Leaky Gut Symptoms and the Gut Tests Your Gastroenterologist Is Not Running

uh joined here today with Dr. Rose. Dr. Rose, thank you so much for making the time. Yeah, happy to be here. Yeah, I'm happy to be here, too. This is going to be fun. So, today we're going to be we're just live right now. We got some people joining in. So, welcome. Uh we're going to be talking about gut health and then we're going to dive into probiotics. There's actually a ton to learn about probiotics. We're going to be talking about some of the history, best practices, uh gut issues, all that sort of stuff. So, the theme today is going to be gut health. Going to talk about 30 minutes a piece. Um disclaimer, everything we talk about, none of this is medical advice. Uh this is just for education purposes only. Um with that said, Dr. Rose, uh why don't you give some background and context on your experience with gut health? I believe you've written a book on gut health as well, so kind of the expert here. Tell me more. Yeah. Um I think that probably in most um functional medicine practices, gut health is a pretty big component. Um what happened in my practice probably 10 15 years ago was that um I just noticed that the a vast number of people were coming in with uh whether it was IBS, chronic constipation, inflammatory bowel disease, gird reflux, it just seemed to be like a pretty that whole section of health seemed to be a good chunk a good percentage of the people coming in. Um and then um another good chunk was also kind of mental health, emotional health. And so that's kind of what's what ended up spurring the book topic, which is the mind gut connection and how the nervous system, the emotions play a role in gut health and vice versa. So that was um yeah, so that book came out about 10 years ago. Okay. um and doing the and so what happened is then I you know I needed to do a lot of research around gut health for the book which was really um a great opportunity and really um kind of spurred me to learn even more than I than I already knew and then it just kind of became more and more of an interest and more and more patients coming to me specifically for gut health etc. And the beautiful thing about kind of having a medical practice is that you learn from your patients. You know, they come in, they have, you know, something that's kind of a little bit different and it spurs you to do research and then you learn and then you have that information available to the next group of patients. So, yeah. Gotcha. All right. Thanks for sharing. What's like if I if my mission was to mess up my gut and the gut [laughter] make my gut as unhealthy as possible, what's what are the top three things I should do to screw up my gut health? Um, a diet extremely high in processed sugars. Um, a diet extremely high in alcohol consumption. Um, and let's see. [sighs] I mean, there's just the top three, I guess I would say, like probably super high amounts of um gluten and dairy. Okay. So, a ton of pizza, a ton of donuts, and soda. Okay. You got to do soda, and you got to do lots of bourbon. Gotcha. All right. Um maybe beer. Beer. That's probably worse. Beer. Beer is the worst offender to go. Well, you've got gluten and you've got the alcohol. Why is gluten Why is good why is gluten is just extremely inflammatory and so everybody has different levels of sensitivity to gluten, but um on some level it tends to be in if you if you're consuming large amounts of it, you're going to end up with inflammation at the gut level. Um, and so if that's not balanced by healthy fiber and um, you know, adequate water intake and all of that, then you're just going to end up kind of more and perpetually more inflamed at the gut level in my experience. Gotcha. How how does someone know that they have gut health issues? Like what are the symptoms that should make someone think, "All right, I should do something about my gut health." So when I'm meeting with somebody um I and we're talking about digestive health, I always do kind of a top tobottom review of systems. So I start with are you having symptoms of reflux, heartburn. Sometimes there's silent heartburn where it's not that classic burning, but it's like a it's a dry uh con kind of quite frequent um cough or a tickle in the throat. Um, sometimes it's more of a pressure and that's why kind of the whole um, people think they're having a heart attack and it's and it's really heartburn, but you know, if you suspect that you might be having a heart attack, it's good to go get it looked at. Um, but that's why it can kind of feel more like just a pressure, not not that classic burning. So, we kind of ask about symptoms about that. Nausea, vomiting, um, excessive belching or burping and then and then bloating, right? So there's a lot of people walking around thinking that like feeling bloated most of the time is normal. Um and they've just lived with it for so long. So assessing somebody's level of bloating, distension, um feeling like there's a brick in the stomach after you eat, uh like nothing really moves, and then actual abdominal pain, cramping. You just kind of I keep going lower and lower, right? And then what are your bowel habits? Are how often are you having a bowel movement? Is it complete? Um, so does that answer your question? I mean, all the way down to hemorrh all the way down to hemor hemorrhoids. Is there blood in the toilet, right? Gotcha. So, yeah, the gut affects a lot. For the 11 people who are watching, welcome. Feel free to uh throw in comments. Oh, that's not very nice. Um, so what lost my train of thought here with um I guess start like why is the gut like how does the gut affect so many other things in the body? So there's a lot of um receptors throughout the gut. So there's receptors to hormones, there's receptors to neurotransmitters, and I think we I think we're just kind of at the the tip of the iceberg in terms of understanding how