A Functional Medicine Practitioner’s Approach To Treating IBD

When a patient visits me for the first time with inflammatory bowel disease (IBD)—ulcerative colitis or Crohn’s—they’re usually in bad shape.

They have abdominal pain and cramping, diarrhea, fatigue, and other problems, such as visible blood in the stool.

In other words, they’re experiencing an IBD flare.

People who suffer with ulcerative colitis or Crohn’s experience usually have flare-ups when symptoms are much worse, as well as periods of remission, when their symptoms go away. It can be frustrating and hard to have a “normal” life.

When patients come to me for IBD treatment, the first step is to get the patient out of the flare so we can focus on putting the IBD into remission- for good.

In this blog post I’m going to dive into what I do to treat IBD naturally. We can get lasting remission without the use of medications, as seen in this real-life success story from one of my patients. But, first, a word of caution.

Do NOT try this at home!

There’s a very strategic order of operations. If you do any of the things I mention in this article in the wrong order, you can make yourself worse.

Much worse.

For example, if a patient is in a severe flare I might not throw betaine hydrochloride, a digestive aid, at them until later. If they take betaine hydrochloride during an IBD flare it can make things worse.

That’s why it’s so important to work with a functional medicine provider.

I can’t say it enough: If you have ulcerative colitis or Crohn’s, get yourself a good functional medicine practitioner.

Okay, with that out of the way, let’s briefly recap what IBD actually is and the symptoms it causes.

What Is IBD?

Inflammatory bowel disease refers to conditions like ulcerative colitis and Crohn’s disease. These conditions are linked to ongoing inflammation in the gastrointestinal tract. In ulcerative colitis, patients develop inflammation and lesions on the lining of the large intestine and rectum. Crohn’s disease is a type of IBD that involves the lining of the digestive tract. Crohn’s usually involves inflammation in deeper layers of the digestive tract compared to ulcerative colitis.

What Causes IBD?

IBD is an autoimmune disease believed to be caused by an abnormal immune response to gut microbiota or food in susceptible people. In IBD, the immune system malfunctions and attacks the cells in the gastrointestinal tract. The cells in the intestines are innocent bystanders but the immune system thinks they’re foreign invaders. The primary cause and the triggers of IBD are still unknown.

IBD may have a genetic component, since it occurs in some people who have family members with the disease. However, most IBD patients don’t have a family history of the disease.

IBD risk factors include:

Younger Age – Most people with IBD are diagnosed before the age of 30, but some patients don’t develop the condition until they’re in their 50s or 60s.
Family History – People with a close relative who has IBD are at higher risk of the condition.
Cigarette Smoking – This is a risk factor for Crohn’s disease.
Nonsteroidal Anti-inflammatory Medications (NSAIDS) – Anti-inflammatory drugs like ibuprofen (Advil, Motrin, etc.) and naproxen sodium (Aleve) as well as others in this class may increase the risk of developing IBD or worsening the condition in people who already have it.

Inflammatory Bowel Disease Symptoms

IBD symptoms are different depending upon how severe your inflammation is and where it’s located. IBD patients usually go back and forth between disease flares and periods of remission.

Symptoms of ulcerative colitis and/or Crohn’s include:

Abdominal pain
Blood in the stool
Constipation, especially when inflammation occurs in the rectum.
Diarrhea
Fatigue
Poor appetite
Unintended weight loss

IBD Complications

Ulcerative colitis and Crohn’s disease share several complications. These include:

Increased risk of blood clots
Increased risk of colon cancer
Increased risk of primary sclerosing cholangitis, a condition that causes scarring within the bile ducts, leading to liver injury.
Inflammation of the skin, eyes, and joints

Patients with IBD also take medications that can have side effects. For example, corticosteroid drugs increase the risk of osteoporosis and high blood pressure, as well as other conditions.

Possible complications of Crohn’s disease:

Anal fissure, a small tear in the tissue lining the anus.
Bowel obstruction
Fistulas. Inflammation leads to these abnormal connections between different body parts. In Crohn’s, fistulas can develop near the anal area and may become infected.
Malnutrition

Possible complications of ulcerative colitis:

Dehydration caused by frequent diarrhea.
Toxic megacolon, a condition where the colon rapidly widens and swells.
Perforated colon, a hole in the colon that often occurs due to toxic megacolon.

Fight The Flare

The first thing I do for a patient who’s in the middle of an IBD flare is to begin an anti-inflammatory protocol while at the same time ordering important tests. The two goals at first:

Prevent tissue inflammation
Bring symptoms into remission

One of the best ways to calm the tissue inflammation and get out of flares is the specific carbohydrate diet (SCD). The SCD diet is a whole-foods diet including vegetables, fruit, fish, meat, nuts, beans, and healthy fats and oils. It excludes sugars, processed foods, preservatives, all grains, starchy vegetables, and lactose. In patients with diarrhea, I’ve really seen the SCD make a HUGE difference. The elemental diet is also very useful for seven to 10 days. An elemental diet is a liquid formula providing all of the basic nutritional elements you need for health, in a form that your body can easily absorb. One clinical trial of 23 patients with ulcerative colitis found that 56% went into remission on an elemental diet and nearly half of those remained in remission for 7 to 28 months.

Even if the patient isn’t gluten sensitive, I urge the patient to go on a gluten-free diet. Gluten promotes leaky gut, a condition that will stop a patient from going into remission. Mostly, I encourage any patient in an IBD flare to go on a paleo-type diet, with no gluten and no carbs.

For patients in flare mode, I also recommend a Chinese herbal formula called Yunnan Paiyao. In addition, I put them on high-dose DHEA to support the adrenals as they withdraw from corticosteroid drugs.

It’s also important anyone with diarrhea take electrolytes like magnesium and potassium. And Epsom salt baths and butyrate enemas are a part of my anti-flare strategy.

Interpreting Test Results and Treating Accordingly

While making those initial changes to diet and supplements, I order a number of tests in IBD patients. These include stool tests, as well as tests to find out if a patient is nutrient deficient, and tests for markers of oxidative stress, methylation, and neuroinflammation. Figuring out a person’s specific problem areas helps build a protocol precisely for their needs.

Oxidative stress is what you might know as free radical damage. Oxidative stress happens when free radical production goes out of control. Inflammation from IBD can cause oxidative stress in the colon.

Methylation is an important process that affects many bodily functions. People can have genetic defects in methylation. These defects are linked to the development of IBD. Often the genetic defect involves the inability to metabolize the folic acid form of the B vitamin folate. We get around this by giving patients a special form of folate that can bypass the pathway needed to use folic acid. This special form of folate is called 5-MTHF.

You’re probably wondering what neuroinflammation has to do with IBD. Well, one is inflammation in the brain and the other is inflammation in the gut. I am interested in markers of neuroinflammation in IBD patients because of the gut-brain axis. What’s happening in the brain is linked to the gut and what’s happening in the gut is linked to the brain.

Stool testing is another important test in patients with IBD. Stool testing detects parasites, an imbalance in the gut microbiome, and fungal infections—all of which can impact your gut health. This type of testing can let me know if specific types of good bacteria are lacking. In this way, I can build up what’s missing in the gut by giving high-dose probiotics, fiber, prebiotics and more to patients who need them.

Adrenal Testing

I order adrenal hormone testing for my IBD patients. Adrenal testing is important because the adrenals make the stress-hormone cortisol. Many patients with IBD are vulnerable to mental stress, which can make IBD attacks worse or even knock someone out of remission.

Patients who are in a flare and on corticosteroid drugs cannot take the adrenal test right away. This type of drug raises cortisol levels and will throw off adrenal test results. In this case, I may have to wait until symptoms are more controlled and the patient can wean off of corticosteroids. I also take them off high-dose DHEA. Only then am I able to test adrenal function.

Mycotoxins Testing

In the past, I only ordered mycotoxin tests in IBD patients who were not getting results from the usual treatments. But now, after years of treating IBD patients, I’ve noticed there’s a strong connection between toxins made by mold (mycotoxins) and ulcerative colitis.

Yes, this is a thing. Even studies published in medical journals confirm it.

That’s why I no longer wait to test IBD patients for mycotoxins. Instead, my attitude is usually: let’s just get ahead of this and deal with mycotoxins if they are a problem.

Food Sensitivity Testing

Food sensitivities are an important factor in IBD. They can trigger inflammation in the gut. They can stress the immune system so that it malfunctions. They can promote intestinal permeability, or leaky gut.

In IBD patients, there could be two things going on:

Actual food sensitivities where you have an immune reaction to certain foods.
Foods irritating the gut without causing any immune reaction. In this case, the irritation and inflammation occurs in a biochemical way. These types of foods are still difficult to digest or are feeding the bad bacteria even if you’re not actually having an immune reaction to them.

The type of food sensitivity testing I like to use not only tests for IgE and IgG but also other aspects of food sensitivities, such as complement. This helps me capture food reactions that are immune-mediated and those that are not.

How To Stay in Remission During IBD

Best Diet For IBD

Conventional “wisdom” says you shouldn’t eat salads and fiber when you have IBD.

Wrong. Very wrong.

You eventually want to emphasize roughage and fiber so you’ll have the prebiotics you’ll need to feed the beneficial bugs in your gut. But timing is everything.

During the remission phase, the goal is to emphasize resistant starch and various types of prebiotics. This type of starch feeds the good bacteria in your colon. I personalize this plan based upon the results of your microbiome testing. The key is to choose prebiotics that only feed the good bacteria, not the harmful ones.

When in remission, expand your diet a little compared to when you were in a flare. Dairy and gluten probably are only going to make things worse. But you can add other things back into your diet one at a time and watch how you react.

The key? Choose foods less likely to cause a flare-up. Avoid gluten, dairy, eggs, nuts, and seeds.

Identify Your IBD Triggers

Another helpful strategy during remission? Focus on preventative management of your stress. For example, if you know you get stressed around the holidays, be proactive and plan ways to reduce your stress such as extra self-care during that time of the year.

The key is to pinpoint your triggers. Do your flares only happen in the winter? Then we need to find out what’s causing them. At that time of year I also want to look at vitamin D levels to make sure yours aren’t too low.

The Best Type of Exercise for IBD

Healthy exercise is also important. By healthy I mean don’t overdo it, especially if you have IBD. Aim for mild cardio three times per week but focus more on weight training, which can help build the microbiome and reduce inflammation.

On the other hand, too much intense cardio (more than 30 minutes), can increase inflammation and spike cortisol levels. Intense cardio can boost levels of an inflammatory protein known as IL-6. High levels of IL-6 are linked to IBD flares.

When you do any cardio exercise, aim for shorter walks or hikes in nature.

Dietary Supplements for IBD

Each of my patients with inflammatory bowel disease has a different supplement protocol customized to their test results and where they are in the course of the disease. Here are some of the supplements I may use in IBD patients:

Yunnan Paiyao, a Chinese herbal formula for inflammation.
High-dose probiotics
Prebiotics
Liposomal glutathione, which as an antioxidant reduces oxidative stress. In the early stages of treatment, I prefer this over the glutathione precursor N-acetyl cysteine (NAC) because NAC can thin the gut lining.
Nutrients that show up deficient on testing such as B vitamins.
Curcumin or turmeric extract to reduce inflammation.

It’s Critical To Work With a Functional Medicine Provider

As I mentioned earlier, if you try to treat yourself you could really make things worse.

Or you could delay your recovery.

There’s an order of treatments that need to take place and this order is unique to each patient.

That’s why I invite you to reach out to me for a free 15-minute troubleshooting call to find out the best course of action for you. If after the call you come on board as a patient, I’ll order the right tests for you and start you on an anti-inflammatory protocol.

The goal is to get you into a long-lasting IBD remission. My protocol has worked on many patients and it’s very effective, but it may take time. At first, you might take one step forward and two steps back. But with persistence, testing, and modifying your protocol, we can find the winning combination to turn off your IBD. In the end, we can calm your gut’s inflammation and get your digestive tract feeling comfortable and healthy again.

If you’d like to see an example of how this approach can bring lasting remission, read a real-life case study of one of my patients with UC (coming soon).

by Bassem

What Causes Restless Leg Syndrome? Natural Remedies for RLS

You’ve just fallen asleep when it hits. That uncontrollable urge to move your legs.

Your legs also ache and throb.

It’s known as restless leg syndrome (RLS), and it makes you feel like you need to put a leash on your legs to keep them from trying to run away. Down boys! Down!

Restless leg syndrome is a condition where your legs are fidgety and uncomfortable, usually at night during sleep. But sometimes it can happen during the day when lying down or sitting for a long time, like when you’re in the car or at the movies.

Symptoms of Restless Leg Syndrome

The main symptom is the urge to move the legs. However, people with restless legs describe other symptoms such as:

Aching
An “electric” feeling
Crawling
Creeping
Itching
Pulling
Throbbing

The condition is known for:

Happening when lying or sitting for a long time.
Relief with movement. The urge usually goes away when walking or stretching.
Occurring mostly at night.

In some people, the disorder happens together with twitching or kicking of the legs while they’re sleeping. This condition is known as periodic limb movement of sleep.

Causes of Restless Legs Syndrome

There are a lot of reasons why you have restless legs. Since I specialize in treating women with gastrointestinal disorders I’m really familiar with one of the most common causes of RLS—small intestinal bacterial overgrowth, or SIBO for short. An imbalance in the gut microbiome—what scientists call dysbiosis—is also often to blame.

But there are other factors that can cause restless legs. In fact, there might be more than one culprit involved. Let’s dive into all those factors in this blog post and I’ll tell you the natural remedies for restless legs syndrome that have worked for my patients.

SIBO and Restless Legs

In my clinical practice, I see a lot of patients with SIBO who also have restless legs. Studies in medical journals confirm the link between SIBO and restless legs.

If you want to know more about what is SIBO, I recommend you read this blog post I wrote. Meanwhile, in a nutshell, SIBO is an imbalance in the microbes that live in the small intestine.

This can mean that there are too many bacteria or the wrong kind of bacteria that don’t belong in the small intestine.

So what does SIBO have to do with restless legs? A lot.

SIBO causes inflammation in the gut, which leads to the release of hepcidin, a hormone critical in delivering iron to the body and the brain.

Iron is necessary for growth and development as well as supplying the body with oxygen through the blood. But more important for our topic here, iron is a cofactor in the production of dopamine, a brain chemical (neurotransmitter) that tells leg muscles to relax at night. Without enough dopamine, muscles can remain hyperactive. The result? Restless legs syndrome.

When the body releases too much hepcidin, you might not even realize there’s a problem with iron. When you get tested for iron levels or for ferritin, the tests come back normal. And yet your body isn’t able to use the iron that’s available.

Eating enough protein is also critical for making dopamine. The body needs the amino acids tyrosine and phenylalanine from protein as well as iron to make dopamine.

I’m not the only one who connected the dots between SIBO and restless legs. In a small study published in the online version of the journal Sleep, SIBO was found in all seven participants with RLS. Compare this to the general population without restless legs; SIBO occurs in less than 15% of people.

Restless Legs Treatment #1: Work with a functional medicine provider to test for and treat SIBO. Dietary changes, probiotics, fiber, digestive support, and antimicrobials are often used to turn around SIBO. Eat 1-1.2 grams of protein per kilogram of body weight, taken daily in divided doses.

Gut Microbes Gone Bad

Sometimes, treating SIBO isn’t enough and the restless legs continue. There could be many reasons for that, but one of them could involve gut dysbiosis beyond just SIBO. Gut dysbiosis causes inflammation in the gut and the body. In my practice, I don’t just test for SIBO. I use stool testing to look for bacterial overgrowth, fungus, and parasites.

Imbalanced gut bacteria lead to many of the same problems that occur with SIBO, such as the release of hepcidin and the inability of the brain to use iron.

Restless Legs Treatment #2: Balance the gut microbiota through the use of a good probiotic and avoid factors that lead to an imbalance such as eating too much sugar and processed foods and stress. Your functional medicine provider may use antimicrobials, antiparasitics, and/or digestive support to optimize your gut microbiome. Eat 1-1.2 grams of protein per kilogram of body weight, taken daily in divided doses.

High Histamine

Another reason why SIBO or dysbiosis causes restless leg syndrome is because they can lead to histamine excess.

Histamine is a chemical found in many cells of the body. It causes allergy symptoms like itchy, red eyes, runny nose, and sneezing. When the body makes too much of it, it changes how the nervous system functions. This can be a problem for people with restless legs.

People who make too much histamine or who have histamine intolerance often have problems sleeping, since histamine is a brain stimulant.

The catch? Because histamine revs up the brain, people with restless legs who also are making too much histamine can get by on little sleep. They’re not sleepy in the daytime and can function even though they’re exhausted.

Scientists are now beginning to believe that targeting histamine receptors may reduce restless leg syndrome. Histamine receptors are proteins found on the surface of some cells. These proteins are triggered by histamine. Think of receptors like locks on a door and histamine as the key that fits into the lock and gets it to open.

Mast cells are immune cells found in the blood that release histamine as part of an allergic reaction. Now researchers are finding that when mast cells are activated, it may cause restless legs. People who have a condition known as mast cell activation syndrome are more likely to have restless legs compared to healthy controls.

Restless Legs Treatment #3: You can start by supplementing with DAO, an enzyme that breaks down histamine. Two other ways to support histamine levels are Natural D-Hist from Orthomolecular Medicine and quercetin. A low-histamine diet may also help.

But keep in mind that histamine excess is complicated. There are different pathways through which people have problems. It’s best to work with a functional medicine provider to find out if histamine excess is part of your problem and if so, why you’re making too much histamine.

B Vitamins for Restless Legs Syndrome

Vitamins B12 and vitamin B1 (thiamine or benfotiamine) can both fend off restless legs. For example, in patients with inflammatory bowel disease, vitamin B12 deficiency is linked to an increased risk of restless legs syndrome.

Vitamin B1 helps the body make a chemical called acetylcholine, which is involved in motor control. In other words, B1 supports the health of the nerves that control the muscles. So it makes sense that if you’re low in vitamin B1, your legs and body will fidget.

The body also needs vitamin B1 to make dopamine. As I mentioned earlier, dopamine is a brain chemical that says to the leg muscles: “Relax! Relax!”

I’ve had patients tell me that even when other restless legs treatments didn’t help, vitamin B1 worked miracles.

Restless Legs Treatment #4: Start by taking a B complex vitamin or vitamin B1 (up to 100 mg). You may need to go up to 300 mg, which you should only do under the supervision of a functional medicine provider.

Food Sensitivities

Food sensitivities may be to blame for restless legs in some people. A case study of three patients found that food sensitivities caused movement disorders including repeated shrugging of the shoulders. In these patients, milk, coffee, eggs, aspartame (Nutrasweet), tea, chocolate, citrus, raspberries, strawberries, potatoes, beef, and pork caused the most problems. This matches my experience in clinical practice.

Restless Legs Treatment #5: Work with a functional medicine provider, who can order food sensitivity tests to find out which foods don’t agree with you. They may also suggest an elimination diet or just removing the foods that bother you from your tests. After a trial period without the foods, your practitioner will instruct you to introduce one at a time while watching for symptoms. That way you can see which food is causing your restless legs.

Other Causes of Restless Legs

Here are other common reasons why my patients develop restless legs:

Alcohol, caffeine, nicotine
Certain medications
Low vitamin D
Pregnancy
Stress/anxiety
Vigorous exercise

Drugs That Cause Restless Legs Syndrome

Sometimes, the cause of restless legs is a certain prescription medication. Here are some of the most common drugs that cause restless legs.:

Allergy meds
Diphenhydramine
Neuroleptics
Selective serotonin reuptake inhibitors (SSRIs)
Tricyclic antidepressants

Getting Rid of Restless Legs

I specialize in treating GI disorders and women’s health. So if you have digestive symptoms and restless legs, I know how to get at the root cause of why your legs are so fidgety.

The first step? Book a free 15-minute troubleshooting call with me to find out the best course of action.

If after the call you come on board as a patient, I’ll order certain tests to show whether your restless legs are caused by nutrient deficiencies, gut dysbiosis, or histamine excess. Whatever the cause, I’ll be on it until I find out what’s wrong. Book a call today so you’ll sleep more deeply tomorrow.

by Bassem

How To Relieve Constipation in Children

I’m a gut health expert, who has done everything “right”... and my toddler daughter has been struggling with constipation!

Yes, it feels a little vulnerable to tell you this, but above all else I want to always be honest.

So here’s the honest truth: no matter how hard we try to care for ourselves and the ones we love, sometimes health issues still present themselves. When they do, we have two choices. We can either bury our head in the sand and wish it wasn’t so, or meet the challenge head on.

So today let’s dig into constipation in kids: what causes it, and how we can help. Plus, I’ll share my own story of helping my daughter through this health challenge.

My Daughter’s Constipation Story

From the time I found out I was pregnant, I did everything I could to set my daughter up for a lifetime of gut health. I used oral and vaginal probiotics leading up to her birth, and pushed for a vaginal delivery (even though I had a lot of pressure for a C-section). When she was born, I gave her probiotics on my nipple, and later in bottles of breastmilk.

We waited to introduce solids until she was a little over 6 months, and then introduced them according to the book Super Nutrition for Babies, which is based on the work of Dr. Weston A. price and heavily influenced by the paleo diet. Her first foods were all high-fat, breast milk-mimicking foods like puréed liver and broth, egg yolk from a very softly boiled egg, puréed fish and lamb, and avocado.

And it seemed to really work: by eight months old, she was downing a cup of broccoli at a time. She loved tasting new food - sauerkraut, pickles, curry, and all the veggies.

But then, after a family vacation to Mexico and a bout of food poisoning, something seemed to change. Suddenly, her belly was protruding more than it had before, and she was skipping multiple days between bowel movements. When she did go, she sometimes cried and complained it hurt. Her diet hadn’t changed - so I couldn’t blame too many crackers and cookies, or low fiber intake. It was something deeper than just diet.

As a functional medicine practitioner, I had some hunches as to what was going on - and I’ll share exactly what I did to get her back to daily poops at the end of this post.

But first, let’s dive into constipation in children: why, what, and how we can help.

Signs of Constipation in Kids

Depending on the age of your child, they may not be able to communicate that they’re feeling backed up. That’s why it’s important for parents to keep an eye on things. (And even kids that are verbal may not connect that their tummy hurts because they haven’t been pooping!)

Here are signs of constipation, based on age:

Babies

Constipation is most common in babies during transitions - either from breastmilk to formula, or with the introduction of solids. If a baby is exclusively being fed breastmilk or formula and has constipation, that’s a red flag for a bigger issue, most commonly food sensitivities.

Signs of constipation include going 4+ days without a bowel movement, less frequent bowel movements than normal, crying while passing stools, dry or pebble-like stool, or struggling/straining while pooping.

Toddlers

Normal is considered anywhere from daily to once every 3 days, but sudden changes are a red flag - like if your usual daily pooper has gone 3 days without going. Older toddlers might tell you their tummy hurts, or that it hurts to poop. You might also notice that their stomach pokes out more than usual, and that it’s hard to the touch. Bowel movements might be difficult to pass or unusually large. The stool may seem to move out and then back in before they can successfully pass it.

Because pooping is painful when they’re constipated, toddlers might also start to hold their poop and avoid going. This only makes the problem worse, so it’s ideal to jump in right away with some of the solutions I'll outline here, before they start holding their bowel movements in.

Foods That Cause Constipation in Children

Not enough fiber is the most common food-related cause of constipation. Your child's age + 5 = the number of grams of fiber they should be consuming each day. The exception are babies under six months of age: they have no need for food besides breastmilk or formula. If you’ve introduced solids before six months and your baby is struggling with constipation, stop feeding them - especially if you started with rice cereal or something similar!

Hand-in-hand with not enough fiber goes too many high-starch foods like crackers, cookies, pasta, bread, etc.

Food intolerances, most commonly to cow dairy and wheat or gluten, are another common food-related cause of constipation. Many kids transition from breastmilk or formula straight to cow’s milk, which for many, is the primary cause of constipation. Wheat is also hard to digest and can be constipating for some children. Separately, they may also have gluten intolerance, where gluten exposure causes inflammation and various GI symptoms.

Foods to Help Constipation in Children

In general, kids should be on a Paleo-template diet that emphasizes lots of whole foods, in whole form, the majority of the time. (If your kids are eating this way, you likely don’t need to worry about fiber). There is always room for “excursions” from the diet for special occasions, but those excursions should remain excursions, and not become part of the everyday way of eating.

If you need to overhaul the way your kids are eating, do it slowly and keep them involved. It’s great to have kids in the kitchen, helping you cook. And don’t forget you can blend veggies into all sorts of things! (I’ve included one of my favorite high-fiber, veggie packed recipes for kids at the bottom of this post!)

Adding in these foods to help constipation in children is especially beneficial:

Sugar free water kefir with chia seeds - provides hydration and beneficial wild probiotic strains, adding chia not only helps moisten the intestine, but makes it more fun for kids to eat

Fermented veggies - more beneficial bacteria and fiber. You might think your kid would never eat them, but you would be surprised how many toddlers and babies love them, especially fermented beets!

High fiber foods - strawberries, apples, pears, prunes, bananas, avocado, beets, blueberries, raspberries, broccoli, chickpeas, lentils, black beans, pumpkin, peas, spinach, and sweet potatoes are some of my favorites.

What about oats? While oats get a ton of buzz for being high-fiber, I find that many children have a very hard time digesting grains. Grains contain lectins and phytates, two anti-nutrients that can cause leaky gut. I don’t recommend emphasizing grains, and instead focusing on other high-fiber foods.

Finally, make sure your kids are well hydrated! Babies over 6 months can have 2-3 ounces of water, a few times daily (and will get the majority of their hydration from breastmilk or formula). Toddlers should be drinking 16-32 ounces of liquids daily, with the majority being water, not milk, milk substitutes, or juice.

If your child refuses to drink enough water, soaking fruit in water in the fridge overnight can add some flavor, as can a splash of something flavorful such as the low-sugar Kefir Water drink mentioned above, or coconut water.

What Else Causes Constipation?

If diet has already been addressed and constipation isn’t improving, it’s time to dig a little deeper. Some of the other causes of constipation I commonly see in children include parasites, H pylori, Candida overgrowth, and Small Intestine Bacterial Overgrowth (SIBO).

Kids touch… everything! And they constantly put their hands in their mouths, making them prime candidates for parasites and pathogens. Plus, their immune systems aren’t yet fully mature, making them more susceptible to things like foodborne illness or parasites in water. (Water can be contaminated when traveling - but even city and well water can become constmainted. That’s why we use a Berkey water filter.)

Acute GI infections, such as food poisoning, can also lead to a condition called Post-Infectious Irritable Bowel Syndrome, better known as Small Intestine Bacterial Overgrowth (SIBO). Learn more about SIBO here..

All of these issues can be diagnosed via stool panels and treated naturally with child-specific herbal protocols. (As a mom, I know how hard it is to get kids to take anything yucky-tasting… so I worked hard to find a treatment plan kids would actually take!)

If your child is old enough to blow into a tube, we can also run a SIBO breath test, but in kids I find treating dysbiosis more generally based on stool panels alone is typically adequate (and saves you money and time, too!)

Constipation Relief Supplements

In addition to diet, specific supplements can make a huge difference in kids’ constipation.

Herbs: I prefer gentle carminative herbs (gas-relieving) over laxatives, because laxatives can be habit-forming (even herbal ones!) That being said, I prefer herbal laxatives over Miralax any day!

Why I Don’t Recommend Miralax

Miralax is often a first line of defense against constipation in kids, but for several reasons, I don’t like it, including that it contains red dye, hasn’t been approved for use in kids or long-term use by the FDA, and is associated with ADHD and other mood/behavior disorders. It can often be habit-forming, and leave kids dependent on it to poop. There are lots of herbal alternatives that work just as well, without these concerns.

Pre- and Probiotics: Probiotics are the good bacteria that live in the gut, and prebiotics are the food probiotics need to thrive. I recommend MegaSporeBiotic (which i use at ¼-½ the adult dosage of 2 caps per day, depending on the child’s weight) and MegaPre prebiotic (2 caps per day, which is ⅓ adult dosage). If you want to try a prebiotic option, I recommend Begin Health Growing up Prebiotics that use human milk oligosaccharides, which are identical to the most abundant prebiotic naturally found in breastmilk [plus get 20% off first purchase with my code: BRIE20].

Magnesium: This mineral can help bring water to the bowels. I use Mag-Go kids.

Try These Tricks to Help Ease Constipation

In addition to diet and supplements, there are a few other tricks to try:

Drink this: For quick relief, I like ¼-⅓ cup aloe vera juice and 1 teaspoon to 1 tablespoon of liquid chlorophyll, 3x daily.

Massage: I use Chinese medicine tuina techniques with oil, followed by raising the knees up to the right and then around clockwise in a circle. Repeat this several times a week for about 10 minutes. Below is another massage location for constipation in children, on the hand. Start at the base of the thumb and work in a clockwise direction, pressing and releasing along the circle.

Get into position: Giving kids a place to rest or elevate their feet while pooping puts them into an ideal posture for pooping. This makes a big difference. I like the Squatty Potty for Toddlers or Super Pooper Plus.

Make time to go every day: Kids are busy moving from activity to activity - and sometimes when the urge to go comes on, they’d rather ignore it than stop what they are doing. That’s why I recommend creating a habit of trying to poop at roughly the same time every day. (If you notice they have a time they most often poop, like after lunch, that’s a good time to try!) Just keep it light hearted: go sit on the toilet, read a book or sing a song, and don’t make a big deal out of it. If they don’t poop, NBD. It’s about building a habit.

Putting The Plan Into Action

Let’s go back to my daughter’s story, and I’ll explain how and what I did to get her pooping regularly again.

Although she was already eating a diverse diet of lots of plant foods, I doubled down on getting her plenty of fiber, made sure she was well-hydrated, and added a magnesium supplement. Despite these changes, we still had an issue.

My next step was adding some simple herbs that are safe for kids, like Easy Going and Bioray Pooper.

When that still wasn’t enough, I ordered a stool test for her. The test showed overall general dysbiosis and low secretory IgA, a sign of immune function. I created a custom protocol of herbs and probiotics to address the dysbiosis and clear the bacteria. We also added chiropractic and acupuncture - (both of which she loved! She asks me to give her acupuncture now, regularly!)

acupuncture

After a few weeks of treatment, we re-tested: the dysbiosis was improved, but her secretory IgA was still low, and now the stool panels had revealed candida and H pylori. (Note: it’s not completely uncommon to treat a finding, retest, and uncover another layer of pathogenic organisms. This often relates to disruption of biofilms). We started a new treatment and added massage and cat/cow stretching - and that did the trick! Now she’s back to regular pooping, her tummy isn’t hard or distended, and she doesn’t have pain when she goes.

