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Dr. 50 Something
S2 E2 The GI Map Revolution: Healing Root Causes Starts with a Hershey's Kiss
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Foreign50Something podcast I'm your host, Dr. Nicole Norris. Whether you are in the midst of midlife or you want to prevent the physical and mental signs of aging that occur in midlife, this is the podcast for you. This is a show where I share my knowledge gleaned in family practice, preventative medicine, and aesthetic medicine to shed light on aging or or better yet, how not to feel or look like you are aging. We should be taking an active role in how we age from an early age. We should not settle with growing old gracefully or letting nature take its course. How we age directly affects our confidence, which impacts all of our relationships with those around us. The length of time in our lives that we feel really good in terms of energy, aches and pains and thought clarity has a definite impact on the mark we can leave on this world. My wish for my listeners is to always be mistaken for being 50 something or less in mind, action and appearance. Let's go. Hello everyone. As promised during my last podcast we were going to talk about some of the testing that we offer in my preventative medicine functional medicine practice. We are now offering a multitude of tests that are not offered by most hospitals or doctor's offices and these tests promote longevity and help to isolate root causes of symptoms. By far one of the most fascinating tests that I have learned to interpret in the last two years since starting my preventative medicine practice is called GI mapp. That stands for Gastrointestinal Microbial Assay plus. Yes, a mouthful. This is a very easy stool test collected in the privacy of your own home that once bagged and boxed up you drop off at FedEx. Yes, we just need a Hershey's Kiss size amount of your stool to do this test. And yes, I did say you drop it off at FedEx. I am not sure why this feels so wrong when you are handing it to the clerk. Fortunately, the FedEx people do not know what GI Mapp is when you hand them the box that says GI MAP in bright blue. Anyone listening from FedEx? Now you know. So what happens next? Your feces flies to a lab in Georgia and has comprehensive testing done. This test relies on quantitative polymerase chain reaction technology PCR testing to detect parasites, bacteria, H. Pylori and fungi. PCR testing has high sensitivity and specificity and so it is very accurate. Besides testing for good and bad bacteria, it also measures levels of fat, blood, digestive enzymes and inflammatory markers. It essentially quantifies the levels of multiple strains of bacteria and other substances in your GI tract. Your test takes about a month to come back to my office. If you can believe it, that one Hershey's Kiss gives us an eight page report. We tell our patients this report is a window into your soul. In the GI MAP testing we have done so far, we have discovered root causes for GI symptoms that some prescription meds have not touched for a lifetime. We have uncovered root causes of eczema and acne that no one could have imagined were due to overgrowth of a bad bacteria in the gut or a parasite. We have even treated a parasite that we happen to find. We can also tell you a lot about your diet and even how you eat your food. From this test, we can tell if you eat quickly on the run or if you sit down and breathe when you eat. On one patient's GI map, we found many elevated markers of significant inflammation and even microscopic blood in her stool. We referred her for a colonoscopy that was thankfully normal. We discovered that she had extreme stress in her life, which was probably causing the findings. By addressing her stress reactions with a form of meditation and adding detox supplements, her GI symptoms resolved, her inflammation resolved, and her anxiety improved. Like I said, a window into the soul. I am going to go through a GI MAP with you just as I do with a patient. But first I want to address who should consider having a GI map. Of course, anyone with GI symptoms such as chronic constipation, chronic loose stools, bloating after meals, gas, nausea, heartburn, reflux, inability to eat first thing in the morning. All of these symptoms are your GI tract screaming at you to do a GI map. Food sensitivity is also a telltale sign that you need a GI map. Anybody who has trouble tolerating certain foods likely has some sort of inflammation going on in their GI tract. If we can treat this inflammation over two to three months, many times patients are then able to tolerate the foods that they once could not More about food Sensitivity testing in this podcast. The second reason to do a GI MAP is if you have any skin problems that are difficult to treat, including acne, eczema, psoriasis, unexplained hives, or dermatographia. There is a direct connection between the GI tract and the skin. The gut