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:

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. 



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:

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.   

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. 

PMS and PMDD symptoms

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.


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


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. 


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

Anxiety Disorder

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 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 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. 


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.  


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.


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.


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. 


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:  

  1. Address Low Stomach Acid and Pancreatic Digestive Enzymes – These antimicrobial enzymes help enhance nutrient absorption and assimilation.
  2. 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.
  3. 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.
  4. 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. 

  1. 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.
  2. 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.
  3. 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.
  4. 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.



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

Toxic Mold Illness

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:

  • 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.

Veggie Smoothie Recipe

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


  • 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.