimately using yourpresentation along with the
(44:41):
results, will ultimately guideus there.
And I will usually preface thatwhen we do the first round of
testing by planning that seedand say now, this is good data,
we've got a benchmark.
Now.
Speaker 1 (44:57):
Let's earmark it for six months that we do another
test.
Dan, I have to ask where can welearn more?
Do you have any e-courses oranything like that that you
provide to practitioners, oreven patients at all, to learn
from?
Speaker 2 (45:09):
It's funny.
You ask I'm in the um processof putting slowly together an
online autoimmune masterclassand um, that's something that's
been on the mind for years, soit's taken me a while to to get
into action.
But, um, yeah, I, I, I planlater this year, early next year
, to to put that out.
So my, my main sort of onlinepresence is through Instagram.
(45:32):
That's where you can find meand reach out.
And, yeah, practicing stillMonday to Friday I do my four
patients a day, with gaps inbetween, and just keep it at
that and that's how we tend tomanage it.
But yeah, so look out for thatto come out online and also the
website functionalnaturopathcom.
Speaker 1 (45:54):
Love it, dan.
We could learn so much morefrom you.
Thank you so much for taking usthrough gut inflammation
markers and management today.
I really appreciate it, mypleasure.
Speaker 2 (46:03):
Good to chat to you, Andrew.
Speaker 1 (46:06):
And thank you everyone for joining us today.
Remember you can catch up onthe show notes for this podcast
and they will be lots, plus allthe other podcasts on the
Designs for Health website.
I'm Andrew Whitfield-Cook.
This is Wellness by Designs.
Music.
This is Wellness by Designs,and I'm your host, andrew
Whitfield-Cook.
Joining us on the line today isDan Sippel, a naturopath,
herbalist and nutritionist.
Today, we're going to betalking about gut inflammation
markers and management.
Welcome to Wellness by Designs,dan.
How are you?
Speaker 2 (00:38):
Very well.
Thank you, mate.
Thank you for having me.
Speaker 1 (00:40):
It's a pleasure to be here I wish I was there, where
you are down on the south coastof New South Wales.
It's a pleasure to be here.
I wish I was there.
Where you are down on the southcoast of New South Wales, it's
a favourite place of mine in theworld.
Speaker 2 (00:50):
Yes, yes, we're very lucky.
Down here in the south it'scold in the winter, but the
sun's been shining all week, sowe can't complain.
Speaker 1 (00:59):
Beautiful Dan.
Can I start a little bit withyour career?
What's your background?
How did you arrive at aninterest in naturopathy and
herbalism?
Speaker 2 (01:10):
Yeah, sure thing I'll give you the concise version,
andrew, otherwise we'd probablybe here all day years ago now
and I'll sort of do my best topaint the picture.
But it was the good old sort ofEpstein-Barr virus into.
You know, never will sensescenario for me.
(01:31):
So not uncommon, as you know,in our industry, but yeah, just
definitely that path of illnessto kind of discovery and then
eventually recovery.
So high school certificate year, year 12, lots of pressure.
High school certificate year,year 12, lots of pressure, hsc
and all the things.
And I come down with a prettyheavy case of glandular fever at
(01:53):
the time and two weeks laterthat sort of you know eventuated
and two weeks later I was backdoing my HSC.
So it was all quite fast andhappened very quickly.
But point being, I sort ofdidn't recover well after that
and for the next two years I wassort of doctor shopping, if you
like, and just kept gettingtold the same old thing that you
(02:13):
just need to rest your body,you're still getting over
Epstein-Barr.
And yeah, as I say, it got toabout the two year later mark by
the time I was about 19.
And I could just definitelytell that something else was not
quite right Just wasn'tthriving.
Lots and lots of upperrespiratory tract infections,
(02:33):
fatigue, brain fog, you name it,but certainly wasn't presenting
in a typical way that you wouldto suspect that there was an
underlying gut sort ofauto-inflammatory process
happening.
So I was eventually diagnosedceliac.
When we changed gears a littlebit and saw an integrative
doctor, she ran a barrage oftests and found those celiac
(02:56):
antibodies quite raised and sofrom there it was a big aha
moment and a lot of relief.
And you know, going down thepath of the GI specialist and
the okay, you need to be on agluten-free diet for life and
this is how we manage thecondition.
But you'll do that and lifewill return to normal and you
know we'll never hear from youagain.
(03:16):
Basically, everything will goback to normal within a matter
of weeks to months.
For me that was not the case and, uh, I, I, I guess over the the
course of the next few years,kind of worked that out and and
went on a bit of a journeybecause it was recovering from
all the damage that that I'dtaken.
Um, throughout that period ofmisdiagnosis, with subsequent
(03:37):
antibiotics, just one after theother, boom, boom, boom.
So lots of antibiotic cocktailsand and by that time in my
early 20s, I was quite beat up.
So the gluten-free dietdefinitely helped initially, but
I quickly worked out that itwas kind of the end of the road
with the modern medicineapproach as far as celiac
recovery and management went.
(03:58):
This is where I started learningabout gut dysbiosis and the
microbiome and more sort ofintegrative approaches.
So that sort of evolved into areally keen interest and I
worked out by probably the ageof 23, 24, that, yeah, just that
that I had a really keeninterest in the science side of
(04:19):
it and learning about theautoimmune and gut connection
and so forth and eventuallystarted studying it in my
mid-20s, took up thenaturopathic degree through
Endeavor and did that over thecourse of the next five or six
years on and off, and I wasstill working at the time so
started practice at the age of30.
