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Gut Inflammation, Markers and Management with Dan Sipple · Wellness by Designs - Practitioner Podcast

• 0:20
  Speaker 1: Music.
• 0:20
  Speaker 1: This is Wellness by Designs, and I'm your host, andrew Whitfield-Cook.
• 0:23
  Speaker 1: Joining us on the line today is Dan Sippel, a naturopath, herbalist and nutritionist.
• 0:29
  Speaker 1: Today, we're going to be talking about gut inflammation markers and management.
• 0:34
  Speaker 1: Welcome to Wellness by Designs, dan.
• 0:36
  Speaker 1: How are you?
• 0:38
  Speaker 2: Very well.
• 0:39
  Speaker 2: Thank you, mate.
• 0:39
  Speaker 2: Thank you for having me.
• 0:40
  Speaker 1: It's a pleasure to be here I wish I was there, where you are down on the south coast of New South Wales.
• 0:44
  Speaker 1: It's a pleasure to be here.
• 0:45
  Speaker 1: I wish I was there.
• 0:45
  Speaker 1: Where you are down on the south coast of New South Wales, it's a favourite place of mine in the world.
• 0:50
  Speaker 2: Yes, yes, we're very lucky.
• 0:52
  Speaker 2: Down here in the south it's cold in the winter, but the sun's been shining all week, so we can't complain.
• 0:59
  Speaker 1: Beautiful Dan.
• 1:01
  Speaker 1: Can I start a little bit with your career?
• 1:03
  Speaker 1: What's your background?
• 1:04
  Speaker 1: How did you arrive at an interest in naturopathy and herbalism?
• 1:10
  Speaker 2: Yeah, sure thing I'll give you the concise version, andrew, otherwise we'd probably be here all day years ago now and I'll sort of do my best to paint the picture.
• 1:28
  Speaker 2: But it was the good old sort of Epstein-Barr virus into.
• 1:30
  Speaker 2: You know, never will sense scenario for me.
• 1:31
  Speaker 2: So not uncommon, as you know, in our industry, but yeah, just definitely that path of illness to kind of discovery and then eventually recovery.
• 1:39
  Speaker 2: So high school certificate year, year 12, lots of pressure.
• 1:44
  Speaker 2: High school certificate year, year 12, lots of pressure, hsc and all the things.
• 1:51
  Speaker 2: And I come down with a pretty heavy case of glandular fever at the time and two weeks later that sort of you know eventuated and two weeks later I was back doing my HSC.
• 1:59
  Speaker 2: So it was all quite fast and happened very quickly.
• 2:02
  Speaker 2: But point being, I sort of didn't recover well after that and for the next two years I was sort of doctor shopping, if you like, and just kept getting told the same old thing that you just need to rest your body, you're still getting over Epstein-Barr.
• 2:15
  Speaker 2: And yeah, as I say, it got to about the two year later mark by the time I was about 19.
• 2:22
  Speaker 2: And I could just definitely tell that something else was not quite right Just wasn't thriving.
• 2:28
  Speaker 2: Lots and lots of upper respiratory tract infections, fatigue, brain fog, you name it, but certainly wasn't presenting in a typical way that you would to suspect that there was an underlying gut sort of auto-inflammatory process happening.
• 2:45
  Speaker 2: So I was eventually diagnosed celiac.
• 2:47
  Speaker 2: When we changed gears a little bit and saw an integrative doctor, she ran a barrage of tests and found those celiac antibodies quite raised and so from there it was a big aha moment and a lot of relief.
• 3:02
  Speaker 2: And you know, going down the path of the GI specialist and the okay, you need to be on a gluten-free diet for life and this is how we manage the condition.
• 3:10
  Speaker 2: But you'll do that and life will return to normal and you know we'll never hear from you again.
• 3:16
  Speaker 2: Basically, everything will go back to normal within a matter of weeks to months.
• 3:20
  Speaker 2: 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 journey because it was recovering from all the damage that that I'd taken.
• 3:33
  Speaker 2: Um, throughout that period of misdiagnosis, with subsequent antibiotics, just one after the other, boom, boom, boom.
• 3:40
  Speaker 2: So lots of antibiotic cocktails and and by that time in my early 20s, I was quite beat up.
• 3:45
  Speaker 2: So the gluten-free diet definitely helped initially, but I quickly worked out that it was kind of the end of the road with the modern medicine approach as far as celiac recovery and management went.
• 3:58
  Speaker 2: This is where I started learning about gut dysbiosis and the microbiome and more sort of integrative approaches.
• 4:04
  Speaker 2: So that sort of evolved into a really keen interest and I worked out by probably the age of 23, 24, that, yeah, just that that I had a really keen interest in the science side of it and learning about the autoimmune and gut connection and so forth and eventually started studying it in my mid-20s, took up the naturopathic degree through Endeavor and did that over the course of the next five or six years on and off, and I was still working at the time so started practice at the age of 30.
• 4:38
  Speaker 2: I'm 37 now, so this is my seventh year in practice and we moved down from Sydney down to the south coast when I started.
• 4:46
  Speaker 2: So what's that?
• 4:46
  Speaker 2: Yeah, seven years ago, and fast forward to 2024, and here we are.
• 4:53
  Speaker 1: Can I go back to the diagnosis?
• 4:56
  Speaker 1: What was it that twigged in your doctor's mind to test?
• 5:01
  Speaker 1: Because you know you've got that age bracket.
• 5:05
  Speaker 1: You know the sort of late or sort of mid to late teens.
• 5:09
  Speaker 1: The high school certificate is the classic, the hormones around that era and the stress.
• 5:16
  Speaker 1: So that perfect storm is when EBV just knocks people.
• 5:21
  Speaker 1: But how many get tested and how many don't?
• 5:28
  Speaker 2: so what was it?
• 5:29
  Speaker 2: where your doctor said, listen, we need to test, we need to find out I can remember going in I was still under the care of my my folks at the time and I can remember going in to to this particular integrative doctor who I maintained a great relationship with for years after, and doing the old palpation on the gut.
