In this episode of Functional Medicine Research, I interview Dr. Liz Lipski in a discussion about how to choose the best therapeutic diet for gut health.  We discussed the low FODMAP diet, comprehensive elimination diet, Simple Carbohydrate Diet (SCD), GAPS diet, Paleo diet, histamine, pancreatic elastase and low HCL levels.  Liz discussed why we would choose each one of these diets for an individual and what each diet entails.  I use all of these diets in my practice so it was nice to have an overview of each diet from one of the top experts in gut health.

Dr. Hedberg: Well, welcome everyone to "Functional Medicine Research." I'm Dr. Hedberg. And I'm really looking forward to my conversation today with Dr. Liz Lipski. And Dr. Lipski, she's a Professor and the Director of Academic Development for the Nutrition Programs at Maryland University of Integrative Health. She has a PhD in Clinical Nutrition, two board certifications in nutrition, one in functional medicine, and she's a fellow of the American College of Nutrition. She's the author of the fantastic book "Digestive Wellness" which I highly recommend. And she's the founder of the Innovative Healing Academy. She's on faculty for the Institute for Functional Medicine and the Metabolic Medicine Fellowship in Integrative Medicine. She's been a pioneer in the field of functional nutrition for four decades. Liz, welcome to the program.

Dr. Lipski: Thanks, Nick. It's so nice to be with you today.

Dr. Hedberg: Yeah. This is gonna be a great talk. We're gonna be talking about how to choose the best diet for gut therapy. And why don't we start by just a general question about, you know, what is the best overall diet for GI health? Do we really know, based on the research at this point, what the vast majority of the population should follow? Do we have any insights on that?

Dr. Lipski: I do. I think a lot about what's different between people who are healthy and wanna work on tweaking their health or preventive health, and then people who are already in a deep hole where already their health is compromised. And hands down, when we look at research, it looks like a whole foods diet based on a Mediterranean-type diet is the very best diet. When we look at it, cancer rates go down and diabetes rates go down and cardiovascular disease rates go down, but we also have some research on GI.

And one of the main issues in the way that we're eating... And I know you see this in your practice, Nick. What we see is, when you ask people, "Well, how do you eat?" And what do they tell us? They say, "I eat pretty well." Right? Don't you hear that all the time?

Dr. Hedberg: Yeah. Yeah.

Dr. Lipski: And then you look at somebody's food diary and maybe they do, but usually they don't. And so for me, steering somebody at first to a whole foods diet is the most important thing because what we know is that according to a recent study based on kind of looking at every food that has a barcode and it represented, you know, any food company that had more than, you know, a tiny share of the market, they looked and they said 70.9% of the foods that we Americans are eating are ultra-processed. Ultra-processed.

And so we now have other studies that say, "Well, if you have more than two servings a day of these ultra-processed foods, we have a 62... For each 10% increase in ultra-processed foods, we increase our risk of cardiovascular disease by 12%, and heart disease by 13%, and strokes by 11%."

So, we also have some research on cancers as well. And so, you know, it's not that we can have a treat. It was just my son's birthday and I made a cake and we all had cake. It's not like, you can't have some treats, but at least I made the cake. I knew every ingredient that was in it. And most of us are just eating, the majority of our food is fast, easy, cheap, and filled with all kinds of additives and highly-processed foods. And so the first step is moving towards a whole foods diet and trying to make at least 80% of what you eat every day as real food and cooking.

And so that's kind of a long answer to, like, what's the best diet for GI? So, for people who are healthy, you know, tons of vegetables and fruits and legumes and nuts and seeds and whole grains and good-quality proteins. That's really what our diet should look like. And for the most part. But then, when we're sick, we have to do different things.

Dr. Hedberg: Right. Right. It's such a confusing topic for the consumer. We're talking about colonizing Mars and we can't even figure out what to eat, you know, on our own planet. But we can wade through some of that, especially when we're talking about specific therapeutic diets. Why don't we jump into this area and go through a few specific therapeutic diets? Why don't we start with the elimination diet? This is a diet that I've used quite a bit over the last 16 years. And so can you tell us, you know, how do you choose the type of patient to use an elimination diet with and what does that diet look like?

Dr. Lipski: Okay. When both of us started, this was pretty much our only therapeutic diet. And so, like you said, you have a lot of experience with it, I have a lot of experience with it. And I've said over and over that if you can take somebody who has inflammation, maybe even somebody with autoimmune disease, and put them on a comprehensive elimination diet, within two weeks they often feel at least 50% better. And so I think that this is one of the greatest reducers of inflammation of all time is dietary change because eating is the most inflammatory thing we do, depending on what we're eating and who we are.

So, the comprehensive elimination diet, I think about it for somebody who has a lot of pain, somebody who has migraines, somebody who has arthritis, somebody, again, maybe if they have autoimmune disease and they're not ready to kind of turn their lives 100% upside down.

And what you can eat on an elimination diet is you can eat poultry, preferably organic. You can eat bison and meats that aren't eaten that often. You can eat fish. You can have fruits and vegetables. You can have non-gluten containing grains like rice and wild rice and buckwheat. You can have seeds like amaranth and quinoa. You can have other seeds like sunflower seeds and pumpkin seeds. And you can use oils like avocado oils and olive oil and walnut oil and sunflower oil. You can use herbs and spices. And that's pretty much what comprises it.

One of the things I like about the diet a lot is you can pretty much walk into most restaurants and be able to find something that you can eat. You could have a salad or you can have grilled chicken with some vegetables and baked potato. What's not on this diet is alcohol, sugar, gluten, dairy, eggs, soy. Unless somebody is a vegetarian, I don't include any legumes because legumes, as people know, can cause a lot of gas and bloating if people aren't used to them. But if they're already part of somebody's diet, we can talk about that. One of the big deals that I typically make is if somebody is a big coffee drinker, we negotiate on that. Do you do that too?

Dr. Hedberg: I do. Yeah. Because cold turkey on coffee can be very, very hard for some people.

Dr. Lipski: Yeah. It's not the most... We know that coffee has, you know, probably a couple of hundred different components to it and some of those are really anti-inflammatory and antioxidant and helpful for us. So, usually, it's not caffeine, is usually not somebody's biggest issue. It's usually, usually, usually in 80% to 90% of cases, it's gluten, dairy or eggs. But I really like to start with a pretty, you know, broad-brush because what I'll ask somebody to do is to do this diet 100% for two weeks and then come back into the office and then we reevaluate where they are.

If they have zero benefit, then it's kind of like, "There is zero benefit? Well, maybe we are barking up the wrong tree." Right? But for most people, I've seen people come in who had arthritis, depression or have mental health stuff. This works so amazingly well for depression, anxiety. And I've seen people come in, they're fatigued, they're not sleeping well, they're depressed and anxious and they have pain. And they come in after a couple of weeks and they go, "Oh, my gosh. I feel like a different person."

And that's when I say, "Do you think you could do this two more weeks?" Because I'd like to give a longer period of time. We know that the half-life of antibodies is about 21 days. So, if we can have somebody stay on this diet for at least three or four weeks 100% then we can kind of tamp down that antibody response. And then when they actually reintroduce foods, they get often a big kind of kick that says, "Uh-oh, my symptoms are coming back."

And how I like to do this, and everybody does it a little bit differently, is I like to have people, for example, if they're gonna add eggs back into their diet, I would like them to have eggs at least a couple of times that first day and a couple of times the next couple of days. And if they have any negative reaction, sometimes people have a negative reaction immediately, then eggs are off their list, and they know that. But if they don't really notice anything, I want them to keep eating eggs for a few days in rather high amount to see what happens. Because often somebody feels fine the first day and it's a second or third day, all of a sudden, their symptoms kick back in. I'm sure you've seen that too.

So, that's kind of the comprehensive elimination diet. And it always used to be my first go-to diet. And it's still one of my main first go-tos and I think it's because people can wrap their heads around it pretty easily and because it works remarkably well so often.

Dr. Hedberg: And you're doing around three weeks to start or do you do it a little longer, a little bit shorter?