I'm 37 now, so this is myseventh year in practice and we
(04:42):
moved down from Sydney down tothe south coast when I started.
So what's that?
Yeah, seven years ago, and fastforward to 2024, and here we
are.
Speaker 1 (04:53):
Can I go back to the diagnosis?
What was it that twigged inyour doctor's mind to test?
Because you know you've gotthat age bracket.
You know the sort of late orsort of mid to late teens.
The high school certificate isthe classic, the hormones around
(05:15):
that era and the stress.
So that perfect storm is whenEBV just knocks people.
But how many get tested and howmany don't?
Speaker 2 (05:28):
so what was it?
where your doctor said, listen,we need to test, we need to find
out I can remember going in Iwas still under the care of my
my folks at the time and I canremember going in to to this
particular integrative doctorwho I maintained a great
relationship with for yearsafter, and doing the old
palpation on the gut.
It was probably the first timethat my mother was saying he's
(05:52):
not thriving.
There was that word and I waslike what does that even mean,
daniel's not thriving?
And it made sense.
It was like in all aspects itjust was like I hit a sort of
roadblock and prior to that,mind you, there were no signs or
symptoms to alert us toanything celiac related.
So I didn't have the classicpicture with gut symptoms and
(06:13):
that's probably why it wasmisdiagnosed for so long.
For me it was more fatigue,brain fog, extreme, extreme
brain fog.
So it was a very cerebralpicture, um, recurrent
tonsillitis, which was whyprobably EBV kept getting blamed
, you know, for the um, for theillness, and, and whilst that
might have been partially true,um, the celiac was kind of there
(06:35):
, you know, bubbling away in thebackground.
So malabsorption, you know,then ensued.
So it was eventually I had toget really, really low for it to
be recognized.
So we're talking about, youknow, getting to the level of,
you know, weight loss, grayingof the skin, not leaving the
bedroom, yeah, very, veryrecluse.
And so that, I think, tippedthe doctor off to the fact that
(06:57):
there could be an absorptionissue.
And that was the first timethose antibodies were run.
And sure enough they were skyhigh yeah high yeah yeah.
Speaker 1 (07:05):
So what's really interesting to me is, you know,
fatigue in in a teenager.
Obviously we think about ironfirst, but if there's
chronically low iron then you'dgo, uh, absorption celiac.
Was there any hint of low ironthroughout your earlier years or
any hint of like breathlessness, or you, you know,
(07:27):
underperforming when you didsports day or anything like that
?
Speaker 2 (07:31):
The latter Exactly.
So what, where I really knewsomething was wrong, was I was
trying, you know, with mylimited knowledge at the time to
quote, unquote get well.
So that meant for me liftingweights and trying to, you know,
build my body and just buildback.
But when I do that I would gocatabolic.
I would actually break down andsometimes for weeks, and then
(07:51):
I'd come kind of good again.
So I'd do it again and thatpattern kept happening.
So, once again, that's where,you know, I eventually had to
just keep pleading with theoldies.
Something is wrong, I'm tellingyou, and it's not just
glandular fever, you know.
With the oldies, something iswrong, I'm telling you, and it's
not just glandular fever, youknow, yeah.
So, like I said, I did have toget quite low for the
practitioners to think outsidethe box and I've always carried
(08:12):
that with me, even as anaturopath.
Now, to never I mean obviouslyI'm biased, being a celiac but
to never disregard theimportance of running that
celiac serology when you'reseeing that sort of not thriving
picture and the amount of timeswe've seen, you know, even low
level active antibodies and youwouldn't otherwise suspect it.
(08:33):
Then you get your classic caseswhere it's very, very, you know
, true to classic sort ofhallmark celiac symptoms.
Speaker 1 (08:38):
Yeah, can I ask you something you just mentioned
before and you said it as if itwas inconsequential, but it's
got to do with labels.
You said I'm a celiac versussomeone who has celiac disease.
Yeah, do you know that, thatyou know where, where the
disease becomes the person, ifyou like.
(08:59):
Does that bother you?
Speaker 2 (09:03):
it did for a long time.
It doesn't now, I think,because it's been so long, so
it's been over half my life andum yeah the awareness now is
very, very, you know, differentto what it was 20 years ago.
So it definitely did for a longtime.
Um, and I've it's interestingyou bring it up, because
sometimes I do say thatunknowingly and um, it's
something that I don't thinkabout anymore, but I often catch
(09:26):
patients saying it you know,I'll talk to them about that
that sort of that mindset andchanging their terminology.
So, yeah, it's, it's a quiteimportant thing to to raise to
people that feel that they've, Iguess, been, you know, dealt,
you know a bad card or you know,that sort of victim mindset.
Speaker 1 (09:50):
Yeah.
So I guess where I'm goingthere is because you're
proficient in what you do.
You have a level of comfort.
It doesn't define you.
You're quite fine with it.
But for somebody who'sinvestigating this along their
journey, they might be a littlebit touchy on the subject.
Is that how you felt and whatyou see in your patients?
Speaker 2 (10:09):
It was yeah, yeah, like I say, for a long time, and
I think it's more in the socialsettings that it becomes quite
apparent.
You know, at home it doesn'tbother you Quite often, the
whole household will just begluten-free and it's not
something that you tend to thinkmuch about.