• 5:47
  Speaker 2: It was probably the first time that my mother was saying he's not thriving.
• 5:52
  Speaker 2: There was that word and I was like what does that even mean, daniel's not thriving?
• 5:57
  Speaker 2: And it made sense.
• 5:58
  Speaker 2: It was like in all aspects it just was like I hit a sort of roadblock and prior to that, mind you, there were no signs or symptoms to alert us to anything celiac related.
• 6:09
  Speaker 2: So I didn't have the classic picture with gut symptoms and that's probably why it was misdiagnosed for so long.
• 6:16
  Speaker 2: For me it was more fatigue, brain fog, extreme, extreme brain fog.
• 6:21
  Speaker 2: So it was a very cerebral picture, um, recurrent tonsillitis, which was why probably EBV kept getting blamed, you know, for the um, for the illness, and, and whilst that might have been partially true, um, the celiac was kind of there, you know, bubbling away in the background.
• 6:37
  Speaker 2: So malabsorption, you know, then ensued.
• 6:39
  Speaker 2: So it was eventually I had to get really, really low for it to be recognized.
• 6:43
  Speaker 2: So we're talking about, you know, getting to the level of, you know, weight loss, graying of the skin, not leaving the bedroom, yeah, very, very recluse.
• 6:53
  Speaker 2: And so that, I think, tipped the doctor off to the fact that there could be an absorption issue.
• 6:58
  Speaker 2: And that was the first time those antibodies were run.
• 7:00
  Speaker 2: And sure enough they were sky high yeah high yeah yeah.
• 7:05
  Speaker 1: So what's really interesting to me is, you know, fatigue in in a teenager.
• 7:11
  Speaker 1: Obviously we think about iron first, but if there's chronically low iron then you'd go, uh, absorption celiac.
• 7:18
  Speaker 1: Was there any hint of low iron throughout your earlier years or any hint of like breathlessness, or you, you know, underperforming when you did sports day or anything like that?
• 7:31
  Speaker 2: The latter Exactly.
• 7:32
  Speaker 2: So what, where I really knew something was wrong, was I was trying, you know, with my limited knowledge at the time to quote, unquote get well.
• 7:39
  Speaker 2: So that meant for me lifting weights and trying to, you know, build my body and just build back.
• 7:45
  Speaker 2: But when I do that I would go catabolic.
• 7:47
  Speaker 2: I would actually break down and sometimes for weeks, and then I'd come kind of good again.
• 7:52
  Speaker 2: So I'd do it again and that pattern kept happening.
• 7:55
  Speaker 2: So, once again, that's where, you know, I eventually had to just keep pleading with the oldies.
• 8:00
  Speaker 2: Something is wrong, I'm telling you, and it's not just glandular fever, you know.
• 8:03
  Speaker 2: With the oldies, something is wrong, I'm telling you, and it's not just glandular fever, you know, yeah.
• 8:07
  Speaker 2: So, like I said, I did have to get quite low for the practitioners to think outside the box and I've always carried that with me, even as a naturopath.
• 8:14
  Speaker 2: Now, to never I mean obviously I'm biased, being a celiac but to never disregard the importance of running that celiac serology when you're seeing that sort of not thriving picture and the amount of times we've seen, you know, even low level active antibodies and you wouldn't otherwise suspect it.
• 8:33
  Speaker 2: Then you get your classic cases where it's very, very, you know, true to classic sort of hallmark celiac symptoms.
• 8:38
  Speaker 1: Yeah, can I ask you something you just mentioned before and you said it as if it was inconsequential, but it's got to do with labels.
• 8:46
  Speaker 1: You said I'm a celiac versus someone who has celiac disease.
• 8:52
  Speaker 1: Yeah, do you know that, that you know where, where the disease becomes the person, if you like.
• 8:59
  Speaker 1: Does that bother you?
• 9:03
  Speaker 2: it did for a long time.
• 9:05
  Speaker 2: It doesn't now, I think, because it's been so long, so it's been over half my life and um yeah the awareness now is very, very, you know, different to what it was 20 years ago.
• 9:16
  Speaker 2: So it definitely did for a long time.
• 9:18
  Speaker 2: Um, and I've it's interesting you bring it up, because sometimes I do say that unknowingly and um, it's something that I don't think about anymore, but I often catch patients saying it you know, I'll talk to them about that that sort of that mindset and changing their terminology.
• 9:31
  Speaker 2: So, yeah, it's, it's a quite important thing to to raise to people that feel that they've, I guess, been, you know, dealt, you know a bad card or you know, that sort of victim mindset.
• 9:50
  Speaker 1: Yeah.
• 9:50
  Speaker 1: So I guess where I'm going there is because you're proficient in what you do.
• 9:52
  Speaker 1: You have a level of comfort.
• 9:52
  Speaker 1: It doesn't define you.
• 9:54
  Speaker 1: You're quite fine with it.
• 9:56
  Speaker 1: But for somebody who's investigating this along their journey, they might be a little bit touchy on the subject.
• 10:03
  Speaker 1: Is that how you felt and what you see in your patients?
• 10:09
  Speaker 2: It was yeah, yeah, like I say, for a long time, and I think it's more in the social settings that it becomes quite apparent.
• 10:16
  Speaker 2: You know, at home it doesn't bother you Quite often, the whole household will just be gluten-free and it's not something that you tend to think much about.
• 10:23
  Speaker 2: Um, but it's sort of those social settings where the rubber meets the road, where you know you'll be.
• 10:28
  Speaker 2: You know, classic one is you're sitting at a a big, um, you know dining table at a restaurant, you're doing the order and it gets to you and all the attention's on you and, uh, you know you.
• 10:39
  Speaker 2: You say can I please have the?
• 10:40
  Speaker 2: The?
• 10:40
  Speaker 2: You know the item on the menu that's marked chef?
• 10:42
  Speaker 2: Oh and, and, by the way, I'm celiac.
• 10:44
  Speaker 2: Can you let the chef know?
• 10:46
  Speaker 2: So that's where you get reminded, yeah.
• 10:49
  Speaker 1: Yeah, but do you find there is a greater awareness now that it's?