the microbiome um in the gut, those those beneficial microbes, organisms really kind of impact those receptors and therefore neurotransmitter balance, hormone hormone balance. Um, there's also something called the entic brain. Um, and it is part of the central nervous system. And so we think of the brain as being in the skull, but there's this whole second brain that's in the gut. And so it's this real intimate relationship between the nervous system, the brain essentially, and the gut. Um, and it's a two-way. It it goes both ways. So thus like yes anxiety for example can affect your digestion but also your digestive health can affect your mood um you know whether it's a tendency more towards anxiety or depression. So I think we're just kind of at the beginning research-wise of how how how that works what that interplay is. Gotcha. Okay. what are like what are things people could do like what are the easiest things people could do on their own to improve their gut health and what are like noticeable improvements they might see after you know doing these things for say 3 months right so it's a little bit of a difficult question because we are all unique we are like we all have different baselines in terms of our microbiome in terms of food sensitivities um so in an ideal world, someone is getting tested and maybe we can talk about what that what that testing can look like. But if somebody is not able to or you know wants to kind of get going on this before having the opportunity to to get a gut health panel then um like vegetables and fiber I think is kind of you know maybe underrated. Um why is fiber good for the gut? like what's so insoluble fiber, one thing is that it basically can it can bind toxins really. It can help to bind toxins and then they're more easily eliminated through the stool. The other thing is that fiber just um can kind of uh bul what we say bulk up the stool therefore making it easier to pass. So a lot of my patients are const have different levels of constipation and by for most people who tend to be constipated if we increase water intake and increase fiber content in the food and or add in an insoluble fiber supplement bulking up the stool makes it easier to pass. And so once and if you're pooping every day and they're complete so I'm not talking rabbit pellet poops. I'm talking about like healthy formed stool then again for most people not everybody but for most people then your bloating and your discomfort is going to go down. So there's three things right there. there's adequate hydration, there's vegetable, therefore fiber intake, and then if that's not quite enough, um or you're traveling during the holidays, for example, and it's hard to get like the right amount or type of vegetables that you want, an insoluble fiber supplement, um can be can can be great. So, those are three things. Uh was it what was the question? Five things that you can do to benefit your gut. I I think I was just asking in general like what are the things you could do? um to benefit your gut. I think that was a good list. What is okay like with bloating um because this is something we hear a lot in the practice they're getting bloated. Yeah. What like what actually causes bloating? What's going on in the gut that makes someone bloated? So most of the time it has to do with these microbes. I I I could say bacteria, but it's not they're not all bacteria, but they are all anorobic organisms. So there's these kind of microscopic organisms in the small intestine and the large intestine and they um are most of them are supposed to be there but only in small amounts. when um somebody is maybe not eating the right food for them or there's an imbalance in that microbiome, we get too many of those organisms and some of those organisms um secrete hydrogen gas. Some of them secrete methane gas and then a smaller um percentage of them can also put out hydrogen sulfate gas. It's the gas that's causes the distension. It's the gas that causes the discomfort. And so, um, it's again super common. People are people, some people realize that it's not normal and not ideal. And again, I think a lot of people just have been [clears throat] dealing with it for so long that they just think that's that's what they expect. And some people will have bloating primarily after they eat and then it dissipates. And other people, unfortunately, are living with kind of a some grade or some level of bloating most of the day. H okay. Um [clears throat] what are they doing to like like what can you do to stop bloating? Is it just the foods you're putting in your mouth or like what like what are because I know a lot of like if you have bad bloating can be really uncomfortable. Yeah. The way you look like what are like really actionable things you can do to take care of bloating. Um, [sighs and gasps] one, um, nutrition or dietary experiment that you can do is something called a low FODMAP diet. It's F as in Frank, O D like David, MAPS, MAPS. Um, and it stands for fermentable, oligo, di mono something, polysaccharides. These are basically starches that aren't easily digested. So, a diet that's low in these starches can for some people minimize bloating. It's kind of a I think of it as like a lowhanging fruit for people. They can do it on their own. They can just experiment. Um some some foods that tend to be really high in FODMAP um uh starches would be onions and garlic um apples and pears. So cut so cut onions, pears, garlic out of your diet if you have as an experiment as an experiment. And so you can easily Google low FODMAP diet. Um, anybody can find that. And um, it's again, it's not intended to be a forever way of eating, but if you want to see if you're sensitive to those foods, it can be a way to to determine to see, you know, if that if if that's playing a role for you at all. Um, and then a lot of people will end up being relatively strict on a low-fat map diet for a