Um, but it's sort of thosesocial settings where the rubber
meets the road, where you knowyou'll be.
You know, classic one is you'resitting at a a big, um, you
(10:32):
know dining table at arestaurant, you're doing the
order and it gets to you and allthe attention's on you and, uh,
you know you.
You say can I please have the?
The?
You know the item on the menuthat's marked chef?
Oh and, and, by the way, I'mceliac.
Can you let the chef know?
So that's where you getreminded, yeah.
Speaker 1 (10:49):
Yeah, but do you find there is a greater awareness
now that it's?
I mean, we should have had thisfor at least 10 years minimum,
but do you find that there's annot awareness, acceptance,
indeed care, by eatingestablishments, food
establishments that know nowabout what a celiac is?
(11:10):
No, you can't sneak that in.
No, it can't have a little bit.
Speaker 2 (11:14):
It's got to be zero it's definitely, it's definitely
improving, um, and I alwaystell people, um, despite that
and the awareness, you got toremember that you know the, the
waiter takes your order, it thengoes to to the kitchen, which
is, you know, a separate area,and that's.
You know something that youneed to be very confident in.
(11:34):
So pick, pick your restaurantswisely, stick to the same.
You know routine and um, yeah,you'll avoid trouble and
fortunately for me, it's been,oh gosh, probably over a decade
since I've been gluten poisonedtouch wood.
Speaker 1 (11:49):
Gotcha.
Yeah, let's go into our topictoday because it's quite broad.
When we're talking about seeinga patient first for any sort of
gut issue, where do you start?
Where does the patient journeybegin with you?
Do you begin with testing?
(12:09):
Do you begin with you?
Know family history, patienthistory?
Do you start on like a fewsupplements first before you
test?
How does it look?
Do you start on like a fewsupplements first before you
test?
Speaker 2 (12:21):
How does it look?
I'd say it's probably differentfor each patient, andrew, but I
make a very strong point in myintake form to be very thorough
so that by the time I'm jumpingon the call with them I've got a
very well-rounded understandingof where they're at, their
family history, their currentsymptoms.
My intake form probably takes agood 10 to 15 minutes to fill
(12:44):
in.
So, as I say, by the time wejump on the call I've usually
got a whole lot of pathology notalways, but most often as well
to go with it.
So that helps me, after theinitial 45 minutes of
questioning, to sort of work out.
Do we jump straight intotesting, or has this person
already been to three or fourpractitioners and they've got a
plethora of decent testing, butthey're just after a different
(13:07):
opinion?
In that case we usually justjump into treatment.
But generally speaking, I dolike to start with testing.
I feel like it's a goodinvestment.
Um, five years ago maybe Iwould have said something
different, but with what we cansee of the microbiota and the
ecosystem now, I feel like thatmoney is quite well spent.
And I always say to the patientif we don't have the funds to
(13:28):
test, that's okay.
It's not a prerequisite, but ifwe can test, I can be very,
very specific with theapplication of different
nutraceuticals or prebiotics orprobiotics, without the
guesswork.
So it's that whole thing oftest and don't guess, I suppose,
mind you.
You know, after seven years andmy own personal history and and
(13:49):
just being in the health andwellness space for a while, a
lot of practitioners would agreeyou get a pretty good sort of
understanding of what tools arevery likely to be useful versus
others.
Speaker 1 (13:59):
Gotcha.
Speaker 2 (14:00):
Even without testing yeah, yeah, yeah.
Speaker 1 (14:03):
So what tests do you tend to favour?
What do you employ?
Speaker 2 (14:08):
If we're looking at the, yeah, if we're looking at
sort of understanding, well,first of all we've got to
understand is the patient'sdigestive symptoms in the small
bowel or large bowel or both?
So in an ideal scenario, if thefeasibility isn't an issue,
we'll do testing for smallintestinal bacterial overgrowth
via a series of breath tests andfollowed by then the stool test
(14:31):
, to give us a really good,well-rounded understanding of
the ecosystem, where we're notjust kind of fixated on looking
at pathogens but we're lookingat the balance of the whole
ecosystem.
And I'm quite, you know, in thecamp of.
You know, yes, we want tounderstand what critters are in
there that are causing dysbiosisand inflammation and so forth,
(14:51):
but equally, if not moreimportant, we need to look at
the balance of the other guyswhich, you know, let's face it,
even 10 years ago we couldn'teven see half of what these guys
were doing or, you know, didn'tknow what roles they had, and
we can talk about differentspecies that sort of make up
that commensal ecosystem as wego.
So to answer the question, yeah, if we can do both, we'll get
(15:15):
an understanding of where theproblems are Sometimes it's very
classic that it is all smallbowel and we'll get a positive
breath reading for SIBO andyou'll usually understand that
from the interview with thepatient.
You know, oh, I eat, and it'sonly half an hour to 45 minutes
later that I'll get a lot ofsymptoms, versus the person that
says a lot of my symptomshappen in the PM hours of the
(15:38):
day, the back end of the day,you know, I kind of wake up, I
go to the bathroom, I do mybusiness.
The first half of the day isokay.
Later on in the day is when Istart getting, you know, quite a
lot of signs and symptoms.
Yeah, so we can tell.
You know, by questioning we canget a pretty good idea.
But ultimately the testinghelps us elucidate the specifics
(15:59):
.
Speaker 1 (16:00):
Gotcha, and so you know we're talking about
microbial testing.