Dr. Lipski: Well,

I’d like to share with you all the things I’ve been doing since the COVID-19 pandemic started to better myself and stay as healthy as possible. I like the quote, “Whenever one door closes, another door opens.” Of course, I miss doing many of the things I normally do to have fun and interact with other people but this has been a time to take advantage of the many opportunities available. No matter what kind of health issues you’re dealing with, some of these ideas can have significant impact on your overall health.

Birding

Birding or birdwatching has been a growing passion of mine for the last few years but quarantine has given me more time to dedicate to this fascinating hobby.

Recent research by Cox and Graston found that people living in neighborhoods with more birds are less likely to suffer from anxiety, depression, and stress. The study participants had lower levels of depression, anxiety, and stress simply by looking at birds, trees, and shrubs. The more birds the participants could see, the better their mental health. The study participants who spent less time outdoors had higher levels of anxiety and depression.

Dr Daniel Cox, who led the study, stated: "This study starts to unpick the role that some key components of nature play for our mental well-being." Birds around the home, and nature in general, show great promise in preventative health care, making cities healthier, happier places to live."

Here are my tips to get into birding so you can avoid any of the mistakes I made:

1. Only buy Squirrel Buster feeders from Brome. These will save you a lot of time and money if a squirrel finds your feeder. Squirrels will eat all the food and sometimes destroy a feeder, but they have no chance of getting the food in a Squirrel Buster feeder. “Fiery Hot” squirrel food blends that are supposed to burn the squirrel’s mouth with hot pepper oil just don’t work well so save your money.

2. Avoid bird mix blends that are filled with millet, milo, and wheat. These are cheap fillers that most birds won’t eat so it may seem like you’re saving money by buying cheap bird food but most of it will just be thrown to the ground by the birds. Start out with just black oil sunflower seeds which will attract the most amount of birds.

3. A water feature is just as important as a bird feeder to attract birds to your property.

4. When you put up a new feeder, sprinkle some seed below the feeder on the ground to attract birds.

5. 120 million birds die every year flying into windows. Put up some stained-glass features or buy anti-bird stickers to put on your windows near the feeder so no one ends of dying.

Whenever I’m stressed I like to sit outside on my porch and watch the birds come to my feeders. It always puts a smile on my face no matter how stressed I may be.

Astronomy

I’ve been into astronomy for many years but it had fallen by the wayside the last few years. You don’t necessarily need a telescope to get started as you can use binoculars in the beginning. The stars and the planets are always there for you to enjoy. I just saw the moons of Jupiter and the rings of Saturn the other night and I’m still in awe of how amazing it was.

You can install an astronomy application called Stellarium on your computer or cell phone which tracks the entire night sky. It makes it easy to find any planet, the moon, or stars with a built-in compass so you can find anything quickly by whatever direction you’re facing.

Astronomy makes you realize how vast the universe really is and the great astrophysicist Carl Sagan really puts things in perspective with his Pale Blue Dot narrative:

Coding

Learning how to code is very easy these days due to the sheer number of free resources. I am currently learning HTML, CSS, and JavaScript, so I can build my own websites and web applications.

The key to learning to code is to have a passion project that you can begin working on right away. Simply going through tutorial after tutorial won’t teach you how to code so think about something you’ve always wanted to build.

If there is a website you’ve always wanted to create then learn HTML and CSS.

I am currently learning at freecodecamp.com.

Free Audiobooks and Kindle Books

I stumbled upon a free app called Libby which easily gets you free audiobooks and Amazon Kindle books. Just install the app and connect it to your local library using your library card number and PIN. Library cards and free and easy to sign up for which will open up a bastion of free audiobooks to listen to on the Libby app. You can also connect Libby to your Amazon Kindle account and read any of the digital books your library system has available on your Kindle.

I’m saving tons of money on books and audiobooks now since I can read or listen to them for free with the Libby app. Sometimes you have to wait a few weeks for a book to become available but you just put a “hold” on what you want and you’ll be notified by the app when it is available.

I love this because I don’t have to go to the library lugging books around since everything is digital now.

Cooking

I’ve been upping my cooking game by watching recipes on YouTube. You can now learn how to cook pretty much anything by watching videos or pulling up recipes online. No matter what type of diet you’re following, you’re bound to find videos and resources online of someone who is creating excellent content to help you eat better.

There are so many things available to us in the natural world that are free or barely cost anything. Quarantine is a time for self reflection and a time to expand our knowledge and improve ourselves.

We have known since the early 1970s that infections can trigger autoimmune diseases and now we have an interesting hypothesis on the potential triggering of Hashimoto’s disease by COVID-19 infection.

A recent case study out of Singapore published in the Singapore Medical Journal entitled, “COVID-19 complicated by Hashimoto’s thyroiditis” presents an individual who developed Hashimoto’s thyroiditis after contracting COVID-19.

COVID-19 can cause a hyperinflammatory state in the body which is a potential recipe for developing autoimmune disease. The authors begin by pointing out the most current literature on COVID-19 connections to the autoimmune diseases antiphospholipid syndrome, autoimmune thrombocytopenia, autoimmune hemolytic anemia, and Guillain-Barre syndrome.

This patient was a 45-year-old Chinese man who developed a non-productive cough and rhinorrhea for one day after exposure to COVID-19 in his dormitory. On the second day of his symptoms he was diagnosed with confirmed COVID-19 infection.

His symptoms went away after 7 days, but he reported new onset of severe generalized fatigue and muscle weakness. Before these symptoms happened, he was in good health, not taking any medications or supplements, working productively, and no history of smoking. He had no family history of autoimmune disease.

His physical examination was unremarkable and his thyroid was normal without goitre. However, his TSH level was high at 6.49 and his free T4 was low at 9.19 which is a classic presentation for hypothyroidism. His thyroid peroxidase antibody was extremely high at >2,000 confirming Hashimoto’s disease. His inflammatory markers were normal as well as electrolytes and other metabolic tests. Chest x-ray was completely normal.

He was prescribed 25mcg of levothyroxine once a day and five weeks later he reported increased energy, and he had started running again. His TSH was 6.59 and free T4 was 10.91 so those markers did not improve despite the medication and his energy improving.

The authors state that the onset of his symptoms from the time he first developed COVID-19 to the time he developed Hashimoto’s disease was similar to the onset of the other 4 autoimmune disease connections noted above in previous studies.

The authors conclude that the hyperinflammatory state triggered by COVID-19 also known as a “cytokine storm” can predispose patients to developing autoimmune diseases such as Hashimoto’s thyroiditis.

Dr. Hedberg’s Comments

Some patients will develop Hashimoto’s disease after getting the flu or other infections such as Epstein-Barr virus, H. pylori, Yersinia enterocolitica, Blastocystis hominis, Parvovirus-B19, Hepatitis C, and Herpes 6 to name some of the most common triggers.

Infections can cause abnormal shifts in the immune system thus triggering autoimmunity in predisposed individuals. Normally, it takes three important factors to trigger autoimmune disease:

1. A genetic predisposition.

2. A gut problem such as leaky gut or intestinal dysbiosis.

3. A triggering event such as infection, physical or emotional trauma, giving birth, mold exposure, medications, radiation exposure, excessive iodine exposure, or toxin exposure such as mercury.

What is interesting about this case is that he did not have a genetic predispostion at least not that we knew of or was stated in this paper. We also don’t know if he had any gut problems.

The cytokine storm caused by COVID-19 can be quite intense compared to other infections so perhaps any predisposing factors were overriden by the storm. This is just speculation on my part but with only a single study subject and not more data about this individual, there isn’t much more to go on other than what we know about how the immune system responds to infections and how autoimmune diseases are triggered.

Additional speculation on my part would be that if you have an autoimmune disease like Hashimoto’s disease, contracting COVID-19 could cause a major flare up of your symptoms.

This is all the more reason to wear a mask and practice all the recommended guidelines for minimizing exposure to this virus. Remember that if you have one autoimmune disease you have a greater chance of developing a second autoimmune disease. A COVID-19 infection may be a trigger for another autoimmune dsease which would be a tragedy for someone already dealing with one autoimmune disease.

We are still learning more and more each day about COVID-19 and based on the research cited in this paper we may be seeing increased rates of autoimmune disease or exacerbation of existing autoimmune disease symptoms due to this pandemic.