• 10:55
  Speaker 1: I mean, we should have had this for at least 10 years minimum, but do you find that there's an not awareness, acceptance, indeed care, by eating establishments, food establishments that know now about what a celiac is?
• 11:10
  Speaker 1: No, you can't sneak that in.
• 11:11
  Speaker 1: No, it can't have a little bit.
• 11:14
  Speaker 2: It's got to be zero it's definitely, it's definitely improving, um, and I always tell people, um, despite that and the awareness, you got to remember that you know the, the waiter takes your order, it then goes to to the kitchen, which is, you know, a separate area, and that's.
• 11:32
  Speaker 2: You know something that you need to be very confident in.
• 11:34
  Speaker 2: So pick, pick your restaurants wisely, stick to the same.
• 11:37
  Speaker 2: 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 poisoned touch wood.
• 11:49
  Speaker 1: Gotcha.
• 11:49
  Speaker 1: Yeah, let's go into our topic today because it's quite broad.
• 11:54
  Speaker 1: When we're talking about seeing a patient first for any sort of gut issue, where do you start?
• 12:04
  Speaker 1: Where does the patient journey begin with you?
• 12:07
  Speaker 1: Do you begin with testing?
• 12:09
  Speaker 1: Do you begin with you?
• 12:11
  Speaker 1: Know family history, patient history?
• 12:14
  Speaker 1: Do you start on like a few supplements first before you test?
• 12:18
  Speaker 1: How does it look?
• 12:19
  Speaker 1: Do you start on like a few supplements first before you test?
• 12:21
  Speaker 2: How does it look?
• 12:22
  Speaker 2: I'd say it's probably different for each patient, andrew, but I make a very strong point in my intake form to be very thorough so that by the time I'm jumping on the call with them I've got a very well-rounded understanding of where they're at, their family history, their current symptoms.
• 12:38
  Speaker 2: My intake form probably takes a good 10 to 15 minutes to fill in.
• 12:44
  Speaker 2: So, as I say, by the time we jump on the call I've usually got a whole lot of pathology not always, but most often as well to go with it.
• 12:51
  Speaker 2: So that helps me, after the initial 45 minutes of questioning, to sort of work out.
• 12:57
  Speaker 2: Do we jump straight into testing, or has this person already been to three or four practitioners and they've got a plethora of decent testing, but they're just after a different opinion?
• 13:07
  Speaker 2: In that case we usually just jump into treatment.
• 13:10
  Speaker 2: But generally speaking, I do like to start with testing.
• 13:13
  Speaker 2: I feel like it's a good investment.
• 13:15
  Speaker 2: Um, five years ago maybe I would have said something different, but with what we can see of the microbiota and the ecosystem now, I feel like that money is quite well spent.
• 13:25
  Speaker 2: And I always say to the patient if we don't have the funds to test, that's okay.
• 13:29
  Speaker 2: It's not a prerequisite, but if we can test, I can be very, very specific with the application of different nutraceuticals or prebiotics or probiotics, without the guesswork.
• 13:42
  Speaker 2: So it's that whole thing of test and don't guess, I suppose, mind you.
• 13:45
  Speaker 2: You know, after seven years and my own personal history and and just being in the health and wellness space for a while, a lot of practitioners would agree you get a pretty good sort of understanding of what tools are very likely to be useful versus others.
• 13:59
  Speaker 1: Gotcha.
• 14:00
  Speaker 2: Even without testing yeah, yeah, yeah.
• 14:03
  Speaker 1: So what tests do you tend to favour?
• 14:05
  Speaker 1: What do you employ?
• 14:08
  Speaker 2: 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's digestive symptoms in the small bowel or large bowel or both?
• 14:19
  Speaker 2: So in an ideal scenario, if the feasibility isn't an issue, we'll do testing for small intestinal bacterial overgrowth via a series of breath tests and followed by then the stool test, to give us a really good, well-rounded understanding of the ecosystem, where we're not just kind of fixated on looking at pathogens but we're looking at the balance of the whole ecosystem.
• 14:41
  Speaker 2: And I'm quite, you know, in the camp of.
• 14:45
  Speaker 2: You know, yes, we want to understand what critters are in there that are causing dysbiosis and inflammation and so forth, but equally, if not more important, we need to look at the balance of the other guys which, you know, let's face it, even 10 years ago we couldn't even see half of what these guys were doing or, you know, didn't know what roles they had, and we can talk about different species that sort of make up that commensal ecosystem as we go.
• 15:11
  Speaker 2: So to answer the question, yeah, if we can do both, we'll get an understanding of where the problems are Sometimes it's very classic that it is all small bowel and we'll get a positive breath reading for SIBO and you'll usually understand that from the interview with the patient.
• 15:27
  Speaker 2: You know, oh, I eat, and it's only half an hour to 45 minutes later that I'll get a lot of symptoms, versus the person that says a lot of my symptoms happen in the PM hours of the day, the back end of the day, you know, I kind of wake up, I go to the bathroom, I do my business.
• 15:44
  Speaker 2: The first half of the day is okay.
• 15:45
  Speaker 2: Later on in the day is when I start getting, you know, quite a lot of signs and symptoms.
• 15:50
  Speaker 2: Yeah, so we can tell.
• 15:55
  Speaker 2: You know, by questioning we can get a pretty good idea.
• 15:57
  Speaker 2: But ultimately the testing helps us elucidate the specifics.
• 16:00
  Speaker 1: Gotcha, and so you know we're talking about microbial testing.
• 16:04
  Speaker 1: What about other sort of inflammatory markers, for instance Calprotect?
• 16:10
  Speaker 1: And you know we can go and go, but what do you tend to rely on most or what do you find is most useful?
• 16:16
  Speaker 1: What do you find is most useful?
• 16:19
  Speaker 2: The testing I'm currently using.
• 16:20
  Speaker 2: I really love the fact that we understand the species you know down to, you know, a really really definitive level, so what pathobionts and what you know commensals are in the gut.
• 16:35
  Speaker 2: But we also have an array of digestive markers and inflammatory markers, like you mentioned, which is very handy.