month or two. And then um I usually counsel people to kind of slowly reintroduce. And so people will often end up on more of like a modified low FODMAP diet where they can they find that they can tolerate most of those foods at least in moderation. Um and really the ones that they have to stay away from are you know they they can't really have like two apples a day. That's going to trigger bloating. But otherwise they're okay. So that is one thing that somebody could do on their own. Okay. All right. That makes sense. Um, switching topics up here a little bit. Patient goes to a gastro with IBS. Patient goes to a functional medicine doctor with IBS. How do these two providers treat the same thing differently? So, usually if you go to um a gastronurologist, they much of the depends on what you're presenting with. So you could have IBSD which is the diarrhea dominant form. You could have IB IBS which stands for irritable bowel syndrome. You could have C the C version with which is constipation. Or you could have mixed whereas you're alternating diarrhea and constipation. So a gastronurologist um most likely will do a colonoscopy or a also known as a lower endoscopy. Um, and that what they're doing with that is they're they're ruling out something more serious. They're ruling out something like cancer, inflammatory bowel disease, which is Crohn's or ulcerative colitis or a different type of colitis. Um, and if those things are not detected on the colonoscopy, then IBS is considered a diagnosis of exclusion. So there's nothing else is evident and so you're given an IBS diagnosis and again maybe you're given a recommendation for uh Mirax which is a over-the-counter laxative. Um some of some gastronurologists might tell you to follow a low FODMAP diet. They also might say that it's stress related and they might just tell you to deal with your stress or to go on something like Wellbutrin. um functional medicine um we are most likely going to want to um run some kind of comprehensive stool analysis. So a test that is a stool test and we're looking at um the microbiome in a lot of detail. We're looking at levels of inflammation at the gut level. We're looking at um uh if there's any oult blood, like blood that you can't visibly see in the toilet or in the stool, but it's there. Um we are looking we're ruling out all sorts of infections. So bacterial, viral, parasitic, um candida or yeast. So again, in an ideal world, we can get all of that information. And then um that also helps us rule out other things like inflammatory bowel disease or infection. Um and IBS can also look exactly like something called SIBO, small intestine bacterial overgrowth or even SEO, small intestine fungal overgrowth. So they can present very similarly. Bloating, constipation, diarrhea, cramping. Um but but that is an infection like the bacterial overgrowth or the fungal overgrowth. Those are infections and those do require some kind of antibacterial or antifungal treatment like an antibiotic um or an anti-oral antifungal. So, it's just I guess I would say you come to a functional medicine provider with um a previous diagnosis of IBS like we are going to dig deeper. We're going to make sure that it it is IBS. It's not something else. Um most of us are not going to have the training or ability to do a colonoscopy, but we have these other tools. Um and you know we are going to see is there is there a nervous system component to the IBS? Do do your digestive system symptoms worsen when you are stressed or or anxious? Um we are going to look at um all sorts of things from food sensitivities to um you know um autoimmune conditions, all sorts of things that can potentially kind of contribute to this IBS picture. Um and just kind of keep digging deeper and individualize it. Again, everybody's different, but um we do have the benefit of having these advanced tests which can help us together with the data with the results from those tests piece that together with the person's history to kind of figure out what really is going on. Gotcha. So, when should because that I mean it sounds like the diagnosis of IBS is almost like a I don't want to say out, but it's like okay, you don't have anything else or we're just going to give you this. It is. It is for Okay. So why like so do patients in like conventional medicine like how often are they just getting an IBS diagnosis and told sorry that's just how it is nothing more is that the case I think that's pretty common I mean the way that kind of conventional medicine is right now like if somebody's symptoms are um if they persist if they if they've come like say three times now to their primary care doc and you know again the mirax hasn't worked the um you you know, whatever kind of suggestion was made hasn't done anything, they will probably be referred to gastro to gastronurology. Um, yeah. Gotcha. Um, what so when should a patient go to like a conventional gastro versus go to a functional medicine doctor who like yourself who specializes in something like gut health? So, you know, if there's um uh significant amount or frequent blood in the stool um and or mucus um and or um so to me those can be red flags for inflammatory bowel disease. Again, inflammatory bowel disease is kind of the umbrella um term for ulcerative colitis, microscopic colitis, um Crohn's disease. I I really like having a person I treat a lot of people with inflammatory bowel disease, but I really want them to have that colonoscopy. That's kind of the only definitive way to diagnose it. And even though we have a lot of tools um beyond like biologics for treating inflammatory bowel disease, I really like using the gastronurologist, the colonoscopy to get that diagnosis and to see to get a baseline level of inflammation, ulceration, the location within the um colon of where what is affected um because they hopefully will have a repeat colonoscopy. in three or 5 years and we're