What about other sort ofinflammatory markers, for
instance Calprotect?
And you know we can go and go,but what do you tend to rely on
most or what do you find is mostuseful?
What do you find is most useful?
Speaker 2 (16:19):
The testing I'm currently using.
I really love the fact that weunderstand the species you know
down to, you know, a reallyreally definitive level, so what
pathobionts and what you knowcommensals are in the gut.
But we also have an array ofdigestive markers and
inflammatory markers, like youmentioned, which is very handy.
And you know, even five yearsago that information was just
(16:41):
starting to be sort of, you know, more common, very handy, and
even five years ago thatinformation was just starting to
be sort of more common to a lotof the different reports that
we use.
And that's where thatinformation is really helpful
for me with patients.
So, yes, I love to know whatspecies are present in someone's
gut.
Equally important, as I saidearlier, is what the metabolites
you know are and what's sort ofwhat's being produced and
(17:03):
what's predominating.
So, for example, are we seeinglots of hydrogen sulfide gas
production?
Are we seeing lots of ammoniaproduction?
If so, what are the speciesthat are responsible for that
and what can we do about it?
And it's really interesting,andrew, when you interview
different patients that are ondifferent types of diets.
You know you interviewdifferent patients that are on
different types of diets.
You know you can usually tellby their biome reports how
(17:24):
they're eating and you know bywhat sort of species are
overrepresented orunderrepresented and we can get
into the specifics of that.
But you know, 2024, it's verypopular for people to be on
these extreme ends of the dietspectrum.
So we can, as I say, we can seea lot from the biome, the
impact of that, whether you knowsomeone's having issues with
(17:45):
breaking down all the proteinand the fat that come from a
more sort of paleo-esque type ofcarnivore type of approach,
versus someone who's on more ofa plant-based diet.
Speaker 1 (17:56):
Yeah, Do you ever use a particular food or group of
foods as like a challenge to seeif a particular forgive me that
the type of bacteria might besitting there quiescently and,
(18:18):
like you said, you know they,the patient tends to get
symptoms later in the day.
You might be seeing them in themorning, but do you ever say,
listen, why don't we challengewith this sort of food that you
ordinarily have at lunchtime,for instance, that you don't
have at breakfast, to see if youcan elicit a response with your
testing when you do the test?
Or actually, no, that doesn'tmake sense, does it?
(18:41):
Because the test is done by thepatient at home.
Speaker 2 (18:45):
It's interesting, it's a great question.
What I often do, andrew, is Isay to them I paint a bit of a
hypothetical scenario and I say,all right, I want you to
envision yourself eating a bowlof chickpeas for lunch today.
And you can usually tell by theexpression on their face the
folks that might have you knowthe presence of SIBA.
They usually say, oh no.
(19:06):
Straight away they startshaking their head no, that's
going to be disastrous.
Oh no, very, very soon.
If I tried to do that, the lasttime I happened to do that at,
you know, x, y and Z was quitedisastrous.
On the flip side to that, whenwe've done a lot of, you know, a
lot of treatment and we've putthem through various protocols
(19:27):
to balance out the ecosystem,one of the foods that I do use
as a bit of a proxy is blackbeans and I explain to them
these are, you know, probablythe most gentle out of the
legume kingdom, great prebioticcontent.
And I say start with a smallhandful, cook them really,
really well, soak them if youcan, and see how you react.
Give yourself a few daysbetween and then try again, and
(19:47):
we just try and build up thetolerance.
I've had patients come in thatyou know they've been through
all sorts of antibioticcocktails and told they've had
parasites and it's just kill,kill, kill for years and years,
to the point to where they're onliterally four or five foods
and bringing those patients backcan be quite challenging.
But those usually are thepatients where it's just a mess
(20:09):
with those metabolites.
So we're seeing elevated levelsof branched-chain amino acids,
hydrogen sulfide, ammonia,histamine and a lot of the
critters that sort of secrete.
These metabolites are quiteabundant and it's a slow and
steady process with those guysto get them back to normal.
Speaker 1 (20:28):
Gotcha.
Can we go through some of these, testing these metabolites in
greater detail?
Ammonia, for instance,calprotectin, but there's others
as well.
Speaker 2 (20:40):
It's calprotectin, but there's others as well.
Yeah, definitely, yep.
So secretory IgA I alwaysexplain to folks is an
interesting marker that's madein the mucin.
It's kind of like the policetask force and we're looking at
levels between sort of 500 to2000 micrograms per gram as
being sort of the normal range.
If we see it quite low andunderneath and underrepresented,
(21:02):
it's kind of that immunedepletion picture and you do see
that it's probably rarer thatyou see that.
Quite often what I'm seeingmore commonly is the elevated
presence of secretory IgA andwhen we see that we're usually
correlating that with adysbiotic picture or an
auto-inflammatory picture.
So the task force are just onhigh alert.
(21:23):
Essentially that's how Iexplain it to people.
In line with that, faecalcalprotectin is a great marker.
That's the one that mainstreamGI specialists will often use to
look at IBD patients andmeasure different interventions
and pharmaceuticals and whatnotto see if it's active or in
remission.
But as naturopaths again,that's kind of a great marker
(21:46):
that we can utilize to look atwhether people are kind of in
the clear for very full-oninflammation or they're in that
borderline kind of area which is, I think, around 50 to 100.