• 16:38
  Speaker 2: And you know, even five years ago that information was just starting to be sort of, you know, more common, very handy, and even five years ago that information was just starting to be sort of more common to a lot of the different reports that we use.
• 16:46
  Speaker 2: And that's where that information is really helpful for me with patients.
• 16:51
  Speaker 2: So, yes, I love to know what species are present in someone's gut.
• 16:55
  Speaker 2: Equally important, as I said earlier, is what the metabolites you know are and what's sort of what's being produced and what's predominating.
• 17:04
  Speaker 2: So, for example, are we seeing lots of hydrogen sulfide gas production?
• 17:08
  Speaker 2: Are we seeing lots of ammonia production?
• 17:09
  Speaker 2: If so, what are the species that are responsible for that and what can we do about it?
• 17:14
  Speaker 2: And it's really interesting, andrew, when you interview different patients that are on different types of diets.
• 17:19
  Speaker 2: You know you interview different patients that are on different types of diets.
• 17:22
  Speaker 2: You know you can usually tell by their biome reports how they're eating and you know by what sort of species are overrepresented or underrepresented and we can get into the specifics of that.
• 17:31
  Speaker 2: But you know, 2024, it's very popular for people to be on these extreme ends of the diet spectrum.
• 17:37
  Speaker 2: So we can, as I say, we can see a lot from the biome, the impact of that, whether you know someone's having issues with breaking down all the protein and the fat that come from a more sort of paleo-esque type of carnivore type of approach, versus someone who's on more of a plant-based diet.
• 17:56
  Speaker 1: Yeah, Do you ever use a particular food or group of foods as like a challenge to see if a particular forgive me that the type of bacteria might be sitting there quiescently and, like you said, you know they, the patient tends to get symptoms later in the day.
• 18:22
  Speaker 1: You might be seeing them in the morning, but do you ever say, listen, why don't we challenge with this sort of food that you ordinarily have at lunchtime, for instance, that you don't have at breakfast, to see if you can elicit a response with your testing when you do the test?
• 18:38
  Speaker 1: Or actually, no, that doesn't make sense, does it?
• 18:41
  Speaker 1: Because the test is done by the patient at home.
• 18:45
  Speaker 2: It's interesting, it's a great question.
• 18:46
  Speaker 2: What I often do, andrew, is I say to them I paint a bit of a hypothetical scenario and I say, all right, I want you to envision yourself eating a bowl of chickpeas for lunch today.
• 18:57
  Speaker 2: And you can usually tell by the expression on their face the folks that might have you know the presence of SIBA.
• 19:05
  Speaker 2: They usually say, oh no.
• 19:06
  Speaker 2: Straight away they start shaking their head no, that's going to be disastrous.
• 19:14
  Speaker 2: Oh no, very, very soon.
• 19:15
  Speaker 2: If I tried to do that, the last time I happened to do that at, you know, x, y and Z was quite disastrous.
• 19:24
  Speaker 2: On the flip side to that, when we've done a lot of, you know, a lot of treatment and we've put them through various protocols to balance out the ecosystem, one of the foods that I do use as a bit of a proxy is black beans and I explain to them these are, you know, probably the most gentle out of the legume kingdom, great prebiotic content.
• 19:38
  Speaker 2: And I say start with a small handful, cook them really, really well, soak them if you can, and see how you react.
• 19:44
  Speaker 2: Give yourself a few days between and then try again, and we just try and build up the tolerance.
• 19:49
  Speaker 2: I've had patients come in that you know they've been through all sorts of antibiotic cocktails and told they've had parasites and it's just kill, kill, kill for years and years, to the point to where they're on literally four or five foods and bringing those patients back can be quite challenging.
• 20:05
  Speaker 2: But those usually are the patients where it's just a mess with those metabolites.
• 20:10
  Speaker 2: So we're seeing elevated levels of branched-chain amino acids, hydrogen sulfide, ammonia, histamine and a lot of the critters that sort of secrete.
• 20:20
  Speaker 2: These metabolites are quite abundant and it's a slow and steady process with those guys to get them back to normal.
• 20:28
  Speaker 1: Gotcha.
• 20:28
  Speaker 1: Can we go through some of these, testing these metabolites in greater detail?
• 20:34
  Speaker 1: Ammonia, for instance, calprotectin, but there's others as well.
• 20:40
  Speaker 2: It's calprotectin, but there's others as well.
• 20:42
  Speaker 2: Yeah, definitely, yep.
• 20:43
  Speaker 2: So secretory IgA I always explain to folks is an interesting marker that's made in the mucin.
• 20:48
  Speaker 2: It's kind of like the police task force and we're looking at levels between sort of 500 to 2000 micrograms per gram as being sort of the normal range.
• 20:58
  Speaker 2: If we see it quite low and underneath and underrepresented, it's kind of that immune depletion picture and you do see that it's probably rarer that you see that.
• 21:07
  Speaker 2: Quite often what I'm seeing more commonly is the elevated presence of secretory IgA and when we see that we're usually correlating that with a dysbiotic picture or an auto-inflammatory picture.
• 21:21
  Speaker 2: So the task force are just on high alert.
• 21:23
  Speaker 2: Essentially that's how I explain it to people.
• 21:27
  Speaker 2: In line with that, faecal calprotectin is a great marker.
• 21:29
  Speaker 2: That's the one that mainstream GI specialists will often use to look at IBD patients and measure different interventions and pharmaceuticals and whatnot to see if it's active or in remission.
• 21:43
  Speaker 2: But as naturopaths again, that's kind of a great marker that we can utilize to look at whether people are kind of in the clear for very full-on inflammation or they're in that borderline kind of area which is, I think, around 50 to 100.
• 21:55
  Speaker 2: So when there's that borderline result, sometimes it is useful to send them off to a GI specialist for an opinion, certainly when it's over 100, we're doing that regardless of what we're doing as naturopaths, to explore the underlying cause there, sort of auto-inflammatory IBD kind of case where there is very overt inflammation.