As a mom and a health practitioner, there’s nothing like seeing a successful treatment! But as you may have noticed - it wasn’t a simple one-step process, or just a matter of adding in one supplement. The human body is complex, and often the treatments that are most effective are a little more complex, too.

But don’t worry - you don't have to figure this out yourself! If you’ve already tried the suggestions in this blog post, and your little one is still struggling, book a free 15-minute consult with my team here.

Brie

PS - Here’s one of my favorite recipes for muffins - kids love it, and it packs a great dose of fiber and veggies.

by Bassem

Fiber and Veggie Muffins

Here’s one of my favorite recipes for muffins - kids love it, and it packs a great dose of fiber and veggies.

Ingredients

1 and 1/2 cups Paleo Flour or Gluten Free Baking Flour (which happens to be high fiber!)-- Bob's Mills.
1/2 cup flax seed
1 generous tbsp baking soda
3/4 tsp salt
1 generous tsp pumpkin pie spice can use combination of cinnamon and nutmeg
3 tsp of chia seeds soaked in 3 tsp of water for 10-15 minutes
1 cup milk (we use Milkadamia or almond milk in our house)
1 and 1/2 tsp of vanilla
1/3 cup of olive oil
1 tsp apple cider vinegar [optional 1/2 cup maple syrup or honey]
1/2 cup of ripe banana
1/2 cup of unsweetened organic canned pumpkin.
1/2 cup of mashed cooked (or organic canned) sweet potato

Instructions

Preheat oven to 420 degrees.
Mix all of your dry ingredients together.
Mix all of the wet ingredients together well.
Combine the wet and dry ingredients by folding them together. Do not over mix.
Pour into a muffin tin with liners.
Bake at 420 degrees for 20 minutes. Then turn down to 400 degrees for 20 minutes. Additional cooking time depends on your oven and ranges from 10-35 minutes. Check occasionally with a toothpick. It should come out clean.

Important! Cool for 30 minutes before removing from tin. The longer they rest, the more solid the muffins will become.

by Bassem

How Diet and Nutrition Can Help Thyroid Issues

Fatigue that no amount of caffeine can shake, uncomfortable constipation, and wait… is that a bald spot???

These are just some of the key symptoms of Hashimoto’s Disease, the most common cause of underactive thyroid (hypothyroid) in the United States.

But sadly, despite being so common, Hashimoto’s is poorly understood by many doctors and likely under-diagnosed. And that’s a huge bummer, because there is SO much we can do to manage and control Hashimoto’s - you don’t just have to accept it!

So today, let’s dig into what Hashimoto’s is, how it affects the body, and most importantly, what we can do to treat it holistically, including how diet and nutrition can help thyroid issues.

What is Hashimoto’s Disease?

Hashimoto’s is an autoimmune disease where the immune system attacks the thyroid gland, causing tissue damage and preventing it from producing adequate thyroid hormones. Low thyroid hormones cause the symptoms of Hashimoto’s including:

Fatigue
Depression
Constipation
Hair loss
Pale and dry skin
Loss of fertility
Intolerance to cold
Heavy or irregular periods

While Hashimoto’s can occur in both men and women, it (and all autoimmune disease) is more common in women.

How Do I Get Tested for Hashimoto’s?

Hashimoto’s is diagnosed via blood test for thyroid stimulating hormone (TSH) and thyroid peroxidase (TPO) antibodies. High TSH levels and the presence of antibodies are both indicative of Hashimoto’s. However, even if TSH levels are normal (or even low!)high TPO levels are still indicative of Hashimoto’s. High TSH levels occur when available active thyroid hormone (T3/T4) levels are low, or receptivity to these hormones is low, tricking the body to think they aren't around. All this is to say that it’s important to test both TSH and TPO for an accurate diagnosis.

There are three stages of Hashimoto’s:

Silent Autoimmune - This occurs when antibodies are elevated, but there are no symptoms of hypothyroid or tissue destruction. If not addressed, this will progress to the next stage.

Autoimmune Reactivity - Elevated TPO antibodies, with symptoms of hypothyroidism (fatigue, thinning hair, etc.), but no clinically noticeable loss of thyroid tissue.

Autoimmune Disease - Occurs when antibodies are elevated, hypothyroidism symptoms are present, and there is measurable tissue destruction.

Ideally, we would catch Hashimoto’s at the silent autoimmune phase, but the reality is that most people are not tested until symptoms are present, and are therefore in the reactivity or disease stage when they begin treatment. This is one reason why I advocate for routine thyroid screening, ideally annually. At the very least thyroid levels should be screened at the time of the first period (menses), postpartum, and during menopause, because these are the three periods of life when women are most likely to express and autoimmune condition.

Hashimoto’s and thyroid disease are not always synonymous. If TSH levels are high, but no antibodies are detected, it could be hypothyroidism from another cause.

Can Hashimoto’s Disease Be Cured?

Getting a Hashimoto’s diagnosis is scary, and it’s only normal to wonder “Can I fix this?”

The answer isn’t black and white. Technically, Hashimoto's is considered incurable (as are most autoimmune diseases). However, that does not mean you’re doomed. In functional medicine, the goal is to get autoimmune disease into remission.

I promise, you absolutely can be healthy and have an autoimmune disease in remission! My job is to help you do just that.

So how do we do that? As a functional medicine practitioner, I treat disease by addressing the root cause. That means understanding why you got sick is incredibly important. The “why” will inform how to best treat your disease. Before we get into treatment, let’s talk about why disease occurs.

What Causes Hashimoto’s?

Like all autoimmune diseases, hashimoto’s doesn’t have one cause. Instead, it develops due to a complex interplay of predisposing factors and a triggering event. Predisposing factors “set the stage” so that when a trigger occurs, disease develops. If you’re not sure what risk factors or triggers could be present for you, we can work together to test and establish your root cause.

Here are some established risk factors for Hashimoto’s:

Genetic (having a family member who also has Hashimoto’s)
Other autoimmune disorders (vitiligo, Grave’s disease, type 1 diabetes, lupus, Rheumatoid arthritis, etc.)
Polycystic ovarian syndrome (PCOS)
History of Traumatic Brain Injury
Maternal autoimmune disease, especially if inflammation was present during gestation
Chronic infections (bacterial, viral)
Multiple adverse reactions to foods, chemicals, etc. (loss of tolerance)

Let’s go over some of the more common triggers I see with my own patients:

1. Toxin Exposure

For some people toxin exposure is not a serious issue, but for others, toxin exposure can trigger autoimmunity. (The difference is likely due to differences in detox capabilities, including the ability to biotransform heavy metals). In those who do struggle with toxin exposure, common chemicals like BPA have been shown to trigger autoimmunity. The issue can be with both total toxin exposure, as well as chemical immune reactivity. In chemical immune reactivity, even very small exposures can create an immune reaction.

It’s very important that people with autoimmune disease aggressively detox toxins, but it's essential to do it in the right order! If detox is begun before the autoimmunity is under control, the detox can actually flare autoimmune symptoms and make them worse.

2. Viruses

Viruses are known to trigger autoimmune disease. Hepatitis C, human Parvo b12, Coxsackie, and herpes viruses, in particular Epstein Barr Virus (EBV - the virus that causes mononucleosis), are all known to trigger Hashimoto’s.

3. Bacteria

Bacteria and the biofilms they create can both trigger autoimmune disease. Bacteria can closely resemble human tissues well as decorate the extracellular matrix (ECM) of their biofilms with molecules that resemble human tissues. These molecules are recognized by the immune system, causing activation of autoimmune pathways.

These bacteria have all been implicated in the development of Hashimoto's: H. Pylori (which can actually be protective in IBD, but, can be a trigger for other autoimmune conditions like psoriasis, vitiligo, and RA), Borrelia Burgdorferi (Lyme), Yersinia Enterocolitica, Staph, and Strep.

4. Gluten

Gluten induces leaky gut, even if a person doesn’t have Celiac disease. It is immunogenic, cytotoxic, and proinflammatory. In those with autoimmune disease, gluten can flare symptoms and prevent remission. It can have a negative effect on the microbiome and boost oxidative stress.

However, gluten isn’t the only problem food! In many people, other common trigger foods include grains, eggs, dairy, soy, chocolate, coffee, and legumes.

5. Mold

Mold is a silent epidemic that can trigger and exacerbate autoimmune conditions. Both the individual and the home need to be tested and treated for mold. In individuals, mold can be tested using urinary mycotoxins, CIRS markers, and VCS testing. An IEP (indoor environment professional) should assess the home for mold with an ERMI test. In general, humidity over 50% in any room is a problem. Test this with a hydrometer.

How to Treat Hashimoto’s Naturally

Now that we’ve covered some of the more common causes I see in Hashimoto’s, we can get into the good stuff: what you can do to put the disease in remission!

1. Test to Find the Root Cause

There’s a lot to cover here, but the first thing I do with any new patient is testing to help determine what their root cause is. Some key things I’m looking for are gut pathogens, bacteria, fungii, viruses, and chemical compounds that can trigger the immune system.

With that information in hand, I move down the line of treatments, starting at the mouth!

2. Optimize the Microbiome & Gut Health

The microbiome begins in the mouth, so that’s where I start treatment as well. We need to optimize the oral flora and change out any products that could be damaging the mouth’s microbiome for healthier picks. Next up, I’ll start a protocol to heal leaky gut. Healing leaky gut is essential, but it’s not the only step, so don’t stop here!

We’ll also optimize digestive secretions and microbiome resilience in this step to help prevent any future gut infections. A lack of adequate stomach acid prevents proteins from being fully broken down. Those larger, more intact proteins then enter the bloodstream and are more likely to trigger immune activity. For anyone with autoimmune issues, or who is having immune reactions to specific foods, supplemental HCL to boost stomach acid levels is a must.

3. Balance Your Blood Sugar

No matter what dietary changes you do or don’t make (more on that below), the most important is eating in a way that supports balanced blood sugar. When blood sugar is high, the pancreas produces a surge of insulin. That insulin surge has an inflammatory effect on the body, causing autoimmune conditions to flare. This connection is so strong, I have seen clients put their autoimmune condition into remission just by balancing their blood sugar. It’s really that important. If diet changes alone aren’t enough, we can use key supplements to help bring blood sugar back into balance.

4. Optimize HPA-Axis Hormones

The hypothalamic-adrenal-pituitary (HPA) axis hormones include cortisol, the “stress” hormone. Optimizing this system often requires active stress management - more on that below.

5. Measure & Adjust Key Nutrient Levels

Key nutrients for Hashimoto’s health include omega fatty acids, selenium, zinc, and vitamins A,C, and D. Before supplementing, I always test.

6. Detox Safely

If testing has revealed the presence of compounds like heavy metals, it’s very important that detox is done safely. Aggressive detox strategies can backfire for people with autoimmune disease, as the detox process can flare the autoimmune condition if the person has an immune reaction to the chemicals being detoxed. I recommend testing for what chemicals a person has reactivity to, then working to calm the reactivity, and finally detoxing with herbs and supplements like glutathione, as well as exercise and sweating.

7. Helminth Therapy

OK, this does sound crazy at first, but the research backs it up. Helminths are a specific type of worm, and the larval form (not the whole worm) is a common infection in much of the world. In countries with the highest infection rate of helminths, autoimmune disease rates are lowest. Helminths release tuftsin-phosphorylcholine (TPC), which turns on T- and B-regulatory cells. A prescription version of TPC has been shown to cure autoimmune conditions in animals, and clinical trials are underway. In the meantime, helminth therapy can be life-changing. I’ve been studying helminth therapy for years - read my blog post about it here.

How Diet and Nutrition Can Help Thyroid Issues

There’s no one perfect diet for Hashimoto’s (sorry!). Instead, I start with the Autoimmune Paleo (AIP) diet and customize based on the individual. No one should blindly follow a highly restrictive diet like AIP long term. Diversity is the key to a strong and healthy microbiome, so don’t eat the same thing day in and day out.

That being said, restricting certain foods can be helpful. At a minimum, I recommend avoiding gluten and dairy. For many people with Hashimoto’s, removing nightshades can also be beneficial. And if testing shows the presence of antinuclear antibodies (ANA) or rheumatoid factor (RF), I suggest cutting lectins as well. Also consider reducing sodium intake (or supplementing with potassium at salty meals) since high sodium activates the pro-inflammatory immune pathway TH-17, which pours gas on the Hashimoto’s fire.

In some cases, intermittent fasting, a lower calorie or starch diet, and exercise (but not all 3 at once!) can be used to increase autophagy (clearance of proteins). Poor autophagy can increase immune reactivity. But please note, this is not me telling you to starve yourself. These are advanced techniques that should only be used in certain people under the care of a highly trained practitioner.

Lifestyle Changes for Hashimoto’s Remission

While they aren’t “sexy,” lifestyle changes to better manage stress, get adequate sleep, and exercise are probably the most important part of any plan to treat Hashimoto’s.

1. Why Sleep Matters

We know that sleep disorders (in those without sleep apnea) increase the risk of developing autoimmune conditions. The body primes and develops immune cells while we are sleeping, and a lack of sleep also induces an inflammatory response. Lack of sleep also leads to dysfunctional natural killer (NK) cells, a key part of the immune system, especially important for fighting viruses.

If you take away one thing from this blog post, let it be this: unless you’re getting proper sleep, you have very little chance of autoimmune recovery. It’s that important! In fact, I consider sleep and blood sugar (see above) to be the two “cornerstones” of healing autoimmunity. The easiest way to get started on a better sleep pattern is to develop a routine pattern of sleep, rising and going to bed at roughly the same time every day - and bonus points if your bedtime can be before 10 PM.

2. Managing Stress

Stress activates interleukin-17, creating a cascade that affects the immune system. But, it’s important to differentiate between good stress, which does not affect IL-17, and negative stress, which does. Positive stressors include things like exercise you enjoy, while negative stress might be an unsupportive partner or an unfulfilling job. I suggest active practices to reduce stress like GUPTA, Inaura, EMDR, therapy with a trained professional (especially Somatic therapy), Synctuition, Hypnotherapy, Ziva meditation, and MBSR training.

3. Exercise

Sedentary behaviors can heighten inflammatory responses in the body. Any increase in movement is a good thing and better than none - so simple changes liking parking further away or taking the stairs instead of the elevator really can help. That being said, more intense workouts do have more anti-inflammatory actions, and are a great tool for those who are able to do them. However, going too hard is a real risk. A good rule of thumb is that you should be able to recover from the workout within one day. If you’re laid out on the couch for days after a workout, it was too hard.

Will I Need Medication, Too?

I believe in mixing the best of both Western and alternative medicine… which means sometimes, yes, medication is a tool we need to use. Using medication isn't “failing” and it doesn’t mean taking other steps to heal your Hashimoto's - like the ones I’ve described in this article - aren’t worth the effort.

No matter where you’re starting or what your goals are, we can work together to find an effective, sustainable path toward remission.

Need Help With Hashimoto’s?

Helping women overcome health challenges like Hashimoto’s is my (gluten free) bread and butter. There’s nothing I love more than meeting a new client, hearing their story, and helping them create a customized plan to achieve their health goals.

If you have Hashimoto’s and you want support finding the root cause, creating a customized treatment plan, and recovering your health, I would be honored to support you. The first step is to book a free, no-obligation consultation with my team.

Let’s tackle your health goals together!

>>> Book a free consult today

by Bassem

How To Detox Your Body The Right Way

So you’ve decided to go on a detox cleanse.

Maybe you’re starting a seven-day cleanse.

Or you’re going on a juice fast.

NEWSFLASH! Neither of these methods are true detoxification, the kind that can remove harmful toxins from your body.

Don’t get me wrong. Both seven-day cleanses and juice fasts can have real benefits. Seven-day cleanses are great for people who are generally healthy and who want to reset their bodies. Juice fasts give your gut a break, and you’re boosting your antioxidant intake.

But if you’ve been exposed to toxins and really need to detox your body, those strategies aren’t going to work.

In this blog post, I’ll go into what detoxification is and what it isn’t. But before we go there, let’s review the red flags that suggest you need to detoxify in the first place.

Common Symptoms of Broken Detox

The only way to know for sure if you need to be on a detoxification program is to work with your functional medicine provider to order the right tests (more on this later).

But there are some symptoms of toxin exposure that can clue you in that you need detox. For example:

Autoimmune problems
All over joint and connective tissue pain
Brain fog
Flare ups of latent viral infections (loss of immune tolerance). For example, your herpes infection comes out of hiding after 10 years and causes you to suddenly get cold sores.
General malaise
Random headaches
Rapid skin aging
Resistant weight loss
Skin breakouts like eczema, acne, rashes
You just don’t feel as well
You react to everything around you: food, chemicals, environmental exposures like pollen, the fact that it’s Wednesday. ☺

But you don’t have to be a complete mess to have a detox problem. In many cases, the full ramifications of having toxins build up in your body doesn’t show up until years later.

A lot of people are overburdened with toxins and don’t know it because symptoms haven’t showed up yet.

Sources of Toxin Exposure

Toxins are all around us in the food, air, and water supply. Here are some of the more common ones we’re exposed to daily:

Chemicals like bisphenol-A (BPA) and plasticizers like phthalates.
Heavy metals like mercury
Mycotoxins from mold
The herbicide glyphosate
Other herbicides and pesticides

Toxins show up in places you’d never think about—like the disposable plastic lid on that almond milk latte you just grabbed to go. Some common places that you’ll encounter toxins include:

Seafood (mercury)
Non-organic fruits and vegetables (glyphosate, pesticides)
Water-damaged buildings (mycotoxins). Half of all buildings in the United States are water damaged, so mycotoxins are a common problem.
Items not labeled BPA-free: Linings of cans, cash register receipts, toothbrushes, cloudy plastic containers. However, even items labeled BPA-free can contain BPS. This is another type of chemical that is just as toxic or more so than BPA.
Personal care products like shampoo, conditioner, moisturizers (phthalates)
Pesticides and herbicides sprayed on your yard or around your office (glyphosate and others)

You can’t get away from these environmental toxins, so your best bet is to get tested to make certain your detoxification is working like it’s supposed to do. With those results, a detox program can be tailored to your needs. How do you do that? By working with functional medicine providers like me to order the right tests and design customized protocols.

How To Test for Toxins in Your Body

Before starting a detox cleanse, it’s critical to get tested to see if you have a detox problem and how severe it is.

Patients who have had an obvious exposure should definitely get tested. For example, if a person grew up in an agricultural area, or near a coal plant, or worked in a hair salon, it’s a safe assumption that a detox treatment is needed.

Sometimes, however, it’s not so obvious. Exposure can come from working in the garden, eating food that’s not organic, drinking tap water for years, living or working in a building with water damage, and the list goes on and on.

We often see patients who are loaded with really nasty toxins.

Testing not only helps us understand how well your detoxification is working—it also helps us establish a baseline, so we can get a snapshot of whether detox treatments are working by retesting again after treatment.

The tests I use to tell how well your detox pathways are working are reviewed in the next section. But popular detox cleanses and juice fasts miss all of this. They don’t address how well your body’s detoxification- your unique biochemistry- is actually working.

Common Detox Tests

Your body cleanses itself of toxins using glutathione, sulfation, methylation, and a few other pathways. So, I always run tests to tell me how well these detoxification pathways are working in your body.

We want to know whether you have a glutathione deficiency as indicated by urine pyroglutamate and sulfate tests. Low sulfate levels show the body is using up glutathione faster than it can make it due to the high burden of toxins.

When you run out of glutathione, it leads to a high level of oxidative stress, which is an imbalance between damaging free radicals and beneficial antioxidants. The body needs some oxidative stress, but when there’s too much of it, cells become damaged. Tissues can be harmed. Disease processes can be triggered and aging speeds up.

My favorite antioxidant test? Urine 8-hydroxy-2-deoxyguanosine, or 8-OHdG for short, is a marker of DNA damage due to free radicals. If that marker is 3.5 or higher it means your detoxification is shot. Your rate of all-cause mortality just went up significantly, you have a greater chance of getting cancer, and you’re aging faster. But there’s good news. We can balance your DNA damage by boosting levels of glutathione and antioxidants.

Detox tests often measure levels of the following markers:

Pyroglutamate – High levels mean that your body is detoxing vigorously and needs glutathione support.
Sulfate – Low levels indicate your body is running out of what it needs for detoxification, especially sulfation and glutathione.
8-OHdG – High levels indicate your detoxification is weak and antioxidants are out of balance.
P-hydroxyphenyllactate – High levels of this marker show that your antioxidant levels are getting too low. You may need vitamin C.
Hydroxymethylglutarate – High levels show you’re not getting enough of the antioxidant and energy producer, coenzyme Q10.
Methylmalonate – High levels show you’re having trouble with your methylation detoxification pathway. You need vitamin B12.

What a Detox Program Is Not

First, going on a juice fast is not detoxing because it’s low in protein. All the detox pathways need amino acids. And where do we get amino acids from? You guessed it: protein.

The best way to ruin your body’s natural detox abilities is to go on a protein-deficient diet. That’s why we see a lot of vegans or vegetarians who can’t carry out detoxification. Many of these patients haven’t developed a comprehensive nutrition plan to make sure they get enough protein, because creating this type of plan is labor intensive. And carrying through with it is even more difficult!

Going on a vegan or vegetarian diet often comes from a place of compassion and doing what seems best for your health. But there are some risks.

It is very hard to get all of the nutrients you need on a meat-free diet. Vegans and vegetarians who aren’t getting the nutrition they really need and who have protein malnutrition can be highly toxic. Sure, they eat a lot of antioxidant-rich plant foods. But due to the lack of protein and impaired detox, they can ironically have a lot of oxidative stress. Remember, oxidative stress results when detox mechanisms aren’t working and it damages tissues and cells and speeds up aging.

We find that vegans and vegetarians can also have problems with an important process known as methylation. Healthy methylation is involved in so many processes in our bodies, including detox. Vitamin B12 is a critical nutrient for methylation, but vegans and vegetarians are often deficient in this vitamin.

Having said all that, a plant-forward diet is something everyone should be on for good health regardless of what other diet criteria you choose.

A Real Detox Cleanse Takes Time

A real detox program is stretched out over time. It’s not the same as a seven-day detox cleanse. If your glutathione levels are depleted and you notice your aging is accelerated it’s going to take three to six months, or more in some cases, to get your detox tests in the normal ranges. It might take a year to get your glutathione levels up to where they need to be.

How To Detox Your Body

The first step is to work with a functional medicine provider to help you personalize an effective protocol. When a patient needs to undergo a detox program, I always start with what’s going on in the gut. Often, the gut is the main source of toxins and oxidative stress. That’s why in most cases, I clean up the gut first.

In regards to dietary supplements, it’s really important that you address both Phase I and Phase II liver detoxification pathways.

In Phase I, the liver breaks down toxins and makes them less harmful and water-soluble. This process creates a large amount of free radicals, which leads to excessive oxidative stress.

In Phase II detoxification, another molecule is linked to the toxin to make the toxin less harmful. This is known as conjugation.

Herbal combos that include dandelion, milk thistle, and artichoke leaf really just emphasize Phase I liver detox. If you’re taking supplements that address only Phase I and not Phase II, you can go into what’s called pathological detox. This means your efforts to detoxify are actually backfiring. You’re not effectively getting rid of toxins. You’re making yourself more toxic.

When a patient feels bad during detox it’s often because the patient is doing pathological detoxifying by only supporting the Phase I pathway. Or, in some cases, the patient doesn’t have enough bile flow to move the toxins out.

Here are the detox supplements I often use in my patients to make sure I’m supporting both a patient’s Phase I and Phase II detoxification:

Amino acids
Glutathione precursors (Click here to email an order request)
Antioxidants like vitamins C and E
Liposomal glutathione because it increases endogenous glutathione levels when taken for six months or more
Sulforaphane (a sulfur compound from cruciferous vegetables like broccoli)
Megaguard for bile flow
Herbal combos that include herbs like milk thistle (silymarin), artichoke, and dandelion
Amino-D-Tox from Designs for Health (Click here to email an order request)

Coffee enemas can also promote bile flow.

Don’t Go It Alone

Your body’s detox can break in so many ways. That’s why a detox cleanse is going to be more effective if I customize a detox protocol designed especially for your needs. I do this based on testing to find out how well your body is—or isn’t—getting rid of toxins. Book a free 15-minute troubleshooting call with me to find out the best course of action.

If after the call you come on board as a patient, I’ll order the right tests for you. I’ll also support your gut health and your body’s unique biochemistry to address the root causes of your detox problems. If the tests warrant, I’ll put you on a cleansing detox program that supports both Phase I and Phase II in order to eliminate uncomfortable detox symptoms. The goal? Make your body as clean and pure as possible so you’ll feel your best once again.

by Bassem

What Causes Diarrhea in Adults and How to Stop It

Diarrhea can take control of your life. I’m not talking about the average tummy bug kind of diarrhea. I’m talking about the type of diarrhea that lasts for days, weeks, months, or even years…chronic diarrhea.

Diarrhea can disrupt the rhythm of your daily life, and take a real toll on your body. But, the good news is that you do not have to live with chronic diarrhea! Diarrhea is a treatable medical condition. Together, we can uncover what’s causing your diarrhea, help to treat your symptoms, and get you back on the road to good health.

Diarrhea Symptoms

Passing loose, watery stools three or more times per day is the primary symptom of diarrhea. Other symptoms can accompany diarrhea including:

Belly bloating
Cramping
An urgent need to use the bathroom
Nausea
Abdominal pain

Some people can experience more severe symptoms including:

Blood or mucus in your stools
Fever or chills
Vomiting
Light-headedness or dizziness

What Causes Diarrhea?

There are a variety of factors that can cause diarrhea. Temporary diarrhea, lasting one to two days, can result from a viral infection, the food you ate or traveling.

On the other hand, chronic diarrhea can indicate a more serious problem. The most common causes of chronic diarrhea include inflammatory bowel disease (Crohn’s disease and ulcerative colitis), chronic infections, and malabsorption syndromes (cystic fibrosis, Celiac disease, lactose intolerance, etc.) in which food is not digested and absorbed.

Chronic diarrhea is a common complaint amongst our patients. Below are seven of the most common causes of chronic diarrhea that we treat including gallbladder removal, IBD, gut dysbiosis or pathogen imbalance, histamine intolerance, gluten intolerance or Celiac, dairy intolerance, and SIBO.

1. Gallstone or surgical removal of the gallbladder

Frequent loose, watery stools after having gallstones or having your gallbladder removed (cholecystectomy) is common. The gallbladder collects bile to release when you eat aiding in the digestion of fats. Removing the gallbladder takes away the main storage site for your bile acid. Instead, the bile acid is stored in the gut causing it to be less concentrated and drain into the intestines. Once in the intestines, it can have a laxative effect making stools looser.

GI transit times can also be altered after gallbladder surgery causing transit times to decrease in the small intestine and accelerate in the colon. This impairs the body’s ability to absorb water from your stool leading to looser, watery stools.

2. IBD

Inflammatory bowel diseases (IBD), including Crohn’s, Ulcerative Colitis, and other types of colitis (microscopic or lymphocytic colitis), are diseases of chronic inflammation. IBD causes tissue destruction and inflammation of the bowel walls limiting the body’s ability to absorb fluids. This results in loose, watery, or even completely liquid stools.

Patients with IBD may experience frequent and urgent bowel movements because fluid moves more rapidly through the intestine. You may also see blood in or on the stool and experience extreme weight loss, anemia, fever, and loss of appetite.

3. Gut Dysbiosis or Pathogen Imbalance

Gut dysbiosis is a generic term for an imbalance in gut flora. Our digestive tract contains a delicate balance of different kinds of bacteria. When one species becomes overgrown or gets wiped out, the balance is thrown off leading to diarrhea along with many other symptoms.

There are several pathogens known to cause gut dysbiosis including bacterial, yeast, parasites, and viral pathogens.

Acute Bacterial Pathogens: The most common bacterial organisms to cause diarrhea include: e coli, shigella, Campylobacter Jejuni, Citrobacter, yersinia enterocolitica, salmonella, and Staphylococcus aureus. Chronic bacterial toxins like those secreted by C Difficile can also lead to diarrhea. Older adults in healthcare facilities, like hospitals or nursing homes, or who have recently been on antibiotics, are more at risk for contracting C Difficile.
Yeast and Fungal Overgrowth: Rapid growth of Candida (a yeast) and cryptococcus (a yeast-like fungus) in the GI tract can lead to diarrhea, especially after antibiotic use.
Parasites: Intestinal parasites including giardia, entamoeba histolytica, Cryptosporidium Parvum, and Protozoan parasites like blastocystis hominis, Cyclospora, Dientamoeba Fragilis, Entamoeba coli, and endolimax nana can cause diarrhea. Parasitic infections are often, but not always, marked by stomach cramps, bloating, nausea, and watery diarrhea.

4. Histamine Intolerance

Histamine is a chemical that notifies the brain when to release stomach acid for digestion. And, it is part of our response to injury or an allergic reaction. Histamine intolerance occurs when the body is unable to break down enough of it in the intestines, causing histamine levels in the blood to rise.

Histamine intolerance can result from a multitude of factors including a combination of genetics, and a leaky gut. This leads to decreased secretion of DAO enzyme (used to break down histamine), liver detox overburden, and dysbiosis.

5. Gluten Intolerance or Celiac

Gluten, a protein found in wheat, can cause inflammation in the gut and can change the structure of the gut wall. For people with gluten intolerance or Celiac disease, gluten can cause chronic diarrhea along with other GI symptoms.

6. Dairy

Dairy products contain three components that can cause diarrhea: lactose, whey, and casein.

Lactose intolerance is an inability to digest lactase, a sugar found in milk products. Lactose intolerance occurs when the small intestine does not make enough of the digestive enzyme lactase. This condition is common in adults with a genetic predisposition or after an injury, disease, or infection of the small intestine. Lactose intolerance causes diarrhea by increasing the volume of water in the colon, which in turn increases the volume and liquid content of the stool.

Casein and whey, the two proteins in milk products, can cause an allergic reaction when the body thinks the protein is harmful. Most people with an allergy to casein or whey have symptoms that appear as infants and outgrow them with age. However, patients with gut wall damage can experience dairy protein intolerance with diarrhea and other GI symptoms.

7. SIBO

SIBO is an overgrowth of bacteria in the small intestine. Normally, the small intestine contains fewer bacteria than the large intestine and is focused on food absorption. For many who have SIBO, diarrhea is a common symptom.