It this episode of Functional Medicine Research, I interview Dr. Lucy Mailing in a discussion about the best diet for your gut microbiome.  We had a fascinating discussion focused on all of the different diets out there and how they affect the gut microbiome including the ketogenic diet, plant-based diets, high-fat, low FODMAP, and the autoimmune paleo diet.

 

We also talked about fiber, protein, hydrogen sulfide, resistant starch, butyrate, gluten, lectins, stool testing, and whether or not you should take probiotics after taking antibiotics.  I think you'll find this conversation quite eye-opening about a number of exciting topics related to the gut micobiome.

Below is a transcript on the best diet for your gut micobiome:

Dr. Hedberg: Well, welcome, everyone to "Functional Medicine Research". I'm Dr. Hedberg and I'm really looking forward to my conversation today with Dr. Lucy Mailing, PhD. She is a microbiome researcher, educator and passionate scholar of integrative, evidence-based gut health. Lucy received her bachelors in biology from Kalamazoo College and her PhD in nutritional sciences from the University of Illinois where her graduate research focused on the impact of diet and exercise on the gut microbiota. She has authored numerous peer reviewed journal articles, regularly presents at national, international conferences and was named an emerging leader in nutritional sciences by the American Society for Nutrition in 2017. Lucy is the founder and sole author of lucymailing.com, a website dedicated to integrative, evidence-based articles about the gut microbiome, health and nutrition science.

Dr. Mailing, welcome to the show.

Dr. Mailing: Thanks so much for having me.

Dr. Hedberg: Great. So you've done some great writing and research on some topics that a lot of people are interested in. That's why I wanted to have you on. So why don't we begin by really focusing on diet and the gut microbiota and what the research is really showing at this point? So why don't we start with one of the very popular diets out there which is the ketogenic diet and we can kind of lump in just the high-fat diet in general with that. So what can you tell us about high-fat diets, ketogenic diets and how it affects the gut microbiota?

Dr. Mailing: Sure, yeah. That's a great place to start. I think one of the key things to keep in mind here is that we're still in the infancy of microbiome research and especially in our understanding of what constitutes a healthy microbiome. And we have certainly done a number of studies looking at how diet can impact the microbiome. A lot of this has been done in animal models where we can essentially really control the diet of the animals and determine what effects that has on their microbiome. So a lot of the studies with the high-fat diet in the literature are kind of misleading because they're labeled as a high-fat diet but they're really more accurately a diet that is very high in refined fats and also high in refined sugar and low in fiber. So we can't really take that and compare it to the equivalent of a very healthy, like a health-conscious ketogenic diet that's got lots of non-starchy vegetables, healthy fats. There's just really not much comparison we can make there.

And the other thing is that the gut microbiome has really evolved with us, often in the context of periodic ketosis. So if we think about human evolution, we've been coevolving with our gut microbiome for thousands of generations. And the environment we evolved in required regular adaptation to changing conditions. When there was nutrient scarcity or even just carbohydrate scarcity, our metabolism would shift to reflect what was available in our environment to consume.

And so we have that metabolic flexibility in our host genome, right. As humans, we have the ability to metabolize carbs or metabolize fats in periods of carbohydrate scarcity. So the real question is why would our bodies not have this...why would our bodies have this metabolic flexibility to deal with the shifting availability of foods and our gut microbiome not also have that same metabolic flexibility and ability to be healthy even when carbohydrates are scarce?

Dr. Hedberg: Interesting. You brought up a really great point about some of these research papers that, you know...the media's guilty of this and different websites and things like that where they'll post a kind of really catchy tagline about this diet does this and this diet does that and it's just focusing on one variable like fat, but they fail to discuss all the other factors in the diet of those individuals. Like you said, what is the quality of the carbohydrates, the fat, the protein, the sugar intake and then everything else in someone's life? You know, how much are they exercising? Do they smoke? Do they drink alcohol? And things like that. Do you see any good science out there where they take those considerations into account?

Dr. Mailing: Yeah, definitely. There have been quite a few studies actually now on ketogenic diet and how it impacts the human gut microbiome where they're using a relatively healthy ketogenic diet and generally controlling for all those other variables or at least including them in their analyses. And so for example, in 2014, there was a study by Dr. Peter Turnbaugh's group at UCSF where they essentially put healthy human volunteers on a short-term plant-based diet or an animal-based ketogenic diet. You know, just for five days but they found that there were distinct gut microbial communities that emerged within as little as three days.

So there was a distinct shift with the animal-based ketogenic diet. And not necessarily one that was, you know, any more pathogenic. There was some increase in hydrogen sulfide producers, which we can talk about a little more later if you want. So in some cases, there might be certain gut microbial patterns that might be...you know, certain overgrowths that might be exacerbated on a ketogenic diet for the average person going on a ketogenic diet, I don't think we have any real evidence to suggest that that's gonna be bad for the gut microbiome.

Dr. Hedberg: Excellent. Yeah, that makes sense just because it was...like you said, we evolved with various types of diets and there were certainly sometimes long periods where very low fiber, not much plant food was available and people were only eating meat. We can see certain populations around the world that eat diets like that.

So based on your research and what's showing now, there...correct me if I'm wrong. So there's not much evidence that a ketogenic diet is necessarily bad or pathogenic for someone's gut microbiota other than you mentioned if there's some level of bacterial overgrowth. Is that correct?

Dr. Mailing: Yeah, specifically hydrogen sulfide overgrowth because there's certain hydrogen-sulfide-producing organisms like Desulfovibrio and Bilophila wadsworthia being the two most common. Those, if they're overgrown, they tend to really thrive on animal protein and fat and so if you have an overgrowth of those particular bacteria at baseline and then you go on a ketogenic diet, you're probably going to exacerbate those overgrowths just because they thrive on those particular types of foods.

Dr. Hedberg: Yeah, that makes sense. So a lot of people...you know, there's talk about diversity and the importance of that but there's also, at least from my research, that's not necessarily all that conclusive either and it seems from my understanding that the real key is reducing inflammation in the gut and if you can reduce inflammation in the gut, then the type of diet isn't going to have much of a negative effect on the microbiome. What can you say about diversity and where we are as how we look at that and is it really important to have a lot of diversity or are we okay...certain individuals for some periods of time eating a diet that is going to decrease diversity of the gut microbiota?

Dr. Mailing: Yeah, great question. So diversity is definitely tricky to think about. It's clear that Western populations have significantly reduced diversity compared to much more traditional cultures like the Hadza hunter gatherers, some Nepalese populations that have been studied that are more agrarian. They definitely tend to have higher microbial diversity and that's also associated with a lack of chronic disease. So we think that this loss of diversity in our essentially industrialized microbiota is potentially contributing to our predisposition to chronic disease.

Now within a western population we tend to see that higher microbial diversity is more associated with health but that's not always a perfect correlation. I think I've seen a few studies. For example, there was one with individuals with major depressive disorder and they found that those individuals actually had higher diversity than healthy controls but it wasn't necessarily a healthy type of increased diversity.

So diversity does tend to correlate with health but it's certainly, you know, not the only thing we should be considering when we're determining, you know, whether we've got a healthy microbiome. And honestly, like I mentioned earlier, we're still really in the early stages of defining a healthy microbiome but I think what you said about inflammation is really key because if we have...you know, there's many unique states of a healthy microbiome. You know, you and I only share about a third of our gut microbiota and the rest is unique to us. But if we're both healthy, we should both have, you know, very low inflammation. And so that seems to be a key that is shared across healthy individuals is lower inflammation and a healthy colonic metabolism that actually promotes a healthy microbiota that's unique to us.

Dr. Hedberg: And just wanna ask you about protein because usually the conversations tend to revolve around fat and carbohydrate and fiber intake.

In this episode of Functional Medicine Research, I speak with therapist Martina Barnes about how EMDR can help people overcome trauma.  I have personally used EMDR with great success in overcoming trauma and I routinely refer for EMDR to help patients get well.  One of the most important aspects of practicing functional medicine is understanding how much trauma can be connected to chronic illness.  Many patients won't get well until they address their past and how it is affecting their current health issues.  All the healthy diets, supplements, exercise, sleep, exposure to nature, community etc. won't be enough if there is underlying trauma history wearing you down.