and the skin are twins. One lives inside and one lives outside of your body. Almost every patient who comes to us for a GI MAP notices that when they decrease the inflammation in their gut and balance their microbiome in their gut, their skin is clearer and healthier. If you suffer from acne that no product regimen or prescription drug regimen has worked. I would definitely consider a GI map, especially before starting Accutane. Essentially, your skin mirrors your gut health. A third patient type that benefits from a GI MAP is anyone with autoimmune disorders such as Hashimoto's thyroiditis, rheumatoid arthritis, fibromyalgia, lupus, type 1 diabetes. Your body's immune system cannot be balanced and healthy if your GI tract is not balanced. The GI tract affects your entire immune system through a complex relationship with something called the gut microbiome. The gut microbiome is a physical barrier inside the small and large intestine. This physical barrier keeps the good bacteria, AKA commensal bacteria, inside, which helps us with absorption of nutrients and prevents toxins and bad pathogenic bacteria from entering the bloodstream. If you lose this physical barrier, which is also called your your mucosal barrier, it is called leaky gut syndrome. Leaky gut exacerbates inflammation in the body and can contribute to autoimmune disorders and even increase susceptibility to infections. A fourth patient that we often recommend GI MAP to is anyone who's in our 12 week get fit body composition change program. Who is stuck? They can't lose more fat. There is actually a healthy bacteria that lives in the gut called Akkermansia. When Akkermansia bacteria in your gut is low, these people often have a hard time losing weight. This is a bacteria that thrives on something called polyphenol. If your diet is low in red and purple fruits, which is the main source of polyphenol, this bacteria is always low and these patients have a harder time losing fat. Lastly, anyone who wants to optimize their health and longevity should have a GI MAP at least yearly. It's like doing routine blood work. It makes you honest. You may think you are doing everything right to be active and healthy to live into your 90s. You may have a healthy body composition with more muscle than fat, and you for sure have optimized your hormones. You've researched all the supplements and you may even be dabbling in all the latest peptide biohacks. But I guarantee when I look at your GI map, I will be able to tell you a few important things that you are missing on your quest to have the best possible healthspan. All of us, with optimized hormones and a newfound zest for life, want to maximize our health span, not just our lifespan. Okay, let's break down this report. The first section of the test looks at pathogens, or in other words, things that should not be in the GI tract at all. These are the bad guys. These could be bacteria like Clostridium difficile, parasites and viruses. Fortunately, 95% of the tests we run come pack negative for these as they should. However, we did have one 18 year old patient that we did a GI map on who had a parasite that we successfully treated and his body acne that he had had for two years cleared up in two months. The next section of the report tells if you have Helicobacter pylori in your GI tract, this is also known as H. Pylori. So far, about half the tests we have done for H. Pylori have come back positive for this to some degree. The test also tells us how virulent the strain of H. Pylori is that is present and what the colony count is. The GI map even picks up H. Pylori that the breath test for H. Pylori does not. Very virulent strains of H. Pylori are known to give patients high risk for ulcers and stomach cancer. The not so virulent strains, however, are often associated with lifelong upper GI symptoms like reflux, heartburn and bloating. Some patients with chronic H. Pylori infection also have allergy symptoms due to histamine release from the bacteria and also difficult to treat acne. H. Pylori is transmitted orally, so there are often multiple people in a household who have this think maybe mom or dad had it chronically and they kiss their kids and as babies. Also sharing utensils and drinking from the same cup are common forms of transmission. It is even important to get a new toothbrush once we have treated H. Pylori. If your H. Pylori is positive and it is a virulent strain, prescription antibiotics are necessary to treat it. If it is not a virulent strain, it can be treated initially with a combination of supplements that are bacteriostatic because some patients want to try treating without a prescription first. Now back in my family practice office days I would have never considered treating bacteria with a supplement, but my my eyes have been opened since I started my training on GI mat. By using some potent supplements to change the bacteria in the GI tract, you can actually avoid causing leaky gut syndrome and of