How is Chronic Diarrhea Diagnosed

The key to diagnosing chronic diarrhea is to uncover the underlying root causes so that we can address them and prevent future relapses. Common tests for patients with chronic diarrhea may include:

Comprehensive Stool Microbiome Testing – A stool sample can be used to evaluate the root cause of digestive tract issues. Functional medicine stool tests provide information about absorption, digestion, yeast overgrowth, bacterial imbalance, parasite infection, inflammation, metabolic activity, and immune function.
SIBO Breath Testing with both lactulose and fructose for best accuracy
Blood Test – Specific blood tests can help identify celiac disease antibodies and yeast antibodies.
Imaging – Imaging can include endoscopy, colonoscopy, or sigmoidoscopy and is generally used to diagnose or rule out Inflammatory Bowel Disease or structural issues as a driver for symptoms.

Natural Remedies and Treatments for Diarrhea

The challenging part of treating diarrhea is that there is not a one size fits all treatment plan. Many mild cases of diarrhea will resolve on their own. But, for more severe, chronic cases of diarrhea there are a variety of natural remedies and treatments available.

Diet

Specific Carbohydrate Diet (SCD):

The SCD diet is incredibly effective at stopping urgent, frequent bowel movements. This is for you if you run to the bathroom 10 to 20 times per day. The SCD diet focuses on removing carbohydrates that are not fully digested and remain in the gut leading to an overgrowth of harmful bacteria. It is particularly helpful for my patients who have Crohn’s disease, celiac, ulcerative colitis, and chronic diarrhea.

Download a free guide to properly starting the SCD diet from the team at Healthy Gut.

Starch and Meat Diet:

A starch and meat diet is an alternative to the SCD diet that works for some people. This whole-food diet is focused on eating foods like white rice, white potatoes, meat, fish, and poultry. Like the SCD diet, this diet limits all processed and canned foods.

Diet Considerations During Flare-Ups:

Curing the cause of chronic diarrhea can take time. And, flare-ups happen. During diarrhea flare-ups keep these diet considerations in mind.

Be cautious with fruit, except for bananas
Raw vegetables can be hard to digest and cause GI upset
High amounts of fats and oils can be difficult for a sensitive digestive system. Limit high-fat foods like egg yolks, cream, oils, and bacon.

Many other diets (low FODMAP, Low Histamine, Low Salicylate, Low Oxalate, or Autoimmune Paleo) can be useful for the treatment of diarrhea depending on the underlying causes.

Stress Reduction

Have you ever had to run to the bathroom before a presentation or a big event? That’s your gut responding to stress! Increased levels of stress can cause changes to your gut motility, which means that your body can slow down or speed up food processing based on your levels of stress.

Active stress relief activities are a critical component of naturally treating diarrhea. Try watching a funny movie, taking an Epsom salt bath, meditating, or practicing moderate exercise daily.

Sleep

Many of your body’s metabolic processes occur during the night, including digestion. And, sleep provides your body the much-needed energy for digestion to happen.

A few nights of poor sleep might not have a major impact on your GI health. But, chronic insomnia or poor sleep can impact your GI and contribute to your chronic diarrhea.

Supplements

Depending on the cause of your diarrhea, a variety of supplements may be beneficial to you. I often incorporate the following supplements into my patient’s treatment plans.

Digestive Enzymes:

After eating, enzymes break down the food so that we can absorb the carbohydrates, fats, and proteins. Without enzymes, larger food pieces remain in our gut and begin to ferment, feeding the bacteria. This can either slow down digestion or speed it way up.

There has been significant research indicating the successful use of digestive enzymes to support patients with chronic diarrhea. The key to digestive enzymes is taking enough with the right balance of acidity for them to work. It may take some time, but my patients who use digestive enzymes report amazing results!

I recommend Holozyme by Healthy Gut.

High Dose Probiotics:

High-dose probiotics have been shown to balance the gut microbiome and improve intestinal permeability promoting intestinal barrier functions and alleviating many inflammatory responses.

Depending on the cause of your diarrhea, I recommend a variety of probiotics usually containing 250 (or more) organisms daily to help control diarrhea. Below are a few of my go-to probiotics:

S. Boulardii, a probiotic yeast strain, is my number 1 go-to for helping alleviate diarrhea, especially if it was a result of antibiotic use. But, in my clinical experience, patients with IBD should proceed with caution with introducing S. boulardii because Anti-Saccharomyces cerevisiae antibodies (ASCA) have been associated with Crohn’s disease. Saccharomyces Cerevisiae (Brewer’s/Bakers yeast) is similar enough to S Boulardii that the immune systems of sensitive individuals can cross-react, potentially triggering a symptom flare.
Bacillus Claussi, a spore-forming probiotic, is an effective probiotic for treating diarrhea, preventing antibiotic associated diarrhea, and may be viable as the only treatment in some cases of SIBO where tolerated.
Bacillus Subtilis is a multifunctional probiotic ideal for preventing the growth of bacteria and enhancing nutrient digestion. HU58, a strain of bacillus subtilis, is used for the management of antibiotic-associated diarrhea in adults.
Lactobacillus Rhamnosus GG (LGG) is one of the most widely used probiotic strains and it is ideal for patients with histamine driving their diarrhea. In addition, there are many well-documented studies showing that LGG is indicated for the prevention and treatment of gastro-intestinal infections and diarrhea.
UltraFlora Intensive contains Lactobacillus plantarum 299v, a probiotic strain of lactic acid bacteria that is naturally occurring in the human gut. This probiotic is excellent at decreasing anti-inflammatory symptoms making it ideal for reducing diarrhea in patients with IBS, C. diff, spontaneous colitis, and high E coli levels.
High-dose lactobacillus, found in TheraLac, promotes healthy, rapid growth of all beneficial bacteria that can boost immune health and promote regularity.

Immunoglobulins or Colostrum:

Immunoglobulins and colostrum help strengthen the body’s natural immune system. While also fighting bacteria and viruses that cause diarrhea. I recommend utilizing a bovine-derived serum that is lactose-free to repair and support healthy gut barrier functions.

Chinese Herbal Formulas:

This is far from an exhaustive list of Chinese herbal formulas for diarrhea, but these are three of my favorites to use with my patients.

Shen Ling Bai Zhu San – Usee for poor nutrient absorption, bloating, and/or loose stools.
Raise Qi – Helpful for poor digestion, bloating and gas pain, chronic diarrhea, and loose stools.
Huo Xiang Zheng Qi San – Ideal for treatment of acute diarrhea or travelers' diarrhea.

Short-Term Support in a Pinch

When you're in a pinch, it’s always helpful to keep a few diarrhea treatments in your arsenal. I recommend keeping these on hand:

Bismuth Subsalicylate: Also known as Pepto-Bismol, increases the amount of fluid your intestines can absorb while reducing inflammation and overactivity of your intestines. Note that both liquid and chewable Pepto-Bismol may contain fermentable sweeteners. Follow the label for dosage.
Imodium: Imodium works to slow motility for sudden diarrhea. Follow the label for dosage.

I Can Help Identify the Cause of Your Diarrhea and Get You Back on the Path to Good Health

Are you ready to troubleshoot your chronic diarrhea? Get a better understanding of your digestive health and the natural approach to resolving diarrhea once and for all, by booking a free 15-minute call with me.

If after the call you come on board as a patient, your clinician will order the best tests for your specific situation, and develop a unique treatment plan so that you can get back on the road to good health.

References:

"Symptoms & Causes of Diarrhea | NIDDK." https://www.niddk.nih.gov/health-information/digestive-diseases/diarrhea/symptoms-causes. Accessed 31 Mar. 2022.

"GI-MAP® Interpretive Guide - Diagnostic Solutions Laboratory." https://www.diagnosticsolutionslab.com/sites/default/files/u16/GI-MAP-Interpretive-Guide.pdf. Accessed 6 Apr. 2022.

"Histamine: The Stuff Allergies are Made of - MedlinePlus." 1 Apr. 2019, https://medlineplus.gov/medlineplus-videos/histamine-the-stuff-allergies-are-made-of/. Accessed 6 Apr. 2022.

"Enzyme therapy for functional bowel disease-like post-prandial ...." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6910206/. Accessed 12 Apr. 2022.

"Probiotics for infectious diarrhea - PMC - NCBI." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1773578/. Accessed 19 Apr. 2022.

"Bacillus clausii - The Probiotic of Choice in the Treatment of Diarrhoea." https://www.longdom.org/open-access/bacillus-clausii--the-probiotic-of-choice-in-the-treatment-of-diarrhoea-2157-7595-1000211.pdf. Accessed 12 Apr. 2022.

"Bacillus subtilis HU58 and Bacillus coagulans SC208 Probiotics ...." 11 Jul. 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7409217/. Accessed 12 Apr. 2022.

"Towards a better understanding of Lactobacillus rhamnosus GG - PMC." 29 Aug. 2014, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4155824/. Accessed 12 Apr. 2022.

The role of Lactobacillus plantarum 299v in supporting treatment of ...." 25 Jan. 2021, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7882405/. Accessed 12 Apr. 2022.

by Bassem

It Takes Two To Tango: Testing Your Household for Candida Overgrowth and Common Bugs

You’ve done a full lab work-up with a functional medicine provider and found out you’ve got an overgrowth of some bugs. Maybe Helicobacter pylori (H. pylori), Candida albicans, and protozoan gut parasites like Giardia.

You follow your doctor’s treatment program to get rid of these infections. The only problem? The infections stubbornly refuse to go away and your health problems continue.

So why, oh why, won’t your tests and health conditions clear up?

The problem could be someone else living in your household. Maybe it’s your lover. Maybe it’s your child. Maybe it’s another relative who shares utensils and dishes with you.

The point is, they could be infected, too. And even if you follow your doctor’s recommendations to the letter, if the people living with you are infected but doing nothing about it, you could get re-infected over and over.

The key to getting rid of the unwanted organisms in your body and feeling better is to have everyone in your household tested.

In this blog post I’ll share the story of one patient I’ll call Carla and her boyfriend, Neal. I insisted Neal get tested to see if he had the same organisms that infected Carla. When he was tested, the results were interesting, to say the least.

Carla’s Story: Resolving Pain and Other Problems

Carla’s symptoms began more than 10 years ago, although her health problems became extreme a year ago. She complained of excruciating neck and back pain that became worse a week before and during her period.

She had extreme fatigue and a history of vaginal and urinary tract infections and now felt a frequent urge to urinate. She also struggled with diarrhea and bloating. Autoimmune disease ran in her family, specifically her mother.

To find out what was happening to Carla, I ordered tests. These showed she had a mild H. pylori infection. She had low levels of beneficial bacteria like Clostridia and Faecalibacterium prausnitzii. This indicated she had gut dysbiosis, a condition where the good bacteria in the intestines are outnumbered by the bad bacteria.

She also had mildly elevated levels of the protozoan parasite Giardia intestinalis, as well as some yeast.

The Big Breakthrough in Pain Relief

One of the big breakthroughs in Carla’s case came when we tested her amino acid levels. Her levels of the amino acid homocysteine were very low. Normally, doctors get concerned about high homocysteine levels, since homocysteine is a red flag pointing toward cardiovascular disease risk and inflammation.

In Carla’s case, since she wasn’t making enough homocysteine that meant she didn’t have enough of the amino acid methionine, which is recycled from homocysteine.

Methionine is essential for a process known as methylation, which regulates many processes in the body. Methylation is involved in the way your body processes estrogen and histamine. It regulates brain chemicals known as neurotransmitters. And you need healthy methylation to detoxify those pesticides, herbicides, or pollution you’re exposed to while eating, drinking, or breathing.

When your methionine levels are low, you don’t make enough of another important substance known as S-adenosylmethionine (SAMe).

I gave Carla SAMe and guess what happened? Her pain almost completely resolved! The pain now only showed up right before her periods. She was in tears while she was on the phone with me, saying she had “got her life back.”

That was major progress. But we still had to get the pain to go away completely and to improve gut health, because there was likely an autoimmune component to her problems. That’s when I suggested that we order the same tests for her boyfriend.

Fungi and Parasites and Bacteria, Oh My!

So why did I insist Neal get tested? It’s because not everybody who has an infection with a pathogenic microbe actually has symptoms. It’s a concept called, “asymptomatic carrier.” People can have H. pylori or Candida and because they have no symptoms, they would never know they had it- until they get tested.

Whether or not a person has symptoms from a pathogenic bug is determined by a few factors. It has to do with how robust and resilient our immune systems are and how a bug interacts with our genetics and our health history. Someone who has leaky gut or autoimmune issues from other causes is going to have a much higher tendency to be symptomatic.

Likewise, someone who has any microbiome destruction is less resilient. It’s like an equation. It depends on how resilient we are versus how pathogenic is the bad microbe.

If you’re sick and your sexual partner isn’t, that can still mean that they have Candida or H. pylori. Candida can be a reservoir for H. pylori, which is why H. pylori is known to be sexually transmitted. H. pylori can live vaginally inside the Candida.

So, if you have oral sex (blush! blush!), guess what? Your partner has Candida in their mouth and now they give it to you after you’ve finally gotten rid of your vaginal yeast problem. Or you could give your partner H. pylori. Not the kind of gifts you want to give each other!

H.pylori infects at least 50% of people, but that doesn’t mean it’s normal. Although it can be asymptomatic, it causes so many problems in so many people that when possible, especially when treating kids, I make sure we do our best to get rid of the infection.

Carla’s boyfriend Neal didn’t have any specific H. pylori or Candida symptoms but he did have some health problems that served as red flags.

He had colon issues including diverticulitis. In this condition, pouches in the colon known as diverticula become inflamed and sometimes infected. This leads to abdominal pain, nausea, fever, and changes in bowel habits.

He’d also had his gallbladder removed. The gallbladder produces bile, which kills bacteria and fungus.

So it wasn’t surprising that his tests revealed some problems.

Testing Carla’s Partner for Intestinal Pathogens

It turns out Neal and Carla had a lot in common. Neal’s test results were similar to Carla’s. He had Giardia. He also had a moderate amount of yeast. In addition, he had a protozoan parasite known as Endolimax nana.

Like Carla, he also had H. pylori. And like Carla he had low levels of beneficial bacteria in his GI tract. At the same time, he had high levels of opportunistic bacteria that can lead to an imbalance between the good guys in the gut and the bad—in other words intestinal dysbiosis. We see this a lot in people who have had their gallbladder removed because they lose the protective effect of bile against infections.

Treating for H. Pylori and Parasites

Based on their test results, I treated Carla and Neal in much the same way. Their H. pylori wasn’t particularly pathogenic, meaning they had less harmful strains. Their symptoms also didn’t match what I might see in someone who has a bad H. pylori infection.

So instead of treating it like an H. pylori overgrowth, I took a more proactive stance. I had them take PyloGuard probiotic to stop H. pylori from going out of control and causing more problems. When H. pylori is left unchecked it can cause gastrointestinal inflammation and symptoms like reflux, gastritis, ulcers, and more.

PyloGuard is a specific probiotic called Lactobacillus reuteri DSM 17648 known to inhibit H. pylori. It’s an easy-to-take H. pylori treatment—just open one capsule per day in water and sip it. This approach will help you reduce H. pylori naturally.

I also treated both of them for parasites, giardia, and yeast.

Looking to the Future

We’re not done with treatment yet, but we’re seeing a lot of improvement. Carla says her energy is much better and her brain fog has decreased. She had more improvements in her pain after she started taking progesterone. She is a different person.

Prior to beginning the parasite program, Neal complained that his respiratory tract seemed congested. He noticed less congestion after beginning the program.

When Carla first arrived in my office, she was a mess and was at the end of her rope. Now, she’s feeling so much better, which gives her hope and motivates her to take further steps. When you feel even a little bit better you want to keep going.

As treatment progresses with Carla and Neal, stay tuned for more updates on their progress.

We’ll Help You and Your Loved Ones

If you’re feeling sick and not getting any better, it’s a good idea to have your household members and sexual partner tested and treated, too. You don’t want to keep getting re-infected. Book a free 15-minute troubleshooting call with me to find out the best course of action.

If after the call you come on board as a patient, I’ll order the right tests for you and your loved ones, check for common parasites, Candida, and H. pylori if warranted, and get rid of the root cause of your health problems. That way, we’ll restore your energy and make you feel like yourself again. Your loved ones will also reap the rewards of this approach.

by Bassem

How to Naturally Slow the Aging Process and Get Glowing Skin

One of the most common questions I get is “What do you do for your skin?” And while I have a lot more to share than just “beauty secrets,” this question never annoys me, because truth be told… I am incredibly proud of my skin!

My skin didn’t always look like it does now. This is me at 22 - when I went from clear skin to horrible acne. At the age when most people’s teenage breakouts were ending, mine were just beginning.

skin breakouts

Let’s skip to the good part - here I am today:

photo of brie

So how did I get here? It wasn’t one special product, a miracle facial, or just “growing out of it.” I learned quickly that glowing, clear, youthful skin starts internally.

Yes, products can be fun (I love my nighttime routine) - but if you want gorgeous skin, you have to start on the inside.

What finally worked for me was a combination of:

Addressing hormone imbalances (I have PCOS)
Switching up my diet (I was eating way too many carbs and not enough protein as a vegetarian)
Healing my adrenals and gut
Using Chinese medicine to speed healing and prevent long-term damage

(Learn more about acne and PCOS here.)

These principles not only helped me clear my skin back then - but now more-years-than-you’d-probably-guess later, they're the same principles I use to keep my skin youthful and glowing.

Yep - the real “beauty secret” has nothing to do with fancy products, lasers, or needles. It’s all about what’s happening inside! Let’s dig into what really matters for beautiful skin - and how you can achieve it.

6 Factors that Actually Matter for Naturally Youthful Skin

How our skin ages is about both our genetics and the environment in which those genes exist. That means having good genes isn’t a get-out-of-jail-free card for caring for your skin - and it also means even if you’re genetically predisposed to less-than-perfect skin, you’re not a lost cause!

If you want to change the look or feel of your skin, there are 6 factors to focus on:

Gut health
Oxidative stress & inflammation
Hydration
Omega 3 & 6 balance
Liver health
Hormone balance

Let’s go through each of these and explain it a bit and I’ll offer some easy, right-now things you can do to optimize each one.

Factor 1: The Gut

Younger skin literally starts in the gut. As you probably know, the gut isn’t just where food is digested - it’s home to the gut microbiome, a stronghold of beneficial bacteria that play a massive role in the proper function of almost every aspect of the body.

Research has shown that various species of probiotic bacteria found in the gut impact everything from UV damage and repair to acne. Skin barrier function, hair growth, oil production, and the acidity of skin are all impacted by the bacteria of the gut microbiome.

A healthy gut - meaning a diverse, healthy microbiome, healthy gut cells, and intact, tight junctions (no leaky gut) - has been proven beneficial in the prevention or treatment of:

Inflammatory skin diseases
Acne
Atopic dermatitis
Psoriasis
Rosacea
Aging skin changes
Hair loss
Some pigmentary disorders

If you have any history of gut symptoms or digestive issues, or a history of skin issues like eczema, psoriasis, or acne, I recommend starting with a comprehensive stool test like GI Map and a Parawellness parasite and pathogen test. With my clients, these tests are often the first step in a customized gut-healing protocol.

If you don’t have digestive symptoms, or have already resolved your digestive issues, the Biome Fx test by Microbiome Labs is a great way to better understand the bacteria living in your microbiome so that you can strategically supplement to tweak and optimize your microbiome for overall well-being, longevity, and glowing skin.

Factor 2: Oxidative Stress & Inflammation

Oxidative stress is what literally kills us all. Oxidative stress occurs when unstable molecules called free radicals outnumber stabilizing antioxidants, creating a state of inflammation and “cellular aging.” Free radicals are created both by your body (as a result of normal metabolism) and are found environmentally in things like pollution and UV light from the sun.

Research has shown oxidative stress plays a major role in the skin’s aging process both internally and externally. Sun spots, wrinkles, and hyperpigmentation are all a direct result of oxidative stress.

To assess oxidative stress levels in my clients I rely on the ION Panel and Organix Organic Acids testing to assess antioxidant and nutrient levels.

The best defense against oxidative stress is to minimize free radicals and increase antioxidants. Some easy ways to do that are to:

Avoid excess sun exposure, and wear a clean sunscreen when you’re in the sun (I like Supergoop)
Get plenty of internal antioxidants from foods like green tea, fruits and veggies
Supplement with Glutathione, L-ascorbate (vitamin C), α-tocopherol (vitamin E), CoQ10, alpha lipoic acid, and vitamin A, and NAD+

NAD+ is especially important - it's a coenzyme essential for cellular energy and mitochondrial health, two key factors of anti-aging. If you’ve heard a lot of buzz lately about niacinamide as a skincare ingredient, here’s why: it converts to NAD+ down the line! NAD+ levels naturally decline with age, so supplementing can be especially helpful. I like a liposomal NAD+, which is the best absorbed.

Vitamin C can be used internally and topically - this one absorbs well through the skin and results show in a matter of weeks.

Because many people have genetic SNPs that impede the transformation of beta carotene (found in plants like carrots) to bioavailable forms of vitamin A, I use a product like Acnutrol or Hi-Po Emulsi D3. (If you’re wondering if this or other genetic SNPs are impacting your health, I can help - book a call to learn how we use data from over-the-counter DNA tests like 23andMe to unlock the next level of health.)

Finally, be sure you’re eating plenty of foods high in antioxidants like:

Fatty Fish
Avocados
Organic nuts and seeds - especially walnuts and sunflower seeds (for healthy fats, vitamin E, and zinc)
Tomatoes, which contain lycopene
Blueberry (and other berries like pomegranate and raspberry)
Spinach and other leafy greens
Dark Chocolate
Green Tea
Bone Broth
Lemon
Turmeric

And don’t forget to make sure you’re getting adequate protein! Proteins are needed to regenerate the skin, protect skin integrity and prevent sagging.

Factor 3: Hydration, Hydration, Hydration!

Almost everyone I work with is chronically dehydrated. Dehydration isn’t just about a lack of water - it’s also about a lack of electrolytes and minerals like magnesium, potassium, calcium, sodium, chloride, and phosphate. Electrolytes help draw water into the skin, deeply hydrating the aquaporins, the intricate system of channels in the skin that control hydration. Without adequate hydration and electrolyte levels, skin becomes dehydrated and looks dull and lifeless.

What can you do about this? Simple: go refill your water bottle! It’s essential that you’re drinking clean, filtered water - I highly recommend a home filtration system like Berkey, which is what I use personally.

Also consider adding a pinch of natural mineral sea salt or an electrolyte product like BodyBio Electrolytes to your water.

You might also see skincare products infused with electrolytes, but it’s actually much more efficient to balance electrolytes internally by consuming them. Remember, your skin is an outward expression of your internal health!

Factor 4: Omega 3 & 6 Balance

Omega 3 and 6 are two types of essential fatty acids that can have major impacts on your skin.

Omega 3 regulates the skin’s oil production, balances hydration, and minimizes breakouts and signs of aging, and soothes skin irritation. Research has shown that taking fish oil, a potent source of Omega 3, can help protect against skin cancer and UV damage.

Omega 6 improves skin moisture, firmness and elasticity. It can reduce transepidermal water loss and improve the skin barrier, making it especially beneficial for eczema and dry skin. Research has also shown its anti-inflammatory qualities can help clear acne.

While Omega 3 and 6 both have benefits, for maximum benefit they need to be in balance. Most people have far more Omega 6 than 3, and need extra support getting balanced. The ION Panel can show you where you are, and 500 mg of Omega 3 or 2 servings of fatty fish per week can help bring balance. If you’re supplementing, I recommend a purified, tested fish oil like Microbiome Labs.

Factor 5: Liver Health and Detox

When you think of skin health, you probably don’t think of the liver - but you should! The liver and the skin are both part of the body’s larger detox system. When the liver becomes overburdened, it often presents through the skin as rashes or eczema, acne, premature or accelerated wrinkling, brownish “liver spots”, and lack of youthful tone and elasticity.

The liver’s main job is to filter blood coming from the digestive tract to obtain nutrients and remove toxins and waste products from the blood, detoxify chemicals, and metabolize drugs that are secreted into bile for elimination. Today, our livers have to work much harder than they ever have before to detox the slew of chemicals, pesticides, solvents, and plastic-related compounds present in the air we breathe, the water we drink and bathe in, foods we eat and personal products we use every day. Skincare and beauty products in particular often contain estrogen-mimicking chemicals that must be metabolized and eliminated by the liver.

In addition, I see many people struggle with toxins generated from internal pathogens like candida overgrowth, bacterial overgrowth, mycotoxins from mold, and viral pathogens.

Using the ION Panel, I can actually see exactly how my clients’ detox pathways are functioning. Two markers I look at are antioxidant status and organic acids. Having looked at thousands of these results with my clients, I see a direct correlation with antioxidant status and external signs of aging. Those who seem to “not age” usually have the highest antioxidant levels, and those with early signs of aging have the lowest.

Eating lots of antioxidant-rich foods (see the list above) can help protect your liver cells from damage and allow for completion of phase 2 detoxification by a series of enzymatic pathways in the liver. The antioxidants also help to protect your skin cells from free radicals, and therefore premature aging.

(Want to learn more about detox? Make sure you’re subscribed to my email list to receive my upcoming deep dive article on detox! Sign up for emails here.)

Factor 6: Hormone Health

This topic is one close to my heart. Your skin health is often a direct expression of your hormone health. One of the most common things I see is a correlation between PCOS and acne, like I experienced personally. You can learn more about PCOS and acne here.

But acne is not the only way hormones can affect your skin! Both estrogen and progesterone impact skin integrity as we age. Low levels of these hormones can result in dryness and the appearance of premature signs of aging like wrinkles, fine lines, and loss of tone. Estrogen and progesterone can also impact hyper and hypopigmentation. Low DHEA is another hormone issue I keep an eye out for, as it can slow skin repair.

For suspected hormone issues, I always start with a comprehensive hormone test. My favorite is the DUTCH panel, which gives a far more in-depth and comprehensive look at hormone levels than a typical blood test can. Once we know exactly what the imbalance is, I create a customized protocol to return your hormones to harmony.

Do This Now For Better Skin

Keeping in mind all the factors discussed, there are some simple steps you can start taking today for better skin:

#1 Optimize Nutrients

Vitamins A, C, D, E, alpha lipoic acid (ALA), calcium, magnesium, biotin, selenium and zinc are some of the most important nutrients for skin health. Vitamin C, zinc, copper, manganese and silica are cofactors for the production of collagen and keratin, which help keep hair and skin supple and strong. Eating a diet with lots of antioxidant-rich fruits and veggies can help provide many of these essential nutrients.

Two other supplements I recommend are fish oil for Omega 3s and a collagen supplement, paired with vitamin C and hyaluronic acid for the best results.

#2 Add Probiotics

Multiple studies have found that specific probiotics can help protect the skin from sun damage. In one study, the probiotic bacteria Lactobacillus johnsonii NCC 533 (La1), provided protection from UV rays. In another, probiotics actually reversed existing sun damage.

This is my favorite targeted probiotic for skin health— I take this daily

#3 Try Chinese Herbs

Chinese herbal formulas have been used to slow aging and stimulate repair for thousands of years. General beauty and anti-aging herbs include goji berries, tremella fungus, green tea, Dong Quai (Chinese Angelica), He Shou Wu, Ginseng (Asian Ginseng), Schisandra, and Pearl Powder.

For best results, Chinese medicine formulas need to be personalized for your skin conditions and your constitution. A trained Chinese herbalist will assess your skin - is it dry, and easy to wrinkle? That’s a sign you need to nourish Yin. Do you have sagging? That tells us spleen Qi will need support as well. Rashes and redness? Clear heat. This is how custom formulations can be made. (Need help with this? Book a free consultation with my team here.)

What About Products?

I love skin care products as much as the next girl - but the truth is that products simply aren’t as important as what is going on internally. Products and external practices like microneedling should always be a compliment to what's going on inside.

That being said, here’s some of what I use and recommend:

DRMTLGY Needle-Less Serum - this is wonderful for fine lines and collagen! Studies have shown it produces a 15% reduction in the appearance of wrinkles and volume in only 2 weeks and 190% increase in elastin production after 11 days.
DRMTLGY Vitamin C E + F to reduce fine lines, decrease hyperpigmentation and provide strong antioxidant protection.
Skin Saint Tretinol .5% Renewal Serum and The Dream Eye Cream include safe and effective levels of retinol plus vitamin C to reduce dark circles, promote collagen production, and improve fine lines
Anything by Biologique Research - but these products should be prescribed by a licensed esthetician trained in the use of the products.
A high-quality sunscreen (I like Supergoop).
I also love microneedling, facial gua sha and cupping. A microneedling tool like this one makes it easy to get started and this is the cupping and gua sha kit I use.

Need more guidance on cupping and gua sha? Watch my three how-to videos below to get started:

Health Looks Good On You

Good health glows - it shows in your hair, nails, mood, and of course, your skin. If you want to look better, you need to start with feeling better!

So if you’re looking in the mirror and not loving what you see… don’t go spend a fortune on new products. It’s not the answer! Instead, consider booking a no-obligation consult with my team. Let’s uncover what isn’t working in your health, right the wrongs, and get you that glowing-from-the-inside look you really want!

>>> Let’s talk! Book a free consult here

Modern medicine does a great job of healing acute diseases, but a poor job of looking at the bigger picture and helping you optimize your health so that your most vibrant version of you can shine. That’s where I can help. Book your free session now to learn more!

by Bassem

What Causes Chronic Constipation in Adults and How to Relieve It

You’re all plugged up and can’t poop. You feel more backed up than a rush hour traffic jam.

Maybe it feels like there’s something in there that refuses to budge.

Your stomach is so bloated it looks like you swallowed a bowling ball.

If you have chronic constipation, we’re sure you’ll agree when we say it’s a real pain in the butt.

The good news? There are ways to get things moving again. But before we go into constipation relief, we’ll talk about what constipation actually is and what causes it.

What Is Constipation?

From a conventional medicine perspective, constipation is defined as having less than three bowel movements per week.

Functional medicine providers, on the other hand, usually want patients to have one to three bowel movements per day. That’s because they recognize the importance of bowel movements for removing toxins and other waste products.

Constipation can also refer to unhealthy stool. Doctors use what’s known as the Bristol Stool Chart to determine the health of a patient’s poop. This type of chart describes stool as being one of seven types. Type 1 (separate hard lumps) or type 2 (lumpy and sausage shaped) both indicate constipation.

What Causes Constipation?

Constipation can have a variety of causes, which is why it’s also a good idea to work with a functional medicine provider to find the root cause.

In some cases, people can have structural and anatomical issues that cause constipation. Medications like opioid drugs can also lead to constipation.