• 22:24
  Speaker 2: But even then, you know, as naturopaths I like to think that there's a lot of nutraceutical tools that we can use to intervene or add, as you know, adjunctive therapies there to help drive that down.
• 22:33
  Speaker 2: And I've seen that quite commonly, even with just good old curcumin at the right dose.
• 22:39
  Speaker 1: And Dan, what about ammonia, for instance?
• 22:43
  Speaker 2: Yeah, ammonia is an interesting one.
• 22:45
  Speaker 2: It's an emerging metabolite and I always sort of make a point when I get a patient through that is on a more.
• 22:53
  Speaker 2: I mean, yeah, athletic diet, carnivorous diet, paleo sort of diet, however you want to refer to it, but a diet essentially where there's, where there's not much of that fermentable carbohydrates coming in and it is quite protein and fat heavy, which can be great short term for metabolic reasons, but long term, for the microbiome can start to tip the balance.
• 23:11
  Speaker 2: And this is where branch chain amino acids, ammonia and hydrogen sulfide and histamine come to think of it.
• 23:17
  Speaker 2: The four of those can be quite elevated and it's an interesting one because the patient doesn't necessarily have a whole heap of gut symptoms always in that case, and it can be quite different.
• 23:28
  Speaker 2: And what I mean by that is for some people high ammonia can just mean brain fog, for another person it can be chronic fatigue, for another person it can be achy joints, and so that sort of highlights the importance.
• 23:39
  Speaker 2: For another person it can be achy joints, and so that sort of highlights the importance about looking at these metabolites and understanding that the microbiota isn't just simply the composition of what species make it, it's how your diet is interacting with those species and then what compounds they're producing, and I always explain to patients those compounds that they're producing can either be anti-inflammatory and driving your health, or pro-inflammatory and driving your health, or pro-inflammatory and degrading your health.
• 24:03
  Speaker 2: And, of course, there's always going to be a balance.
• 24:05
  Speaker 2: It's an ecosystem, after all, with hundreds and hundreds of species, um, but looking at that data is quite valuable.
• 24:13
  Speaker 2: Um, I've said it already on the podcast today, but even five years ago, uh, we, we weren't able to see much of that in terms of the metabolites produced and therefore it was more just focusing on what species were present and whether we had enough good guys and quite unquote bad guys in a balance.
• 24:30
  Speaker 2: But I do use that data when I follow up and do another repeat test, which I usually recommend either six to 12 months later, if the budget's there, and it's really interesting to see what interventions work to balance that out.
• 24:45
  Speaker 1: Great Anything else that we need to be aware of with regards to the metabolites, because these are really, these are interesting to me, really interesting.
• 24:55
  Speaker 2: The other one is hexa-LPS, so lipopolysaccharide, and you, it's, it's the citrobactors and the e-colis and uh, klebsiella's and these types of pathobionts that, when they get too high, make this thing called endotoxin or liposal lipopolysaccharide, and it's.
• 25:11
  Speaker 2: It's not something where the bugs are trying to to harm us, it's just how our immune system, um, you know, surveys them and, in response to them, if they're too high, will produce more inflammatory compounds as a result.
• 25:23
  Speaker 2: But elevations of these pathobionts is, you know, typically what we see drive the sort of Western dysbiotic gut, and then from there you can then argue, you know, we're seeing offshoots to various disease risk conditions such as obesity, type 2 diabetes, parkinson's, you know, and a plethora of other conditions that wouldn't ever been linked to the gut microbiome 10, 15 years ago.
• 25:46
  Speaker 2: Even so, it's quite exciting to see that sort of space, you know, evolve.
• 25:52
  Speaker 1: Can I ask you, with people who are neurodivergent for instance, they tend to have an overabundance of the clostridiaceae Are there any things that we need to be aware of, apart from identifying that overabundance, for instance, metabolites, particular metabolites they may throw out?
• 26:16
  Speaker 1: Is there anything that we need to be aware of with regards to a?
• 26:22
  Speaker 1: Um, these people who have these conditions and their gut scenario, if you like, but also how we intercede with them?
• 26:30
  Speaker 1: Um, that's a bit of a broad sword, that question, isn't it?
• 26:36
  Speaker 1: How, um, what can we see if we did testing on neurodivergent people?
• 26:41
  Speaker 1: Is it plain as day or is it nuanced?
• 26:46
  Speaker 2: When you ask that, I think straight away back to a case I saw about a year ago which was an autism case and I don't treat that presentation clinically often.
• 26:57
  Speaker 2: It has obviously cropped up over the years a couple of times but it's certainly not my area of specialty.
• 27:01
  Speaker 2: But I do recall when we did shotgun metagenomics testing on this particular case I think it was the prevotella species or the e-coli was making on its own, I think, almost half of the microbiome.
• 27:16
  Speaker 2: So the abundance of that species or that genus, the microbiome, so the abundance of that species or that genus, was that represented um, which was the highest I've ever seen.
• 27:25
  Speaker 2: I've not, I'm not aware of you know, whether that's a classic finding for that sort of, you know, neuro archetype, but I just remember thinking that that is very significant and and it's quite likely that that is adding you know, degree of you know what would you call it influence on how that sort of condition plays out.
• 27:48
  Speaker 1: Gotcha Any other metabolites that we need to be aware of.
• 27:53
  Speaker 2: The only other one I think about is mucin degradation, and that's again a newer sort of kid on the block.
• 28:00
  Speaker 2: But the gut obviously, as we know, makes mucus, it sows and reaps mucus and there needs to be a good turnover and balance of that for protective reasons.
• 28:09
  Speaker 2: But when there is a lack of that fermentable fibre, the critters in the biome will go to that as a fuel source and thin the gut wall and therefore make the walls of the gut in the large intestine more thin and leaky.
• 28:22
  Speaker 2: You know, and as we know, leaky gut is kind of uh and permeability is a is a precursor to a lot of these.
• 28:28
  Speaker 2: You know western, you know type of conditions that we're seeing.
• 28:30
  Speaker 2: You know massive amounts of.
• 28:32
  Speaker 2: So, um, I think that does come back to the conversation about fiber.