course antibiotic resistance. H. Pylori is also known to lower our stomach acid. We need stomach acid to keep bad bacteria and good bacteria balanced. Patients with H. Pylori usually have too many bad bacteria in their gut and not enough good ones, so leaky gut syndrome or the imbalance of good and bad guys is common in people with H. Pylori and it causes our bodies to not be able to digest food so we can't bring in good nutrients. It also makes us more susceptible to toxins and pathogens. So no matter if a patient chooses antibiotics or supplements to treat the pathogens in the gut caused by H. Pylori, we always do a GI MAP in three to six months to make sure they are clear. The next section measures all of our spec good gut bacteria, also called commensal bacteria. These bacteria help to support immunity, weight loss, hormonal balance and even mental health. When we are looking at these good bacteria, we are checking to make sure that these levels are not too low. If they are low, we can use specific probiotics to raise the ones that are low. Another thing I have learned since working with GI maps is that one probiotic does not fit all. There are tons of different probiotics. Think of them like food for the animals at the zoo. There is not one food for all the different species. Different good gut bacteria thrive on different probiotics. So with GI mapp we can help guide you to the ones that you need. Next, we look at levels of opportunistic bacteria, which are also the bad bacteria that have been given the opportunity to overgrow because of things like low stomach acid, poor digestion or eating too much processed foods. Processed food like lunch meat and things that come prepackaged to make for dinner are huge culprits for encouraging bad bacteria in the gut. Processed food is essentially the opposite of a probiotic. Other causes of high levels of bad bacteria can be taking prolonged courses of antibiotics. When you have overgrowth of opportunistic bacteria, you are more prone to acne, food sensitivity, constipation and eczema. Treating the bad bacteria and encouraging growth of good bacteria can improve these symptoms. Most often this starts with diet changes, I. E. More foods that have a mother or a face grew in the ground and specific probiotics. The Mediterranean diet in particular is often considered the most anti inflammatory diet in terms of healing the gut. Next up, GI MAP tests for fungus, or as some people call it, yeast. The most common yeast we see is Candida. Symptoms of yeast infection in your gut are often bloating and acne. If you are a female with yeast in the gut, it can travel downstream and put women more at risk for vaginal yeast infections. We typically use antifungal prescription medications to treat this. If we find it, the next section in this very long test tests for parasites. Parasites can come in different shapes and sizes, but the most common is a worm. There are many, many symptoms of parasites. Depending on what you read, they can present very differently from joint pain to headaches to anal itching. I have even heard the symptom of jaw clenching or teeth grinding when you sleep be attributed to a parasite. Regardless of the potential symptoms, nobody wants a parasite in their body. They are most often acquired from contaminated water, close contact with animals or eating meat. It is also not uncommon to pick them up on a trip to a country that may not have the cleanest water supply. Treatment for parasites can be with prescription medication or supplements pending the patient's preference. Once again, we always do another GI MAP in three to six months to make sure that parasite has cleared. In the next section we examine markers for intestinal health. One of them, steatocrit, tells us the level of fat in the stool which can tell us how well your gallbladder is functioning. If you have had your gallbladder removed, we are going to see more steatocrit or fat in the stool. Elastase1 gives us an idea of the levels of digestive enzymes that you have to break down your food. If these are low, patients will often have immediate uncomfortable fullness right after they eat. Another enzyme, beta glucuronidase, signifies a need for detoxification in the liver. Calprotectin levels can be high if there is significant inflammation in the gut. And lastly in this section it reports if there is any blood in the stool sample scent if there is microscopic blood in the stool that is not normal and may require for further workup such as a colonoscopy. In the last section of the GI map we look at our immune function. Did you know that 70 to 80% of our immune system is housed in our GI tract? Secretory IGA is a marker that looks at how well your immune system is functioning and how strong your mucosal barrier is that I mentioned earlier. Patients who have a high secretory IGA often have an over responsive immune system and are at risk for autoimmune disorders. It can also be high in patients who have food