When those are not the issue, the most common causes of constipation are:

Alterations in Gut Microbiology
Candida or Yeast/Fungal Overgrowth
Hypothyroidism
Not Drinking Enough Water
Parasites
Pregnancy
Small Intestinal Bacterial Overgrowth (SIBO)

The Good Bugs vs. the Bad Bugs

The collection of microbes in your gut—both good and bad—are called the gut microbiome. When the microbes that make up the microbiome become imbalanced—either by the bad outnumbering the good or by too much of one type of microbe—it can lead to gastrointestinal problems, including constipation.

Indeed, research shows that an imbalanced gut microbiome can affect how quickly food moves through your bowels and cause constipation. On the other hand, researchers have shown that a healthy gut microbiome prevents constipation. They accomplished this by performing what’s known as a fecal transplant, a procedure where fecal matter from patients who are healthy is transplanted into someone who has gastrointestinal problems. When scientists performed this procedure on patients with constipation, the patients’ gut microbiota and their constipation symptoms improved.

Because constipation is linked to an imbalanced gut microbiota, it’s also linked to other health problems you would never think have anything to do with the gut. For example, people with constipation are at an increased risk of having hay fever.

Candida or Yeast/Fungal Overgrowth

An infection with Candida or any other type of fungus can lead to an imbalance in the gut microbiome. This spells trouble for GI health and stool not moving as smoothly through the intestines.

Sluggish Thyroid

The thyroid gland is important for many processes in our bodies. When it’s underactive—a condition known as hypothyroidism—it causes the body’s processes to slow down. Hypothyroidism slows down the speed at which food moves through the digestive tract.

Dehydration

If you want to know how to relieve constipation in adults, drinking enough water is one of the best solutions.

The large intestine isn’t supposed to be the Sahara desert. It needs fluids to function. When you haven’t had enough water, the colon will grab it from the food, turning stools hard, dry, and more painful to pass. Being well-hydrated also keeps food moving through the intestines.

Parasite Infection

Usually, a parasitic infection starts with acute diarrhea soon after the infection started, like right after returning from a trip. But in my clinical practice I regularly see parasite-caused diarrhea turn into either chronic constipation or constipation alternating with diarrhea.

Patients who have parasite-caused constipation also have bowel movements that feel incomplete.

Pregnancy-Related Constipation

Constipation is a common complication of pregnancy. Nearly half of all pregnant women get constipated at some point during their pregnancy.

During pregnancy, constipation is caused by the dramatic increase in the hormone progesterone, which affects the intestinal muscle and causes food to move through the intestines more slowly.

Small Intestinal Bacterial Overgrowth

Small intestinal bacterial overgrowth—SIBO for short—is another common cause of constipation. SIBO is an abnormal increase in the bacterial population of the small intestines, especially with species of bacteria not usually found in this area of the body.

Diarrhea is a more common symptom of SIBO. When constipation occurs with this condition, it’s usually due to the methane-dominant form of SIBO. In this type of bacterial dysbiosis, there is an overgrowth of bacteria that make methane which can be detected on SIBO breath tests.

How To Relieve Constipation in Adults

It’s no fun being all backed up. Your body can’t get rid of waste and digestion is hampered. You may lose your appetite and when the poop finally comes out, it hurts. While you have probably tried the popular recommendations of drinking water and taking fiber, it may not have been enough. Here are my tried-and-true chronic constipation treatments to get my patients regular again.

Stay hydrated – Drink at least eight glasses of filtered water every day. Coffee and juice don’t count. Neither does tea unless it’s herbal tea. Helpful hint: put a pinch of sea salt in the water. This will help you absorb the fluid better.

Also, sip on warm water with lemon first thing in the morning. Drink this slowly and it will stimulate the gastrocolic reflex, which controls the movement of food through the GI tract after a meal.

Get a good night’s rest – Our bodies have their own internal clocks which control our circadian rhythms. When we ignore our natural circadian rhythms, it can lead to many problems, including constipation. That’s why between 48% and 81.9% of people working either rotating or night shifts have some form of GI problem including constipation.

Researchers also have found that morning IBS symptoms were worse after a night of poor sleep. The IBS symptoms improved after the study subjects slept better.

One reason why lack of sleep causes constipation is because it can affect the gut microbiota.

Get Moving – Walking and yoga are both helpful for constipation relief. Exercise is linked to what scientists call better gut motility—in other words it helps move food faster through your digestive tract.

Use a Squatty Potty – As the name implies, this allows you to squat when you poop. It’s a better, more natural angle and decreases straining.

Biofeedback – Biofeedback is a way to control some of your body’s functions. You can use it to help train your colon muscles to become more coordinated.

Foods to Help Constipation in Adults

I have found that a paleo diet can really get things moving again. This diet mimics a hunter-gatherer diet of meat, fish, eggs, seeds, nuts, fruits, veggies, and healthy fats and oils. In the paleo diet, there is no sugar, refined flour, gluten or dairy.

A low FODMAP diet or specific carbohydrate diet (SCD) has also worked in many of my patients with constipation. FODMAP stands for fermentable oligo-, di-, and monosaccharides and polyols. These are nondigestible carbohydrates which can trigger gut symptoms in some people. The SCD eliminates most carbohydrates including grains, starches, dairy, and sugars with only specific carbohydrates that require minimal digestion allowed. Fresh fruit, most vegetables, grass fed meat, and wild-caught fish are allowed while starches, grains, and processed or canned foods are prohibited. Usually, these types of diets are used for chronic diarrhea, but I’ve seen them kickstart bowel movements, especially when a patient has a chronic infection or an imbalanced gut microbiome.

If you find that your constipation gets worse with starches and sugars, stop eating sweets, which is really a good idea for your health anyway. Avoid using flours. Eat only whole food carbs like root veggies and whole grains if tolerated. Examples of root vegetables are daikon radish, beets, carrots, and parsnips. Beets are the best option especially if you notice that insoluble fiber makes your constipation worse.

Increasing healthy fats from olive oil, ghee, coconut, organic butter, and eggs is also helpful. Make sure you’re getting 2 tablespoons or more per meal—6 tablespoons per day. Fats can increase the rate at which foods move through your digestive tract.

If you tolerate dairy, try making 24-hour yogurt from full-fat cream. Yogurt is a good source of probiotics, which nourish the gut microbiome.

Unless you know or suspect that FODMAP veggies make your constipation worse, get more fiber in your diet by eating seven to 11 servings of vegetables per day.

It’s also a good idea to boost potassium intake. A great way to do this is by making homemade juice with cucumber, tomato, spinach, chard, and melon. Ripe bananas, avocados, and kiwi are also rich sources of potassium.

Fermented foods like chia soaked in kombucha are another ideal choice. These can promote a diverse and balanced microbiome.

Supplements for Constipation

The most common method of constipation relief are laxatives and stool softeners. Warning: these are gut irritants and are not a friend to the gut lining. What’s worse, you can become dependent (otherwise known as habituated) on laxatives so that your gut “forgets” how to poop regularly on its own.

People also often use fiber supplements for constipation, but this can backfire. Fiber supplements can make some people worse. Acacia and partially hydrolyzed guar gum (PHGG) are often the fiber supplements that constipated people can handle the best.

Digestive enzymes and a hydrochloric acid (HCL) supplement are other good choices. Bile support, especially in people who have trouble digesting fats, can help regulate gut motility and transit time (the amount of time food takes to get through your intestines). MegaGuard is a bile support supplement that works well for my constipated patients.

Magnesium oxide or citrate (500 – 2,000 mg at night) can get things moving. Work up to the higher dose slowly. Some people do better with magnesium hydroxide. Magnesium is osmotic, which is just a fancy way of saying it pulls water into the colon. Remember, the colon needs water and magnesium helps there. Natural Calm is a high-dose magnesium supplement you can try.

Another way to increase magnesium levels is to take an Epsom salt bath before bed. This will also soothe away stress.

Buffered vitamin C (2,000 mg) before breakfast and lunch will get your bowels moving. Colon Rx, which includes both Magnesium Oxide and the Ayurvedic herb triphala, has been used for millennia for bowel regulation. Both of these are non-habituating and very safe ways to reduce constipation.

If you have methane-dominant SIBO, Atrantil can treat constipation. It works for many people, but not everyone. It can take up to 21 days to see the full effect.

If you have a severe episode of constipation and nothing else is working, try glycerin suppositories or enemas using water, saline, or coffee. These can make a huge difference to get the gut moving in quick time.

Herbal formulas can work. But be cautious with ingredients like Senna, rhubarb, and aloe. You can become dependent (or habituated) on all of these stimulant laxatives if you use them too often and for too long. If you’ve been taking any of these ingredients, taper slowly while using other support.

Some herbal formulas I like are:

Bowel Mover
Digestive Stimulator
Cleanse More

Smooth Move tea is another herbal option to help with constipation relief. It also contains Senna, so only use it occasionally and work with your functional medicine provider to uncover and address the root causes of your constipation.

Probiotics for Constipation

In choosing a probiotic supplement, avoid formulas that have too high a level of fructo-oligosaccharides (FOS), galacto-oligosaccharides (GOS), inulin, chicory, or arabinogalactan. These ingredients at too high a level can cause a flare in imbalanced gut microbiota. If you have a gut infection, wait until it is cleared to take any supplements with those ingredients.

Some probiotics for constipation that I like:

Test one species first. Start with about 40 billion and then ramp up as far as 300 billion by doubling your dosage every three days. Stop if your symptoms worsen.

Critical Tests If You Have Chronic Constipation

As you read earlier in this article, there are a lot of causes of constipation. Some of them could be damaging more than just your GI tract. That’s why it’s important to test for parasitic and other gut infections, Candida and fungal overgrowth, and an imbalance in the gut microbiota. Depending on the specifics of your case, we might choose to use the GI-MAP, the Parawellness Stool Pathogen panel, or the BiomeFX panel. We might also include Lactulose and Fructose Breath Testing for gasses that can indicate SIBO.

You really don’t want to tackle these types of gut imbalances on your own. Instead, book a free 15-minute troubleshooting call with me to find out the best course of action. If after the call you come on board as a patient, I’ll order the right tests, recommend a plan customized for you, and put you on the path to feeling like your regular self again.

by Bassem

A Functional Medicine Approach to Healing IBS

So, your doctor says you have IBS - Irritable Bowel Syndrome.

This diagnosis can either feel like a relief or a nightmare.

On the one hand, an IBS diagnosis means some of the causes of digestive issues like Crohn’s, Ulcerative Colitis, and Celiac disease have been ruled out - that’s a good thing.

But on the other hand… IBS is essentially a name for “something’s wrong but we don't know what.”

And in the functional medicine, holistic approach I use - that’s not a good enough answer. In fact, it's not an answer at all!

An IBS diagnosis leaves people to suffer through their symptoms alone - which is bad enough - but even worse, it ignores the root cause of the issue.

And because the gut is so integral to overall health, issues in your gut inevitably lead to more health issues - hormones, mental health, weight concerns, thyroid issues, and more.

So why do we accept this? Why do doctors tell you that you “just” have IBS and send you out the door?

Because treating IBS isn’t easy! There’s no one pill that can fix it, because no two people have the same causes. It requires a multi-step, hands-on treatment approach that usually needs to be tweaked in real time. That’s not the kind of care most standard MDs are able to provide.

Don’t worry - I got you! Today I’m going to share my approach to treating IBS.

But buckle up, because this isn’t a quick 3-step process (sorry!). Today, we’re diving deep into the nitty gritty of treating one of the trickiest conditions out there.

You’re Entitled To More Than One Problem

In Chinese medicine school, I often heard the saying “You’re entitled to more than one problem at the same time.” This was the tongue-in-cheek way of saying it’s the norm, not the exception, for a patient to have multiple contributing factors to any health challenge they faced.

And this is especially true in the case of IBS because the gut is so intricately connected to every part of the body, but also because one gut issue - like inadequate digestive secretions (due to stress, medications, etc.) - can create the environment for another problem to arise.

That’s why the treatment plan I use for IBS has a lot of steps. Because you may have low stomach acid, or bacterial overgrowth, or a parasite… but that’s more than likely not going to be the only issue you’re dealing with. Instead of obsessing over discovering the one root cause of your IBS, my approach works systematically through the most common issues, creating a powerful foundation for lasting health.

So let’s peel back the layers, step-by-step, and tackle this together.

Start From The Top and Work Down

Most people don’t think of it this way, but the mouth is actually the start of the gut. The mouth has its own microbiome that directly influences the composition of the large intestine microbiome. In fact, research has shown that simply brushing your teeth 3x daily can measurably lower levels of candida in the stool.

94% of Americans have some degree of gingivitis and the mouth and sinus are home to fungal strains including Candida species (present in 75% of participants), followed by Cladosporium (65%), Saccharomycetales (50% for both), Aspergillus (35%), Fusarium (30%), and Cryptococcus (20%). In addition, gram negative bacteria such as Enterococcus faecium, E faecalis, Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis are also common in the mouth. These are the same bacteria most commonly overgrown in cases of Small Intestine Bacterial Overgrowth (SIBO).

The best defense is controlling bacteria levels in the mouth with your oral hygiene routine. I recommend Dentalcidin toothpaste and Biocidin Dental Rinse as an important first step for anyone with dysbiosis or candida, SIBO, IBD, IBS, gas that clears the room, or a history of poor dental health.

Optimize Your Gut Terrain

Once you’ve got your new oral hygiene routine in place, the next step is to optimize your gut terrain and environment.

Before we ever run a stool panel, clear a pathogen or take those precious leaky gut supplements, and especially before we start going down side rabbit holes like mold, we need to replace any missing digestive secretions and work on meal hygiene and transit time. This literally sets the stage for a healthy gut.

Digestive secretions include stomach acid (HCL), bile, and pancreatic enzymes. HCL is secreted by parietal cells in the stomach in response to the smell and taste of food, as well as distension in the stomach and small intestine (distention occurs when food enters the stomach).

HCL is particularly important for the breakdown of protein. Most importantly, however, HCL acts as the first domino for all the other digestive secretions. Without adequate HCL, all other secretions will suffer!

The #1 reason for inadequate HCL? Stress. HCL release is triggered via the vagus nerve which connects the brain and the gut. Vagus nerve activation requires a parasympathetic state of the nervous system. You might know this as the “rest and digest” mode. Eating while stressed, busy, or otherwise unfocused is therefore a major cause of low HCL. Other causes include the use of PPIs and other acid-blocking meds, as well as the presence of certain bacteria in the gut like H. pylori, which can denature HCL.

Adequate HCL then triggers the release of bile from the gallbladder. Bile is necessary for the digestion of fats, but bile also acts as an antimicrobial in the small intestine, helping to prevent bacterial overgrowth. Bile also collects toxins for the liver to secrete. Bile levels can be impacted by inadequate HCL, dehydration, gallbladder issues or removal, and exposure to high levels of toxins. If bile is inadequate it can lead to dysbiosis of the microbiome and deficiencies in fat soluble vitamins like A, D, E, and K and nutrients.

Pancreatic enzymes are secreted by the pancreas and play key roles in breaking down carbs like sugar and starches as well as fats. Pancreatic enzymes allow starches to be broken down in the small intestine, rather than fermented, preventing bacterial and fungal overgrowth. Pancreatic enzymes act as a bactericidal against Escherichia coli, Shigella species, Salmonella species, and Klebsiella pneumoniae, and have fungistatic activity against Candida albicans. The release of pancreatic enzymes is dependent on adequate HCL.

HCL, bile, and enzymes can all be supplemented if needed, but there are other things you can do as well. First up, make sure you’re hydrated. Proper hydration is necessary for the production of digestive secretions - think of water as the key ingredient. Secondly, slow down and really chew your food. Thorough chewing allows time for the brain to signal the gut that food is coming, and the gut to secret HCL and bile in response.

With my one-on-one clients I utilize gut testing to check enzyme levels, and often supplement HCL, bile, and enzymes as needed.

What About Probiotics?

I tell my clients to introduce fermented foods as tolerated - even if that’s only a single strand of sauerkraut to start.

Beyond that, certain probiotics can be really helpful. Some strains support secretory IgA, which protects the mucosal barrier of the gut. Those include spore based probiotics, S. boulardii, L. plantarum, L. Reuteri, and B. lactis.

Generally well-tolerated probiotics include OrthoSporeIG, or MegasporeBiotic. For those who are highly sensitive, you may want to start with HU58 instead, which is a single spore organism.

Probiotics can also support specific symptoms of IBS. For diarrhea, S. boulardii works well. I like Floramyces. For constipation, Optibac (1-4 doses per day) or HN019 strain of Bifidobacterium lactis (Xymogen’s Probiomax) are my favorites. BioGaia Protectis drops, which contain Lactobacillus reuteri DSM17938, are my favorite for bloating. And in general, many IBS patients benefit from Ideal Bowel Support which contains L.plantarum 299V.

Address Motility & Transit Time

Addressing motility and transit time goes hand-in-hand with optimizing the terrain of the gut. Bacteria in the gut bloom like a coral reef after meals. If food and bacteria are moving through the gut and into the large intestine, that’s a great thing. But if food isn’t moving as it should, bacteria can bloom in the small intestine, and that’s a problem.

Bacterial overgrowth in the small intestine (SIBO) is a factor in as many as 80% of all IBS cases. (That being said, it’s not the only cause of IBS. I see it more often as a contributing cause - more the “branch” than the “root” of IBS!)

Motility is controlled by the migrating motor complex (MMC), an electrical wave that originates in the brain via the vagus nerve. The MMC acts like a broom, sweeping food and bacteria through the small intestine and into the large. Many factors can contribute to a deficient MMC, including bacterial overgrowth itself, which can secrete toxins that disrupt the vagus nerve.

To improve motility, I use prokinetics (not to be confused with laxatives), which help trigger normal MMC function, as well as other approaches to keep bowels moving regularly. But if motility issues are chronic, it’s a sign of an impaired gut-brain axis. Modalities that can heal the gut-brain axis include:

Neuroplasticity
Biofeedback
Frequency Specific Microcurrent
Vagal nerve stimulation
Acupuncture
Therapy like EMDR, or somatics for trauma

Nutrition Based On Symptoms

Once the gut terrain and motility have been addressed, it’s time to look at your diet. For all my clients dealing with IBS or other gut issues, I have some basic diet recommendations:

Paleo or Autoimmune Paleo as a foundation
Focus on nutrient dense foods, including gut-healing foods like bone broth, 24-hour yogurt, and sauerkraut (just start small)
Gluten, dairy, and added sugar-free
Avoid eating the same foods day after day - variety is key
Stay well hydrated
Practice good meal hygiene (sitting down to eat, avoiding screens while eating, slowing down, chewing thoroughly)
Incorporate fermented foods as tolerated (start really small)
Incorporate fiber-containing plants as much as tolerated

While many people want to skip these simple diet changes, they matter. It’s a foundation, not an aside. You will not get better if you’re only eating gluten free toasted waffles, even if you tolerate them well! By the same token, if you’ve found you can stay symptom-free by eating a very limited diet, we eventually need to expand your phytonutrients and nutrients in general if you want to actually get better (and enjoy eating again!).

For those patients with more specific concerns, I do often trial special therapeutic diets like the Specific Carbohydrate diet (SCD), low-FODMAP, or low histamine. Having diarrhea 15 times per day? Try the SCD Diet. (Just make sure you don’t skip the essential Intro phase!) Tons of bloating, belching, and some loose stool or constipation? I’d suggest a low-FODMAP trial. And for those with lots of rashes, headaches/migraines, hives, itching, anxiety, insomnia, brain fog, sudden episodic diarrhea after meals, and allergies with foods, I will try a low histamine diet. (And some may need to take it a step further and follow low nickel - especially if rashes or eczema are present - or have salicylate or oxalate intolerances as well.)

And Now We Test

You might be surprised to see that only now am I considering testing - stool testing, breath tests, or even hormone panels. The truth is that there is so much to work on long before any labs need to be ordered. And for some people, simply improving the health of the oral microbiome, optimizing the gut environment, and making some nutrition changes are all that is needed to completely resolve symptoms! I too often see people on fancy gut protocols, who aren’t getting results, simply because they have addressed the foundation first! Bottom line: don’t skip ahead!

But once we’ve covered the basics, testing can provide invaluable information that leads us forward in the right direction and saves you a ton of wasted time, energy, and money.

My two essential tests are multiple stool panels and hormone testing. In addition, I often find breath testing for SIBO, organic acids tests, and food sensitivity testing to be valuable tools, as well.

Why You Need Hormone Testing for A Gut Problem

It might seem odd if your symptoms are all in your gut, but hormone testing is a must-have tool for treating IBS. Why? Because your struggle with inflammation in the gut, and your ability to resolve it, is to some extent limited or empowered by how harmonious and optimized your hypothalamic–pituitary–adrenal (HPA) axis is. Cortisol, the primary “stress hormone” whose production and release is controlled by the HPA axis, is like your own endogenous prednisone. If cortisol levels are sky high, or have tanked and are too low, the body can’t repair tissues (like leaky gut) or resolve inflammation. Trophic hormones like DHEA are also essential for tissue repair. Stress and cortisol also inhibit secretory IgA, the most important immunoglobulin for repairing the mucosal barrier of the gut. I think of secretory IgA like the immune system of the gut.

Most of my clients have some level of hormone dysfunction - but once we know what it is, we can take active steps to mitigate it. I recommended actively addressing stress and trauma with tools like therapy, EMDR, vagal nerve stimulation, and tools like the Gupta Program or the Inaura platform.

Order These 2 Stool Tests

I always use two stool tests to detect pathogens like H. pylori, fungal overgrowth, and parasitic infections. Right now my favorites are GI Map and Parawellness. To get started, I prefer to use tests that focus on identifying pathogens vs. microbiome tests like BiomeFx or the Genova Panel. While general microbiome wellbeing is incredibly important, if pathogens aren’t first tested and cleared, they will usually impede any improvements to the health of the microbiome. (That said, I do love the BiomeFX for really targeted rebuilding of the beneficial microbiome after we’ve “weeded” the garden!)

That being said, the microbiome is essential in understanding why pathogens are a problem for some people but not others. It’s not just about what pathogens are present, but how your body responds to the pathogen. This is akin to the concept in Chinese medicine of Wei Qi. Wei Qi has its roots in the Kidney Qi (your core energy, or how strong you were when you came in, based on genetics, and how well you’ve nurtured that with nutrition, lifestyle, and exposure).

Wei Qi is the concept that the hand of cards you were dealt (genetics), under the influence of the exposures you’ve had or lifestyle you’ve chosen or been able to afford = your resilience. You might have also heard of this concept as “epigenetics.” Chinese medicine practitioners have been talking about it for 5,000 years!

Pathogens can shift or suppress the immune system, increasing susceptibility to SIBO and other opportunistic dysbiosis. Parasites and gut infections degrade the protective lining of the gut, called the mucin lining, to decrease secretory IgA levels. They do this to stay alive: they need to degrade the immune system in the gut to prevent being destroyed.

In addition, many parasites can mimic or directly trigger IBS or Inflammatory bowel disorders including Giardia lamblia, Entamoeba histolytica, Cyclospora, and Cryptosporidium. In one study, blastocystis infection was found in 67% of IBS patients, and other research found that the prevalence of blastocystis, cryptosporidium and giardia is higher in IBS patients than in controls, and likely play a role in the development of IBS.

If you’re thinking, “There’s no way I have a parasite,” think again! Risk factors include simple things like travel outside the U.S. and swimming in lakes/oceans/rivers. Lots of food intolerances - or food intolerances that change frequently - are also a warning sign for parasites, as parasites are able to “switch” the immune system from innate immune response (the TH1 immune system) to the “food allergy” response (TH2 immune system). Many people report no obvious symptoms. That’s why I test everyone, across the board.

Creating Your Custom Treatment Plan

One we have test results in hand, it’s time to create your customized healing strategy. While no two cases of IBS are the same, there are some general rules I follow:

#1 Start With H. Pylori (If Present)

Because H. pylori breaks down stomach acid, as well as “partners” with and encourages other pathogens, if it is present, it’s where I start. (H. pylori also promotes histamine synthesis and can contribute to histamine induced symptoms).

#2 Clear Other Pathogens

Once H. pylori has been addressed I move down the list of parasites such as Endolimax nana, Giardia, Entamoeba coli, Entamoeba histolytica, etc.

#3 Candida & SIBO

Next, I like to tackle candida overgrowth and SIBO. I often clear candida first, especially in the case of methane-dominant SIBO, because there is a strong association between candida and methane SIBO, and the SIBO often won’t respond to treatment unless the candida is cleared first.

#4 Find & Treat Other Factors (If Needed)

If candida is not clearing after appropriate clinical steps, or, if SIBO won’t resolve after appropriate treatment, I look “further down the rabbit hole” for other things that could serve as impediment to those resolving like:

Heavy metals burden
Mycotoxins (Mold exposure)
Other biotoxin issues like Lyme and tick-borne diseases, chronic viral infections

(And if a patient has a known history with these - like a mouthful of mercury amalgam fillings, or once lived in a moldy apartment, or known tick bites - I skip ahead and test for these issues earlier.)

Let’s Talk About SIBO

Like I mentioned earlier, SIBO is an underlying cause of IBS in as much as 80% of cases. But that doesn’t mean SIBO is the only cause of your IBS. SIBO is often just one aspect of a bigger set of issues. In fact, I often see patients who have had four or more rounds of SIBO treatment and still have symptoms. Why?

Often it’s because they have other parasites or pathogens that haven't been treated. Another common reason is that they actually have SIFO - small intestine fungal overgrowth. A 2015 study showed 25% of patients with unexplained GI issues actually had SIFO. SIFO symptoms are the same as SIBO symptoms, but common SIBO treatments like rifaximin and neomycin are just fuel on the SIFO fire. SIFO can be treated, too - it just requires a different treatment.

Exceptions to the Rule

Now you know my basic treatment approach for IBS - but there are some exceptions. If someone is too overburdened, run down, or “weakened”, by what they’ve endured in body burden, often combined with a lifetime or period of high stress, sleep deficit, limited nutrition (because of what they can’t tolerate, or what is available), and poor assimilation, and are running on a deficit - they may need a different approach.

In these cases, a person may be too vulnerable to tolerate pathogen removal, either because it would leave them more vulnerable to another pathogen, or damage the microbiome itself. (Even natural agents can cause damage - looking at you, Oregano oil!)

A few weeks of support for healing gastritis, esophagitis, or leaky gut prior to digging in to increasing enzymes or HCL levels or endeavoring to clear a pathogen can make all the difference. They may also need several weeks of gentle detox support. I might use Chinese herbs, immunoglobulins and/or probiotics for secretory iGA support, or treatments aimed at supporting HPA Axis normalization. I think of this as strengthening Spleen (digestive) Qi and Wei Qi.

Retest, Rebuild, Revitalize

We’ve already covered a lot, but we’re not done yet. In fact, these three final steps might be the most important. Please don’t skip them!

#1 Retest

Once we’ve completed our first round of treatment, it’s time to retest. Failure to retest is the most common reason people relapse after treatment. Yes, it really is worth the time and money! Retesting gives us insight into how you responded to treatment, if further treatment is needed, or if problems have been resolved. The only exception to this is SIBO testing: if your SIBO symptoms are 90% or more resolved, we often don’t need to retest, because SIBO doesn’t always look perfect on paper.

#2 Repair & Rebuild

We have already started the process of improving the gut terrain and environment. Now is the time to kick it into high gear and increase both probiotic and prebiotic foods. These help “bulletproof” the microbiome, preventing future infections and problems. Now is also the time to add supplements for anti-inflammation and leaky gut repair (butyrates, glutamines, curcumins, immunoglobulins, prebiotics, probiotics, nutrients like vitamins A, D etc).

This is also the right time to utilize advanced microbiome testing like BiomeFX. We can use that information to focus on further diversifying the microbiome, because diversity is strength.

#3 Revitalize

Finally, I focus on detox support, nutrient replacement, and optimization of other systems that may have been impacted as innocent bystanders of the gut issues. Using an organic acids panel like ION, I take a look at liver detox, antioxidant status, amino acid status, neurotransmitter status, leaky brain, skin, and lungs, mitochondria and metabolism, and inflammation throughout the body.

Even if you do every other step in the process, missing this one is like missing the icing on the cupcake. (I know, bad analogy for someone practicing nutritional medicine, even if it’s a gluten free, sugar free cupcake!).

This step is WHY we bother doing the rest. You set out to clear your IBS because you don’t want to run to the bathroom 10 times per day. You don’t want to struggle to get to sleep, stay asleep, think clearly, or deal with rashes or autoimmunity. You don’t want an overburdened detox system and excess oxidative stress to cause you to age prematurely. But clearing the gut and supporting the microbiome will only get you part way to relief (very far, but not entirely).

For long term resilience and vitality, here’s what else I’m looking at:

Replacing missing nutrients
Supporting detox pathways
Glutathione status
Ability to optimally metabolize (aka use for energy) carbs, fats, and proteins,
Omega fatty acid balance
Mitigating inflammation
Supporting mitochondrial function
Lowering oxidative stress
Optimizing brain function

Healing IBS Is A Journey

In case you haven’t picked up on it yet… healing IBS isn’t a “quick and easy” process. But most things that are really worth it in life take time and effort. You likely are not going to see impressive results by just taking a few supplements or cutting gluten from your diet.

But that’s not a reason to get discouraged. Trained practitioners like myself have years of experience, working with thousands of clients.There’s nothing more gratifying than helping a patient - especially if that patient feels they have tried “everything” - peel back the layers of their IBS one by one and finally find relief!

If you need support healing IBS, I want to invite you to book a complimentary, no-obligation chat with my team. We’ll hear your story and let you know how we think we can help.

>>> Schedule your free consultation here

Living with IBS is hard. You don’t just have to accept this as your normal. We would love to help.

by Bassem

Natural Treatment of PMS and PMDD

Raise your hand if you struggle with menstrual cramps, painful periods, irritability, mood swings, depression, and more the days and weeks leading up to your period.

If you raised your hand, you are not alone!

Nearly 90% of all menstruating women in the United States experience premenstrual syndrome (PMS) in their lifetime. And approximately 3% of those women experience such severe symptoms that they can be categorized as having premenstrual dysphoric disorder (PMDD).

Contrary to what some people may think, PMS and PMDD are real conditions. They can cause significant physical discomfort, impact your mental and emotional health, and disrupt your daily life.

Below, we’ll review the symptoms, causes of PMS and PMDD and how to naturally treat them.

What are PMS and PMDD?

PMS is a group of symptoms that many women experience during the luteal phase of their menstrual cycle. Typically starting around ovulation and ending the first day of their period.

PMDD, on the other hand, is a type of PMS but the symptoms are much more severe. Women who suffer from PMDD experience a decreased response to the body’s inhibitory molecule, GABA, which helps to limit activity associated with stress and anxiety. Causing women to experience five or more common PMS symptoms for seven or more days.