 

Mental health professionals are severely underutilized yet they should be the first line of therapy for the majority of patients with chronic illness.  Unfortunately, they usually end up being the last.  This interview should help shed some light on the benefits of EMDR and how it can help you heal and get well for lasting health and well-being.

Below is a transcript on overcoming trauma with EMDR

Dr. Hedberg: Well, welcome everyone to "Functional Medicine Research." I'm Dr. Hedberg and really excited today to have Martina Barnes on the show. Martina has a Master's Degree in Counseling Psychology from Western Carolina University and that was completed in the year 2000. So, many, many years of experience and Martina's theoretical underpinnings are informed by attachment theories of human development which determine our interpersonal basis for relationships. And when working with individuals together, we seek to understand the attachment wounds developed in childhood and how your style impacts your relationship with yourself and others.

And Martina says you can transform your life by transforming the way your brain and nervous system are wired. She utilizes a range of evidence-based yet cutting-edge holistic modalities such as Trauma Resilience Model, EMDR, which is what we're gonna be talking about today in detail, Internal Family Systems, Neuro-Linguistic Programming, and mindfulness, and Martina has been a speaker and educator at trauma recovery conferences and seminars for victims of murder, suicide, and even sudden death. So, Martina, welcome to the show.

Martina: Thanks, Nick, and great to be here. I'm excited to share what I know about EMDR.

Dr. Hedberg: Yeah. I'm excited as well. This is something that I've been wanting someone on the show for a long time to talk about EMDR. This is something that I've used myself and recommended to many patients. So, why don't we just talk about some of the basics and why don't you give us an idea of what exactly is EMDR and what does it stand for?

Martina: Yeah. Great. So, EMDR stands for Eye Movement Desensitization Reprocessing. And it's a modality that originally only used eye movements to help give the brain bilateral stimulation to help clear trauma. It's gone to incorporate other types of bilateral stimulation. Maybe hand taps or also bilateral auditory tones can be incorporated as well. And it's one of the most powerful trauma recovery modalities that I've ever utilized. It was discovered in 1988. So, it's been around quite a long time.

Dr. Hedberg: And who invented EMDR?

Martina: Francine Shapiro who was a psychologist invented EMDR quite by accident. She loved to take long walks and when she was walking, she would notice if she was thinking about something that's setting or something disturbing that her eyes would dart back and forth, back and forth, and then they would stop darting, and she would notice that she had cleared that disturbing thought. So, it occurred to her that she might be able to develop some kind of protocol that would involve the eye movements to help clear disturbing thoughts. And she first decided to try this on veterans who had PTSD.

Dr. Hedberg: Fascinating. And so, this modality, so, like you said, it's been around for quite a long time and I've had it with two different practitioners. One used the lights and the handheld vibration device.

Martina: Yes.

Dr. Hedberg: And then the other one just used her hand with her finger moving back and forth. So, can you talk about the different ways to do EMDR? Is there any advantage to one way of doing it over the other?

Martina: That's really up for debate. There's been a lot of clinical studies on EMDR and some of the clinical studies have indicated or the meta-analysis of several research studies have indicated that there is a higher benefit to doing the eye movement. However, other studies indicate that that's not necessarily the case, as long as the brain is getting the bilateral stimulation. So, when I began, I would say, probably the first 8 to 10 years, I just use my hand or my fingers and would have the client follow the backend force of my hand with their eyes. And sometimes I would speed up, sometimes I would slow down.

Then these machines, like the light bar came into and that could sound like the clinician use with you. There are handheld devices that individuals can use that they will administer, like, a vibration back and forth to the palms of the hands, which again is bilateral stimulation. And then as I mentioned before, sometimes auditory tones are used. And I found in my experience that it's really dependent on the patient because some patients don't tolerate eye movements well without feeling a little bit off-balance or dizzy, sometimes a little nauseous, some tolerate the hand vibrations or the hand taps better. So, some like a combination of the hand taps and the auditory stimulus. So, the most important component seems to be that you are getting the brain bilateral stimulation. So, personally, I have not found any significant difference. The differences are really in the individuals.

Dr. Hedberg: Let's talk about trauma because that's what it's mainly used for. Trauma is such a difficult thing to deal with for any type of practitioner. And obviously, there's different types of trauma. Some can be a single event or trauma can be an ongoing, you know, stress to the body. How do you define trauma? How do you look at trauma? And what kind of trauma do you think EMDR is best used for?

Martina: Those are all great questions. So, in the trauma recovery field, we often talk about big traumas and small traumas. And right now, as we're recording this, we're in a pandemic. I would say that to most everyone in the world, this is resulting in some type of trauma and defining trauma to be an incident that occurs to the brain that impacts the survival mechanism, the fight-flight mechanism. And it's defined really as having an incident or several incidences or exposure to long-term incidences that are more than the body's system can process. So, I would include in that the body, I would include the nervous system, I would include the brain. So, in my experience, single episode traumas such as having a car accident, going through a really difficult divorce, moving through the after effects of being raped or sexually assaulted or mentally abused, if it's a single event like a car accident, for example, or one rape, or maybe several single incidences, I find that the EMDR is most helpful in clearing those types of trauma.

When you get into the trauma that comes out of childhood with repeated exposure to trauma which we call complex trauma, then the EMDR may need to be paired with some other modality such as the Trauma Resiliency Model, which is helping regulate the nervous system, or perhaps internal family systems, which is working with the young parts that are traumatized. We can also use EMDR. However, I find that we need a multipronged approach when there has been long-term exposure. Also keep in mind that if a child is exposed to physical, mental, or emotional abuse, alcoholism as a child or a parent that is mentally ill, then that trauma is occurring while their body's developing, their nervous system is developing, and their brain is develop. So, it's a much more complex situation that we're trying to treat. Does that make sense?

Dr. Hedberg: Yeah. It makes perfect sense. So, for example, I'm just thinking through, you know, patients that I've had. So, for example, let's take a woman who was forced to be a ballerina at the age of five, and she had an ongoing critical mother about her body and also, a highly critical, you know, teacher for years. That would be something that, like you said, that would be kind of an ongoing trauma that EMDR might not be the best thing for. Would that be correct?

Martina: Yes. That's exactly correct because the neural pathways in the brain have been formed as that individual is developing. So, we can imagine those grooves are quite deep. If you contrast to that, another situation where a person has a single-event trauma, for example, someone came in with a car accident, they have not been in a car accident before, but it was quite traumatizing, they're having PTSD symptoms, they're having flashbacks, they don't feel safe driving anymore, their startle response is quite heightened, then EMDR is such a beautiful and effective choice for that. Also, if a person has done, let's say, one tour adaptive duty as a military person, and there are perhaps a couple of incidences that were quite traumatic, EMDR would be an excellent choice. One of the reasons is because we are not requiring the individual to go through that entire week counting or recalling of that trauma blow by blow. Instead, we work with a template, we work with a protocol, and we're pulling out significant aspects of the trauma to treat. And because the brain has otherwise been healthy, we just need to clear some of the inroads, not vast amounts of the network. Does that make sense?

Dr. Hedberg: Yes. Yes. Definitely. Yeah. You know, as someone who is not trained in mental health as a practitioner,

In this episode of Functional Medicine Research, I interview Dr. Tommy Wood on the question of whether commercial genetic testing for SNPs is helpful or harmful.  This is a topic I have wanted to cover in detail for a long time so when I read Dr. Wood's paper and listened to him speak, I knew his expertise would be invaluable to this conversation.  It is important that practitioners and patients know the truth about the current state of genetic testing and whether or not it is scientifically valid or invalid.

Dr. Wood has done the necessary research to outline all of the reasons why genetic testing is not a valuable tool in practice and he presents compelling data that it can be more harmful than helpful.  As stated in the interview, this is an area that I have never bought into because the science simply doesn't support genetic testing or interventions to address SNPs in clincial practice.  I think you'll find this interiew invaluable to your understanding of genetic testing.

If you have any published papers to refute any of this information, myself and Dr. Wood would love to read these papers.