• 28:35
  Speaker 2: But then it's from there.
• 28:37
  Speaker 2: It's like fiber isn't just the the one thing.
• 28:39
  Speaker 2: It comes in all different shapes and sizes, as um one of my mentors, jason horlach, likes to quote all the time.
• 28:45
  Speaker 2: It's so true I I use that often in consults, even today.
• 28:49
  Speaker 2: Get people thinking about you know, away from thinking that fiber is just this thing that comes in cereal, uh, which we all grew up in the 80s and 90s.
• 28:56
  Speaker 2: Thinking of.
• 28:57
  Speaker 2: You know the kellogg's fiber, uh that.
• 29:01
  Speaker 2: You know thinking about polyphenols and you know blacks and purples and blues and the colors of the different skins on various fruit and veg as microbiome feeders.
• 29:10
  Speaker 2: So you know that's getting back to the 40 plants a week, 50 plants a week type of conversation and I always make a point to say you know, I'm so not a practitioner, who's is more plant geared.
• 29:21
  Speaker 2: I believe in the power of animal protein as well, but there just needs to be a good balance of both at the end of the day um, so that was going to be my next question.
• 29:29
  Speaker 1: It's sort of you know, we always talk about when.
• 29:33
  Speaker 1: When we're talking about good bacteria feeding good bacteria, it is always an only plant food.
• 29:37
  Speaker 1: But there is a balance.
• 29:39
  Speaker 1: We are omnivore, omnivores, sorry, vegans, I'm gonna get lambasted, I know, but but if we're talking that, then surely a there's obviously that critical balance.
• 29:56
  Speaker 1: But surely bacteria that are fed by meat, proteins and fats are not in and of themselves bad.
• 30:07
  Speaker 1: It's just this abundance, correct.
• 30:11
  Speaker 2: Exactly right, exactly right, bad, it's just this abundance, correct, exactly right, exactly right.
• 30:13
  Speaker 2: And I mean the reality is that in non-civilized, non-western nations, hunter, gatherer societies, when they looked at the, the biomes of these people, um, who, by the way, when they make a kill, are going to gorge on animal protein, um and and preference it, yes, that said, they're not going to make kills every day and have meat for breakfast, lunch, lunch and dinner.
• 30:33
  Speaker 2: So that comes back to the conversation about well, there's these fallback foods, which are the plant foods, and the tubers and the berries, and the nuts and seeds and that sort of thing.
• 30:42
  Speaker 2: 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 diet ideally is somewhere between, you know, perhaps 60% to 70% plant fibres versus that 30% of animal proteins.
• 31:02
  Speaker 1: Yeah, yeah, I often describe to people who are wanting to investigate the paleo diet, wanting to investigate the paleo diet, and they think it's all protein I would say hang on.
• 31:13
  Speaker 1: Cavemen didn't eat mammoths along the way to killing the mammoth.
• 31:18
  Speaker 1: The mammoth was the prize at the end of it, but along the way they had to eat tubers and berries and nuts, things like that.
• 31:25
  Speaker 2: That's a statement, sometimes for days on end.
• 31:27
  Speaker 1: Lauren Cordain.
• 31:28
  Speaker 1: In fact, when he presented at a symposium, who was it?
• 31:33
  Speaker 1: Pete Evans.
• 31:34
  Speaker 1: Pete Evans begged to do the menu for that symposium and when you go out there to lunch it was largely plant food, absolutely spectacular plant food, with some you know obviously generous amounts of meat.
• 31:54
  Speaker 1: But I wonder if part of the issue these days is not so much what we're eating but how much.
• 32:04
  Speaker 2: How much we're eating, how changed it is from its natural state when it's harvested, how it's stored, where it's travelled from, what's added to it.
• 32:13
  Speaker 2: Yeah, all of those things, for sure.
• 32:15
  Speaker 2: And the abundance, yeah, the intake.
• 32:18
  Speaker 1: Yeah, yeah, which is obviously my demise.
• 32:22
  Speaker 1: But, dan, can we go into a little bit more depth about what you use with most merit?
• 32:32
  Speaker 1: You've spoken about curcumin previously.
• 32:35
  Speaker 1: If we're talking about gut inflammation, you know you've got classic things like fish oil, for instance, but even things like food, like I've been keenly interested in these for years and forgive me for rabbiting on about them, but they're called p-dens now.
• 32:54
  Speaker 1: So plant derived exosome, exosomal, like nanoparticles, right, p-dens.
• 33:00
  Speaker 1: And the original one that I investigated with gin was ginger, so back then it was ginger exosome, like nanoparticles or gilms.
• 33:10
  Speaker 1: What basically the message is that the ginger plant, when we eat it they butt off this little vesicles packages that contains RNA.
• 33:26
  Speaker 1: That RNA talks to the bacteria, the genes in the bacteria.
• 33:32
  Speaker 1: The genes in the bacteria then talk to the genes of the human to say settle the hell down.
• 33:38
  Speaker 1: It was really interesting.
• 33:40
  Speaker 1: Well, that was my mouse study.
• 33:42
  Speaker 1: They're now investigating these plant-derived exosome-like nanoparticles, p-dense, for drug delivery and what they found was that they dampened inflammation.
• 33:53
  Speaker 1: They made an anti-inflammatory medication safer and more efficacious.
• 33:59
  Speaker 1: I'm keenly interested in this.
• 34:01
  Speaker 1: So you mentioned before about Jason Horolak talking to you that fiber isn't just the cereal fiber, that it's in a heck of a lot of other foods.
• 34:12
  Speaker 1: Do you find that you select certain foods to elicit certain responses at all, like you mentioned, endotoxins, lps.
• 34:29
  Speaker 2: Yeah, yeah.
• 34:30
  Speaker 2: So look, I'm one of those practitioners where I like to use a combination of of, obviously, diet and, and the, the medicines, and, but I I always try and place more emphasis on what they can do in the diet, because everyone not everyone I should say, but most people are very much geared towards the what's the latest and greatest, you know what's the silver bullet.