PMS and PMDD Symptoms

PMS can begin a few days or up to two weeks before the start of a woman’s period with mild to moderate symptoms. These symptoms only occur within those two weeks and are not present during the rest of the month.

PMS can present with a variety of physical, emotional, and cognitive symptoms including:

Bloating
Headache
Fatigue
Acne flare-ups
Breast tenderness
Mood swings
Depression or anxiety
Changes in appetite
Insomnia
Constipation or diarrhea

PMDD shares many of the same symptoms as PMS, but these symptoms are much more severe. These symptoms can be so severe that they disrupt tasks of daily living. And, many women experience very little relief from common over-the-counter medications.

What Causes PMS and PMDD?

Scientific research hasn’t conclusively identified the cause of PMS or PMDD. Nor has it determined why some women experience it more severely than others. But, research has suggested several different theories as to what causes PMS and PMDD.

Hormonal changes that occur during the menstrual cycle:

Many believe that PMS occurs in response to the changing levels of the hormones estrogen and progesterone. Also referred to as the sex hormones.

These hormonal fluctuations are thought to increase anxiety, irritability, and other mood changes experienced before your period.

Interaction between sex hormones and neurotransmitters:

The fluctuating levels of the sex hormones can impact the brain chemicals serotonin, dopamine, and GABA. Estrogen is required to synthesize serotonin and increases the number of serotonin receptors in the brain. Whereas progesterone helps stimulate dopamine release and increase GABA function.

Because both estrogen and progesterone levels drop before your period, the production and the effect of these “feel-good” chemicals are impacted. Leading to increased anxiety, changes in mood, and insomnia.

In women who struggle with PMDD, progesterone alters the shape of their GABA receptors making it harder for GABA to bind to them and improve mood, depression, or anxiety.

Other contributing factors:

There are other contributing factors that could lead to both PMS and PMDD including:

Genetics – There are hundreds of genes that help eliminate toxins from our bodies. One example is the COMT gene which helps to eliminate estrogen from your body. Those with the slow COMT gene mutation struggle to eliminate excess estrogen and can experience endometriosis, strong PMS, and fibroids to name a few.
Weight – No matter the cause for being overweight, an increase in fatty tissue equals an increase in hormones. Increased production of estrogen can cause inflammatory responses in the body and promote many PMS symptoms.
Estrogen Dominance – If the gut is not processing estrogen or the liver is unable to detox estrogen, the body will have an increased level of estrogen relative to progesterone.
Detox Issues – If the liver is unable to detox excess estrogen it may be too stressed and require you to decrease your toxin load in other ways.
Gut Health – Our intestines are filled with trillions of bacterial cells (known as the microbiome) that work together to regulate the production, metabolism, and detoxification of hormones. When the microbiome is disturbed and the bacteria is damaged, dysbiosis can occur. Learn more about the importance of gut health and hormones here.
Histamine Intolerance – How your body reacts to the foods you eat can be driven by hormone fluctuations. Estrogen dominance can increase histamine and adequate progesterone can help balance it out.

Diagnosing PMS and PMDD

There is no definitive test to diagnose PMS or PMDD. However, there are several screening tools I used when diagnosing PMS and PMDD.

Estrogen and Progesterone – DUTCH test or a serum blood test done seven days post ovulation to evaluate your estrogen and progesterone levels.
Adrenal Testing – DUTCH test to evaluate your adrenal health and confirm you are not experiencing an HPA axis dysregulation.
Thyroid – You need adequate amounts of thyroid hormones for your ovaries to make progesterone. Progesterone also helps the thyroid function well. Research has reported that a high percentage of women with PMS also have hypothyroidism.
Blood Glucose and Insulin Sensitivity – High blood sugar levels lead to high insulin levels which decreases the sex hormone-binding globulin (SHBG). If your insulin is always high there won’t be much SHBG causing estrogen and testosterone to rise relative to progesterone.

Natural Treatment of PMS and PMDD

If you have PMS or PMDD, there are several natural treatments that I use to relieve symptoms. These can include strategies such as diet modifications, exercise, and supplements. All focused on improving your overall well-being, stress relief, and symptom management.

Here are some of my more commonly used natural treatments for PMS and PMDD.

Diet

Eating healthy is critical to managing PMS and PMDD. Some foods can increase the likelihood of some symptoms like bloating, blood sugar fluctuations, fatigue, and mood swings. I recommend:

Omit refined sugar, carbs, caffeine, and alcohol.
Choose grass-fed, wild, and organic foods when possible.
Boost your veggie intake! Load up on cruciferous veggies and fruits high in antioxidants like broccoli, cauliflower, brussels, kale, and arugula.
Increase your fiber during the luteal phase of your cycle.
Add 2 TBSP of ground flaxseed to your diet daily

Exercise

Move your body daily! Several research studies have shown that moderate cardio exercise everyday can help improve PMS and PMDD symptoms in four to eight weeks!

Aim for 30 to 40 minutes per day of cardio exercise or yoga.

Supplements

Getting the required dietary supplements each day has been shown to improve PMS and PMDD symptoms. Depending upon your symptoms and dietary requirements I recommend the following supplements:

Magnesium: Migraine headaches, anxiety, adrenal concerns, blood pressure issues…your magnesium is likely lacking. Think of it as a calming agent that you can use just about anytime.
Vitamin B6: Helps to produce progesterone and promote GABA synthesis which can ease fatigue, irritability, and insomnia. I recommend beginning with 50 mg.
Vitamin E and good fats. Vitamin E supplements and essential fatty acids help combat the effects of PMS by reducing the effects of the hormone prolactin. I suggest starting with 800 iu Vitamin E Tocotrienols, 2 caps of omegaMonoPure 1300 [email office for more information on this product], or 2 caps of EPO (bonus: EPO is great for glowing skin!).
Calcium: Adding additional calcium support has shown to be a simple and effective treatment for the luteal phase symptoms of PMS. I recommend adding 1200 mg of calcium per day.
Saffron: In women with mild to moderate depression, saffron has shown to have an antidepressant-like effect. And, it can be used throughout the luteal phase of your cycle. I used the product MoodStasis beginning with 15 mg twice a day.
Progesterone Drops. Augmenting your progesterone with natural progesterone drops based on your labs can help mimic your body’s progesterone production. This cyclic taper allows us to taper up or down based on your personal need. (email our office for help with this product)
Hormone-balancing herbal blends. A hormone-balancing herbal blend can help promote progesterone production and estrogen clearance. I often use Vitex, DIM, or CDG to promote progesterone production. I use Calcium d-Glutarate to help prevent estrogen metabolites from recirculating back into the bloodstream from the gut and to help eliminate excessive estrogen. And there are many classical Chinese herbal formulas specific to women’s health and hormones that I will often incorporate based on your constitution and symptom presentation.

Liver Detox

If the liver has to work hard to filter out harmful toxins from the body, its capacity to cleanse the blood from estrogen can be compromised. In addition to decreasing your overall toxic load, eliminating alcohol can help improve your liver’s ability to detox excess estrogen. Alcohol increases allopregnanolone (a neurosteroid made from progesterone) which can reduce the effectiveness of GABA. Ultimately increasing symptoms of PMS and PMDD.

Say Goodbye to PMS and PMDD Naturally

The bottom line is…if your PMS symptoms occur month after month and affect your quality of life, it’s time to get some help! You don’t need to live with physical discomfort, mood swings, anxiety, or depression.

Based on your symptoms and lab results, we will develop a personalized treatment plan to help you say goodbye to PMS and PMDD!

Are you ready to say goodbye to PMS? Begin by scheduling a free 15-minute troubleshooting call.

by Bassem

Anxiety Disorder Symptoms, Hormonal Imbalance, and Histamine Intolerance: The Surprising Connection

Your brain is foggy. Making even small decisions feels overwhelming.

You’re worried about everything and it’s hard to sleep at night.

The fatigue that nearly overpowers you makes you want to go back to bed and pull the covers over your head and hide from everyone and everything.

You’re cranky, restless, and on edge. Panic attacks cause your heart to race and your palms to get sweaty.

Even if you only have only a couple of these problems, you may have generalized anxiety disorder. That’s the bad news.

The good news? You can feel at peace, happy, and calm again. The answer lies in balancing your hormones. But that’s not all. You’ll also need to get rid of problems like blood sugar imbalance that cause your hormones to get out of whack. Then there’s histamine intolerance, which is strongly linked to hormonal imbalances and anxiety.

Hormone Imbalance: The Victim Not the Villain

Imbalanced hormones are not the villains responsible for your anxiety disorder. They’re more like the victims of other problems happening in your body. That’s why as a functional medicine provider specializing in irritable bowel syndrome, inflammatory bowel disease, and women’s fertility issues I see a lot of patients who also suffer from anxiety and panic attacks.

In fact, 75% of my patients present to my clinic with anxiety along with other issues like acid reflux, irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), digestive issues, endometriosis and many more.

Hormones are actually responders, the language the body uses to talk to itself. Hormones express what they’re seeing in the different tissues around your body and tell your body how best to respond.

In other words, when hormones break, it’s not typically the root cause of your problems. Rather, the hormones shift in response to the root cause or causes of your health problems.

That said, working to adjust and balance hormones can help you feel better. When your hormones are balanced, you will have more energy and bandwidth to work on the real root cause underlying your health problems.

In this article, I’m going to dive into one common factor that breaks hormonal balance. Then I’ll hone in on one of the most important hormones for people suffering from anxiety disorder and its link to histamine intolerance.

I’ll also shed light on some of the other reasons for anxiety and panic attacks and let you know what you can do to feel less anxious and more at peace.

First, though, let’s talk about what generalized anxiety disorder actually is and its symptoms.

What Is Generalized Anxiety Disorder?

Everyone gets anxious from time to time. Work deadlines, tests at school, dealing with relationship problems or other stressors can all lead to occasional anxiety.

People with generalized anxiety disorder, on the other hand, experience ongoing worry or fear much of the time.

Often, people with anxiety disorder feel anxious or get panic attacks even while trying to make simple decisions. Generalized anxiety disorder can cause problems at work, in school, and in your relationships.

Symptoms of generalized anxiety disorder include :

Difficulty concentrating or brain fog
Fatigue
Insomnia (difficulty falling or staying asleep)
Irritability
Restlessness
Worry

Generalized anxiety disorder and panic disorder are some of the most common mental disorders in the United States. These are different types of anxiety disorders. Technically, conventional medicine considers panic attacks to be a separate disorder. However, in my experience as a functional medicine provider, most people aren’t going to have panic attacks without already having generalized anxiety disorder.

Symptoms of panic attacks include:

Feeling out of control
Feelings of impending doom
Pounding heartbeat or rapid heart rate
Shortness of breath, smothering, or choking
Sweating
Trembling

Past trauma can trigger panic attacks. But they can also happen in people who have never experienced any trauma.

Blood Sugar Imbalances Wreak Havoc on Hormones

One of the most common reasons why hormones break is because your blood sugar isn’t balanced. I have seen many patients get 90% better just by balancing their blood sugar.

Low blood sugar mimics anxiety. When your blood sugar crashes, the body attempts to push up blood glucose levels. It does this by making epinephrine, otherwise known as adrenaline, which triggers glucose production in the liver.

Increased adrenaline leads to a “fight-or-flight” stress response in the body. This same biochemical process is also linked to anxiety.

If you tumble into a chronic, on-going low blood sugar state, your body may boost its production of the stress hormone cortisol. This helps tissues in the body be less reactive to insulin, which boosts glucose circulation in the bloodstream. But high levels of cortisol can cause problems, too.

Guess what higher cortisol levels are also linked to? Anxiety.

What’s more, in my work with thousands of patients, blood sugar swings have been the biggest driver of fatigue, anxiety, and mood swings!

A functional medicine provider can order the right tests for blood glucose and insulin sensitivity. These include LDH (lactate dehydrogenase), HbA1c (hemoglobin A1c), SHBG (sex hormone binding globulin), fasting glucose, fasting insulin, and sometimes glucose response testing.

To resolve low blood sugar problems that show up on the tests, eat more healthy fats, which are easier to assimilate and digest.

High quality protein is also important. Back before I knew I had polycystic ovary syndrome – a condition linked to insulin resistance – I was eating vegan and vegetarian and chowing down on carbs. This was the wrong approach because anytime you have a problem with blood sugar or insulin, carbs are the bad guys.

The Soothing Effects of Progesterone

Your brain has receptors for sex hormones like progesterone. So it’s not surprising that progesterone can influence brain function and mood.

If you have anxiety, progesterone is one of your best friends.

Women with low progesterone levels are prone to anxiety. That’s why in conditions of low progesterone such as during PMS, post-childbirth, perimenopause, and menopause there’s an increase in anxiety and frequency of panic attacks.

Progesterone and its metabolite allopregnanolone act as a natural antidepressant, enhance mood, and relieve anxiety. Progesterone has a calming effect on the brain. It increases the actions of a feel-good, calming neurotransmitter known as GABA (gamma-aminobutyric acid).

By giving GABA a helping hand, progesterone acts like a hormonal lullaby, helping you fall asleep easier and stay asleep longer.

What’s Histamine Intolerance Got to Do With It?

Histamine is a chemical released by some cells of the body. If you’ve ever had an allergic reaction or seasonal allergies, you’re likely familiar with its effects such as runny rose, sneezing, or hives.

Histamine isn’t always the bad guy. We need some histamine to release stomach acid and to help move food through the gut. The important thing is for histamine to complete its life cycle by being broken down and cleared from the body.

When that doesn’t happen histamine intolerance occurs. This is when the body makes too much histamine and too little of the diamine oxidase (DAO) enzyme needed to break it down.

Anxiety is a symptom of histamine intolerance. Other symptoms include headaches, fatigue, nausea, irregular menstrual cycles, sinus issues, digestive problems, tissue swelling, and dizziness.

In my experience, people most likely to suffer from histamine intolerance are people who are perfectionists. These are often the same people who suffer from anxiety and panic attacks. They want things to be a certain way and hold high expectations.

Characteristics of people most likely to develop histamine intolerance include:

Academic overachievers
Highly motivated
Inner anxiety with a calm exterior
Being competitive – with themselves and/or others
Having obsessive/compulsive or ritualistic behaviors, or a need for structure and strong routine, feeling of order and control over things.

The above characteristics can actually be positive and work in your favor. If you have those characteristics you’re highly intelligent, super productive, and probably are successful in work and life. When your hormones are in balance these traits can work for you.

However, if your histamine is too high and your hormones are out of balance then you might develop poor stress tolerance, feelings of anxiety, and insomnia.

Progesterone Guards Against Histamine Intolerance

Progesterone enhances DAO, the enzyme that breaks down histamine. So progesterone helps histamine meet its maker and clear it from the body.

Estrogen dominance, on the other hand, boosts the body’s production of histamine. Women whose histamine production is estrogen driven will see flares of their problems either right before ovulation or more likely right before their period, because that’s when they’re naturally estrogen dominant.

Does anything else cause histamine intolerance besides estrogen dominance? You bet. Genetics can play a role. My own histamine intolerance was partly caused by genetics. But the gut plays a huge role, too. For me, my high histamine and hormonal imbalance came down to the “bad” organisms in my digestive tract (Helicobacter pylori, Giardia, and Candida albicans)

Leaky gut leads to lower levels of DAO and in turn high histamine. This is because the place where your body makes DAO is mostly mucosal barriers like the intestines.

If your liver isn’t working its best, that will cause problems, too. The liver detoxifies histamine. If its detox abilities are weakened, histamine will build up in the body. It’s just one more thing to fill your bucket up to the point of overflowing.

Other Hormones to Watch in Anxiety and Panic

In my patients with anxiety, I always keep an eye on other hormones besides progesterone. These include:

Thyroid – If thyroid hormone levels are up and down like in Hashimoto’s it can mimic bipolar disorder. Low thyroid hormones are also linked to low progesterone.
DHEA (Dehydroepiandrosterone) – DHEA is the most abundant circulating hormone. Balancing levels of DHEA can lead to better mood and less anxiety.
Serotonin/Estrogen – Serotonin makes you feel content, happy, calm, and ready for sleep. It reduces anxiety and the tendency to think about sad or dark thoughts over and over (cyclical thinking or ruminating). You need estrogen to convert amino acids into serotonin.
Cortisol – Cortisol is primarily produced by the adrenal glands. Adrenal fatigue can make you less likely to cope with stress. If you have a poor stress response, cortisol can be too high or too low. If cortisol goes up due to stress, your progesterone levels can take a tumble.

Strategies to Reduce Anxiety and Panic Attacks

Here are some simple changes you can make to feel calmer and less anxious:

Reset your inner clock. First thing in the morning, immerse yourself in bright outdoor sunlight without wearing sunglasses. After sundown, expose yourself to dim light. If you’re not doing these things, neither dietary supplements nor hormone replacement therapy will work.
Let go of toxic people, habits, and behaviors
Seek professional therapy
Practice stress management techniques like transcendental meditation, hypnotherapy, somatic therapy, nature immersion, the Gupta Program, and psychedelic journeying.

Natural Hormone Replacement and Dietary Supplements for Stress

Natural Progesterone - Please email office to discuss

A functional medicine provider can prescribe personalized, low-dose bioidentical progesterone. This can relieve symptoms of histamine intolerance and estrogen dominance.

Vitamin B6

Vitamin B6 supplements can help with histamine balance including PMS related to histamine. Vitamin B6 can:

Help produce progesterone.
Promote GABA synthesis.
Convert L-tyrosine and 5-hydroxytryptophan (5-HTP) to dopamine and serotonin, respectively.
Enhance DAO production and lower histamine.

Start with 50 mg of vitamin B6 in the form of P5P. You can take more under the guidance of a functional medicine provider.

Magnesium

Magnesium is a natural stress reliever. I prefer the chelated form of glycinate and the product Neuro-Mag.

L-Theanine, Passionflower

L-theanine, a substance found naturally in green tea, produces calming brain waves. Passionflower (Passiflora incarnata) also has soothing effects.

Taurine

Taurine is an amino acid that promotes formation and release of GABA, which quiets down excitatory signals in the brain. A typical dose is 250 mg – 1,000 mg/day.

Glycine

Best for acute panic attacks rather than chronic anxiety, glycine is an amino acid that interferes with the release of the neurotransmitter norepinephrine. At the first sign of a panic attack, place two grams of glycine powder under the tongue and let it slowly dissolve. This process can be repeated every few minutes if necessary and, in most cases, the problem will resolve within 10 to 15 minutes.

Cannabidiol (CBD)

This phytocannabinoid has calming, soothing effects. In human studies, CBD reduced anxiety caused by a public speaking test in subjects with social anxiety disorder.

Lavela

This lavender-derived substance (also known as Silexan™) promotes relaxation and calms nervousness.

I Can Help Balance Hormones and Relieve Anxiety

To find out whether the root cause of your anxiety disorder and panic attacks is blood sugar issues, low progesterone, or problems with other hormones, you’re going to need an experienced functional medicine practitioner. The first step is to book a free 15-minute troubleshooting call with me.

If after the call you come on board as a patient, I’ll order the best tests for you and develop a treatment plan based on your unique biochemistry. You will find out the steps you need to take to feel calmer and happier. I know anxiety isn’t easy but together we’ll find a solution to make your life easier.

by Bassem

How to Prevent SIBO (Small Intestinal Bacterial Overgrowth) Relapse

You have SIBO (Small Intestinal Bacterial Overgrowth) and you completed all the necessary steps in the “kill phase” of treatment. You run a follow-up breath test and your gas levels have normalized! Or, you didn’t retest, but your symptoms are 90% better! This is great progress and it feels like you are finally moving forward!

But, if you’re just killing the bacteria – you’re only halfway there!!

Many SIBO patients get their initial SIBO treatments and feel good for a while. But then, all the bloating, gas, cramping, constipation, or diarrhea begin to make a very unwelcome comeback. For various reasons, too much bacteria will once again start colonizing the wrong part of the GI tract leading to SIBO relapse.

Unfortunately, it’s common to have SIBO relapse. But, don’t get discouraged. You’re not wading through the murky waters of SIBO treatment alone.

Let’s break down if your symptoms are IBS or SIBO, why SIBO relapse might happen, what you can do, and how to help prevent a relapse in the first place.

Are my symptoms IBS or SIBO?

When it comes to gut issues, it can be difficult to identify and understand your symptoms. In general, there are two common conditions of the intestines that can present very similarly: Irritable Bowel Syndrome (IBS) and SIBO.

IBS is a functional gastrointestinal disorder. It affects the two-way communication between your digestive system and your brain. When this communication system malfunctions it can throw off your entire digestive tract. Leading to symptoms like abdominal pain, bloating, and altered bowel habits such as constipation or diarrhea. Sounds a lot like SIBO, doesn’t it?

A single underlying cause of IBS has not been identified. But honestly, there are many factors that could lead to IBS including food sensitivities, severe infections, stress, or intestinal muscle issues. What’s interesting is that up to 78% of patients diagnosed with IBS have SIBO.

IBS and SIBO are complex conditions. But, since these conditions can present so similarly it’s important to rule out SIBO with a breath test so that we can customize your treatment plan.

What causes SIBO relapse?

I know what you’re asking…if I’ve done the work to identify the cause of SIBO and the SIBO treatment…why on earth is my SIBO coming back?!

Unfortunately, approximately 45 percent of all SIBO patients will experience a SIBO relapse. There are three primary reasons that my patients experience SIBO relapse: diet, underlying gut conditions, and medications.

Diet

Let’s call it like it is, diet changes are never a quick fix, they are a lifestyle change. A diet that is high in sugar, refined carbohydrates, FODMAP vegetables, or alcohol can make SIBO symptoms like gas, bloating, constipation or diarrhea worsen or relapse. It’s important to introduce foods like starchy veggies in the long run because it feeds the good gut flora. But introducing too much too soon is when you run into issues.

Underlying Gut Conditions

A physical obstruction in the gut can be both a cause of SIBO and subsequently the cause of SIBO relapse. Crohn’s disease, celiac, diabetes, and leaky gut are the four most common gut conditions that can cause SIBO.

Medications

Some medications may help with certain issues while wreaking havoc on others. Medications like antibiotics, antihistamines, NSAIDs, acid-blocking drugs (PPIs), and steroids all disrupt your normal gut flora. Some kill healthy bacteria and others increase the permeability of your gut. But, they all increase your chance of SIBO relapse.

How To Prevent SIBO Relapse

Preventing SIBO relapse starts during the “kill” phase of your SIBO treatment. There’s a lot you can be doing during and after SIBO treatment to prevent SIBO relapse. Here are a few things I like to include in SIBO treatment plans:

Address Low Stomach Acid and Pancreatic Digestive Enzymes – These antimicrobial enzymes help enhance nutrient absorption and assimilation.
Support your Oral Microbiome – 94 percent of Americans have some levels of gingivitis or bacteria in their oral cavities that can impact gut health. I recommend Blocidin toothpaste and dental rinse. Plus, don’t forget about flossing. Sorry, no water picks.
Liver Support – The toxins from SIBO have inundated your liver. The endotoxins (the toxic substances bound to bacterial cell walls) from having SIBO saturate the bile and add to your total liver toxic burden. These systems need their own love to get back up to speed. Resolving the excess gram-negative bacteria is the first step. My favorite for bile support is MegaGuard by Microbiome Labs. Learn more about bile support and gut health.
Repair Leaky Gut/Mucosal Inflammation and Damage – SIBO has likely led to an inflamed gut and has damaged the cellular walls and lining. Not only do you need to kill off harmful bacteria and rebuild healthy gut flora, but you also need to repair any structural damage. I recommend Super Curcumin by Apex, with either MegaMucosa by Microbiome Labs, or GI Balance by Xymogen.

What To Do After You’ve Cleared the Bacteria Causing SIBO

The first phase of SIBO treatment is tough and you’ve survived it. Congratulations! But now what?

Great question! There is a lot you can do after SIBO treatment to prevent relapse and stay healthy.

Stay on a modified low FODMAP or SIBO Biphasic. To allow your microbiome to heal, I recommend following one of these diets for two to three months, followed by gradual reintroduction of foods that you have omitted.
Add a Prokinetic to address gastroparesis and support the Migrating Motor Complex (MMC). Gastroparesis slows your stomach’s motility preventing it from emptying properly. MMC sweeps residual bacteria and leftover carbohydrates and protein particles out of the small intestine. Waiting 4 hours between meals allows MMC to work because it is only triggered during a fasted state. So, if we snack all the time or chug large amounts of liquid, we’re inhibiting the MMC housekeeping wave. Limit snacks and sip, don’t chug, your fluids. So remember, eat, stop, eat.
Restore your vagal tone and your MMC by retraining your nervous system signaling. All of the approaches to restoring vagal tone for improved digestion focus on promoting your parasympathetic nervous system activity, over your sympathetic activity. The parasympathetic nervous system helps restore the body to a calm and composed state and prevents it from overworking. Sympathetic activity, on the other hand, prepares the body for a stress-related activity. Depending on what may be causing your sympathetic activity several techniques can be personalized based on your symptoms. This includes vagal nerve stimulation, gut-focused hypnotherapy, Frequency Specific Microcurrent, acupuncture, or the Gupta Program. And, if there has been a big stress or trauma other treatments like EMDR can be considered. Check out inaura.com to identify additional personalized therapy options.
Add single-strain probiotics and prebiotics to your daily routine. Probiotics and prebiotics, added slowly to your diet, can help to rebuild and maintain your healthy gut flora. Because multi-strain probiotic blends are not generally tolerated by SIBO patients I recommend several single strain options based upon your specific symptoms and tendencies (i.e. bloating, constipation, diarrhea, histamine intolerance, etc.). I personalize your routine with some of my favorites including HU 58 (Microbiome Labs), BioGaia Protectis, probiomax by Xymogen, and Ideal Bowel Support (L Planetarium 299V). I start all my patients on a partial dose and work up to help bulk the stool without triggering SIBO. Once you are tolerating partial doses, we can reintroduce most FODMAP foods along with other strains of probiotics for continued gut repair. The key is going slow and steady. Adding any probiotics too soon or too quickly can flare SIBO.

To get you started, let’s focus on diet, probiotics, and prebiotics.

SIBO Treatment: Low FODMAP Diet and SIBO Biphasic Diet

Many of my SIBO patients hit the internet and find a lot of information on the “SIBO diet”. The SIBO diet is also known as a low FODMAP diet.

I recommend following a low FODMAP diet during SIBO treatment and for a short time after. But, in the long haul, a low FODMAP diet can be too restrictive. It does not offer you the necessary food diversity required for a robust and diverse microbiome. But, after the initial treatment, you can slowly reintroduce foods that will support your gut health and regularity.

Some patients also have a lot of success with a SIBO biphasic diet. This diet plan is as restrictive as the low FODMAP diet to start. But, it slowly reintroduces the most tolerated and least fermentable foods back in overtime. The foods eliminated don't change on the biphasic diet. Instead, it provides more guidance on what foods to reintroduce and when.

In reality, diet does not cause SIBO. Period. Diet can cause many other things like candida and poor microbiome health, but SIBO isn’t caused by diet. Instead, a highly-processed, low-quality diet tends to lead to increased symptoms and SIBO relapse. Diet is simply a way to manage your SIBO symptoms during the kill phase and long-term. And, it’s unique to each patient. Whether you follow a low FODMAP or biphasic diet, your SIBO treatment should include a full evaluation of your diet to help manage and control your symptoms.

Benefits of Probiotics and Prebiotics

I know it sounds strange, but utilizing probiotic and prebiotic supplements in the treatment of SIBO can be beneficial. It seems counter-intuitive. If excess bacteria in the small intestine cause SIBO, why would you want to add more?

Probiotics help to reduce bacterial overgrowth and hydrogen concentrations. And, probiotic supplements can help improve symptoms and restore a healthy gut microbiome. Which in turn increases your resilience against SIBO or general dysbiosis by promoting healthy expression of gut immunity and maintaining a strong and resilient mucosal membrane.

Prebiotic supplements, on the other hand, essentially provide the nutrients needed for healthy bacteria to flourish in your gut.

Ongoing research shows that probiotic and prebiotic supplements can be very effective in the treatment of SIBO. They can help improve symptoms, improve lab values, and support long-term gut restoration. Yet, not all probiotics and prebiotics are equal. It’s important to introduce the right supplements to focus on helping resolve your specific issues slowly and only as tolerated. Too much, or the wrong things can lead to SIBO relapse if the body isn’t ready. Generally, I start with PHGG (Partially Hydrolyzed Guar Gum) and Acacia.

Get Help With SIBO Relapse

SIBO is an incredibly complex condition that requires a great deal of time and energy to resolve.

Every case of SIBO requires personalized treatment. And as your health guide, we're here to put the pieces of your puzzle together and get you back on track. You deserve to live your life freely and feel well every day!

So, if you find yourself feeling defeated in your journey to better gut health, we are here to help!

Start by scheduling a no-cost, no-obligation 15-minute consultation call to regain control of your health.

References

"Probiotics for Preventing and Treating Small Intestinal Bacterial ...." https://pubmed.ncbi.nlm.nih.gov/28267052/. Accessed 10 Feb. 2022.

by Bassem

Is Toxic Mold Illness to Blame for Your Digestive Problems?

It’s frustrating. You’ve got digestive problems but you’ve hit a roadblock in the healing process.

Maybe you have irritable bowel syndrome (IBS).

Or maybe you have small intestinal bacterial overgrowth (SIBO).

But you’re not getting any better.

Newsflash: there’s one thing you probably haven’t tried to get rid of your digestive problems. I’m talking about toxic mold exposure.

The Fungus Among Us

Mold is a type of fungi and it’s everywhere around us. It’s in water-damaged homes, on the tiles of our showers, in the soil of potted plants—even in some of the foods we eat.

Really gross, isn’t it?

Well, yes and no. Molds certainly won’t win any beauty contests. Yet, they serve their purpose on this planet. They’re essential to the breakdown of organic matter like fallen leaves or dead trees.

There are thousands of species of molds. Many of them are harmless to your health. But some molds produce health-harming mycotoxins.

I have made great strides with my IBS and SIBO patients once I realized many of them have symptoms of mold sickness. This isn’t the root cause for all of my patients, but in the people who have mold exposure, resolving the problem can lead to major breakthroughs in their health.

In this article, I’ll dive deeper into the issue of mycotoxin exposure and how it can wreak havoc on your digestive health. I’ll also give you some suggestions on what you can do about it.

What Are Mycotoxins?

Mycotoxins are substances produced by some molds, usually when the mold feels as if it’s in danger. Kind of like the way a spider or snake shoots out venom when threatened.

While mycotoxins are good for the fungus, they’re not so good for our health. Mycotoxins are to blame for mold symptoms and are real troublemakers for digestive health.