Below is a transcript of the interview if genetic testing is helpful or harmful:

Dr. Hedberg: Well, welcome, everyone, to "Functional Medicine Research." I'm Dr. Hedberg and very excited today to have Dr. Tommy Wood on the show. We're gonna be talking about genetics and genetic testing. And Dr. Wood is a research assistant professor of pediatrics in the University of Washington, Division of Neonatology. Most of his academic work is focused on developing therapies for brain injury in newborn infants but also includes adult neurodegenerative and metabolic diseases, as well as nutritional approaches to sports performance. Tommy received an undergraduate degree in biochemistry from the University of Cambridge before obtaining his medical degree from the University of Oxford. After working as a doctor in central London, he moved to Norway for his PhD, and then to the University of Washington as a postdoc.

So, in addition to his academic training, he's coached athletes and dozens of sports, weekend warriors to Olympians and world champions. He's the outgoing President of the Physicians for Ancestral Health Society, a Director of the British Society of Lifestyle Medicine, and sits on the Scientific Advisory Board of Hinson performance, which includes researching performance optimization strategies for Formula One drivers. Tommy's current research interests include the physiological and metabolic responses to brain injury and their long-term effects on brain health, as well as developing easily accessible methods with which to track human health performance and longevity. So, Dr. Wood, welcome to the show.

Dr. Wood: Thanks so much for having me. I'm excited to be here.

Dr. Hedberg: Great. So, before we got on, we were just talking about a lot of the big issues in functional medicine include, unscientific and unvalidated testing and therapies and things like that. And so that's why I was really looking forward to this because genetics is something that I've never really got on board with as far as testing and treating patients. So, why don't we lay some bedrock for the listeners? And if you could just let us know, what is the current academic position by scientists on commercial genetic testing for SNPs and the interventions that some practitioners are using?

Dr. Wood: That's a great question. And having spent a lot of time sort of straddling both traditional allopathic medicine, traditional academic research, and then also functional medicine, particularly with athletes, but also with various clients with chronic health conditions, there's this real tension between the two in terms of, you know, what's done and the evidence that supports it. And I think that's where some of these genetics stuff comes into play. And when I started really looking into this, you see very rapidly that academic geneticists who have been, you know, studying these things for, you know, probably two decades now, at least, since the beginning of the Human Genome Project. The current state of the science would say that direct to consumer tests, single nucleotide polymorphisms are essentially useless in terms of their ability to either predict disease risk or say response to a personalized nutrition or supplement regimen based on SNPs because most, A, the disease risk is usually very small if there is an increase in risk associated with the SNP, and then the vast majority, you know, 99.99% of suggested interventions based on SNPs just haven't been rigorously tested in any kind of clinical trial. So, if you will get to ask an academic geneticist about direct consumer tests and actionable advice based on them, they would tell you, there's basically nothing that you can do with your 23andMe, for example.

Dr. Hedberg: Right, right. I do wanna mention your paper for those interested. The title is "Using Synthetic Datasets to Bridge the Gap Between the Promise and Reality of Basing Health-Related Decisions on Common Single Nucleotide Polymorphisms." It's a great paper. It is freely available, and I'll link to that so everyone can read it. Let's just talk a little bit about how these things are actually studied. So, when we're looking at design risk in genetics. What are the problems with the methodology in these studies from your point of view?

Dr. Wood: So, the main... Well, there's two ways that you might look at the heritability of a certain phenotype. So, say obesity or an increase in BMI is perhaps one of the ones that was first looked at. And you can do twin and family studies which tried to sort of isolate the effect of genetics like what is passed down from parents to children, the difficult to control for the effects of a shared environment. But sort of looking at population in general, you might do something called a genome-wide association study where you look at hopefully hundreds of thousands of people and then maybe millions of potential SNPs and you look at which particular SNPs might then be associated with a given phenotype. So, say an increased risk of obesity or an elevated average BMI. And then from there, you sort of can dig in a bit further and try and quantify the effect.

There is a problem with doing that because you're looking at more SNPs than you have people to study. And for statistical reasons, this basically means that you're likely to overestimate the effect size of a given SNP. So, that's one aspect, but then when you try and quantify the effect and then report it back, so you might want to tell somebody that there's a given effect size of say, an FTO SNP, so the Fat and Obesity Associated protein. There is one SNP in the FTO gene that's probably the single SNP that's most associated with an increase in BMI or risk of obesity. And they might say, on average, if you have one copy, your BMI is 0.3 higher, which is about 2 pounds in body weight for an average person. And then it's double that if you have two copies of this. So, you can have either one, two or zero copies of any given SNP.

The problem there is that those are based on singular averages. So, you take the mean, you know, you add up all the BMIs and everybody with a given genotype and you divide that by the number of people and then you do the same for those with a SNP. And then just on average, you might see a slight increase. The real problem comes from the fact that there is so much variability, which is lost when you try and describe that average increase. So, the thing that I did in the paper was using basic statistical theory. If somebody tells you the mean and standard deviation of, say, BMI for a given SNP, you can then reconstruct a full data set that follows a Gaussian or normal distribution, which it should. And then you can look at, say, how much does the full distribution of BMI is in those with a higher risk genotype overlap with those with a lower risk genotype.

And you can do that for any single genotype. You could do it with polygenic risk scores as, you know, multiple SNPs affect the same disease or disease risk. And what you start to see or what we saw is that for most single SNPs that people are talking about in terms of disease risk, there is more than 90% overlap between the high risk and the low-risk genotypes. So, that means that if you have, say, two copies of the higher risk FTO SNP, you still...90% of the people with that genotype would have a BMI that is perfectly in keeping with a low-risk genotype. So, then only 10% of people might have a BMI that is associated with an increased risk due to genotype. And so that's a very different way of talking about risk. So, if somebody just talks about the average effects, they might say, "Oh, you're going to be on average four pounds heavier." Whereas in reality, there are probably less than 10% of people who will see any effect on their weight because of their genotype. And when you look at the effect of the genotype on BMI in total, FTO genotype explains things about 0.2% of the variability in BMI. It's so tiny that is basically inconsequential.

Dr. Hedberg: Yeah, that was so interesting about your paper. I mean, some of these numbers for some of the SNPs that you mentioned, you know, the overall, the actual impact on the individual was sometimes less than 1%, you know, 0.4%, 0.09 to 0.05%. And that alone is not factoring in all of the factors in an individual's life on top of that. I mean, we don't know if they were breastfed or, you know, fed formula or if they had a lot of antibiotics the first three years of life. We don't know they're necessarily, you know, smoking, exercise, adverse childhood experiences. I mean, there's so many factors that could come into play in these numbers. Do you agree with that or do you think that there's been a good job of taking into account all of those confounding factors.

Dr. Wood: So, in the studies,

Adrenal adaptogens are one of the most commonly prescribed supplements by functional medicine practitioners due to the impact of chronic stress on the majority of sick patients. Stress breaks your body down in every way imaginable so mitigating the negative effects of stress is priority number one in most patients.

I’ve been using adrenal adaptogens in my practice for over 15 years now and I’d like to share my favorite adrenal adaptogens that may help you feel better. Adrenal adaptogens can cause negative reactions in some patients so do not take any of these without proper evaluation from a healthcare practitioner to avoid side effects.

What is an adrenal adaptogen?

An adaptogen has “non-specific” activity and acts by increasing resistance of the organism to a broad spectrum of adverse biological, chemical, and physical factors. Adaptogens act by regulating and normalizing organ and system function in the body.  Adaptogens work primarily by affecting the Hypothalamic-Pituitary-Adrenal (HPA) axis and the autonomic nervous system. Thus, adaptogens modulate our response to stress (physical, environmental, or emotional) and help regulate the interconnected endocrine, immune, and nervous systems.

Your adrenal glands produce cortisol and adrenaline which make you more susceptible to infections and weaken the immune system. Adaptogens can help with infections through immune-building properties over time.

Adrenal adaptogen myths

Adrenal adaptogens do not increase cortisol levels above that of normal physiologic levels. Adrenal adaptogens do not lower cortisol levels below that of normal physiologic levels. Adrenal adaptogens will only help to normalize levels that may be too high or too low.

“Adrenal fatigue” does not exist based on the most recent scientific evidence. There is no doubt that adrenal gland and HPA-axis dysfunction exists but not in the way that adrenal fatigue has be traditionally described. I still use the term on this website since it is searched for online so I want people to be educated when they come to this website.