sensitivities. Patients with low secretory IGA are not able to fight off infections as well and need immune system support. Also included in this section is a test for the presence of anti gliadin iga. This tells us if you have gluten sensitivity. There's also another add on test called gluten peptide test for patients who have known celiac disease and are pretty sure they're gluten free but are still symptomatic. This tests for gluten in their stool, meaning that somehow they have have still some gluten contamination in their diet. Another add on test is zonulin. This is a great test for leaky gut. The main symptom of leaky gut is food sensitivity to multiple foods. Notice I did not say allergy. There is a difference between allergy to food and sensitivity to food. An allergic reaction to food is going to most often be hives, lip swelling and progressive worsening reactions with each exposure that can actually result in death due to swelling of the airway. Food sensitive sensitivity reactions, however, are typically not as severe and often present as different forms of GI upset. Food sensitivity reactions are not an allergy. They are a result of inflammation in the gut due to too many bad guys and not enough good guys. Food sensitivity reactions can be treated by stopping the offending foods for several months and simultaneously working on healing the lining of the gut. Then, after healing the gut mucosa, most patients can add back the offending foods gradually. But with true food allergies, it is very uncommon to be able to ingest the offending agent without a worsening reaction. So how do we tell which is which and when? Do you need to do a food sensitivity test? The most common foods that patients are sensitive to in my practice are eggs, dairy and gluten. In a patient with inflammation in the gut, for whatever reason, these foods are going to make the inflammation worse. So when patients have history of multiple food sensitivities, I recommend doing a GI max first. Even before food sensitivity testing, I like to see what's going on with the good and bad bacteria first. Because often when you balance the gut microbiome, you then heal the leaky gut syndrome and then the food sensitivities resolve on their own. Now, during this time, of course, that we're trying to heal the gut, I usually recommend avoiding the main culprits of inflammation such as eggs, dairy and gluten for at least three months. And then once we've healed the gut, we can try adding back one at a time. If the patient's GI symptoms are persisting still, after treatment of the issues we found on GI Map or adding back dairy, eggs or gluten, flares them up again. That's when I recommend food sensitivity testing. With food sensitivity testing, we draw your blood in the office and then we send it to a different lab for analysis. These reports come back with a list of foods that you have high levels levels of IgG4. This means these foods are the ones that are causing inflammation in your body. This test does not measure food allergies. Food allergy tests measure IGE as in Edward and are done by an allergist. The first page of this test rates the food in terms of how much inflammation they are causing from one to four, four being the worst. These are usually on the test result page in red. If you can commit to avoiding all the foods 2 or above for at least a few months, your gut will have a chance to heal. The report also breaks down milk into different proteins like whey and casein. Casein is in cheese. Many protein drinks have whey, so of course it's good to know if whey is a problem. It also delineates egg yolks from egg whites. In terms of sensitivity. The end of the report ends on a positive note and tells you all the foods that you can eat and will help your gut heal. If you are having trouble figuring out how to avoid the inflamma listed foods, we have a lot of resources for you to read or we can even connect you with a nutrition coach. Hippocrates, the father of medicine, was alive from 460 to 370 BC. It is known that he said all disease begins in the gut. We have known this for a very long time and it boggles my mind that only now in the 21st century AD are we offering our most health conscious patients. If you are interested in having a GI map in our office or know someone who would surely benefit, we would be happy to connect you with a collection kit and then schedule a follow up appointment to go over the results. Please share this episode with everyone you know because like the Children book says, everybody poops. Thank you for joining this episode of the Dr. 50 Something Show. If you are intrigued by this show and never want to miss an episode, click Follow. If you are a really great friend, share it. The content of this episode is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare provider to answer any questions you may have about your personal medical conditions. Until next time, get fit, get fabulous, get firm, and take care of yourself.