Some mycotoxins are found in foods and beverages:

Mycophenolic acid, found in Bleu cheese
Ochratoxin, found in cereals, cocoa, coffee, wine, beer, spices, dried fruit, and grape juice.
Aflatoxin, found in cereal crops like corn, wheat, and rice, peanuts, eggs, meat, and milk from animals fed contaminated grains.

One of the most common sources of exposure is from coffee mold, which produces mycotoxins in coffee. Ochratoxin A and aflatoxin B1 are the main mycotoxins that might be found in your daily cup of Joe.

Some mycotoxins are found in buildings, especially those produced by black mold:

Trichothecenes made from the mold called Stachybotrys (black mold)
Ochratoxin, which may hide out in wallpaper, furniture, and fiberglass insulation.

Research suggests that up to 50% of buildings in North America and Europe have water damage that can lead to mold infestations. This has to do with how we build buildings. We wrap them in plastic and use materials that are susceptible to water damage and mold growth.

What’s more, the mold could be lurking in your home without you even knowing it’s there. Creepy, yes? It’s sometimes good at hiding because not all mold causes that yucky musty smell.

Black mold is the one many people think about when they hear about toxic indoor mold. That’s because it’s one of the most common toxin-producing molds. Black mold symptoms include those mold toxicity symptoms I mention later in this article.

Black mold may be one of the most common — and grossest – molds many people are exposed to, but it’s not the only one that causes issues in people with digestive problems.

Here are some other mycotoxin-producing molds that can cause mold toxicity symptoms:

Aspergillus
Chaetomium
Cladosporium
Fusarium
Mucor
Penicillium
Rhizopus
Wallemia

When inhaled or ingested by humans, mold-made toxins can do a real number on the health of susceptible people.

When Mold Meets Your Immune System

When exposed to mold, your body can react in one of two ways:

Mold allergy – This is a reaction by the immune system to the mold itself. Think runny nose, red eyes, itchy skin.
Mold illness – Unlike mold allergies, mold illness causes problems throughout your body. Mold illness can cause widespread inflammation called chronic inflammatory response syndrome (CIRS), otherwise known as biotoxin illness. CIRS can be caused by other factors, but when it occurs together with a known history of mold exposure, odds are mycotoxin exposure is playing a role in this inflammatory illness.

CIRS is also linked to food sensitivities and intolerances. There’s also a connection between CIRS and hypersensitivity to chemicals and other substances that never bothered you before you were exposed to mold.

Symptoms of Toxic Mold Exposure

After exposure to toxic mold, your body may react by developing certain symptoms. In some people, these can be crippling. I’ve treated people exposed to mold who almost couldn’t function. Often, they couldn’t think straight to the point it was very hard for them to even follow my protocol for healing. Many of them had severe pain, nervous system, and/or immune system problems.

Other mold-exposed people have vague symptoms that are milder or come and go.

Here are some of the common symptoms of mold exposure:

ADD/ADHD
Anorexia
Asthma
Body aches and pains
Chronic fatigue syndrome
Depression
Digestive problems
Headaches, especially migraines
Histamine-related symptoms
Hives
Hormone imbalances
Hypersensitivity to foods, chemicals, and other items that didn't previously bother you
Insomnia
Immune system dysfunction
Memory/learning problems
Mood disorders
Poor word recall
Pulmonary diseases
Rashes
Sinus symptoms
Unwanted weight loss
Weight gain

Are You Susceptible to Toxic Mold Syndrome?

Just because you’re exposed to mold doesn’t mean you’ll develop any symptoms of mold poisoning.

Some people can live in a super moldy home, where the mold is actually visible, and yet not experience a single symptom.

So you’re wondering why you’re not one of those lucky people. Maybe you’re extremely sensitive to mold exposure. You live in the same building with others who are perfectly healthy, yet you’re sick. This can be because:

You’re exposed to more mold (you have a higher body burden or toxic load).
You’ve been exposed for longer.
Your genetic makeup. Some genes boost the susceptibility to mold toxicity by 24%.
Your immune system doesn’t identify and clear mold toxins as easily as someone else’s does. In this case even smaller overall exposure levels can harm your health.

Other reasons why some people are more susceptible to mold sickness than others:

Type of mycotoxin you’re exposed to
Age
Gender
Health status
Nutritional status

Mold and IBS

Digestive problems don’t always come to mind when thinking about mold toxicity. Yet, mold exposure can cause major problems in your digestive tract.

Mycotoxins can declare all-out war against the good bacteria in your intestines. This causes the bad bacteria to take over.

The result? Constipation, diarrhea, and abdominal pain. Leaky gut also often develops when mycotoxins damage the gut barrier. In leaky gut, undigested food particles or toxins from the outside world leak through your gut lining into your circulation, causing problems not only in your gut, but also throughout the body.

The opposite of this is also true. If your gut microbiome – the population of good and bad microorganisms that live in your intestines – is well balanced with just the right amount of good little guys, it will make you less susceptible to mold-related digestive problems. They can also protect you from mycotoxins.

Mold Makes Life Easy for SIBO

Mold can open the door to infections of the gut by reducing immunity. Toxins from black mold are linked to a drop in levels of a substance called IL-8 in the intestine that helps remove pathogens. This leads to infections in the gut.

SIBO happens when there is an abnormal rise in the overall bacterial numbers of the small intestine – especially types of bacteria not usually found in that part of the body.

In fact, many cases of SIBO are really post-infectious IBS that occur after a person has experienced food poisoning. If mycotoxins are present, your small intestine is even more vulnerable to this type of infection.

That means mycotoxins can make you more likely to develop SIBO. And they get in the way of healing this disorder.

Your functional medicine provider can order the right tests to diagnose whether you have SIBO.

Testing for Mold Exposure

If a patient with digestive problems has symptoms of mold exposure or has a known exposure to mold, we will order the Great Plains Laboratory or RealTime Labs Mycotoxin Panel.

There’s also visual contrast sensitivity testing (VCS), which was originally created by the department of defense to find out if soldiers had been exposed to biotoxins. You can take a VCS test online. It costs only $15.

If the mycotoxin panel indicates you have mold exposure, we’ll order blood work to measure how much inflammation the mycotoxins are causing in your body. We’ll order the same blood work to monitor and measure your progress with treatment.

Treatments for Mold Exposure

Here is what we do to treat IBS and SIBO patients who have mold toxicity. With this protocol, we’ve had excellent results clearing roadblocks to healing.

We urge patients to leave the mold-contaminated environment for several weeks, or until the area can be decontaminated or remediated….lots of outside time is helpful!
Remediate your home or office. Use a professional IEP (independent environmental professional) and make sure they check the HVAC system for mold.
Have your home/car/work spaces assessed by trained professionals and also use an ERMI test to make sure your spaces have low enough mycotoxin levels to allow you to start treatment.
Treat and clear GI parasitic pathogens first and improve the health of the microbiota through the use of probiotics. These beneficial bacteria are your gut’s best friend. Many strains of probiotics can reduce the level of mycotoxins by binding to the toxins and boosting the immune system.
Usually wait to treat SIBO or Candida-type fungal dysbiosis until after mycotoxin treatment is underway.
Eat a low-mold diet, including a mold-free diet brand of coffee such as Bulletproof.
Take binder supplements that help bind and remove mycotoxins. We can help you choose the right ones for the mycotoxins that are present. We commonly use activated charcoal, chitosan, silica, and BioAloe.
Agents such as liposomal glutathione to coax mycotoxins out from the intracellular space and help remove them.
Sauna and sweating [check out HigherDose] helps detoxify mycotoxins—especially ochratoxin - but all mycotoxins to some extent.
Neuroplasticity techniques can be extremely effective in helping to minimize symptoms and regulate hypersensitivity in people with mycotoxin issues. My go-to is the Gupta Program.

Say Goodbye to the Root Cause of Your Digestive Problems

Is your IBS, SIBO, or other stubborn digestive problems caused by mold toxicity? The first step to finding out is to book a free 15-minute troubleshooting call.

If after the call you come on board as a patient, I’ll dig down deep to discover the main reason why you have digestive problems – whether it’s mold sickness or some other cause. Then I’ll recommend the right tests and treatments to start you on your healing journey. We’ll remove the roadblocks that hold you back from optimum gut health and get you feeling your best again.

by Bassem

Veggie Smoothie Recipe

Smoothies make for an easy way to start the day but if you throw in a few cups of tropical fruit and some juice….and that super healthy smoothie can actually start to have a lot in common with a can of soda when it comes to sugar content!

I love this veggie forward smoothie for the fiber, water content, minerals, and healthy fats it contains. I’m not a purist— you can certainly throw in some berries or other low glycemic fruit and make it your own creation. But you can feel good knowing that this will feed those commensal microbiome bacteria, provide you with antioxidants, and support stable blood sugar as you get your day going!

Veggie Smoothie Recipe

Ingredients:

3-4 Cups filtered water
1 Avocado
4 Lacinto Kale Leaves
3 Celery Stalks
1 inch Ginger Chunk, peeled, or 1 tsp ginger puree
½ cucumber or 1 zucchini
1/2 Bunch Parsley
Juice of 2 Lemons
1 teaspoon Sea Salt or Himalayan salt

Optional add in’s:

pinch of cayenne
2 tsp Dulse Flakes
substitute cilantro instead of parsley
add collagen powder for protein
add frozen riced cauliflower
add 1 TBS extra virgin olive oil for additional healthy fats.

by Bassem

Need Breakfast In A Hurry? Here’s Your Answer

You’re in a hurry to get the kids out the door to school.

And you have an early appointment or a deadline to make at work.

But your little ones need something tasty and nutritious to eat.

You should eat, too, but who has time to feed yourself?

Take a deep breath to calm your stress levels. Because we’ve got an egg-cellent idea.

This egg recipe makes it easy to feed your kids in the morning. It also snatches away all your excuses to deprive yourself of much-needed nutrients.

It’s perfect for breakfasts on the run or something healthy to put in your kid’s lunch box. Or maybe you want a high-protein snack to balance your blood sugar and take away those cravings for sweets.

If you’re pregnant, it’s a great way to give your baby’s brain extra choline, a nutrient your little one needs for good memory.

When I learned this egg-making hack, I never went back. I doubt you will either!

My absolute favorite part of this recipe? The eggs peel effortlessly – no more stuck-on shell!

Helpful hints: Use the freshest, pasture-raised eggs possible. And watch your timer. If you forget, there are no refunds. ☺ The shell may stick.

Perfect Steamed, Not Boiled Eggs!

Ingredients:

Any number of eggs
Pot of boiling water
Steaming basket

Directions:

Add water to just reach the bottom of the steam basket.
Bring to a rolling boil – not just tiny bubbles. It must be making steam.
Add eggs to the basket in a single layer.
This is the important part – Set your timer!
Steam for 6 minutes for very soft boiled eggs, 7 minutes for somewhat soft boiled, or 10 minutes for hard boiled.
When the timer goes off, run eggs under cold water, or plop them in an ice bath if you’re less lazy than I am. Even if you skip this step, the steam helps separate the shell from the egg, so the eggs will generally peel perfectly. They may just keep cooking a bit longer.

Voila! Fast, easy, nutritious, and delicious.

by Bassem

Eat What You Love Again This Holiday Season and Beyond

Everyone is gathered around the holiday table eating pumpkin pie. But not you. You know how you’ll feel after eating it.

Bloated.

Your tummy will hurt.

Lots of gas.

Maybe your skin will break out or start itching or you’ll be overwhelmed by fatigue.

Such a beautiful-looking pie and you can’t even have a bite. You sigh. It’s like the culinary equivalent of the Grinch Who Stole Christmas. You’re a mean one, Mr. Pie.

And the problem isn’t just the pumpkin pie. It’s all the carbs served with a traditional holiday dinner.

That’s how my patient, who I’ll call Jane, felt. When she first arrived in my office, she dreaded Thanksgiving and the holidays. She knew that if she touched any of the sweet treats or high-carb foods she’d pay the price.

That was until I pinpointed the root causes of her problem. Now, she actually looks forward to the holidays because she can indulge in the edible offerings of the season while still feeling healthy and well.

Yes, it’s possible. How did we do it? And how can you get rid of bloating, abdominal pain, gluten intolerance and more? You’ll discover the answers to these questions and more in this blog post.

A Frustrating Time in Jane’s Life

When Jane first arrived in my office in 2019, she was 12 weeks pregnant with her fourth child. She was having a super hard time and needed relief asap.

For starters, she was exhausted. She’d been pregnant or breastfeeding for the last seven years. She also homeschooled all of her children.

Her tummy hurt, she had near-constant gas, she was bloated and constipated. As if that wasn’t enough fun, she also had gnarly acne, painful canker sores, and regularly itchy ears, scalp, arms, and legs. Her eyes often crusted over in the morning.

She had been barely getting by eating a basic diet. She could only eat clean proteins with olive oil and salt along with above-ground veggies. If she ate anything else her symptoms flared. She couldn’t eat starches and only a little, if any, fruit. Eating nuts gave her canker sores.

As you can imagine, she dreaded Thanksgiving and the holidays. She couldn’t eat turkey if the brine had even a little sugar in it. She couldn’t have stuffing, even if it was gluten-free. And forget about anything high-carb.

No mashed potatoes and gravy. No grains. No dairy.

Can you relate?

Nothing Seemed To Work For Good

It had been six years since she felt “good.” Back then, she was on the Gut and Psychology Syndrome (GAPS) diet. This type of diet addresses the connection between the gut and brain and is often used to heal the gut. It includes meat, fish, eggs, fruit, non-starchy vegetables, and fermented foods.

But Jane had to stick with the GAPS diet religiously, and even then some of her symptoms lingered. After being on the diet, her digestion wasn’t painful anymore and she stopped catching every cold and flu that went around, but she still suffered from daily bloating and constipation.

Jane’s problems actually dated back to before the age of 10. Back then, she had frequent tummy pain. Her parents took her to the doctor a bunch of times, but no one could figure out what was wrong.

In college, doctors put Jane on the drug Accutane for her acne. If I had a dollar for every patient of mine who told me this was part of their history! Accutane devastates the gut microbiome and detoxification. The gut microbiome is the collection of bacteria, both good and bad, that live in your intestines and tune your metabolism, brain, gut health, and immune system.

Even worse, doctors make women take birth control while on Accutane because it can cause birth defects. The birth control sends women into a state of estrogen dominance, which only makes their problem worse.

Not surprisingly, Jane’s stomach pain got worse over the years. In her early 20s, Jane went on a gluten-free diet and the pain went away for a while. But it ultimately came back.

The First Red Flag

During our first appointment, Jane mentioned she had a front-loading washer. It smelled musty and she’d seen mold in it. Gross, right?

In her old house, the washer was in the basement and she could leave the door wide open to reduce the mold. Now the washer was on the main floor in her new house and there was foot traffic, so she had to keep the door closed. The musty smell grew worse.

Helpful hint: get rid of your front-loading washer, like yesterday!

The presence of the moldy washer led me to order a mycotoxin test, which identifies toxins from mold. The result? Jane had HUGE amounts of a type of toxin known as ochratoxin, which are produced by some Aspergillus species of black mold.

Test results

Other tests I ordered were:

GI-MAP stool panel, which detects parasites, bacterial and viral dysbiosis, and Candida
Organix panel, which identifies nutrient deficiencies and metabolic imbalances
Small-intestinal bacterial overgrowth (SIBO) breath test, to determine if she had SIBO, a condition where there is an abnormal increase in the bacteria population of the small intestine, which can cause diarrhea, weight loss, and malnutrition. Jane actually requested this test, after reading about SIBO symptoms in a blog post I had written.

A Trio of Test Results

The GI-MAP stool test revealed Jane had an amoeba parasite called Dientamoeba fragilis, which can live in the large intestines of people. This little bug often causes no symptoms, but in some people it can lead to diarrhea and abdominal pain, as well as loss of appetite, nausea, and fatigue.

DNA Stool Analysis

Jane’s Candida levels were through the roof. And her SIBO test came out positive. She had a type of SIBO known as methane dominant (IMO). This type of SIBO is caused by an overgrowth of single-celled organisms called archaea. It can cause constipation as well as bloating and gas.

Genova Diagnostics test results

And what about Jane’s Organix test? That showed she was deficient in some nutrients. She needed B vitamins, especially vitamin B6.

Test results

Helping a Pregnant Jane Feel Better

In most patients I would have treated the mycotoxin right away, but because she was pregnant I had to put the brakes on that approach. Otherwise, the mold could end up in her breast milk as she was detoxifying.

Until she finished nursing, I decided to focus more on healing her gut and resolving her gut symptoms. Here’s what I did at first:

I gave her enzymes and hydrochloric acid to improve her digestion. I gave her some nutrients and herbs to help her with constipation.
I put her on a low-FODMAP diet for the short term, but only because she was in such extremely bad shape. If you’re pregnant, don’t try this type of diet at home! It’s hard to follow this diet and get all the nutrients you need for you and the baby. You need a trained practitioner to supervise. However, for Jane, it reduced her symptoms and it was only for a short period, so it was worth it!
I had her take several supplements including L-glutamine to heal the gut and butyrate and probiotics to balance her gut microbiome. I also gave her gentle herbs to reduce gas and bloating and encourage more frequent and complete bowel movements. For example, she used stone root (Collinsonia), a safe and effective way to promote better BMs in pregnancy.
Suggested she avoid electromagnetic fields (EMFs) for the health of her and her baby. She noted that this dramatically shifted her symptoms in a short time.

Taking the Next Step to Feeling Well Again

After Jane finished nursing we went after her parasite first. Jane started doing coffee enemas and taking anti-parasitic herbal supplements. At the same time, I wanted to make sure she was making healthy amounts of bile, so I gave her phosphatidylcholine and a liver-supporting supplement known as TUDCA.

Next, we went after the mold toxins. I had her take supplements to detoxify her body of the Aspergillus mycotoxin. These included liposomal glutathione, binders specific to the mycotoxins she showed on her tests, antioxidants, and Quinton liquid, which helps transport toxins out of cells. I also suggested she have mold remediation done on her home. And aha! As I suspected, the problem went beyond the front-loading washer: the remediator found mold in the home’s air ducts.

This wasn’t an overnight treatment. She needed two rounds of the anti-mold supplements, three months per round, with retesting in between.

At the same time, Jane continued to work on healing her gut. She took digestive enzymes, L-glutamine, and Tributyrin-X™, a postbiotic butyrate supplement that promotes gut health, heals the intestinal walls, and encourages regular bowel movements.

At this point, as treatment unfolded, she had less indigestion and gas.

Getting rid of the mold was HUGE!

Things were looking up—but they still weren’t perfect.

Digging Deeper to Heal the Gut

Jane began an anti-Candida protocol. But those stubborn little fungi refused to be beaten.

I decided to retest her gut. And guess what showed up to the party? She was infected with high levels of two critters: C. difficile and H. pylori.

Pathogen test results

She’d probably picked up these bacteria after taking antibiotics for persistent diarrhea and fever during an earlier pregnancy with her third child. The antibiotics made the diarrhea and fever go away but she developed bronchitis. And guess what? The doctor gave her more antibiotics and she developed a vaginal infection. This was probably because the antibiotics caused a flare-up of the Candida. She was given yet more antibiotics. All that during pregnancy!

H. pylori and Candida often go hand in hand. As I’ve written about before, they often work as a team, so getting rid of one helped get rid of the other. Likewise, I have seen that C. difficile always exists in tandem with Candida overgrowth.

In order to tackle the C. difficile and H. pylori, we put the mold treatment on intermission. Once we got rid of these two bacteria, her symptoms were better. And she could finally say goodbye to her Candida overgrowth.

To address the vitamin B6 deficiency showing up in her Organix panel, she started supplementing with this nutrient. Vitamin B6 is important for brain development and keeping the nervous system and immune system healthy. Vitamin B6 plays an important role in the immune system of the intestines. The friendly flora of the gut also need vitamin B6 and other B vitamins to do their job well.

Take a look at her follow-up results for ochratoxin A. So much better! More importantly, this was associated with her symptom reduction. I always look at lab results in the context of how the patient is feeling. This is as much- or more- important than what we see on lab results!

Mycotox profile

This whole process isn’t an overnight fix. It can take nine months or more. This is especially true for people like Jane who have had mycotoxins, bacteria, and other harmful organisms in their gut for a long time. Jane had symptoms almost her entire life. The longer you’ve been infected, the longer it may take to heal.

Be persistent!

Moving forward, we will focus on gut repair while nourishing and rebuilding Jane’s microbiome. We will support her detoxification processes for at least six months and maybe more.

Jane Doesn’t Have To Deprive Herself Anymore

Today, Jane is feeling amazing. She can tolerate a lot more foods. She no longer gets canker sores when she eats nuts. And what about her bloating, constipation, and abdominal pain? Virtually all gone!

Thanksgiving and the holiday season are now something Jane looks forward to for the first time in years. Her body can handle stuffing, potatoes, and pumpkin pie.

It’s the same on a daily basis. Within reason, Jane can tolerate less-than-perfect foods without going into a downward spiral.

Keep in mind that this journey is different for each person. Not everyone with food sensitivities can go back to eating a spectrum of allergenic foods in quick time. And some people may have to avoid a certain allergen for life because it harms their bodies. However, in general, when we improve gut health, people can resume eating foods (in moderation) that previously sent them into a tailspin.

Eat The Foods You Love Again

Do you have food sensitivities, gluten intolerance, or digestive symptoms like bloating, abdominal pain, and gas? You don’t have to live with these forever. Like Jane and I did, you and I can work together to unearth the root cause of your problem. I’ll help you eat your favorite foods again and feel healthier while you’re doing it. Your path to better gut health begins with a free 15-minute troubleshooting call.

by Bassem

Safe Effective Herbal Remedies for Common Childhood Illnesses

Table of Contents:

An Ounce of Prevention is Worth a Pound of Cure
Is It Really a Seasonal Illness—Or Something Else?
Children’s Remedies for Colds, Flus, or Other Ear, Nose, and Throat Symptoms
Children’s Remedies for Belly Aches and Poor Digestion
Children’s Remedies for Skin Irritations, Rashes, and Skin Allergies
Children’s Remedies for Emotional Upset, Agitation, and Poor Sleep
Don’t Be Frightened of Fevers
Safe, At-home Remedy for Fevers
How To Improve Children’s Immunity

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You roll over in bed and open your eyes to the sound of little feet padding across the bedroom floor.

“Mama, I don’t feel so good.” Cough, cough, sniffle.

Ugh. It’s inevitable. Kids get sick. And then, you get sick. And if you have had a little one in daycare or preschool, you may have wondered if your home was getting hit with every virus on the planet, a new one seemingly every 2 weeks.

The good news? Exposure to lots of germs will build your child’s immunity. The bad news? Hearing them cough all night or struggling to breathe through a stuffed-up nose will break your heart.

What’s more, you’re not going to get the sleep you need when you’re concerned about your child. And that will do a number on your immunity, too.

And these days, you’ll also worry whether it’s just a cold or flu or whether it’s COVID.

I have a little one of my own. So I know how heart wrenching it is when a child becomes ill. That’s why I always make sure to have some child-safe dietary supplements and nutrients on hand—just in case.

In this blog, we will cover the most common illnesses that plague our little tykes and the home remedies to turn them around. Beyond seasonal colds and flus (where we will start), I’ll also go over tummy complaints, skin irritations, and emotional upset and agitation. I want you to have these tools to help your child at the earliest signs of illness, when it really counts.

Here are some of the children’s supplements I keep in my own natural home medicine chest. But first…

An Ounce of Prevention is Worth a Pound of Cure

Of course, the best strategy is to keep your child from getting sick in the first place. Nutrition is your first and most powerful tool in keeping kids’ immune systems working right.

Many of us find ourselves wondering what to feed our previously milk or formula fed babies when 6 months roll around and our newly sitting little one, with teeth, shows interest in food. If you’re like me, this caused me more than a little anxiety!

One thing to know is that at least until 12 months, food is really about exploring, introducing, and experiencing. It’s much less about nutrient intake. So don’t stress if you only get a bit or so in (or mostly in….the rest will end up on their outfit, in your hair, or on the floor. If that’s happening, you’re doing it “right”! Solid or semi-solid food can be given every few days, initially. And, even in the toddler years, it’s completely normal for kids' appetites to ebb and flow dramatically. One pediatrician wisely expressed her advice as, “Think about what they consume over a week, rather than this or that meal.”

Without going into detail on what to feed your baby and when, I will link to my favorite book on this subject HERE.

For kids who are eating solid foods, avoid processed foods and grains (fun fact: we don’t really make the digestive enzymes needed to digest grains in adequate amounts until at least 2 years of age). Focus on grass-fed animal products, pasture-raised eggs, and raw dairy. Make stocks and soups from organ meats and bones.

Most importantly, avoid sugar and fruit juice, which weakens immune cells’ ability to fight off infections. One study showed that eating 100 grams of sugar doesn’t decrease the number of immune cells (neutrophils), but it decreases how well they respond to infection. Watch out for processed grains and flours such as fruit, crackers, puffs, and chips. We want to avoid those for our children, however hard that may be. Instead, choose fruit with fiber and starchy vegetables to complement the healthy meats and eggs. And for on the go snack options (yes, i know we all love a good puff ; )-- there are now nutrient dense grain-free options like these, which contain bone broth, cassava root, and whole veggies--toddler approved!

Their pouches are really amazing as well, and include wild caught or pasture raised animal foods, healthy fats, bone broth, and high mineral organic veggies.

Is It Really a Seasonal Illness—Or Something Else?

Before reaching for dietary supplements, be certain your child’s problem is really a cold or a flu and not an imposter. Congestion, fever, hacking cough with a greenish discharge from the nose or eyes can mean your child is actually teething. Teeth breaking through the gums can cause inflammation. This mirrors symptoms of a viral or bacterial infection.

Children’s Remedies for Colds, Flus, or Other Ear, Nose, and Throat Symptoms

Mother and baby

Traditional Chinese Medicine (TCM) is a complete system of medicine that has been used to diagnose, treat, and prevent illnesses for more than 5,000 years. As a TCM practitioner, I have seen these safe, gentle Chinese herbal formulas work wonders for congestion of the ears, nose, throat, lungs, as well as coughs, and colds. Kan is a good brand. I know because I used to work as their herbalist, and I know they test for purity and accuracy of proper composition of herbs, heavy metals, pesticides, and microbial contamination. In general, I recommend using medical grade Chinese herbal formulas that you can buy through a healthcare practitioner.

Give the TCM herbal formulas I mention below to your child when you nurse or when the child eats. Mix them in water, juice, or mashed fruit or veggies. My daughter even loves the taste directly on her tongue and asks for them! Here are general doses to keep in mind:

0-4 years: 15-30 drops, 2-4 times daily.

In very tiny babies (under 6 months), consider 3-5 drops if at all.

4-8 years, 30-45 drops, 2-4 times daily.

8-12 years: 60-90 drops, 2-4 times daily.

1 full dropper = 30 drops

In very little ones, give the TCM formulas through breast milk. If you might need to give this treatment through breast milk to your nursing infant, please consult with a trained practitioner first. Dosing varies for mothers. In general, I recommend mothers take 2 milliliters per dose, 30-45 minutes before nursing for the highest concentration in breast milk.

Immune-Boosting Nutrients

It’s best to start with the basics. Defending your child against common childhood illnesses starts with making sure he or she is nourished with the most effective children’s immune vitamins.

Vitamin C and Zinc – Both of these are immune-boosting powerhouse nutrients that can stop viruses in their tracks. Vitamin C may stop your child from getting sick in the first place. And when your child is already ill, vitamin C and zinc can shorten the amount of time your little one is sick. They can also make the illness less severe.

The bad news? Deficiencies in these nutrients are really common. Zinc deficiency is an especially big problem. That’s because an anti-nutrient known as phytate found in many cereals blocks zinc absorption. If your child gets a lot of upper respiratory tract infections like colds or respiratory flus, you can probably blame it on zinc deficiency. Giving kids zinc reduces the risk of respiratory infections and their duration.

Signs of low zinc:

Growth retardation
Neuro-sensory disorders or cognitive impairment
Rough skin (bumps on arms is need for omega-3 fats or vitamin A usually)
Lowered immunity
Signs of depression and ADHD correlation

Vitamin D – This is another nutrient important for immunity. And many people are deficient. We live in a sun-starved society where people stay indoors for fear of getting skin cancer or are simply too busy to step outside.

I give my kid a sugar-free vitamin D gummy every day. Just be certain your child is old enough to chew, otherwise this type of vitamin D is a choking hazard. You can use vitamin D drops for very young kids who can’t chew and make sure you’re getting enough vitamin D yourself, especially if you’re breastfeeding.

Multivitamin – Still breastfeeding? Then make sure you’re taking a good prenatal vitamin. For children who are older and able to chew, I like Xymogen Kids Chewable Multi.

Anti-Viral Supplement

Monolaurin – This coconut-oil-derived supplement hits the virus where it counts: its protective lipid shield, which destroys the virus’ main defense. South Pacific islanders who ate a lot of coconuts had almost no colds or flus compared to other non-coconut-eating native peoples.

Monolaurin is one of my favorite children’s cold or flu remedies. You can give your child monolaurin proactively or at the first signs of a cold or stomach flu. This reduces their symptoms and speeds up their healing. The product I like is called Lauricidin. The mini pellets should be swallowed with water or juice or placed in apple sauce, pudding, or peanut butter.

Immune Support

Probiotics – These friendly flora do double duty. They can keep children healthy over the long-term and reduce symptoms when your little one is sick. They’re especially good at reducing symptoms of colds and flus and fending off the ear infection known as otitis. I’m particularly fond of Klaire Labs Ther-biotic for Infants powder and Klaire Labs Ther-Biotic Children’s Chewable. Garden of Life Gummy Probiotics is another good one for children who can chew, as is RAW Probiotics Kids.

Colostrum – This is a fluid released from the breasts of female humans, cows, and other mammals after they’ve given birth and before breast milk is released. It’s a powerful immune-booster packed with antibodies that fight infections. This is an important supplement for infants who aren’t breastfed, are under six months old, and who have GI issues. Keep in mind that taking too much colostrum can cause constipation and the non-spray form has dairy. My favorite product is PRP Spray.

Myco-Forte Liquid – This moisturizing supplement is a good choice to support immunity in kids with dry mucous membranes and respiratory tracts. Ideal for kids who tend to have dry skin or get a dry, barking cough when they get sick.

DHA – An omega-3 fatty acid, DHA fortifies kids’ immune and respiratory function in utero and during developmental stages in childhood. DHA also prevents asthma attacks. And we haven’t even touched on its stellar actions for brain development! Important for mom to take during pregnancy and for kids throughout childhood and beyond.