So when there's that borderlineresult, sometimes it is useful
to send them off to a GIspecialist for an opinion,
certainly when it's over 100,we're doing that regardless of
(22:08):
what we're doing as naturopaths,to explore the underlying cause
there, sort ofauto-inflammatory IBD kind of
case where there is very overtinflammation.
But even then, you know, asnaturopaths I like to think that
there's a lot of nutraceuticaltools that we can use to
(22:29):
intervene or add, as you know,adjunctive therapies there to
help drive that down.
And I've seen that quitecommonly, even with just good
old curcumin at the right dose.
Speaker 1 (22:39):
And Dan, what about ammonia, for instance?
Speaker 2 (22:43):
Yeah, ammonia is an interesting one.
It's an emerging metabolite andI always sort of make a point
when I get a patient throughthat is on a more.
I mean, yeah, athletic diet,carnivorous diet, paleo sort of
diet, however you want to referto it, but a diet essentially
where there's, where there's notmuch of that fermentable
carbohydrates coming in and itis quite protein and fat heavy,
(23:06):
which can be great short termfor metabolic reasons, but long
term, for the microbiome canstart to tip the balance.
And this is where branch chainamino acids, ammonia and
hydrogen sulfide and histaminecome to think of it.
The four of those can be quiteelevated and it's an interesting
one because the patient doesn'tnecessarily have a whole heap
of gut symptoms always in thatcase, and it can be quite
(23:27):
different.
And what I mean by that is forsome people high ammonia can
just mean brain fog, for anotherperson it can be chronic
fatigue, for another person itcan be achy joints, and so that
sort of highlights theimportance.
For another person it can beachy joints, and so that sort of
highlights the importance aboutlooking at these metabolites
and understanding that themicrobiota isn't just simply the
composition of what speciesmake it, it's how your diet is
(23:49):
interacting with those speciesand then what compounds they're
producing, and I always explainto patients those compounds that
they're producing can either beanti-inflammatory and driving
your health, or pro-inflammatoryand driving your health, or
pro-inflammatory and degradingyour health.
And, of course, there's alwaysgoing to be a balance.
It's an ecosystem, after all,with hundreds and hundreds of
species, um, but looking at thatdata is quite valuable.
(24:13):
Um, I've said it already on thepodcast today, but even five
years ago, uh, we, we weren'table to see much of that in
terms of the metabolitesproduced and therefore it was
more just focusing on whatspecies were present and whether
we had enough good guys andquite unquote bad guys in a
balance.
But I do use that data when Ifollow up and do another repeat
(24:35):
test, which I usually recommendeither six to 12 months later,
if the budget's there, and it'sreally interesting to see what
interventions work to balancethat out.
Speaker 1 (24:45):
Great Anything else that we need to be aware of with
regards to the metabolites,because these are really, these
are interesting to me, reallyinteresting.
Speaker 2 (24:55):
The other one is hexa-LPS, so lipopolysaccharide,
and you, it's, it's thecitrobactors and the e-colis and
uh, klebsiella's and thesetypes of pathobionts that, when
they get too high, make thisthing called endotoxin or
liposal lipopolysaccharide, andit's.
It's not something where thebugs are trying to to harm us,
it's just how our immune system,um, you know, surveys them and,
(25:18):
in response to them, if they'retoo high, will produce more
inflammatory compounds as aresult.
But elevations of thesepathobionts is, you know,
typically what we see drive thesort of Western dysbiotic gut,
and then from there you can thenargue, you know, we're seeing
offshoots to various diseaserisk conditions such as obesity,
type 2 diabetes, parkinson's,you know, and a plethora of
(25:41):
other conditions that wouldn'tever been linked to the gut
microbiome 10, 15 years ago.
Even so, it's quite exciting tosee that sort of space, you
know, evolve.
Speaker 1 (25:52):
Can I ask you, with people who are neurodivergent
for instance, they tend to havean overabundance of the
clostridiaceae Are there anythings that we need to be aware
of, apart from identifying thatoverabundance, for instance,
(26:13):
metabolites, particularmetabolites they may throw out?
Is there anything that we needto be aware of with regards to a
?
Um, these people who have theseconditions and their gut
scenario, if you like, but alsohow we intercede with them?
Um, that's a bit of a broadsword, that question, isn't it?
(26:36):
How, um, what can we see if wedid testing on neurodivergent
people?
Is it plain as day or is itnuanced?
Speaker 2 (26:46):
When you ask that, I think straight away back to a
case I saw about a year agowhich was an autism case and I
don't treat that presentationclinically often.
It has obviously cropped upover the years a couple of times
but it's certainly not my areaof specialty.
But I do recall when we didshotgun metagenomics testing on
this particular case I think itwas the prevotella species or
(27:09):
the e-coli was making on its own, I think, almost half of the
microbiome.
So the abundance of thatspecies or that genus, the
microbiome, so the abundance ofthat species or that genus, was
that represented um, which wasthe highest I've ever seen.
I've not, I'm not aware of youknow, whether that's a classic
finding for that sort of, youknow, neuro archetype, but I
(27:31):
just remember thinking that thatis very significant and and
it's quite likely that that isadding you know, degree of you
know what would you call itinfluence on how that sort of
condition plays out.
Speaker 1 (27:48):
Gotcha Any other metabolites that we need to be
aware of.
Speaker 2 (27:53):
The only other one I think about is mucin degradation
, and that's again a newer sortof kid on the block.