• 34:52
  Speaker 2: But I always say to people, when it comes to microbiome resolution or balance, there's so much that you can achieve with just dietary changes, and it's actually the doing part where people fall down.
• 35:02
  Speaker 2: So the education can be there till the cows come home.
• 35:05
  Speaker 2: You know, I've got all these charts of here's your black foods, here's your red foods, here's your purple foods.
• 35:09
  Speaker 2: When you're doing your shopping, just simply try and add more, you know, and just work your way up slowly.
• 35:14
  Speaker 2: But being conscious of that on a day-to-day basis and then being consistent with that is the challenging part.
• 35:23
  Speaker 2: But for the folks that do it, we can see massive changes in diversity, for example in the gut microbiota.
• 35:27
  Speaker 2: But to answer your question specifically, one of my favorites and again I have to thank Jason Horolak the Big Mac Horolak as I like to call him for this one, but it's the pomegranate peel.
• 35:44
  Speaker 2: So the peels of the pomegranate and there was even a time where I actually broke them down and got a big delivery of these beautiful biodynamic pomegranates, saved all the peels, cut them up, you know, put them in the blender, dehydrated them and I went through two you know, huge tubs.
• 35:56
  Speaker 2: It took me about two years to get through them, mind you, but not everyone has to go to that length.
• 36:01
  Speaker 2: But you can purchase that online, you know, quite easily.
• 36:04
  Speaker 2: So that's one example.
• 36:05
  Speaker 2: The black beans, which we already mentioned, and I think it comes down as well to saying hey, you know that sweet potato you eat.
• 36:12
  Speaker 2: Yeah, try and get the purple version.
• 36:14
  Speaker 2: Hey, you know that rice that you have three or four times a week, try and get the black and red version as well.
• 36:18
  Speaker 2: And you just get them thinking like that, just to diversify the colour palette coming in, and the effects are quite good.
• 36:25
  Speaker 2: Another one is the EGCG from green tea, such a basic thing that you know just getting people sold on.
• 36:33
  Speaker 2: If you just have a very strong couple to daily of green tea, that goes a long way, not even just with the biome but outside of the biome.
• 36:42
  Speaker 2: So those are my favourites from the sort of culinary, dietary perspective.
• 36:48
  Speaker 2: In terms of the nutraceuticals, I'm very jazzed and excited about the non-dairy serum derived immunoglobulins, um the the people that come through that are dairy sensitive, that their faces light up when you talk to them about a dairy-free colostrum alternative and it works wonders.
• 37:08
  Speaker 2: I've seen great results before and after with leaky gut testing using the lactulose mannitol test and just in those patients like we're talking about earlier, like myself a long time ago, that are just not thriving, that just have a really beat up gut and you're pretty sold on the gut permeability as a core factor there, such a great gentle.
• 37:26
  Speaker 2: Additional tool In addition to that again, something I'm playing around with more and more these days is the human milk oligosaccharides, 2-fl or 2-fucosyl lactose, which is naturally occurring in mother's milk.
• 37:41
  Speaker 2: Using more and more of that In the prebiotic kingdom, which I do more and more of once again and it's not that I don't use probiotics still, but I kind of have a limited range of single strain probiotics that I kind of stick to.
• 37:55
  Speaker 2: I could probably count them on one hand, but outside of that it's more about the prebiotics.
• 38:01
  Speaker 2: Inulin is one of the favourite for the folks that can tolerate it, and coming back to those markers we were talking about earlier Andrew, great for attenuating that.
• 38:10
  Speaker 2: Calprotectin, even when that's borderline or raised, does a great job.
• 38:15
  Speaker 2: Secretory IgA, when that's elevated.
• 38:18
  Speaker 2: There's good research with galacto-oligosaccharides or GOS.
• 38:21
  Speaker 2: Partially hydrolyzed guar gum is another favorite and that's the one that I usually go in with prior to knowing what the biome looks like.
• 38:29
  Speaker 2: Irrespective of that, we say get your sample sent off and, regardless of what comes in, let's just get you started on this guar gum stuff and we'll just start you off nice and slow and gentle.
• 38:42
  Speaker 1: Can I ask about tolerability?
• 38:44
  Speaker 1: So, patient compliance I guess we're talking about here.
• 38:47
  Speaker 1: But when we're talking about some of these fibres, like, for instance, banana fibre, there's a sugarcane fibre, really hard to mix, they're hydroscopic, they float on top and as soon as you put the spoon in they go poof.
• 39:01
  Speaker 1: So, with regards to patient compliance, do you ever talk to them about?
• 39:07
  Speaker 1: Listen, you know, this is how you take this sort of fibre, whether mixing it in with a food, or indeed, well, mixing it in with a food on their plate, or mixing it in with, like a condiment, like, for instance, applesauce or something like that.
• 39:21
  Speaker 1: Yeah, do you ever employ these tactics?
• 39:24
  Speaker 2: Absolutely.
• 39:25
  Speaker 2: The first one that comes to mind and I happen to have it right here in front of me for those folks watching is the inulin and the cell.
• 39:32
  Speaker 2: That I say is it tastes like fairy floss, and it actually does.
• 39:34
  Speaker 2: And um, that's, that's what I say to the, the mums and the dads for the, the kids that I see.
• 39:39
  Speaker 2: You know, you can literally get them to just spoon it straight into their mouth and it doesn't necessarily require that water, um, although it can go in water, but the compliance has been great with that.
• 39:49
  Speaker 2: I mean, you can just get it straight into the mouth and it's got that really nice, naturally occurring sweetness.
• 39:53
  Speaker 2: So inulin is great for that.
• 39:56
  Speaker 2: With the guar gum, I usually say that's quite seamless, so it'll go into everything To your point.
• 40:02
  Speaker 2: The resistant starch, that's a harder one, a trickier one.
• 40:04
  Speaker 2: So smoothies are great.
• 40:06
  Speaker 2: You know, if we can get the patients doing three or four smoothies a week and get a generous dose of the, the rs, in there, um, which which is a prebiotic that you you can go quite high with, or or you get quite better outcomes.