Rhodiola Rosea

Rhodiola rosea is a flowering perennial native to sub-Arctic regions around the globe, notably Scandinavia and Russia, where it has been studied extensively since the 1960’s. Traditionally used in Russia and Mongolia for the treatment of long-term illness and weakness caused by infection, Rhodiola root has been studied for its favorable effect on central nervous system activity and neurotransmitter levels (e.g. dopamine, monoamines and beta-endorphins).

Widely regarded as an effective natural antidepressant, rhodiola is distinguished by its lack of side effects. In addition to mood health, rhodiola has been shown to help improve sleep quality, memory and learning, to help reduce binge eating and to help increase stress tolerance in astronauts. Rhodiola is rich in potent antioxidants including vitamin C, catechins, organic acids, proanthocyanidins and the active compounds salidroside and rosavin.

Rhodiola has the following positive effects on the body:

Enhances utilization of glucose

Increases serotonin levels in the brain

Improves energy and stamina

Balances norepinephrine (adrenaline)

Improves dopamine levels

Reduces anxiety

Enhances memory and brain function

Antioxidant properties

Stimulates healing

Increases work productivity

High altitude sickness

Improves Depression

Antimicrobial

Cardio-protective

Neuroprotective

Immunomodulatory

Improves female fertility

Although low in potential side effects, Rhodiola can be over-stimulating for some patients and can actually cause insomnia.

Recommended dose is 200-600mg a day in divided doses in the morning and around noon with the above caution in mind. Don’t take Rhodiola anytime after the lunch hour.

Ashwagandha

Ashwagandha (Withania somnifera) is a well-researched, multipatented herbal extract, standardized to contain uniquely high levels of withanolides—bioactive compounds in ashwagandha. Long revered in Ayurvedic medicine as a prominent Rasayana (rejuvenator) and nerve tonic, research suggests that concentrated extracts of Ashwagandha may help to support a normal stress response by promoting healthy cortisol balance and cell-mediated immunity. Studies including a 2008 randomized, double-blind, placebo-controlled human trial suggest that Sensoril® may help to significantly decrease biochemical and subjective indicators of stress and anxiety with no adverse effects.

Ashwagandha has the following benefits on the body:

Increases strength and stamina

Improves memory

Aphrodisiac

Provides deep and restful sleep

Antioxidant properties

Immune system enhancement

Enhances T4 and T3 levels

Anti-inflammatory

Anti-anxiety

Anti-depressant

Improves semen quality

Improves generalized weakness

Reduces muscle and joint pain

Ashwagandha is in the nightshade family so use with caution if you have issues with tomato, potato, eggplant, tobacco, paprika, or goji berries.

Recommended dose is 500-2,000mg/day in single or divided doses depending on the goal of the individual. Some people will take it before bed to help with sleep and others will take it in the morning and evening.

Panax Ginseng

Panax ginseng is a well known energy tonic that helps to enhance physical endurance and support reproductive hormone balance, particularly in men. Panax has been shown to support healthy metabolic function when the body is under stress by boosting fat burning and sparing carbohydrate metabolism. Research suggests that ginseng saponin may help to enhance HPA axis sensitivity and to attenuate stress-induced increases in plasma cortisol levels.

Panax ginseng properties include:

Improves fatigue

Improves cancer-related fatigue

Improves libido

Antioxidant

Improves and balances immune health

Supports brain function

Reduces weakness

Enhances physical performance and stamina

May help CFS

Cardiotonic for congestive heart failure

Can be used as a bitter tonic for digestion

Improves blood sugar

Panax ginseng is especially recommended by herbalists for the elderly over the age of 70.

Recommended dose is 250-750mg/day in divided doses.

Eleuthero

Eleuthero (Eleutherococcus senticosus), once known as Siberian ginseng, was one of the first adaptogenic herbs to be researched extensively in the Soviet Union, where modern interest in this class of herbs developed. Eleuthero is routinely used by Russian athletes to enhance performance and promote recovery from injury.

It has been shown to increase alertness, fight fatigue and shorten recovery times following illness. Active principles, which are concentrated in the root, include eleutherosides A-M, polysaccharides, beta sitosterol and lignans. Eleuthero is further noted for having immunomodulatory benefits.

Eleuthero has the following benefits:

Increases energy and stamina

Creates an anabolic state via increasing DHEA and lowering cortisol

Anti-depressant (MAO inhibitor)

Improves blood sugar metabolism

Improves focus and ability to finish tasks

Enhances the immune system

Provides mental clarity

Protects from radiation damage

May benefit CFS/CFIDS

Prevents common cold and pharyngitis

Reduces muscle and joint pain

Balances blood pressure if too high or too low

Autoimmune diseases

Improves athletic performance

Jet lag

Recommended dose is 100-600mg twice a day via capsule. Eleuthero should not be taken after 3pm as it can be too stimulating and cause insomnia.

Licorice

Licorice is considered a “probable” adaptogen at this point meaning we don’t know for certain if it truly is an adaptogen by definition.

Licorice root powder is anti-inflammatory which helps to soothe the irritation that often occurs in mucosal tissues lining the GI tract as a result of chronic low-grade stress. Licorice has been used for centuries by traditional Chinese and Western herbalists to help balance stress and support healthy adrenal function. Because it inhibits the conversion of cortisol to cortisone, licorice also may help to optimize cortisol levels in people suffering from abnormal adrenal function.

Some patients don’t do well with licorice but HPA Select has a small amount of licorice which isn’t enough to cause the usual problems. Licorice should not be taken by those with high blood pressure and it should never be taken without doctor supervision.

Cordyceps

This recommendation may surprise some people but some herbalists now consider cordyceps as an adrenal adaptogen.

Naturally occurring Cordyceps sinensis is a wild fungus found on the Qinghai-Tibetan Plateau of China at an altitude of about 10,000 feet. Cordyceps species is known as a traditional Chinese medicine (TCM) as it has wide applications in the pharmaceutical and health sector. This medicinal mushroom was in the limelight during the Chinese National Games in 1993, when a group of women athletes broke nine world records, admitted that they had been taking Cordyceps regularly. It has been previously reported that Cordyceps also enhances physical stamina making it very useful for elderly people and athletes.

Cordyceps works by enhancing endurance and cellular energy in the form of ATP. In addition to supporting the HPA-axis, cordyceps has the following qualities:

Anti-bacterial

Anti-fungal

Anti-inflammatory

Anti-diabetic

Anti-oxidant

Anti-tumor

Pro-sexual

Immunomodulatory

Anti-HIV

Since cordyceps is too expensive for realistic supplementation, most of the products on the market are adulterated to the point that they are not true cordyceps. Additionally, they may contain toxins such as heavy metals depending on where it is harvested. Therefore, I recommend the Cs-4 form of cordyceps which is a standardized fermented form of cordyceps which has nearly similar effectiveness to whole cordyceps.

There have never been any studies on leaky gut and Hashimoto’s disease but now we have a new study on this connection. Leaky gut was something rejected by conventional medicine despite the fact that papers on leaky gut date back to the 1970s. For many years functional medicine practitioners have been testing for it and treating it which has helped many patients overcome their chronic illnesses. There are currently over 500 published scientific papers on leaky gut so there is no doubt it exists.

Before we get to the new paper, there was an interesting paper published in 2004 which looked at the gut barriers of patients with Hashimoto’s disease. The paper is entitled “Ultrastructural changes in enterocytes in subjects with Hashimoto’s thyroiditis” by Sasso et al. The authors biopsied the small intestine of patients with Hashimoto’s disease and compared the microvilli to healthy controls.

The results showed that patients with Hashimoto’s disease did in fact have structural changes in their microvilli which are the finger-like structures that line the gut barrier. Healthy microvilli are required for proper absorption of nutrients as well as preventing unwanted particles from entering the blood stream. These patients with Hashimoto’s disease had abnormal looking microvilli under the microscope compared to normal looking microvilli of the healthy controls.

The authors also performed a lactulose/mannitol test which is used to assess gut permeability. The results showed that the patients with Hashimoto’s disease had abnormal lactulose/mannitol test results indicating abnormal intestinal permeability.

Now let’s cover the new paper on leaky gut and Hashimoto’s disease entitled “Children With Hashimoto’s Thyroiditis Have Increased Intestinal Permeability: Results of a Pilot Study”.

