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Allison Samon discusses A Functional Medicine Approach to Autoimmune Disease with Dr. Ben Weitz.

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Podcast Highlights

Allison Samon is a Functional Nutrition and Lifestyle Practitioner who works virtually with people to get out of chronic illness, escape from mystery symptoms, and help re-design their lifestyle so they can be fit, energized, and pain free in ways that are easy, fun, and sustainable. Allison struggled with unexplained chronic pain for over 10 years. Her remarkable healing journey became the basis for her programs: Reboot from Chronic Illness and the Chronic Illness Recovery Blueprint. She’s also written an ebook “Detoxing Endocrine Disruptors: Essential Checklist” and is a featured author in the Amazon International Best Seller: Teach Your Expertise. Her website is AllisonSamonFunctionalNutritionist.com.

Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure.  Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.

Podcast Transcript

Dr. Weitz:            Hey, this is Dr. Ben Weitz, Host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates and to learn more, check out my website, drweitz.com. Thanks for joining me, and let’s jump into the podcast.

                                Hello, Rational Wellness podcasters. Today we’ll be having a discussion with functional nutritionist, Allison Saman, about autoimmune diseases and a functional medicine approach. Allison is a functional nutritionist and lifestyle practitioner. She works virtually with people to get them out of chronic illness, help them escape from mystery symptoms and help redesign their lifestyle so they can be fit, energized, and pain-free.  Allison struggled with unexplained chronic pain for over 10 years. Her remarkable healing journey became the basis for her program, Reboot from Chronic Illness, and A Chronic Illness Recovery Blueprint. But her proudest accomplishment is becoming a first time mom over 40 and inspiring other women to successfully have healthy pregnancies despite being considered geriatric. Allison, thank you so much for joining us.

Allison:                 I’m thrilled to be here, Ben. Thank you.

Dr. Weitz:            Can you start by telling us about your personal health journey?

Allison:                 Yeah. What’s funny about that is I considered myself to be healthy and active. I was active, but I was anything but healthy. As you know, the more active you are, the more you are prone to get injured, and that was the conventional wisdom is that I started limping.  I was having chronic pain in my knees, my lower back, my butt, I had numbness in one foot where I was constantly having to stomp my foot on the ground because I didn’t feel it. If I was sitting down, it felt like I didn’t have a foot, and it kept progressing. I had migraines, I had chronic fatigue, and I had an injury that was, I think the initial injury was a skiing accident where I got plowed down, my ski went one way, my knee went the other. That, I think maybe created an initial tear, but being young and active, you heal, or you think that you heal.

                                Several months later, I ran a race and took a nap after the race. I was in college and I was waitressing at night, and got up after my nap and I was limping. I knew that that was a different kind of ouchie, that I must have twisted something while I was running, but you know the difference between like ooh, and that’s not right, something is wrong here.  When I went to orthopedist at the time, he said, “You’re young, you’re athletic, you’re fine.” That was what I was hearing, but I just knew something was different this time and it eventually healed, but not in the same way, and again, over time it just kept progressing and then to other parts of my body.

                                I did everything from seeing neurologists, chiropractors, physical therapists, I basically went to every single person who had a lotion or a potion or some kind of thing to help, and none of it really worked. Acupuncture helped a little bit, but not everything. Didn’t help my knees. It helped my back, it helped my butt, it didn’t help my knees. Sitting was excruciating. I had a long commute, I was in New York City at the time in a completely different career, I worked in television, and sitting… Just having to sit in a chair was just miserable.  The irony is the one thing that all of these practitioners, I went to top people in New York City, Wayne Gretzky’s guy, and nobody ever once asked about what I was eating, not one person. I never made the connection because I thought I was healthy, but I was also thinking if I’m not fat, therefore I’m healthy. That was the mentality, and so I was like I can eat that because I’m just going to work out and it’s going to be fine.  Over time, that’s not true anymore and eventually your body starts to crap out when you’re feeding it such crap. That was a 10-year struggle for me that basically culminated with this top guy saying, “Let’s do exploratory surgery because your scans are not consistent with your pain.” I was like, “That doesn’t sound like a good idea. You’re just going to cut me open to look around and you don’t know?” I didn’t know any better at the time, I just knew that something felt wrong.

                                I was finally introduced to somebody who asked me, he was an alternative practitioner, and he introduced me to the energetics of food. Without even putting anything in my body, what food did just on my body. I was like that’s crazy. He asked me, “What did you have for breakfast?” I was like, “I had Special K and a glass of orange juice and a multivitamin.” Duh, a healthy breakfast. That’s what I thought was the way to go. I had no idea that that actually was just feeding a blood sugar dysregulated cycle that I was subsisting on, and it was fueling all of these symptoms that I had, but I had no idea because it fit the model of the time.