• 40:21
  Speaker 2: I find when you go like more around the sort of 10 to 15 gram mark, even for some folks and with some of those patients.
• 40:28
  Speaker 2: It's important to note too that sometimes with prebiotics the needle doesn't move until you get up to those sort of levels, and that's something that over time I've had to get really comfortable with and sort of go out on a bit of a limb.
• 40:42
  Speaker 2: So three or four years ago it might've been let's just start you on five grams or a teaspoon and just kind of leave you there for weeks to months and see what changes, as patients come back and say that they're tolerating it, though I'm each time now getting them to up it and push the envelope to that level, to just below where there might be a bit of discomfort, and for some patients it's almost like they just turn a corner at that 10 gram mark with inulin or partially hydrolyzed guar gum.
• 41:11
  Speaker 2: It's quite interesting.
• 41:14
  Speaker 1: Right, I know this is going to be a multi-pronged question, forgive me, but with regards to other things that you might employ, if we're talking about healing an inflamed gut, you've got things like zinc, obviously.
• 41:26
  Speaker 1: You've got the zinc carnosine, for instance, which has its own action with healing lesions.
• 41:32
  Speaker 1: Let's say, um, we've got to think about even, you know, liver herbs, for instance, helping with digestion, with bile flow.
• 41:42
  Speaker 1: And then the second sorry about this double prong thing is, if we think about the effect of stress on the gut and we think about how it can be deleterious to healing the gut, how much do you employ, let's say, anti-stress herbs or the, you know, the nerve ions, the adaptogens, in helping somebody to cope with the stressors of life while they're healing their gut?
• 42:10
  Speaker 2: I'm glad you asked.
• 42:11
  Speaker 2: It's huge.
• 42:14
  Speaker 1: I think you're going to hate me.
• 42:16
  Speaker 2: Not at all.
• 42:16
  Speaker 2: Not at all, because it's one of those things that it's very easy to overlook Mindfulness, nervous system balance, parasympathetic versus sympathetic, the role of the vagus nerve between the brain and the gut, which you know over the years I always think of your conversations with Mark Donohoe that you guys have talked about that ad nauseum, and it's so true.
• 42:40
  Speaker 2: You know that the power of the vagus nerve and what the nervous system can influence in these cases, that was very, very like specific to my healing too, andrew.
• 42:52
  Speaker 2: So you know there were periods when 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 had have known about the nervous system back then, I think I could have done a lot more.
• 43:03
  Speaker 2: Um, very easy to say now in hindsight, but uh, yeah, just the power of you know various healing modalities, even just you know walking in nature 20 minutes a day, something so simple, the breath work, and I'm sure we're preaching to the choir when we go on about this, but I concur 100%.
• 43:24
  Speaker 2: You know the amount that we can achieve just by you know the mindfulness and these sorts of you know parasympathetic practices, equally important as just the medicines that they're recommending?
• 43:35
  Speaker 2: Too Sure.
• 43:39
  Speaker 1: You mentioned retesting earlier.
• 43:40
  Speaker 1: Can you just give us a little thing about the benefits of managing somebody's symptomatology, tracking their progress of therapy versus the cost of therapy?
• 43:52
  Speaker 1: How do you sit?
• 43:54
  Speaker 2: Yeah.
• 43:55
  Speaker 2: So it's something that I don't entertain, like if someone says, oh Dan, I want to jump back in there and have a look at what we're doing and see if it's changed.
• 44:02
  Speaker 2: I say, listen, we can do that.
• 44:04
  Speaker 2: It's probably not worth doing that in terms of the invest, the financial outlay until about the six-month mark.
• 44:11
  Speaker 2: You know, realistically and that might differ from patient to patient slightly, but how I sort of approach that conversation, I suppose, as I say, although it is quite a big investment doing that, retesting at the six-month mark or the nine-month mark, that might allow us to cut down your supplement intake by half.
• 44:29
  Speaker 2: So then it's like you work out what you're paying in supplements.
• 44:32
  Speaker 2: You know whether there's six or seven things that we started with.
• 44:35
  Speaker 2: We might only need two of them, you know.
• 44:37
  Speaker 2: But ultimately using your presentation along with the results, will ultimately guide us there.
• 44:43
  Speaker 2: And I will usually preface that when we do the first round of testing by planning that seed and say now, this is good data, we've got a benchmark.
• 44:50
  Speaker 2: Now.
• 44:57
  Speaker 1: Let's earmark it for six months that we do another test.
• 45:00
  Speaker 1: Dan, I have to ask where can we learn more?
• 45:03
  Speaker 1: Do you have any e-courses or anything like that that you provide to practitioners, or even patients at all, to learn from?
• 45:09
  Speaker 2: It's funny.
• 45:09
  Speaker 2: You ask I'm in the um process of putting slowly together an online autoimmune masterclass and um, that's something that's been on the mind for years, so it's taken me a while to to get into action.
• 45:23
  Speaker 2: But, um, yeah, I, I, I plan later this year, early next year, to to put that out.
• 45:28
  Speaker 2: So my, my main sort of online presence is through Instagram.
• 45:32
  Speaker 2: That's where you can find me and reach out.
• 45:34
  Speaker 2: And, yeah, practicing still Monday to Friday I do my four patients a day, with gaps in between, and just keep it at that and that's how we tend to manage it.
• 45:46
  Speaker 2: But yeah, so look out for that to come out online and also the website functionalnaturopathcom.
• 45:54
  Speaker 1: Love it, dan.
• 45:55
  Speaker 1: We could learn so much more from you.
• 45:57
  Speaker 1: Thank you so much for taking us through gut inflammation markers and management today.
• 46:01
  Speaker 1: I really appreciate it, my pleasure.
• 46:03
  Speaker 2: Good to chat to you, Andrew.
• 46:06
  Speaker 1: And thank you everyone for joining us today.
• 46:08
  Speaker 1: Remember you can catch up on the show notes for this podcast and they will be lots, plus all the other podcasts on the Designs for Health website.
• 46:17
  Speaker 1: I'm Andrew Whitfield-Cook.
• 46:18
  Speaker 1: This is Wellness by Designs.