The authors begin by discussing the connection between increased intestinal permeability (IIP) and autoimmune diseases. Zonulin is a compound that controls the tight junctions in the gut barrier which are involved in movement of nutrients in and out of the gut. The higher the zonulin levels, the more severe the increased intestinal permeability. Higher zonulin levels have also been found in patients with autoimmune disease and in those leading up to the onset of autoimmune disease.

How was the study done on Leaky Gut and Hashimoto's Disease?

30 children and adolescents with Hashimoto’s disease and 30 age, gender, and BMI matched patients with congenital hypothyroidism.

Blood tests included zonulin, TSH, free T4, anti-TPO antibodies, and anti-TG levels.

What were the study results?

Serum zonulin levels were significantly higher in the subjects with Hashimoto’s disease compared to the control group. Free T4 levels were higher in the control group but differences in TSH levels were not statistically significant. Anti-TPO and anti-TG antibody levels were higher in those with Hashimoto’s disease as we would expect.

Higher zonulin levels correlated with higher thyroid medication dose (levothyroxine). Zonulin levels did not correlate however with anti-TPO or anti-TG antibody levels.

Author Discussion and Conclusion

Increased intestinal permeability is a key component of autoimmune diseases. The tight junctions in the gut are key regulators of not only nutrient absorption but also the immune system. Increased zonulin levels are linked to aging and obesity so with our population continuing to become more obese, this may be one of the key factors in the increased incidences of autoimmune diseases.

Patients with Hashimoto’s disease need more thyroid medication based on their zonulin levels which may indicate the severity of the disease. The authors do point out that this pilot study is limited due to the small sample size and because the control group wasn’t healthy.

The authors conclude, “Higher zonulin levels in children and adolescents with Hashimoto’s thyroiditis suggested increased intestinal permeability in these patients.”

Dr. Hedberg’s Comments

Based on the research we have today, there is no doubt that leaky gut or IIP is connected to most if not all autoimmune diseases. We just need more studies on specific autoimmune diseases that are of good quality to buttress this connection. This study is an excellent start for Hashimoto’s disease but every practitioner working with Hashimoto’s patients knows their zonulin levels are usually high and they have leaky gut.

Zonulin can also be tested in stool which is how most functional medicine practitioners are testing at this time.

Is there a need to get your zonulin levels tested if you have Hashimoto’s disease? Not really. Functional medicine practitioners always put most of their focus on gut health and healing the gut barrier in patients with autoimmune disease so the test results won’t change how the patient is being treated.

I only run tests that will actually change the way I approach a patient so I don’t normally run zonulin levels unless the patient requests this data.

If you have Hashimoto’s disease, it is important to have your gut thoroughly evaluated so you can identify what may be breaking down your intestinal barrier. Many things can do this including stress, medications, food sensitivities, gluten, sugar, excessive exercise, poor sleep, dental infections, gut dysbiosis, parasites, viruses, yeast overgrowth, low stomach acid, poor diet, trauma and more.

I always find that if we prioritize gut health in my patients with Hashimoto’s disease, we get much better and much quicker results.

There is a new exciting paper on the connection between eradicating the intestinal parasite Blasctocystis hominis and improving Hashimoto’s disease. I previously reported this infection connection in a case study which revealed an individual with Hashimoto’s disease getting better after eradicating Blastocystis hominis. Case studies aren’t the strongest scientific proof of a particular therapy but now we have an excellent paper with three research groups including a much-needed control group.

This paper is entitled, “Improving Hashimoto’s thyroiditis by eradicating Blastocystis hominis: Relation to IL-17” published in the journal Therapeutic Advances in Endocrinology and Metabolism by El-Zawawy et al.

The author’s begin by pointing out a very important fact that Hashimoto’s thyroiditis was once thought to be a TH1-mediated disease but once TH17 cells were discovered it became clear that it is a TH17-mediated disease. TH17 cells drive autoimmunity through production of the cytokine IL-17.

Blastocystis hominis is the most common intestinal parasite in humans and most individuals never get any symptoms. This parasite is opportunistic however so if your gut or immune system becomes compromised, it can multiply and cause gut symptoms such as constipation and diarrhea, joint pain, drive autoimmunity and a host of other health problems.

Blastocystis hominis has a prevalence of 1.6% to 16% in developed countries and up to 60% in developing countries. You can get this parasite from contaminated food or water.

How was this study done on Hashimoto's Thyroiditis and Blastocystis hominis?

60 patients aged 19-57 with 19 females and 1 male in each group.

Group 1: 20 patients recently diagnosed with Hashimoto’s thyroiditis without Blastocystis hominis infection.

Group 2: 20 patients recently diagnosed with Hashimoto’s thyroiditis with confirmed Blastocystis hominis infection.

Group 3: 20 healthy subjects without Hashimoto’s thyroiditis and not infected with Blastocystis hominis infection.

All subjects in group 1 and 2 had a history of fatigue. 9 patients in group 1 and 7 patients in group 2 had a history of constipation. 6 patients in group 2 had a history of diarrhea.

Interestingly, all subjects in group 2 who were infected with Blastocystis hominis had significantly higher blood pressure than the other 2 non-infected groups.

The following tests were done on all subjects:

Free T4

Free T3

TSH

Anti TPO antibodies

IL-17

Stool analysis

CBC (complete blood count)

ALT and AST (liver enzymes)

Albumin

Bilirubin

Cholesterol

Triglycerides

BUN (blood urea nitrogen)

Creatinine

Group 2 which was infected with Blastocystis hominis was treated with the medication Nanazoxid for 3 days to eradicate the parasite and then retested 6 weeks later.

What were the study results?

TSH levels were higher in groups 1 and 2 compared to the healthy group 3 as expected.

Free T4 was lower in group 1 compared to group 3 however group 2 did not have lower levels than group 3.

Free T3 was significantly lower in group 2 compared to group 3. Free T3 levels in group 1 were not significantly different than the control group.

TPO antibodies were the same between group 1 and group 2.

Group 1 and group 2 had significantly higher levels of IL-17 compared to the healthy control group. However, group 2 had significantly higher levels of IL-17 compared to group 1 because group 2 was infected with Blastocystis hominis.

They also found that high levels of IL-17 correlated with higher levels of anti-TPO antibodies and lower levels of Free T3.

What happened to the patients treated for Blastocysis hominis?

10 patients in group 2 reported improvement in fatigue and 5 patients had improved constipation. Diarrhea completely resolved in all 6 patients.

Blood pressure in group 2 which was significantly higher before treatment did not change after treatment.

TSH significantly decreased in group 2 after treatment but Free T4 and Free T3 did not change.

IL-17 levels significantly decreased in group 2 after treatment.

The authors thus conclude that eradicating Blastocystis hominis reduced TSH, anti-TPO antibodies, and IL-17.

The authors point out that we have previously known that Blastocystis hominis increases IL-17 levels which are known to trigger autoimmunity and more specifically Hashimoto’s thyroiditis. They also point out that this parasite can increase intestinal permeability resulting in leaky gut which is a major factor in “many, if not all, autoimmune conditions.”

IL-17 inhibits the conversion of T4 to T3 by suppressing the deiodinase enzyme which is required for proper conversion.

The author’s final conclusion is treating Blastocystis hominis infection can improve Hashimoto’s thyroiditis and potentially stop its progression.

What can you do with this information on Blastocystis hominis and Hashimoto’s disease?

The most important thing to do is to get a stool analysis to see if you have this parasite and then successfully eradicate it. If you have it, you can try to get the medication used in this study to get rid of it but I have found that conventional doctors do not believe that Blastocystis hominis is a problematic parasite and will not prescribe medication for it. You may get lucky however.

I use herbal antibiotics and specific probiotics in my practice for this parasite with excellent success so that is another option without drugs. I always test every Hashimoto’s patient I see for intestinal parasites through stool analysis and I do find this parasite quite often. I have found that eradicating it does help patients feel better and now we have some good research to support this connection.

One additional important note is to be sure you have healthy stomach acid levels and a healthy gut in general. Low hydrochloric acid levels can make you more prone to intestinal infections since microbes can more easily pass into the intestine if there isn’t enough acid to kill them. There are many reasons to have low stomach acid including chronic stress, H. pylori, Zinc deficiency, b-vitamin deficiency, food sensitivities, hypothyroidism, anti-parietal cell antibodies, gut dysbiosis and more. Additionally, a healthy gut microbota and gut barrier will provide you with additional defenses against parasites so be sure you work to improve these aspects of your gut.