But the gut obviously, as weknow, makes mucus, it sows and
reaps mucus and there needs tobe a good turnover and balance
of that for protective reasons.
But when there is a lack ofthat fermentable fibre, the
critters in the biome will go tothat as a fuel source and thin
(28:16):
the gut wall and therefore makethe walls of the gut in the
large intestine more thin andleaky.
You know, and as we know, leakygut is kind of uh and
permeability is a is a precursorto a lot of these.
You know western, you know typeof conditions that we're seeing
.
You know massive amounts of.
So, um, I think that does comeback to the conversation about
fiber.
But then it's from there.
(28:37):
It's like fiber isn't just thethe one thing.
It comes in all differentshapes and sizes, as um one of
my mentors, jason horlach, likesto quote all the time.
It's so true I I use that oftenin consults, even today.
Get people thinking about youknow, away from thinking that
fiber is just this thing thatcomes in cereal, uh, which we
all grew up in the 80s and 90s.
Thinking of.
You know the kellogg's fiber,uh that.
(29:01):
You know thinking aboutpolyphenols and you know blacks
and purples and blues and thecolors of the different skins on
various fruit and veg asmicrobiome feeders.
So you know that's getting backto the 40 plants a week, 50
plants a week type ofconversation and I always make a
point to say you know, I'm sonot a practitioner, who's is
more plant geared.
(29:21):
I believe in the power ofanimal protein as well, but
there just needs to be a goodbalance of both at the end of
the day um, so that was going tobe my next question.
Speaker 1 (29:29):
It's sort of you know , we always talk about when.
When we're talking about goodbacteria feeding good bacteria,
it is always an only plant food.
But there is a balance.
We are omnivore, omnivores,sorry, vegans, I'm gonna get
lambasted, I know, but but ifwe're talking that, then surely
(29:53):
a there's obviously thatcritical balance.
But surely bacteria that arefed by meat, proteins and fats
are not in and of themselves bad.
It's just this abundance,correct.
Speaker 2 (30:11):
Exactly right, exactly right, bad, it's just
this abundance, correct, exactlyright, exactly right.
And I mean the reality is thatin non-civilized, non-western
nations, hunter, gatherersocieties, when they looked at
the, the biomes of these people,um, who, by the way, when they
make a kill, are going to gorgeon animal protein, um and and
preference it, yes, that said,they're not going to make kills
every day and have meat forbreakfast, lunch, lunch and
(30:33):
dinner.
So that comes back to theconversation about well, there's
these fallback foods, which arethe plant foods, and the tubers
and the berries, and the nutsand seeds and that sort of thing
.
So if we try and reflect that,which I look at everything
through an evolutionary lens,when it comes to health, that
makes sense that the dietideally is somewhere between,
(30:54):
you know, perhaps 60% to 70%plant fibres versus that 30% of
animal proteins.
Speaker 1 (31:02):
Yeah, yeah, I often describe to people who are
wanting to investigate the paleodiet, wanting to investigate
the paleo diet, and they thinkit's all protein I would say
hang on.
Cavemen didn't eat mammothsalong the way to killing the
mammoth.
The mammoth was the prize atthe end of it, but along the way
they had to eat tubers andberries and nuts, things like
(31:25):
that.
Speaker 2 (31:25):
That's a statement, sometimes for days on end.
Speaker 1 (31:27):
Lauren Cordain.
In fact, when he presented at asymposium, who was it?
Pete Evans.
Pete Evans begged to do themenu for that symposium and when
you go out there to lunch itwas largely plant food,
(31:48):
absolutely spectacular plantfood, with some you know
obviously generous amounts ofmeat.
But I wonder if part of theissue these days is not so much
what we're eating but how much.
Speaker 2 (32:04):
How much we're eating , how changed it is from its
natural state when it'sharvested, how it's stored,
where it's travelled from,what's added to it.
Yeah, all of those things, forsure.
And the abundance, yeah, theintake.
Speaker 1 (32:18):
Yeah, yeah, which is obviously my demise.
But, dan, can we go into alittle bit more depth about what
you use with most merit?
You've spoken about curcuminpreviously.
If we're talking about gutinflammation, you know you've
got classic things like fish oil, for instance, but even things
(32:41):
like food, like I've been keenlyinterested in these for years
and forgive me for rabbiting onabout them, but they're called
p-dens now.
So plant derived exosome,exosomal, like nanoparticles,
right, p-dens.
And the original one that Iinvestigated with gin was ginger
(33:04):
, so back then it was gingerexosome, like nanoparticles or
gilms.
What basically the message isthat the ginger plant, when we
eat it they butt off this littlevesicles packages that contains
(33:26):
RNA.
That RNA talks to the bacteria,the genes in the bacteria.
The genes in the bacteria thentalk to the genes of the human
to say settle the hell down.
It was really interesting.
Well, that was my mouse study.
They're now investigating theseplant-derived exosome-like
(33:47):
nanoparticles, p-dense, for drugdelivery and what they found
was that they dampenedinflammation.
They made an anti-inflammatorymedication safer and more
efficacious.
I'm keenly interested in this.
So you mentioned before aboutJason Horolak talking to you
that fiber isn't just the cerealfiber, that it's in a heck of a
(34:11):
lot of other foods.
Do you find that you selectcertain foods to elicit certain
responses at all, like youmentioned, endotoxins, lps.