N-Acetyl Cysteine (NAC) – This amino acid breaks up thick gunky mucous in the nasal passages and respiratory tract. It boosts the production of glutathione, the body’s master antioxidant. One bonus: NAC may also make kids with autism less irritable and cut down on obsessive compulsive behavior like hair pulling, nail biting, and skin picking.

Bioray NDF Immune – Supports lungs, throat, and sinuses and reduces body aches during viral infections. It bolsters the immune system, calms irritability, and strengthens respiratory health. The formula contains chlorella, antioxidants from organic fruit, and naturally occurring vitamin C, zinc, copper, manganese, calcium, and potassium. Great to pair up with the two traditional Chinese medicine formulas Chest Relief and Pipe Cleaner (more on these below).

Windbreaker – A combination of Chinese cinnamon, chrysanthemum flower, Chinese mint, burdock seed, and honeysuckle flower, this formula fights an invasion of viruses and bacteria. It’s good for kids with symptoms like sneezing, coughing, runny nose, mild fever, aches, irritability, and itching or scratchy eyes, nose, and throat. Start this at the first sign of illness and continue it while your child is ill. Pair it with any of the below formulas for colds and flu.

Minor Bupleurum combined with Windbreaker – Antiviral and antibacterial, Minor B is used both to ward off colds and flus and to fight them after they’ve gotten into the body. It opens blockages, so I love this for ear infections.

Chest Relief – A combination of citrus peel, licorice, bamboo juice, and white mulberry leaf, Chest Relief formula gently clears phlegm and boosts immunity. It’s best for cough with sticky phlegm that’s hard to cough up and that’s made worse by drafts, temperature changes, or when your child is out in the wind or lying down. It’s not a good choice for severe wheezing.

Pipe Cleaner – This combination of schizandra, radish seed, and honeysuckle flower, normalizes mucous secretion and breaks up congestion and strained breathing. Best for children with symptoms like wheezing, coughing, dry throat, sticky phlegm (yellow or green), and feeling thirsty. This can be used together with Chest Relief.

Open Air – Apricot seed, tangerine peel, and Chinese cardamom team up to relax the chest, and open up air tubes in the lungs known as bronchioles. It’s good for wheezing, shallow breathing, and a cough with phlegm, as well as a dry mouth and throat. Open Air is used more for when cold or flu symptoms resemble asthma.

This Little Piggy and Other Tips

Acupressure of the feet – Massage your child’s sides of toes to open up and drain the sinuses. Gently roll each “little piggy” between your fingers.

Use a Humidifier with Eucalyptus Oil – Adding eucalyptus oil to a humidifier can fill the air with an antiviral scent.

Children’s Remedies for Belly Aches and Poor Digestion

Mother and small child on a couch

Grow and Thrive – This is a gentle Chinese medicine formula that can help with loose stools, diarrhea, poor appetite, slow growth, indigestion, and more. It promotes digestion and assimilation of food for better nutrition and growth. It encourages food to pass smoothly through the intestines, training peristalsis (the muscular actions that squeeze food through the gastrointestinal tract). Grow and Thrive promotes a healthy gut microbiome. It contains lycii berry, Chinese hawthorn berry, tangerine peel, radish seed, fennel, magnolia bark, and toasted kudzu root.

Grow and Thrive is indicated for children with underdeveloped “spleen.”In Chinese medicine, spleen has many functions, but it somewhat correlates with our ability to digest and assimilate our food. When we can’t digest and assimilate properly, our bodies become starved for nutrients and our cells and organs malfunction. When the “spleen” is weak or underdeveloped, we will often see “dampness” in Chinese medicine. In Chinese medicine each organ system has a state of relative moisture and temperature in which it functions optimally; generally speaking, the Spleen operates better when dry and warm, and problems arise when it is cold and damp. A cold, damp spleen can show up as loose stool, drooling, poor appetite, and kids who tend to start solids later. That’s because spleen strength is required to be able to handle and use those solid foods!

When your child cuts teeth, it means that the “spleen” and “kidney” are developing well. Not to be taken literally. In Chinese medicine, “kidney” is related to the ability to develop and grow. In other words, digestion, assimilation, healthy growth, and development are underway!

This is a sign that your baby is ready for solid food introduction. What we feed them can support or hinder this development. Focus on nutrient-dense foods. For example, avoid rice cereal and opt instead for liver and egg yolk. Meat broths, veggie broths, and pureed veggies are great. Fruit in moderation.

Tummy Tamer- This formula helps move food through the intestines and counteracts indigestion, belching, gas, bloating, nausea, bad breath, or stinky poo. With cardamom, fennel, bitter orange, licorice, and water plantain, Tummy Tamer eases belly aches, slow digestion, and irregularity. It also helps relieve symptoms after eating such as nasal congestion, fatigue, or irritability. If your child has these or other food sensitivity symptoms, you will like this product. But dietary changes and addressing root causes of gut-immune imbalance are also necessary to send food sensitivities packing.

Easy Going- If your little one can’t go, this is a gentle and tasty option containing rhubarb root, flax seed, hyssop, and bitter orange fruit. It does many of the good things for digestion as Tummy Tamer but it is specifically designed for constipation. I tend to use this along with Liquid Magnesium (Douglas Laboratories) and sometimes combine it with NDF Pooper formula as well. This should be discussed with a trained practitioner if your child has ongoing constipation, but it is generally safe for occasional or short-term use.

Belly Binder- Much like Tummy Tamer above, Belly Binder moves food through the intestines and optimizes digestion, but it is specifically designed for children with diarrhea or loose stool. It contains lotus seed, Chinese yam, anemone root, and cardamom. Chronic loose stools or diarrhea aren’t normal so you may need to meet with a trained practitioner and run a stool panel to get to the root cause. But for occasional or short-term use, it is generally safe.

Any of the above 3 can be combined with NDF Tummy.

Children’s Remedies for Skin Irritations, Rashes, and Skin Allergies

Fire Fighter – This is a very energetically “cold” formula for rashes, swollen glands, or gooey leaky rashes. It’s great for infections of the eyes, ears, nose, or throat (think sinus infections or Strep throat). It clears and moves heat and toxins out of the blood using dandelion root and flower, Chinese mint, scrophularia root, and clove flower. It circulates healthy blood and oxygen to the skin and mucous membranes where it is needed. Fire Fighter can help with hives, boils, acne, or itchy insect bites or stings. It can help with mild allergic reactions and even food sensitivity symptoms. It is not for long-term use, but is very safe.

Children’s Remedies for Emotional Upset, Agitation, and Poor Sleep

Child sleeping

NAC – Mentioned above for thinning mucus, NAC also helps to calm irritable children. It can help with hair pulling, nail biting, skin picking, children on the autism spectrum, or other signs of obsessive-compulsive disorder. It supports detoxification by making the master antioxidant, glutathione. I recommend 300 – 900 mg/day three times daily in kids over 5 years old.

NDF Focus – Improve your child’s cognitive function, focus, and his or her ability to handle stress. This is a perfect addition when your child also has a histamine response, such as seasonal allergies, runny nose, and/or itchiness. I like this in cases where ADD is a consideration. NDF Focus reduces environmental sensitivities, supports adrenal health (Eluethero, reishi mushrooms, Chinese licorice root, Schisandra berry), and liver health (milk thistle, Agaricus, Chinese licorice).

Quiet Calm - This formula clears heat from the mind and spirit, relaxes muscles and nerves, and stops spasms. It will help your little one with mood swings, crying spells, moodiness, pensiveness, anxiety, timidity, and/or tantrums. With jujube seed, Schisandra, lotus seed, mimosa tree bark, gardenia fruit, and red tangerine peel, it’s good for kids with difficulty falling asleep, staying asleep, or with nightmares. It is even more appropriate if there is mucus in the ears, throat, or sinuses.

NDF Sleepy- Good for restlessness and worry, it is similar to Quiet Calm and can help kids fall asleep more quickly. Similarly, it contains jujube seed, and albizzia bark (bigger happiness tree), which has been shown in studies to improve getting to sleep and staying asleep. It also contains dan Shen and reishi mushroom to soothe irritability and restlessness.

Quiet Calm and NDF Sleepy are very similar, some kids respond better to one over the other. I usually try one and then the other to see which is the best fit.

Nutrition plays a big part in children’s stress, anxiety, attention deficit, and mood. Check out The Better Brain, a book by premier researchers Dr.s Bonnie Kaplan and Julia Rucklidge, which explores the topic further.

Don’t Be Frightened of Fevers

Does your child spiking a fever send you into a panic? Even as a trained medical professional, the first time my child spiked a fever it was scary! We might even reach for the Tylenol (acetaminophen) to lower that fever. After all, it’s safe compared to aspirin, right? Nope. Tylenol (Acetaminophen) in excess is well known to harm the liver. Tylenol is tied to increased risk of asthma, eczema, allergies, and runny nose. All of these are symptoms of liver toxicity and leaky gut, indicating Tylenol could contribute to these two conditions.

Mother and baby

Even worse, Tylenol is dangerous when mixed with other drugs. Every year there are 100,000 calls to poison control centers and 450 deaths from Tylenol-caused liver failure alone. Acetaminophen causes more cases of acute liver failure than all other medications combined.

Listen; I’m not saying don’t ever use Tylenol. Just think twice about whether your child really needs it. Consider leaning on the natural remedies mentioned earlier, first, when your child is feverish, coughing, or congested. Generally, fevers under 102 degrees are not something to worry about. Viruses like cold. They don’t like heat. A fever sends the virus on a one-way trip to the Sahara desert, where it heats and destroys the little bugs and stops them from thriving. The faster your child burns off the virus, the sooner they will be feeling good again!

That said, if you are confused or think you need to seek medical help for your child with a fever, then by all means do so. Your intuition is primary!

Here are some general rules of thumb about navigating your child’s fevers.

Seek medical attention for:

Babies under 3 months with a fever of 100.4 or higher
Babies between 3 and 6 months with a fever of 101°F (39°C) or higher
Kids over age 3 with a fever over 102° F that lasts for 2 or more days

Seek medical attention right away if your feverish child has these symptoms:

Trouble feeding (nursing)
Trouble breathing
Rashes
Vomiting or diarrhea
Inconsolable
Lethargic and drowsy, less responsive, or trouble waking up
Lowered urine output or not pooping (if very young)
Rapid or strained breathing
Rapid pulse
Body or neck seem stiff

Herbs can help lower fever in children but you will need to discuss this with your trained healthcare provider.

Safe, At-home Remedy for Fevers

Here is an old Chinese medicine treatment, called the “Lemon Wrap,” to lower fever. It is safe to try at home, and especially when fevers are on the lower end and not accompanied by any of the symptoms mentioned above. I have used it with babies older than 6 months, and with toddlers, with fevers higher than that mentioned above.

Lemon Wrap Recipe

You will need:

A lemon
Hot water (2-3 cups) in a pan
One pair of adult cotton socks
One pair of adult wool socks
Rubber dishwashing gloves

Directions

Warm up your child’s feet with warm water or a warmed water bottle first.
Squeeze the juice of a lemon in 2-3 cups of water.
Heat in a pan until hot to the touch.
Soak the cotton socks in the mix.
Put on gloves and squeeze out the excess liquid from the socks. It may be hot on your hands. Let the sock cool until you can comfortably touch it, like to the safe but warm temperature of bathwater for your child.
Pull on the cotton socks over your child's feet, all the way up the calves, or thighs if it reaches.
Put the wool socks on over the cotton ones, and cover up your child with a blanket.
Wait until the socks are completely cool to the touch, or dry. They will actually dry out pretty quickly,
Then apply another round. Up to 3 times.

Your child will probably nap after this fever-lowering treatment. You should see the fever come down several degrees in a relatively short time, as few as 1-2 hours. If the fever persists, seek medical help.

How To Improve Children’s Immunity

Illnesses are part of daily life with children. But there are so many preventative, nutritional, and herbal tools at your disposal to ease their discomfort and get them well sooner. If you’d like to work with me to support your child’s immune health naturally, let’s meet for a free 15-minute troubleshooting call. During this chat, I’ll get to know more about your biggest concerns and where your child might be struggling. Then I’ll work with you to devise a customized plan to keep your little one healthy and strong and ready to face any immune challenges that come your way.

by Bassem

Effective Ways to Deal with Postpartum Depression and Anxiety

Feeling like a hot mess after having your baby?

Are you blitzed out in love but also feel like you want to crawl into a hole and disappear? Or are you awake at night worrying even though you need sleep more than anything? Are you having trouble wanting to hold your baby and then feeling guilty about it?

You’re not a bad mom. Your hormones are just scrambled.

While a few days of hormone crash or baby blues is common, anything beyond that is a sign of postpartum depression or anxiety. Having a baby should be one of the happiest times of your life, right?

Sadly, though, many of us feel unhappy after our baby is born and suffer from postpartum depression. The Centers for Disease Control (CDC) says one in eight new mothers have this condition.

In my experience, it’s more like one in three.

Motherhood turns our worlds upside down and there’s no getting around that. But postpartum depression or anxiety makes it so much harder. Keep reading to learn why you’re feeling blue and how to get back to normal as soon as possible after birth. It’s a wild ride and you deserve to feel good while you bond with your new baby and adjust to your new life.

What is Postpartum Depression?

Postpartum depression is a feeling of sadness that new mothers experience after giving birth. Symptoms of postpartum depression include:

Feeling angry
Crying more often
Postpartum mood swings
Not communicating, or withdrawing from others
Feeling numb
Worrying about harm coming to the baby
Worrying you’ll harm the baby*
Preoccupied with the sense that you’re not a good mom
Feeling like you won’t do a good enough job caring for your baby

Sound familiar? Anyone? If so, raise your hand.

* If you feel concerned you might actually harm your baby, please speak with a professional. Generally, your OBGYN office is a really supportive place to start.

Is It Postpartum Depression or Baby Blues?

Postpartum depression isn’t the same as baby blues. Postpartum depression lasts longer than two weeks and can hang around for four years or longer.

Baby blues, on the other hand, usually appear soon after delivery and last only up to ten days after birth. Baby blues are related to the exhaustion from labor and giving birth, as well as the effects of the heroic hormonal shift that occurs during this time.

Baby blues are a normal part of giving birth. They happen in up to 85% of new mothers. Symptoms of this emotional condition may include crying for no reason, irritability, restlessness, and anxiety. These symptoms last a week or two and generally resolve on their own without treatment. Postpartum depression, on the other hand, can be a lot more severe.

Postpartum depression tends to show up within the first month after delivery—usually after the first ten days. Sometimes it can start as baby blues, which turns into a second wave of postpartum depression. You might even be able to tell when baby blues turns into something more.

When You Worry Too Much About Your Baby

Postpartum anxiety is also a real thing. In this condition, new mothers obsessively worry about the health and well-being about their child. Symptoms can include:

Constant or near-constant worry
Feelings of dread and fear about things that could happen
Insomnia even when your baby is sleeping
Thoughts that won’t calm down

You can also have physical symptoms of postpartum anxiety. These include fatigue, heart palpitations, sweating, nausea, shaking, and hyperventilating.

In modern times, we have so many apps and methods to track a baby’s health and progress. Postpartum anxiety might show up as excessively tracking baby’s metrics like feedings, liquid, wet or dirty diapers, etc. If it feels like you are over-focused on this and it is not medically necessary, or if it is adding to your anxiety, consider if tracking your baby’s metrics is best for you. If you are Googling about your baby’s well-being much more than what seems appropriate, it may be a sign of postpartum anxiety.

The Heroic Hormonal Shift

Can’t relate with those magazine-ad mommies who are wearing their new baby while going for hikes in the beautiful outdoors, gorgeous hair whipping in the wind? How about those well dressed and fully makeup’d Instagram influencers?

It’s easy to compare. We’re all guilty to some extent. And while I won’t tell you to stop (easier said than done), I do want to encourage you to try and stay true to yourself and the things you love about you.

This is NOT a moment of weakness. Hormonal changes, depression, and anxiety make this so much easier said than done. It’s cloudy. It’s dark. It’s confusing. It’s a roller coaster. Remember that every single journey is different. Everybody is different and every healing journey looks different, even from someone you may know really well.

When you’re giving birth, your progesterone levels take a nosedive. At the same time, estrogen levels increase. This hormonal shift is what causes the uterine contractions that lead to delivery of the baby.

That’s a good thing. The bad news, though, is that this puts you into a near-instant state of estrogen dominance.

This is a heroic amount of hormonal shift. And it happens in just this one moment of pregnancy.

This sudden dramatic drop off of both estrogen and progesterone essentially mimics menopause.

Interestingly, these changes depend as much on the hormones of the baby, as they do on the mother’s! This is why induced deliveries** are more likely to require hormonal interventions after to restore a mother’s good mood and well-being. When a birth is induced, the hormonal cascades that promote the stages of labor aren’t encouraged in the same way.

Induced labor triggers the release of higher levels of the stress hormone cortisol in the baby. This in turn leads to a drop in progesterone, just like you would experience before your period. Only it’s much more dramatic because progesterone levels are 20 times higher in pregnant women.

Whether labor is induced or occurs naturally, the resulting hormonal changes happen relatively quickly. But it can take a long time to restore them to a more balanced state.

The postpartum period is defined as six to twelve weeks after delivery. Yet, sometimes it takes up to four years for out-of-whack hormones to rebalance themselves. This usually depends upon the stage of your reproductive cycle when you give birth. By that I mean, are you 20-years-old when delivering your baby or 45-years-old and perimenopausal?

During and after birth, new mothers also produce high levels of a hormone known as oxytocin. This is sometimes called the bonding hormone or love molecule. This is because it leads to feelings of euphoria and connection. It makes you love and want to take care of this tiny, needy little animal you have created. Oxytocin is triggered at birth, by touch, and by breastfeeding. It helps take the sting out of the other hormones dropping so severely.

**Please note: Whether you chose or needed a certain intervention in your birth plan, there is no judgement or shaming intended here. We are just talking about the evidence related to these labor and delivery events. Many women dream of the “perfect birth,” and few of us get it.

Hormonal Causes of Postpartum Depression and Anxiety

One or more of four hormones tend to be out of whack in women who are depressed or anxious after giving birth.

Thyroid Hormones

The thyroid works extra hard in pregnancy. It generally returns to pre-pregnancy levels within six weeks after you’ve given birth. But if it’s not working properly this can create depression, anxiety, or fatigue. In this case, a women can have an overactive thyroid (hyperthyroid) or a sluggish thyroid (hypothyroid).

New mothers could also develop thyroid autoimmunity (Hashimoto’s or Graves’ disease). Or they can have a flare-up of a pre-existing thyroid autoimmune condition.

Women who have higher levels of antibodies known as thyroid peroxidase antibodies (TPO), which indicate Hashimoto’s disease, have higher risk for postpartum depression. The same is true for women with lower levels of the thyroid hormone known as free T4.

Cortisol

This is the stress response hormone. Your body produces it according to a circadian rhythm every day. During regular daily life, cortisol is high in the morning and lower at night before bed. That’s why you have energy in the morning and get tired at night. But throughout pregnancy it naturally increases in both mom and baby.

The placenta—an organ that grows in the uterus during pregnancy to provide oxygen and nutrients to your unborn child—is its own hormone manufacturing plant during pregnancy. It acts like this to ensure fetal development is happening like it’s supposed to do.

The placenta signals the baby and mom to make more cortisol. If cortisol levels don’t return to normal after delivery, there’s an increased risk of postpartum depression.

Ironically, though, the problem isn’t high cortisol after giving birth. It’s low cortisol.

Cortisol levels are high during pregnancy. After pregnancy, they drop. This can cause problems because for months the placenta has signaled the mother’s body to make cortisol. Sometimes, a new mom’s body has to relearn how to make cortisol. That’s why cortisol levels don’t always bounce back right away.

Serotonin

Serotonin is a hormone that makes you feel content, happy, calm, and ready for sleep. You need estrogen in order to convert amino acids into serotonin. When estrogen levels take a tumble after giving birth you may not have enough estrogen to encourage adequate serotonin production. This is especially true if you’re close to menopause.

Oxytocin

Trauma early in life is associated with low oxytocin later. High stress also is not a friend to your oxytocin levels.

What’s more, women who are given synthetic oxytocin (Pitocin) during labor might not make enough oxytocin on their own. Research shows these women have a higher risk of postpartum depression. Sadly, women aren’t often told this when deciding whether to use this drug during labor and delivery.

It Takes a Village but You Likely Don’t Have One

It’s not just hormonal issues that are causing your depression. To make matters worse, you’re also exhausted. Caring for a baby is 24-hours a day, non-stop.

You’re not getting together with your friends. You’re losing sleep. You’re often not eating balanced meals or at regular intervals and you’re not exercising like you used to do.

You might also be feeling a loss of sense of self.

We used to live in villages where aunts, uncles, grandparents, siblings, and cousins all helped with the care of a child. Today’s women are feeling the lack of overall support networks. This leads to feeling isolated. New mothers and fathers often have to do the work of a whole village. These feelings of isolation and overwhelm are even worse in women with postpartum depression and anxiety.

Sure, some couples have the support of grandparents that live nearby. But in many cases, grandparents live in distant cities or states and are only visiting for a short while after the birth.

Don’t hesitate to build your support network. Ask for help. Call on friends and family. Use Facebook mother/parent groups in your local area. Check out postpartum support groups through your OBGYN’s office or lactation support organizations. For those who have a religious or spiritual leaning, there are many community resources provided by synagogues, mosques, or churches. Gyms sometimes have childcare rooms to give you a break while you do self-care. Hire help for childcare or housework. Motherhood isn’t something we can do alone.

Risk Factors for Postpartum Depression and Anxiety

You’re more likely to suffer from postpartum depression if you:

Had major depression prior to pregnancy
Experienced high levels of stress before or during pregnancy
Have a history of trauma
Had a traumatic birth.***
Struggled with anxiety disorder prior to pregnancy
Have a history of insomnia or other disruption in your circadian rhythm
Have high testosterone, which occurs more often in women with polycystic ovarian syndrome
Are low in oxytocin
Have low thyroid hormone levels
Have a history of severe premenstrual syndrome (PMS)
Your natural drop in estrogen and progesterone is particularly severe
Fall into the category of low socioeconomic status

***Traumatic births are not often acknowledged by medical professionals and good options for healing and recovery aren’t well publicized. Many people don’t know where to start or that they could get help with this. There are therapists, counselors, and support programs available for women who experienced birth trauma.

Racial Differences in Postpartum Depression

There’s an important fact to bring to light. It’s that women of color who suffer from postpartum depression often don’t receive the right treatment. Postpartum depression care and awareness in all women is lacking. However, there are definite racial and ethnic differences in postpartum treatment.

For example, in one study, 9% of white women began postpartum mental health care, compared with only 4% of Black women and 5% of Latinas. Blacks and Latinas were significantly less likely to begin treatment for postpartum depression compared with whites. Among those who did begin treatment, Blacks and Latinas were less likely to receive follow-up treatment or continued care compared with white women.

Of the new mothers who started taking antidepressant medication, Black women and Latinas weren’t as likely as white women to refill a prescription.

Research shows that BIPOC women experience postpartum depression at a rate of nearly 38%. Meanwhile, the rate is much lower—only 13% to 19%—when statistics include all women with postpartum depression.

Promote Equal Postpartum Care for Mothers of Color

There are certain action steps we can take to make sure mothers receive healthy, safe, fair pregnancy and postpartum care. We recommend you read this Center for American Progress article, which offers a number of great suggestions on what policy-makers, health care providers, and you, can do to support mothers in underserved communities. Here are other steps you can take to bring about social change for this serious problem affecting mothers of color.

Amplify and support women of color-led organizations.
Support policies that improve work-family balance for women in the workplace.
Support the Shades of Blue Project, an organization focusing on maternal mental health in underserved communities, before, during, and after childbirth.
Donate to the National Birth Equality Collaborative (NBEC), an organization that provides training, research, and other assistance for the issue of black maternal mortality.
Support the National Association to Advance Black Birth, an organization founded to help provide training and access to midwives and doulas of color and lower pregnancy-related deaths.
Support the Black Mamas Matter Alliance, an organization that educates and advocates for better legislation to reduce black maternal mortality. They highlight needed research, and spread information about the social determinants of health that influence outcomes like traumatic birth or maternal and infant mortality.

How to Get Rid of Postpartum Depression and Anxiety

If you have postpartum depression and/or anxiety, please know that you don’t have to suffer alone. Here is what I do with my patients who are feeling emotionally and physically debilitated after giving birth. I’ve had a great deal of success with each of these strategies.

Test hormone levels.

I test women’s sex hormones, adrenal, and thyroid markers. I usually use the dried urine test for comprehensive hormones (DUTCH) to look at adrenal hormones (cortisol and DHEA) and sex hormones. This involves collecting a small amount of urine on filtered paper four times per day. I also order blood tests to look at thyroid function.

Various types of therapy.

Here are some I recommend:

In women who have suffered a trauma in the past or who had a traumatic birth, I recommend a type of therapy known as eye movement desensitization and reprocessing (EMDR).
Hypnosis therapy and cognitive behavioral therapy also work really well.
Meditation programs like Ziva can be a powerful tool.
Apollo neuro wearable touch therapy is another interesting solution. You wear it on your ankle or wrist and it emits silent, soothing vibrations that work on your central nervous system.
Body therapies like acupuncture and craniosacral therapy can help.

Hormonal Support and Dietary Supplements

It’s critical you work with a trained functional medicine healthcare practitioner when taking hormones or dietary supplements. He or she can help you use them appropriately for your specific health concerns. They will order testing to find out the root cause of your postpartum depression or anxiety in the first place. Everyone is unique. The problem could be imbalances in hormones like thyroid, cortisol, progesterone, and estrogen. Or the culprit could be nutrient deficiencies, problems with brain chemical imbalances, anemia, etc.

These are the areas I work on with my postpartum patients to kick anxiety and depression:

Oral natural progesterone in appropriate cases
Estrogen (estradiol) support in appropriate cases
Serotonin support, when testing indicates it, and under supervision of a clinician. This involves supplementing with tryptophan or 5-HTP. If your serotonin levels are high, it can be a marker of inflammation and supplementing with tryptophan or 5-HTP can only make things worse.
A prenatal supplement. The same one you used during pregnancy can work wonders on your mood and mental health outlook.
Lactation-safe herbal formulas and nutraceuticals.

At the risk of repeating myself, it is best for you to work with a skilled practitioner on this journey. With that in mind, these products are safe across the board if you’re breastfeeding your baby:

Herb Lore Anxiety Blend tincture. Reduces stress, calms anxiety, fear, and agitation.
Herb Lore Happy Day tincture. For women feeling sorrow, sadness, or depression.
Lavella. An oral lavender essential oil that reduces anxiety and helps with sleep.
Rescue Remedy. For trauma, stress, anxiety, depression, panic attacks, accidents, or injuries. Safe for newborns, pets, siblings, spouses/partners, too!

We Can Help You Feel Happy Again

If you have postpartum depression or anxiety, you’re not alone. We can order the right testing to help you balance your hormones and other factors that can cause your sad mood. We’ll pinpoint the root causes, and design a customized protocol just for you.

Babe, you can get through this rough time. We’ll hold your hand every step of the way to show you exactly what you need to do to feel happiness and joy again.

Your path to a happier life begins with a free 15-minute troubleshooting call. During this chat, I’ll get to know more about what troubles you. If after the call you come on board as a patient, I’ll work with you to get rid of your postpartum depression and anxiety. Book your call today so you can start enjoying the precious moments of a new beginning- for you and your little one.

by Bassem

I Have PCOS – Should I Try The Keto Diet?

Is the Keto diet right for PCOS?

This is one of the most common questions I get as a Functional Medicine practitioner and person with PCOS myself…

And with good reason! The Keto Diet is often touted as a solution for two of the biggest issues people with PCOS face: blood sugar issues and weight gain.

But as with most things related to PCOS, using the Keto diet for PCOS is not a one-size-fits-all solution.

Today, let’s take a deeper look at this question - and hopefully, provide you with a customized answer.

What Is PCOS?

If you’re reading this, you probably either have been diagnosed with or suspect PCOS: polycystic ovarian syndrome.

But even though it's very common (affecting 1 out of very 10 women), this condition is hugely misunderstood, so I think it’s always good to start with a quick refresher on what exactly it is.

First of all, despite what the name implies, people with PCOS don’t necessarily have cysts on their ovaries. (And equally important - just having cysts on the ovaries doesn’t mean you have PCOS!) Instead, PCOS is about hormone imbalance - specifically, an excess level of androgens.

Androgens are hormones typically thought of as “male”: primarily testosterone and androstenedione, but also DHT, DHEA and DHEA-S. (But just to confuse things even further, some people with PCOS will never show high testosterone or DHEA levels.)

Along with androgen excess, people with PCOS generally have “ovulatory dysfunction” - meaning they don’t ovulate monthly. They may have irregular periods (long, short, heavy, or absent) - but they can also have normal-appearing periods (they might not even know they aren’t ovulating, or they may ovulate sometimes, and not others).

Lots of other symptoms go along with androgen excess and ovulatory dysfunction - but none of these HAVE to be present. Some people with PCOS have them all, and some have none:

Insulin resistance (even if the person is not overweight)
Cysts on the ovaries
Excess hair growth on the body
Weight gain and weight loss resistance
Acne
Thinning hair on the head
Oily skin or hair
Infertility

What Is The Keto Diet?

Now that we’ve brushed up on PCOS, let’s do the same for Keto.

Keto is shorthand for the ketogenic diet - this is a pattern of eating where carbs are kept low enough, and fat intake is increased, so that the body shifts from burning glucose (sugar, carbs) for fuel to manufacturing ketones, an alternative source of fuel for your body. The state in which you are using ketones for fuel is called “ketosis.”

It takes a few days of very low carb eating to switch into ketosis - and once you’re there, eating carbs again will bump you back out. That means keto is not a diet you can do halfway or dabble in easily - it's all or nothing.

It varies person to person, but usually carbs need to be kept below 20-50 grams per day to achieve ketosis. That is very low: one banana alone has 27 grams of carbs. This means all starchy foods are out: potatoes, most fruit, oatmeal, rice, bread, etc. Non-starchy foods that are high in sugar - like ice cream - are also out.

But it's not just about cutting carbs - you also have to significantly increase fat intake, with 70% or more of total calories coming from fat - and that’s where this can get a little tricky for some people (more on that to come).

But one REALLY important thing to note before we go any further: keto is not the same as just cutting carbs, and for people with PCOS, it should not involve under-eating. Under-eating calorically can further suppress ovulation, making PCOS symptoms worse.

How Does Keto Help PCOS?