Some patients with Hashimoto's disease have positive anti-parietal cell antibodies which are antibodies that destroy acid-producing cells in the stomach.  The only real option for these patients is to take plenty of Betaine HCL with meals to overcome the loss of hydrochloric acid production.

If you want to improve your gut health and your Hashimoto’s disease, consider working with a functional medicine practitioner who can help you identify these types of gut imbalances and heal them naturally.

I was very excited to interview therapist Samantha Osborne in a discussion about anxiety, irritable bowel syndrome (IBS), insomnia and cognitive behavioral therapy (CBT).  I had been wanting to interview someone for a long time on CBT because it is so effective for conditions like anxiety, insomnia, and IBS.  We discussed why we develop the thoughts that we do as well as beliefs and emotions and the many triggers of these conditions.  We also covered some excellent CBT strategies to overcoming these conditions that you can do on your own.

Below is a transcript on Anxiety, IBS, Insomnia and Cognitive Behavioral Therapy

Dr. Hedberg: Well, welcome everyone to "Functional Medicine Research." I'm Dr. Hedberg. And I'm really looking forward to my conversation today with Samantha Osborne. And Samantha is an Asheville based therapist and she serves busy professionals with anxiety and irritable bowel syndrome. She's certified in cognitive behavioral therapy and integrated mental health techniques. Samantha uses a variety of approaches to help clients move from feeling burned out and overwhelmed by their to do's to engaged and excited by their work and life.

She earned her master's degree at the University of North Carolina at Greensboro and has been a featured speaker in several publications including "The Funk'tional Nutrition Podcast" and "Abundant Practice Podcast." And when she's not serving clients, you'll find her taking long walks with her poodle and listening to her favorite podcast. So welcome to the show, Samantha.

Samantha: Thank you so much.

Dr. Hedberg: So I've been wanting to have someone on for a long time to talk about cognitive behavioral therapy. So this was really serendipitous. And why don't we begin by just laying some bedrock information about, you know, what is the cognitive behavioral model and how does it explain where our thoughts, emotions, and our behaviors come from?

Samantha: So CBT is basically a model of therapy that says that circumstances are really neutral. So no matter what happens in the world, that's not really what's determining our thoughts, emotions, and behaviors, it's just information, is an invitation to that. And then we have thoughts about those circumstances that lead to our emotions that lead to behavior that ultimately determine our results. And so CBT says that our thoughts really originate from, you know, different circumstances that we've had in our lives, you know, all kinds of home media, cultural expectations. Essentially they're formed really early, these core beliefs are, and then they're sort of hardened and solidified over time with different input that we're getting from the environment.

Dr. Hedberg: And kind of that behavioral therapy is based on the ancient philosophy of stoicism, is that correct?

Samantha: I believe so.

Dr. Hedberg: Some of my patients know I'm a big fan of stoicism, stoic philosophy, which, you know, it's my understanding that CBT comes from that particular philosophy. And, I know that, you know, from what I know about CBT, it's very effective for anxiety and other mood disorders and insomnia and also IBS, which we'll be talking about today. So if our thoughts don't come from circumstances, where do they really originate from?

Samantha: So our thoughts really come from core beliefs about ourselves and the environment. So you know, when we are kids we have different kinds of experiences that teach us about who we are and what the world is like fundamentally. And then those beliefs about ourselves and the world are then solidified over time with different experiences.

So for instance, you know, if you grow up in an environment that's really unsafe and abusive then you think that the world is a really unsafe place and then you might have other experiences that reinforce that over time. So then when you're met with circumstances like, you know, someone approaching you at night, you're sort of primed to think, oh no, this is a scary, negative experience because of all of the experiences that you've had that have been scary and negative. It's not necessarily that person or that situation that's creating that fear, but it's all of the things in your life that have been scary, that are sort of priming you to be afraid of this thing. Does that make sense?

Dr. Hedberg: Yes it does. And I've had some guests on previously talking about adverse childhood experiences and things like that. And so do you think that that is really where a lot of these beliefs are shaped or do you think that these things can happen as an adult as well?

Samantha: So I think it's kind of both end, right? So we know from research that if you have a lot of adverse childhood experiences, you're more prone to conditions like depression and anxiety and also trauma of course if you've experienced trauma. And the more of those that you have, the more solid that that becomes and the more difficult it is for us to change those beliefs, it's possible, but it's just more difficult. And that's very different from someone who had a very positive, healthy upbringing without a lot of adverse childhood experiences. They might have, you know, challenges that come up later on, those are easier to change depending on the event.

But this can also be, you know, thoughts or beliefs about smaller things if we want to say that like, oh it's difficult to make dinner for myself at home or, you know, it's very scary to public speak. That might not come from trauma, it might just come from things that you've seen in your environment and then your own experiences reinforcing those.

Dr. Hedberg: Right, right. So let's talk a little bit about anxiety because I know CBT is very effective for that. So what are some of the underlying causes of anxiety? It's my understanding that underlying anxiety can be...like fear is the real cornerstone of anxiety, and then anxiety is worrying about the future, and depression is having negative thoughts about the past. So can you talk a little bit about what's really causing anxiety in most people?

Samantha: So I would say in general, my really simplified explanation of anxiety is when we overestimate challenges or problems and then we underestimate our ability to meet those challenges or problems. And that can show up in a lot of different ways. Often people with anxiety are prone to pretty common thinking errors, and that just means that their mind is giving them information that seems rational or reasonable, but really just keeps them stuck in that anxiety loop. So that could be things like catastrophizing, kind of jumping to the worst-case scenario, jumping to really negative conclusions about the future, filtering out positive or easy things that are happening and over-focusing on negative or hard things that are going on, scary stuff that's happening. So it's really just when we're kind of overblowing this, you know, oh no, the world is hard right now and it's gonna be hard into the future, I can't cope now and I'm not going to be able to cope later on.

Dr. Hedberg: Right. So Homo sapiens are about 300,000 years old, so part of this has to be an advantage through our evolutionary process because if we weren't thinking about the worst-case scenario, we didn't have much chance of survival. So in one sense it was a good thing but now it sounds like it's just, it can become too overwhelming and it's not so much a beneficial trait in Homo sapiens as much as it used to when we were just worried about daily survival. What do you think about that?

Samantha: I think that's a really excellent point and very true. So I think with most mental health conditions like anxiety or depression, even some other things, there are kernels of this that are helpful and they just get kind of twisted to where they become unhelpful or maladaptive, right? So to your point of, oh, if I go out hunting today, I might be attacked by a tiger, so I should prepare for that and take these certain routes because the last time I didn't see a tiger this way, and I'm gonna carry the stick because I know that will help me, right? That's like appropriate planning and preparation for something that could be really negative.

On the other hand, you know, in modern life we're not really faced with that level of risk typically and so, you know, we just end up putting that skill to use in overdrive. So we fear a lot of, well, what's gonna happen if I get stuck in traffic today? Then I'm gonna be late, then my boss is gonna be mad at me, then I'm gonna have to do more work, then I could potentially get fired, right? So it just kind of spirals out of control a lot of times and people with anxiety typically have a hard time walking that back and saying, okay, what's the most realistic thing here that I can appropriately plan for?

Dr. Hedberg: And how do you see social media as a player in anxiety in our modern society? Because I've read a lot of studies on the effects of social media really driving mental disorders like anxiety and depression. So how do you think social media would cause anxiety or make it worse?

Samantha: Well, and I think in some ways there are tools and resources that if people are using them, they can be a real help. So a lot of great accounts on Instagram from therapists, The Holistic Psychologist is somebody that I follow. And they're really doing a lot to kind of put good information out there about how to take care of your mental health. But as far as it being a detriment, I think a lot of this just has everyone kind of being able to see too much into other people's lives in a way that's very filtered and curated.

So feeling behind a lot is what I hear from a lot of my clients. Like, oh, I'm missing out on a lot, I'm not doing as much as other people, I'm not able to keep up as much. And really we're not taking into consideration that that's a very filtered, curated...you know,