Speaker 2 (34:29):
Yeah, yeah.
So look, I'm one of thosepractitioners where I like to
use a combination of of,obviously, diet and, and the,
the medicines, and, but I Ialways try and place more
emphasis on what they can do inthe diet, because everyone not
everyone I should say, but mostpeople are very much geared
towards the what's the latestand greatest, you know what's
(34:51):
the silver bullet.
But I always say to people,when it comes to microbiome
resolution or balance, there'sso much that you can achieve
with just dietary changes, andit's actually the doing part
where people fall down.
So the education can be theretill the cows come home.
You know, I've got all thesecharts of here's your black
foods, here's your red foods,here's your purple foods.
When you're doing your shopping, just simply try and add more,
(35:12):
you know, and just work your wayup slowly.
But being conscious of that ona day-to-day basis and then
being consistent with that isthe challenging part.
But for the folks that do it,we can see massive changes in
diversity, for example in thegut microbiota.
But to answer your questionspecifically, one of my
favorites and again I have tothank Jason Horolak the Big Mac
(35:34):
Horolak as I like to call himfor this one, but it's the
pomegranate peel.
So the peels of the pomegranateand there was even a time where
I actually broke them down andgot a big delivery of these
beautiful biodynamicpomegranates, saved all the
peels, cut them up, you know,put them in the blender,
dehydrated them and I wentthrough two you know, huge tubs.
(35:56):
It took me about two years toget through them, mind you, but
not everyone has to go to thatlength.
But you can purchase thatonline, you know, quite easily.
So that's one example.
The black beans, which wealready mentioned, and I think
it comes down as well to sayinghey, you know that sweet potato
you eat.
Yeah, try and get the purpleversion.
Hey, you know that rice thatyou have three or four times a
(36:16):
week, try and get the black andred version as well.
And you just get them thinkinglike that, just to diversify the
colour palette coming in, andthe effects are quite good.
Another one is the EGCG fromgreen tea, such a basic thing
that you know just gettingpeople sold on.
If you just have a very strongcouple to daily of green tea,
(36:37):
that goes a long way, not evenjust with the biome but outside
of the biome.
So those are my favourites fromthe sort of culinary, dietary
perspective.
In terms of the nutraceuticals,I'm very jazzed and excited
about the non-dairy serumderived immunoglobulins, um the
(36:58):
the people that come throughthat are dairy sensitive, that
their faces light up when youtalk to them about a dairy-free
colostrum alternative and itworks wonders.
I've seen great results beforeand after with leaky gut testing
using the lactulose mannitoltest and just in those patients
like we're talking about earlier, like myself a long time ago,
(37:18):
that are just not thriving, thatjust have a really beat up gut
and you're pretty sold on thegut permeability as a core
factor there, such a greatgentle.
Additional tool In addition tothat again, something I'm
playing around with more andmore these days is the human
milk oligosaccharides, 2-fl or2-fucosyl lactose, which is
(37:39):
naturally occurring in mother'smilk.
Using more and more of that Inthe prebiotic kingdom, which I
do more and more of once againand it's not that I don't use
probiotics still, but I kind ofhave a limited range of single
strain probiotics that I kind ofstick to.
I could probably count them onone hand, but outside of that
it's more about the prebiotics.
(38:01):
Inulin is one of the favouritefor the folks that can tolerate
it, and coming back to thosemarkers we were talking about
earlier Andrew, great forattenuating that.
Calprotectin, even when that'sborderline or raised, does a
great job.
Secretory IgA, when that'selevated.
There's good research withgalacto-oligosaccharides or GOS.
(38:21):
Partially hydrolyzed guar gumis another favorite and that's
the one that I usually go inwith prior to knowing what the
biome looks like.
Irrespective of that, we sayget your sample sent off and,
regardless of what comes in,let's just get you started on
this guar gum stuff and we'lljust start you off nice and slow
and gentle.
Speaker 1 (38:42):
Can I ask about tolerability?
So, patient compliance I guesswe're talking about here.
But when we're talking aboutsome of these fibres, like, for
instance, banana fibre, there'sa sugarcane fibre, really hard
to mix, they're hydroscopic,they float on top and as soon as
you put the spoon in they gopoof.
So, with regards to patientcompliance, do you ever talk to
(39:06):
them about?
Listen, you know, this is howyou take this sort of fibre,
whether mixing it in with a food, or indeed, well, mixing it in
with a food on their plate, ormixing it in with, like a
condiment, like, for instance,applesauce or something like
that.
Yeah, do you ever employ thesetactics?
Speaker 2 (39:24):
Absolutely.
The first one that comes tomind and I happen to have it
right here in front of me forthose folks watching is the
inulin and the cell.
That I say is it tastes likefairy floss, and it actually
does.
And um, that's, that's what Isay to the, the mums and the
dads for the, the kids that Isee.
You know, you can literally getthem to just spoon it straight
into their mouth and it doesn'tnecessarily require that water,
(39:45):
um, although it can go in water,but the compliance has been
great with that.
I mean, you can just get itstraight into the mouth and it's
got that really nice, naturallyoccurring sweetness.
So inulin is great for that.
With the guar gum, I usually saythat's quite seamless, so it'll
go into everything To yourpoint.
The resistant starch, that's aharder one, a trickier one.
So smoothies are great.
(40:06):
You know, if we can get thepatients doing three or four
smoothies a week and get agenerous dose of the, the rs, in
there, um, which which is aprebiotic that you you can go
quite high with, or or you getquite better outcomes.