Keto may help PCOS by addressing one of the biggest symptoms: insulin resistance. And for people with PCOS who have weight loss as a concern, the keto diet may help them shed unwanted weight.

Research has shown that in small groups of people with PCOS, a keto diet can:

Lead to weight loss
Normalize insulin levels and reverse insulin resistance
And, most importantly: The LH/FSH ratio, LH total and free testosterone, and DHEAS blood levels were also significantly reduced

That suggests that the Keto diet isn’t just treating the symptoms - it may actually help to balance hormone levels.

It’s not completely understood yet how this happens, but the endocrine system is very complex, and interactions between hormones matter - and don’t forget that insulin is a hormone, too!

I know it sounds great, but before you dive into keto there is a big catch that we need to talk about.

The Keto Diet for PCOS is NOT One-Size-Fits-All

If you are considering trying a keto diet for PCOS - great! I support you 100%. For my own PCOS, reducing carbohydrate intake was one of the best things I did.

But before you go any further…. I want to give you a quick warning:

Depending on your genetics, you might need to do keto a specific way.

Most people with PCOS need to follow a “Mediterranean keto” diet - in fact, it was this specific diet that led to the amazing results in that 2020 research article I mentioned above.

Mediterranean keto focuses on poly and monounsaturated fats from foods like olive oil, avocados, fatty fish, and nuts and seeds.

Traditional keto focuses more on quantity than quality - it's all about lowering carbs and increasing fat in any way possible.

That often means LOTS of cheese and red meat - both of which are very high in saturated fat.

For some people, there is nothing wrong with saturated fat - they are genetically programmed to tolerate high levels of saturated fat well. But for many people - especially those with PCOS - saturated fat is problematic.

3 Things People with PCOS Need to Know Before Starting Keto

There are two gene variants to look for and one general rule to know about before starting keto.

First, for people with either the FTO or APOA2 SNP variant, saturated fat can be problematic. People with the FTO variant usually don’t tolerate simple sugars or saturated fats well. This variant also makes you more likely to burn fat slowly and struggle with feeling full.

The APOA2 gene variant also affects metabolic hormones. Research suggests that people with this variant do best if they eat under 22 grams of saturated fat a day. That’s very hard to do if you’re eating red meat, dairy, and bacon!

Finally, dairy in particular can be a problem for people with PCOS - whether or not they have the FTO or APOA2 variants. Milk (from cows, goats, sheep, and camels) contains the hormone insulin-like growth factor-1 (IGF-1), which mimics insulin in our body. IGF-1 is a growth hormone (which makes sense, as milk is for baby animals!). In most people, a little dairy here and there can be well-tolerated because humans have a binding protein for IGF-1 that inactivates it.

But for people with PCOS or hormonal imbalance, who already are likely to be insulin-resistant or have high insulin, the added burden of IGF-1 can be a problem. This is amplified because women with PCOS have LESS of the binding protein for IGF-1 and higher IGF-a levels than other people do, too. And the ovaries of women with PCOS are more sensitive to IGF-1 (and other growth hormones), too.

IGF-1 can also cause your ovaries to overproduce testosterone (an androgen) - which is something we’re trying to minimize.

That’s why I recommend most people with PCOS try cutting dairy - and if you’re considering Keto, get some basic genetic testing done to reveal how you tolerate saturated fat (I can help with that).

Your Genes Can Reveal So Much

Whatever your health struggles are - I think investing in genetic testing is one of the smartest choices you can make.

Your genes are like your body’s instruction manual. Your genetic variants can give you information about your diet, lifestyle, exercise needs - and even what nutrients you’re likely to struggle getting enough of.

That’s why I’m making genetic counseling a bigger part of my practice: it helps patients create a truly customized health plan, without wasting time on plans that would never work for you genetically.

Want to learn more? Book a free consult with my team today and we can talk through what we offer. We’d love to support you on the journey to better health.

by Bassem

hormone imbalance after gallbladder removal

Meet Your Gallbladder: The Essential Detox, Hormone, and Digestive Organ Most People Know Nothing About

More than 600,000 people have their gallbladder removed each year in the U.S.

That’s like if every single person in Las Vegas had their gallbladder removed!

Usually, the gallbladder is removed because of painful gallstones. It’s treated as a totally normal, safe procedure with no side effects.

But that’s just not true...

Your gallbladder is actually a crucial part of your digestive, detox, and hormonal systems.

And even if you haven’t had your gallbladder removed, gallbladder dysfunction is becoming more and more common, and can cause symptoms like:

Digestive issues (pain, bloating, diarrhea)
Fatigue
Skin congestion (acne, rashes, eczema, etc.)
Weight loss resistance
Hormone imbalance (PCOS, estrogen dominance, etc)
Fatty liver disease
And more

Today, I want to explore the role of the gallbladder, common signs and symptoms of gallbladder dysfunction, and steps you can take to heal and optimize your gallbladder function. Learn about hormone imbalance after gallbladder removal.

What and Where Is The Gallbladder?

Your gallbladder is a small organ that sits underneath your liver. Your liver makes bile (the digestive liquid needed to break down and absorb fat) and the gallbladder stores it, concentrates it, and then releases it to the stomach on demand.

The gallbladder plays key roles not just in digestion, but also in detox and hormone balance, as bile is needed both for clearing toxins from the body and for the healthy production of hormones, as well as hormone removal and balance. For that reason, the gallbladder isn’t just a digestive organ - it’s also a hormone and detox organ.

In Chinese medicine, the gallbladder is also attributed with governing decision making and qualities like inspiration, action, and assertiveness (think of the saying “they have gall!”). A strong gallbladder is associated with a quick return to normal after a physical or emotional shock. On the other hand, a weak gallbladder is associated with timidity or hesitation, and problems making decisions or following through. Finally, the gallbladder is also seen as a pivot, a turning point for new decisions and stages of life.

What Bile Does

Although it’s not sexy, the bile created by the liver and then stored, concentrated, and secreted by the gallbladder is one of the most important secretions in your body. Bile consists of ~95% water, in which are dissolved bile salts, bilirubin phospholipid, and cholesterol, primarily.

Here are just some of the many roles of bile:

Bile emulsifies fat, increasing fat absorption. Bile is an essential “degreaser” and “emulsifier” of dietary fats. Bile is also essential for the utilization of the fat-soluble vitamins A, D, E and K. Bile deficiency leads to vitamin deficiencies.
Bile prepares nutrients for assimilation in the small intestine. Bile takes food that has been acidified in the stomach and alkalizes it, allowing it to be broken down and absorbed.
Bile assists in detoxification. Bile contains the conjugated toxins - carcinogens, xenobiotic chemicals, pharmaceuticals, heavy metals like mercury, aluminium and lead, and deconjugated hormones - from the 2 phases of liver detoxification.
Bile helps modulate the microbiome. It acts as an antimicrobial, keeping the balance of bacteria in check.
Bile transports excess cholesterol out. In doing so, it prevents cholesterol levels from rising too high.
Bile lubricates the intestines and plays a regulatory role in motility, allowing food to go through the digestive tract a lot easier and preventing constipation.
Bile prevents the formation of gallstones by breaking down fats before crystallization, and also digests and dissolves gallstones, which are composed mostly of cholesterol and particles.
Bile triggers the release of glutathione, which is considered the “master” antioxidant, and helps eliminate bilirubin.
Bile breaks down fats, and as such, is essential for weight loss!
Bile controls the rhythm of the gut - the circadian timing of your gut motility is controlled by the gallbladder. Changes in motility (the time it takes for food to move through the digestive system) can lead to issues like Small Intestine Bacterial Overgrowth (SIBO).

The Gallbladder, Bile, and PCOS

The gallbladder’s role in hormone balance deserves special attention, especially in relation to PCOS (Polycystic Ovarian Syndrome).

Dietary fat and bile (to absorb it) are both necessary for the production of hormones. Even more importantly - bile helps your body excrete excess and used hormones, like estrogen. In addition, estrogen dominance (either as a result of hormone imbalance or due to supplemental estrogen, like birth control pills) are known risk factors for sluggish bile (the precursor to gallstones) and gallstones themselves. This is believed to be because estrogen causes an increase in cholesterol levels in the bile, which can then thicken and form stones.

Interestingly, research has shown that in PCOS, bile acid levels are actually significantly elevated, and that high levels of bile acids correlated with higher levels of testosterone levels, meaning worse PCOS.

The exact mechanism is not yet known, but it is thought to be related to sluggish bile, which is more commonly seen in those with hormone imbalance and PCOS. The sluggish bile raises levels of bile acids in the blood. There, the bile acids act on the Farnesoid X receptor, which has hormonal actions throughout the body, and can lead to elevated testosterone.

In addition to increasing testosterone, high levels of bile acids can also contribute to insulin resistance, another major issue in PCOS.

Bile and Leaky Gut

Bile flow issues or lack of bile can also cause or worsen leaky gut (increased intestinal permeability).

While leaky gut is often attributed to toxins produced in the gut or pathogenic bacteria living there, insufficient bile is another major cause.

One role of bile is to bind with toxins and help them be safely excreted from the body. But if there is inadequate bile to bind with the toxins, they can damage the intestinal barrier, allowing toxins and undigested food into the bloodstream… creating “leaky gut.”

Leaky gut causes widespread, multi-system issues and may even be a major part of triggering autoimmune disease. It is common in IBS (Irritable Bowel Syndrome), ulcerative colitis, Crohn’s disease, Celiac disease, and more.

Signs of Gallbladder Dysfunction

The most common type of gallbladder dysfunction is the result of slow or sluggish bile. This can be a result of not enough water (remember, bile is 95% water!), but can also occur when bile is oversaturated with toxins. The sluggish bile is more like peanut butter than water, and is too thick to flow freely.

In addition, the removal of the gallbladder, as well as other conditions, can lead to reduced levels of bile salts in the bile and weakened bile.

Symptoms of sluggish or weak bile include:

Abdominal tightness
Bloating
Difficulty digesting fats
Diarrhea
Constipation (fat can build up in the intestinal wall and cause slow movement in the digestive tract)
Trapped gas
Bad-smelling gas
Stomach cramps
Gallstones
Fatigue and malaise
Fatty stool that floats or is light in color or grayish white
Increase in allergies, chemical sensitivities, or food intolerances
worsening PMS/Estrogen dominance…
Hormone imbalances like PCOS
Heartburn
Erratic bowel movements
Weight loss
Signs of Vitamin A deficiency: Dry eyes, night blindness, red or white acne-like bumps (on your cheeks, arms, thighs, and buttocks), and dry skin

Why Are So Many Gallbladders Removed?

Typically, the gallbladder is removed due to gallstones. Gallstones are crystallized masses of bile and cholesterol. Around 20% of females over the age of 40 have gallstones.

When gallstones become stuck in the duct of the gallbladder, they can cause pain and inflammation called cholecystitis. The most common treatment for gallstones is simply having the gallbladder removed. The surgeon then ‘“reroutes” the bile to go straight from the liver to the stomach.

Risk factors for gallstones include:

Alcohol
Excess reproductive hormones from supplementation or steroids (most commonly estrogen dominance)
Oral contraceptive pills (birth control pills)
High Endotoxin load causing sludgy bile
Hereditary disorders like Gilbert's syndrome
Thyroid issues or thyroid supplementation with T4
Hepatitis
Pregnancy

However, without the gallbladder, bile isn’t concentrated and lacks adequate bile salts - leading to the problems discussed above. That’s why gallbladder removal isn’t something you should just jump into.

Testing For Gallbladder Issues

If you suspect gallbladder issues, various tests can help pinpoint the problem:

Blood test for cholesterol levels - if a person’s cholesterol production is low, bile production is also likely to be low. I look for cholesterol levels lower than 170.
Digestive stool analysis - can help identify undigested fat in stool, which is caused by low bile availability.
Bloodwork - to look for changes in serum bilirubin, alkaline phosphatase, serum glutamic oxaloacetic transaminase (SGOT), lactate dehydrogenase (LDH), aspartate aminotransferase (AST) and alanine transaminase (ALT). In early stages of gallbladder dysfunction, these levels might not change. However, functional medicine practitioners like me also use a more narrow interpretation of what normal is.
A HIDA scan - this imaging test uses a radioactive material to measure the emptying function of the gallbladder, and can help diagnose:
Gallbladder inflammation (cholecystitis)
Gallstones, which can’t be seen, but can contribute to reduced flow or blockage to less bile flow if blocking
Bile duct obstruction
Congenital abnormalities in the bile ducts, such as biliary atresia

With my own patients, I use the ION panel by Genova (Organic Acids section) to evaluate the various pathways of liver detox and glutathione/antioxidant capacity. These results often illuminate when the liver or gallbladder are overburdened long before we see markers of pathology like elevated liver enzymes in labs. They also give more detail about exactly how the liver or gallbladder are compromised and can best be supported, in each individual.

Support for a Healthy Gallbladder

If you’re having signs of any gallbladder issues, step one is to get tested and find out exactly what’s going on.

In addition, here are some of the steps I turn to again and again with my patients:

Switching out hormonal birth control (pill, patch, ring, etc.) for non-hormonal to reduce estrogen levels
Supplements that support healthy gallbladder function
Digestive enzymes and bitters
Dietary changes: avoid excessive fried, fatty and greasy food and increase leafy greens
Cut out alcohol
Exercise regularly

In addition, addressing the emotional side of gallbladder health can be important. Try to express your emotion freely (journaling is an easy way to get started), address your past traumas (get help from a professional), and forgive.

And if you’ve already had your gallbladder removed? I can help you with strategies to support your digestion and hormones, even without your GB!

Want to learn more? Book a free 15 minute consult with my team now. It’s a zero-obligation opportunity to get a functional medicine opinion on your gallbladder health (and even if removal is something you should consider!).

P.S. Gallbladder issues are more common in women and those on hormones (like HRT or birth control). But if you catch gallbladder issues early on, you can avoid ever developing painful stones. Book a free 15 minute consult now.

by Bassem

Woman holding flowers in front of her face

The Surprising Truth About Low Stomach Acid (And How To Solve It Naturally)

Do you burp after meals? How about get so bloated, you want to unbutton your pants? Does food feel like it just sits in your stomach?

These are all tell-tale signs you might be suffering from a really common but not-well-known condition: low stomach acid, also called hypochlorhydria.

Stomach acid has a bad rap - most people are familiar with antacid medication for heartburn or indigestion, and (understandably) assume that stomach acid is bad for you and must be decreased.

But surprise - the complete opposite is actually true. In fact, adequate stomach acid is a crucial part of the healthy digestive process. And, in my clinical experience, far more people have low stomach acid than high!

Today, let’s talk about why stomach acid is so key, what it feels like when yours is low, and how we can treat this common issue easily and naturally.

The Truth About Stomach Acid

Stomach acid - scientific name hydrochloric acid (HCL) - is one of the key steps in the digestive process.

During the gastric phase of digestion, food you chew and swallow travels down the esophagus and into the stomach. There, distention (literally the stretching of the stomach by the addition of food), triggers the production of acetylcholine (ACh), which then triggers parietal cells in the stomach to release stomach acid.

But even before you start eating, just the sight, smell, and thought of food can also jumpstart the secretion of stomach acid via activation of the vagus nerve. This is called the cephalic phase of digestion.

The stomach is specially designed to handle the incoming acid - the stomach is lined with lipoprotein rich membranes that protect it from being burned by the acid. (Other parts of your body don’t have this same protection - which is why when stomach acid gets into the esophagus, it causes a burning sensation.)

Once secreted by the parietal cells, stomach acid performs several key functions:

It kills any pathogens that may have come in with food (i.e. the kind of bacteria that cause food poisoning) or hitched a ride on the saliva from the mouth, where tons of bacteria live.
It activates pepsin to start protein digestion
It stimulates bile production and release by the liver and gallbladder, so fats can be emulsified and digested
And finally, it triggers the release of pancreatic enzymes in the small intestine, where the partially digested food from the stomach (called chyme), is broken down and absorbed into the bloodstream

What Happens When Stomach Acid Is Low

When stomach acid is low for any reason, it can impact all aspects of digestion.

Low stomach acid can slow and stall out the digestive process - leading to discomforts like burping, bloating, stomach pain, and even (surprisingly) cause heartburn and acid reflux symptoms.

And while these are the symptoms most people notice (and complain about) first, they are actually just the tip of the iceberg.

More troublingly, low stomach acid can have a huge impact on your body’s ability to absorb nutrients from the food you eat. Stomach acid is essential for breaking down protein into digestible amino acids, and for the absorption of certain key nutrients like iron and vitamin B12. Without these key nutrients, the body is unable to repair tissues, produce hormones, and create neurotransmitters - all things necessary to feeling happy and vital!

Finally, low stomach acid also is a common factor in the development of food sensitivities, because it is stomach acid that triggers the release of digestive enzymes in the small intestine. Lack of enzymes is often to blame for food reactions - the one most people are familiar with is lactose intolerance, where a lack of lactase enzymes cause digestive issues like gas, diarrhea, and pain.

If you’re eating a high-quality, nutrient-dense diet but still struggling with symptoms of nutrient deficiency like brittle hair and nails, poor skin quality, cravings, and fatigue - or you have ever-increasing food sensitivity - low stomach acid could be the reason why.

What Causes Low Stomach Acid?

Stomach acid gradually decreases with age, and levels can start to drop as soon as age 40.

In most people, environmental factors are the main cause of low stomach acid. These include:

Stress - the big one that no one likes to talk about! Stress impacts all phases of digestion, and especially the production of stomach acid and other digestive fluids
Low protein diet - this is often a “chicken and the egg” situation, since eating less protein is often a result of those with low stomach recognizing protein-rich foods don’t make them feel well, and consciously or subconsciously cutting back. On the other hand, eating low protein can cause the body to naturally downregulate acid production (since less is needed to digest protein).
Low zinc status - zinc is an essential cofactor for stomach acid production, and the modern diet is fairly low in zinc-rich foods like oysters.
Eating on the go - like stress, eating in a hurry or while distracted can prevent the body from shifting into the “rest and digest” parasympathetic state needed to complete all the phases of digestion adequately.
And finally - using over-the-counter or prescription acid-reducing medications.

Are You Using Antacids?

Antacids include over-the-counter and prescription PPIs (proton-pump inhibitors) like Prilosec or Nexium, H2 blockers like Pepcid or Zantac, and antacids like Rolaids or Tums. They work by either blocking the production of stomach acid, or neutralizing acid in the stomach.

These are some of the most commonly used drugs in the world. And, when used the right way, they can be extremely beneficial. But, many people take these drugs daily for years without any idea of the potential side effects.

Research has shown that PPI use can lead to the development of Small Intestine Bacterial Overgrowth (SIBO), which causes bloating, diarrhea, constipation, food intolerances, and stomach pain. In one study, more than half of people on a PPI for 12 weeks developed SIBO. In addition, research has shown PPI use is a risk factor for candida overgrowth, as well. The connection between PPIs and both candida and SIBO is likely due to the reduced ability of the body to kill pathogens that come in on the food you eat or with your saliva.

The irony with antacids is that most people take them to address the symptoms of low stomach acid - bloating, gas, indigestion - without realizing that they are actually just compounding the problem by further reducing acid levels.

How Do I Know If I Have Low Stomach Acid?

Testing for stomach acid levels is possible with a test called the Heidelberg acid test. However, this test is extremely difficult to come by, and most doctors and practitioners don’t have access to it.

Instead, I use an advanced stool panel to look for several key specific bacterial indicators of low stomach acid. Specifically, I look for these bacteria:

Pseudomonas - this bacteria grows on poorly digested proteins that may be present due to low stomach acid. It also commonly occurs with food sensitivities, as undigested proteins are a main driver for triggering an immune response to foods. If you have high pseudomonas, and especially with food sensitivities, think about raising your stomach acid levels!
Streptococcus and enterococcus - these gram-positive, aerobic species naturally occur in the oral microbiome, gut microbiome (found in the large intestine), and upper respiratory tract. However, they can overgrow or become infectious. Streptococcus commonly causes strep throat and upper respiratory infection, and if stomach acid is low, can infect the stomach. Enterococcus strains are common in dental infections (and found in up to 90% of infected root canals), and if stomach acid is low, can also infect the stomach.
C. difficile - I always work on raising stomach acid levels in those with chronic or recurrent infection with this organism. C. difficile infection can be life-threatening in some cases, causing bloody or profuse diarrhea requiring hospitalization, and is commonly seen in medical settings after the use of broad-spectrum antibiotics. But it also often shows up on stool panels with minor or moderate symptoms, not requiring hospitalization. In addition to raising stomach acid levels I use herbs and probiotics to treat this.
H. Pylori - this common infection thrives in a low-acid environment and even deconjugates stomach acid in order to make its host more hospitable. Ironically, PPIs are often used as part of the treatment for the ulcers and gastritis H. pylori can cause, continuing the cycle. Importantly, however, H. pylori is not always a problem. If levels are high or symptoms like ulcers, gastritis, rosacea, upper GI gas and bloating are also present, it may need treatment. For low or normal amounts of H. pylori, raising stomach acid levels is often all that is needed!
Klebsiella- this bacteria is common in the oral microbiome, but high levels are associated with inflammatory bowel disease like ulcerative colitis and Crohn's disease. Because klebsiella is common in the mouth, elevated levels are often a sign stomach acid isn’t doing it’s job of killing bacteria in the stomach.

(Interested in a stool test like this? Book a free 15-minute consult here to learn more about stool testing and get started!)

How to Support Healthy Stomach Acid Levels Naturally

Creating a customized plan to support your digestion is what I do best. Every person is unique, and needs a unique protocol for best results. But, in general, these are some of the strategies I turn to again and again:

Supplemental HCL - supplemental betaine HCL paired with pepsin (a digestive enzyme that specifically helps with protein digestion into amino acids) can be extremely helpful. One 6-week study in 97 people with indigestion found that taking betaine HCL and pepsin significantly reduced symptoms like stomach pain and burning.

One word of caution: supplemental betaine HCL may not be right for those with ulcers or gastritis. If you have these conditions, try one of the other suggestions or book a free consult for one-on-one support.

Adequate B vitamins - B vitamins have thousands of benefits, one of which may be better stomach acid levels. One study found that increased B vitamin intake lowered risk of acid esophagitis. In addition, low stomach acid levels can hinder B vitamin absorption, increasing your need.
Apple Cider Vinegar - this is a long-time fix for low stomach acid. Try taking a shot of ACV or dilute it with water to drink with meals. Be sure to rinse your mouth with plain water after drinking ACV.
Ginger - helps to stimulate the digestive system. Try ginger tea or ginger chews.
Bitters - bitter flavors stimulate the vagus nerve and tell the body food is coming, promoting the release of HCL and other digestive secretions like enzymes and bile. Try taking a bitter tincture directly on the tongue before eating.

Put Low Stomach Acid in Perspective

If you suspect low stomach acid, taking these simple steps to raise it can help you feel a lot better.

But in my clinical experience, low stomach acid is very rarely the only problem!

It either comes on as a result of other issues - like poor nutrient status and stress - that need to be dealt with, or causes other issues, like SIBO or candida overgrowth that require separate treatment.

If you’re dealing with digestive issues of any sort, I would be honored to support you in healing. Having struggled with health issues myself, I know exactly how debilitating they can be, and what vibrant health feels like (it’s AMAZING!) - and I want that for you, too.

We have a variety of plans and approaches to fit your health needs, schedule, and budget - but Step 1 is always a free, no-obligation chat with my team to learn about you and your concerns.

by Bassem

When H. pylori Met Candida: How They Team Up To Weaken Your Gut

If you have any sort of digestive problem—for example gas, bloating, inflammatory bowel disease (IBD), acid reflux, ulcers etc.—you’re probably wondering, why me? What’s causing me to suffer with bad indigestion or abdominal pain?

Some healthcare providers oversimplify the answer to that question. They try to blame all your digestive problems on one organism. For example, if you have acid reflux or ulcers, then Helicobacter pylori (H. pylori) must be the only organism to blame, right?

Wrong.

First of all, organisms like H. pylori, despite what you may have heard, aren’t always bad. Sometimes, they can actually benefit your health.

It’s actually when H. pylori gets together with its friend Candida albicans that it causes the most trouble.

Organisms that team up like this with other organisms may be called synergists or co-infections.

What does that mean for your digestive health? It means that if you’ve got two different potential troublemakers (certain bacteria or fungi) living in your GI tract, it might spell more trouble than if you only had one.

But it’s more complicated than that. Remember, most of the organisms or “good bugs” living in your gut are helpful or harmless. Scientists call them commensal bacteria. On the other hand, there is a small percentage that can be harmful, or pathogens. We will call those “bad bugs.”

The kicker is that your gut health determines whether a bad bug can cause trouble or not. For example, if you have good gut health with plenty of healthy bacteria and their beneficial byproducts, even a few different bad bugs won’t cause trouble. An unhealthy gut, on the other hand, can make your GI tract more vulnerable to even one type of bad bacteria or fungi that makes its home there.

In this blog post, I’ll use H. pylori and Candida to paint a picture of an example of commensal organisms that can turn bad. I’ll also show you how the presence of these two organisms can make or break your digestive and overall health.

What Is H. Pylori Anyway?

H. pylori is a bacterium that colonizes the lining of the stomach. Its presence is linked to duodenal and peptic ulcers, gastritis (inflammation of the stomach lining), and gastric cancer. Stool tests have also detected it in people with ongoing indigestion and abdominal pain. That’s why a lot of doctors go after H. pylori as a standard peptic ulcer or stomach ulcer treatment.

H. pylori really gets around. In fact, as many as 50% of adults carry this bacterium at some point in their lives but most have no symptoms.

H. pylori isn’t always a nasty bug as I will explain why later. But it can be nasty sometimes. With my clients, I will use agents that fight back an H. pylori overgrowth when any of these conditions are present:

H. pylori overgrowth on testing.
The presence of virulence factors. These are harmful substances that H. pylori makes to set up a home in the gut, avoid the immune system, and cause disease. Virulence factors increase the risk that H. pylori will cause digestive upset, ulcers, or cancers.
Classic H. pylori symptoms such as ulcers, gastritis, upper GI bloating, acid reflux, acne, and more. When H. pylori overgrows in the gut, it tells me there is an underlying weakness. And while I do treat certain patients for it, at the same time I am asking the question: “Why?” Why did H. pylori take root and grow out of control?

What Causes H. Pylori?

H. pylori gains a foothold in your GI tract when levels of stomach acid take a nosedive. This can be a problem because when H. pylori turns bad, it can harm cells, cause inflammation, and damage the stomach lining. Here are some of the things that can cause low stomach acid:

Drinking alcohol
Drugs used to treat acid reflux (proton pump inhibitors)
H. pylori itself
Smoking
Stress

H. Pylori: Not Always The Bad Guy

But here’s the thing about H. pylori: sometimes it’s actually your friend rather than your enemy. It has been co-evolving with us for millennia. At normal levels, H. pylori can be a commensal or friendly bacteria. While it has the potential to be a pathogen, it doesn’t cause disease in many people. In fact, it can:

Reduce allergies, asthma, and skin diseases like eczema, especially in children.
Lead to a lower risk of developing IBD. It does this by making some beneficial changes to the gut microbiome, the collection of bacteria, both good and bad, that live in the intestinal tract. This is why I often don’t want to get rid of H. pylori when I’m treating patients with inflammatory bowel disease.

Really, with H. pylori, what it comes down to is how many of these little guys do you have in your GI tract? And how virulent are they (meaning how likely are they to do damage)?

It’s also important to treat any underlying causes that made it too easy for H. pylori to set up shop.

And then there’s the question of: are you also infected with Candida?

What Is Candida?

Candida is a fungus that hangs out in nearly everyone’s intestinal tract. It’s part of the microbiome and thus a commensal fungus. In fact, Candida species appear in 40% to 80% of normal stool specimens.

However, when Candida goes from Jekyll to Hyde it can cause vaginal yeast infections and oral thrush. What is oral thrush? That’s when Candida builds up in the mouth and causes white sores on your tongue, lining of your mouth, gums, and throat. And that’s just the beginning. In functional medicine practice, I have seen Candida cause brain fog, fatigue, skin rashes, diarrhea, constipation, gas, anal itching, and joint pain.

Just like H. pylori, Candida can be a harmless wallflower in the gut or it can be a deadly pathogen.

What causes Candida to turn from harmless to health-harming? Here are some common reasons for Candida gone bad:

Eating lots of sugary and processed foods
Hormonal imbalances and birth control
Stress
Taking antibiotics, which kill off the good bacteria in your intestines
Untreated diabetes
Weak immune system

When Candida Meets H. Pylori

Candida and H. pylori are good friends. In fact, H. pylori can make itself comfy and at home inside Candida. And once Candida teams up with H. pylori, things go south quickly. Research found that if you’re infected with both these organisms you’re more likely to develop gastric ulcers or have more severe gastric damage than if you had H. pylori alone. Pairing up Candida with H. pylori also leads to a higher risk of peptic ulcer disease, hence the name “synergists.”

A lot of people have both of these infections at the same time. For example, in one study, out of 27 people positive for Candida, 18 were also positive for H. pylori. This is why I test for the presence of both of these organisms in my patients with GI problems.

The partnership between Candida and H. pylori is just one example of how synergistic organisms can impact your health. Candida is a real social butterfly. It has a lot of friends besides H. Pylori. These include the bacterium Clostridioides difficile (aka Clostridium difficile, the microbe responsible for bloody diarrhea). I used the friendship between Candida and H. pylori because it’s one of the best ways to show you how organisms can pair up to make your health worse.

Is Your Gut Ready To Face the Bad Guys?

In regards to GI issues, it’s really not about the “bad guy.” It’s all about whether you can tolerate the organisms that live in your gut. Some people with H. pylori and Candida have no symptoms at all.

The most important factor in this equation is your gut health. If H. pylori and Candida are present in excess it means you’ve got an underlying weakness in your GI tract. And we have to get at the bottom of why the weakness is there.

The answers to four questions will let you know how well your body will deal with invasions by these organisms:

Are the good bacteria in your gut balancing out the bad bacteria?
How effective is your stomach acid and digestion?
How strong is your gut lining?
How well is your immune system working?

It’s not possible to answer these questions on your own. That’s why, if you have GI problems, it’s best to work with me or another functional medicine provider to order the right testing, pinpoint the root causes, and design a customized protocol just for you.

Your path to better gut health begins with a free 15-minute troubleshooting call. During this chat, I’ll get to know more about what troubles you. If after the call you come on board as a patient, I’ll work with you to get rid of diarrhea, constipation, abdominal pain, gas, indigestion, acid reflux, and more. Book your call today and you can say goodbye to those frustrating, painful, and embarrassing GI problems and hello to great gut health!

by Bassem

Bassem

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