going to see if our treatments, you know, what's happening with that. And it's just really I I want that diagnosis. I want to kind of know what we're dealing with before we um begin a a comprehensive treatment plan. So, I guess I would say blood and or mucus. Um and and I and red blood again is usually hemorrhoids. Um like a few, you know, red blood on the toilet paper. That's I'm not saying that hemorrhoids are not a concern, but that's not necessarily indicative of um an inflammatory process happening higher up in the in the colon. Um so yeah, so I would say those two those two are times to go to a gastronurologist. Um it never hurts to have a colonoscopy. Again, I I always like it when people come in and they already they've [clears throat] already had that um because it just gives us a framework of what's going on for what's going on. Sure, that makes sense. Okay. Um is there ever a scenario where someone doesn't need to go to a gastro or do you say that these two should always work together? Like you should always have your conventional doctor, you should always have your functional medicine doctor. No, I don't. There's a lot of times when I don't think somebody needs um needs to go to to a gastronurologist. I think um kind of chronic bloating, chronic constipation, um they can [clears throat] go straight to a functional medicine provider. Um, in terms of the upper GI, like again, I don't I don't I really don't mind having some referring somebody for an endoscopy or someone coming in already having had the endoscopy again for like baseline. Obviously, if you're coughing up blood that, you know, please don't come to me. Come go to go to urgent care. Um, yeah. Um but uh what other what other times can they come to us? Um I mean most things I think it they don't they can kind of start with us. It's really when it's like you know your the blood the mucus you're like really really debilitated and it's it's an urgent situation um that it makes sense to at least start with urgent care. [snorts] Gotcha. Okay, that makes sense. How confident are you? Like if someone comes in with constipation, uh how confident are you that you could fix their constipation if they're willing to make any lifestyle change? They're super motivated to fix, you know, this gut issue. I'm pretty confident. I've got a lot of tools, you know. Give me a number like what? Like 90% 99%. [laughter] Um I am um 90% confident that I can improve their bowel habits. Now they might not end up having like you know a stellar bowel movement every day for the rest of their life but um uh I can I can 90% of the time I can improve the quality uh fre and frequency of the bowel movements. Gotcha. And how do you do that? Sometimes it's dietary modifications. Um, sometimes it's figuring out if there is something like SIBO, small intestine bacterial overgrowth going on. Um, and that if that's happening, it means that there's these microbes that are putting out methane gas. Methane gas slows the motility of the gut. And when you slow down the motility of the gut, there's no longer what we call paristalsis. So there's no longer that muscular contraction. And so nothing moves. Um, so if we kind of get to the root of that, um, and we treat that and then we bring back often what we bring back some motility, then they're going to start going again. Um, there there's neutrauticals. Um, again, everybody's a little bit different. So, say the person doesn't have SIBO, they just have slow motility. we and we we're bringing in things like magnesium, fiber, um you know, if we have to, there are natural laxatives out there that I don't like to use long term, but I will use short term. Um sometimes the tools that your grandmother told you about like prunes and prune juice, that can actually that can do the trick. Um so there's a lot of investigative work that goes on of why is this person constipated? Why is there slow motility? You know, is it And then once we kind of figure out why uh we can start playing with different different tools. Gotcha. Okay. How do um how often do you use a lot of patients come to us because we have access to a lot of peptides. How do you you use peptides in helping patients improve their gut health? Gut health. Um yeah. So two of my favorite peptides for gut health. One is actually BPC157. Um, and this is a peptide that it's actually a sequence of amino acids that mimics part of our own stomach acid. Um, and it has the way that peptides work in general is that they have affinity for different parts of the body, different tissues. And so BPC 157 has an affinity affinity for the gut. Um, it's probably more well known for its affinity for connective tissue and joints and inflammation in connective tissue and joints, but it does also help to heal inflammation in the gut. Um, so I really like using it for that. I've had some good success with that. And then a second peptide that I like to use specifically for leaky gut syndrome um, is laorazzide. And that's actually an oral peptide and that um was originally studied in people with celiac people who have celiac disease. Um but it has this ability to um heal what we called tight junctions um which are so in leaky gut syndrome uh the interasittes the cells that make up the the lining of the gut they normally line up together like this and they are permeable enough to let nutrients into the bloodstream but um close enough to keep things that we want to keep in the stool in the stool. So proteins, foreign things, um just larger molecules that really shouldn't get into the bloodstream. So a tight junction is like this. And then with inflammation, it's like this. And so things get through that shouldn't. Lorazzide is a peptide that can come in and help to heal that gut, heal that tight junction, bring it back together. Um, so those are probably the two that I start with, the two peptides that I'll start with with a um, digestive health case.