I find when you go like morearound the sort of 10 to 15 gram
mark, even for some folks andwith some of those patients.
(40:28):
It's important to note too thatsometimes with prebiotics the
needle doesn't move until youget up to those sort of levels,
and that's something that overtime I've had to get really
comfortable with and sort of goout on a bit of a limb.
So three or four years ago itmight've been let's just start
you on five grams or a teaspoonand just kind of leave you there
(40:49):
for weeks to months and seewhat changes, as patients come
back and say that they'retolerating it, though I'm each
time now getting them to up itand push the envelope to that
level, to just below where theremight be a bit of discomfort,
and for some patients it'salmost like they just turn a
corner at that 10 gram mark withinulin or partially hydrolyzed
(41:11):
guar gum.
It's quite interesting.
Speaker 1 (41:14):
Right, I know this is going to be a multi-pronged
question, forgive me, but withregards to other things that you
might employ, if we're talkingabout healing an inflamed gut,
you've got things like zinc,obviously.
You've got the zinc carnosine,for instance, which has its own
action with healing lesions.
Let's say, um, we've got tothink about even, you know,
(41:38):
liver herbs, for instance,helping with digestion, with
bile flow.
And then the second sorry aboutthis double prong thing is, if
we think about the effect ofstress on the gut and we think
about how it can be deleteriousto healing the gut, how much do
you employ, let's say,anti-stress herbs or the, you
(42:00):
know, the nerve ions, theadaptogens, in helping somebody
to cope with the stressors oflife while they're healing their
gut?
Speaker 2 (42:10):
I'm glad you asked.
It's huge.
Speaker 1 (42:14):
I think you're going to hate me.
Speaker 2 (42:16):
Not at all.
Not at all, because it's one ofthose things that it's very easy
to overlook Mindfulness,nervous system balance,
parasympathetic versussympathetic, the role of the
vagus nerve between the brainand the gut, which you know over
the years I always think ofyour conversations with Mark
Donohoe that you guys havetalked about that ad nauseum,
(42:39):
and it's so true.
You know that the power of thevagus nerve and what the nervous
system can influence in thesecases, that was very, very like
specific to my healing too,andrew.
So you know there were periodswhen I think back to my journey
where I'd come good and then I'd, you know, get poorly again and
then come good, and if I hadhave known about the nervous
(43:01):
system back then, I think Icould have done a lot more.
Um, very easy to say now inhindsight, but uh, yeah, just
the power of you know varioushealing modalities, even just
you know walking in nature 20minutes a day, something so
simple, the breath work, and I'msure we're preaching to the
choir when we go on about this,but I concur 100%.
(43:24):
You know the amount that we canachieve just by you know the
mindfulness and these sorts ofyou know parasympathetic
practices, equally important asjust the medicines that they're
recommending?
Too Sure.
Speaker 1 (43:39):
You mentioned retesting earlier.
Can you just give us a littlething about the benefits of
managing somebody'ssymptomatology, tracking their
progress of therapy versus thecost of therapy?
How do you sit?
Speaker 2 (43:54):
Yeah.
So it's something that I don'tentertain, like if someone says,
oh Dan, I want to jump back inthere and have a look at what
we're doing and see if it'schanged.
I say, listen, we can do that.
It's probably not worth doingthat in terms of the invest, the
financial outlay until aboutthe six-month mark.
You know, realistically andthat might differ from patient
to patient slightly, but how Isort of approach that
(44:18):
conversation, I suppose, as Isay, although it is quite a big
investment doing that, retestingat the six-month mark or the
nine-month mark, that mightallow us to cut down your
supplement intake by half.
So then it's like you work outwhat you're paying in
supplements.
You know whether there's six orseven things that we started
with.
We might only need two of them,you know.
But ultimately using yourpresentation along with the
(44:41):
results, will ultimately guideus there.
And I will usually preface thatwhen we do the first round of
testing by planning that seedand say now, this is good data,
we've got a benchmark.
Now.
Speaker 1 (44:57):
Let's earmark it for six months that we do another
test.
Dan, I have to ask where can welearn more?
Do you have any e-courses oranything like that that you
provide to practitioners, oreven patients at all, to learn
from?
Speaker 2 (45:09):
It's funny.
You ask I'm in the um processof putting slowly together an
online autoimmune masterclassand um, that's something that's
been on the mind for years, soit's taken me a while to to get
into action.
But, um, yeah, I, I, I planlater this year, early next year
, to to put that out.
So my, my main sort of onlinepresence is through Instagram.
(45:32):
That's where you can find meand reach out.
And, yeah, practicing stillMonday to Friday I do my four
patients a day, with gaps inbetween, and just keep it at
that and that's how we tend tomanage it.
But yeah, so look out for thatto come out online and also the
website functionalnaturopathcom.
Speaker 1 (45:54):
Love it, dan.
We could learn so much morefrom you.
Thank you so much for taking usthrough gut inflammation
markers and management today.
I really appreciate it, mypleasure.
Speaker 2 (46:03):
Good to chat to you, Andrew.
Speaker 1 (46:06):
And thank you everyone for joining us today.
Remember you can catch up onthe show notes for this podcast
and they will be lots, plus allthe other podcasts on the
Designs for Health website.
I'm Andrew Whitfield-Cook.
This is Wellness by Designs.
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