Dr. Weitz:            We’ve all seen that model of the healthy breakfast.

Allison:                 Right, and it couldn’t be more wrong. The funny thing is I don’t even like orange juice, I hated it always. I was drinking it because of the vitamin C. I thought I was being a good girl.

Dr. Weitz:            You regained your health once you started changing your eating? How did you change your eating?

Allison:                 The first thing I did was when he told me I didn’t have to drink orange juice and I was like that is insane, but okay. Thrilled, I’m thrilled not to. He’s like, “Why don’t you eat an orange or have broccoli or strawberries?” I’m like, “I can do that?” That was the first thing I did was I just stopped drinking orange juice, and my knee didn’t hurt the next day. I was like that’s crazy. What more can I try?  I wanted to see what other foods could I take out and I think that’s how it started. What can I take out and still eat because at the time, I was eating pretty much like a bachelor. Pasta out of a pot, cereal for dinner. I worked television, I didn’t have time to think about any of that stuff, but this is what opened my eyes to oh, maybe there’s something I’m missing. There was a lot that I was missing and I didn’t realize it.  The Lean Cuisines that I was having, all those microwave meals that I thought were healthy weren’t serving me in the way that I had hoped. When I started, it just opened my eyes to oh, yeah. That’s a lot of preservatives and that’s a lot of sodium. Maybe I’m not eating very many actual foods, like whole foods. What if my body likes that? Oh my gosh, it really did.  The inflammation started going down, I started not having pain in my knees. It didn’t happen overnight, let’s be clear, but it started this obsession of this new religion that I was taking on, which is nutrition. Why don’t people know about this? Nobody talked to me about it. I wasn’t having migraines anymore. I was on medication for migraines and I didn’t have them anymore, and I think it was because I was dehydrated, I was constipated, I was malnourished, and all of these things and exhausted, not sleeping. All of these things, it was ripple effect of like oh, you take one thing out and things start to get better, things start to improve. It sounds so simple, and yet it is.

Dr. Weitz:            You regained your health and now one of the types of conditions that you often see patients for, we discussed earlier, are autoimmune diseases. Perhaps you can explain what is an autoimmune disease, what is some of the most common ones, and what can we do about them?

Allison:                 Yeah. Autoimmune, it’s funny because when I was going through all… Nobody could figure out what was wrong with me. And they were looking at lupus, and I did have Raynaud’s, my fingers would turn white, I’d go and get a gallon of milk out of the refrigerated section in the supermarket because I was drinking copious amounts of milk as well, and my fingers were turned white. They were talking to me about a bunch of autoimmune.  Autoimmune, what I always tell people is you have to win the trifecta for autoimmune to occur. One, there’s a genetic predisposition, and two, there has to be some kind of dysbiosis in the gut. There’s something in the terrain that is there, whether it’s an infection, a microbial imbalance, there’s something. Three would be some kind of insult, some kind of trauma, some kind of event.

                                Autoimmune is when your body starts to turn on itself, it starts to think that its tissues are actually a pathogen or an invader. I haven’t seen anybody in my clinical practice who hasn’t had trauma as part of their story, even if they don’t realize it, that it was a triggering event, because sometimes pregnancy can be the triggering event because they had that predisposition and then it’s a physical and emotional trauma. There’s major changes going on, and the trauma could even be blood sugar swings. I mentioned that briefly before.  I was having severe blood sugar swings, and I didn’t realize it was an issue because that was how I kept my energy up was sugar. Some people use coffee, soda, cigarettes. I didn’t do any of that because I was a healthy person, but I used fat-free candy. That was my way. You have those high highs and high lows, and that is actually stress on the body, which if you have an underlying autoimmune condition, that could be a trigger.

Dr. Weitz:            What are some of the most common triggers for autoimmune diseases? You mentioned blood sugar imbalances. What are some of the other ones?

Allison:                Depending, inflammatory foods, so things like gluten and dairy, those were things that were absolutely staples in my diet and they’re inflammatory in the gut. Again, if you-

Dr. Weitz:            Are they inflammatory to everybody or just to some patients?

Allison:                I would say that they’re inflammatory to everybody. I don’t think that they manifest the same in everybody. I always say if you don’t have hormonal issues, if you don’t have digestive issues, then it can be okay for you.  There’s a lot of pushback about that, but if you have an autoimmune gluten absolutely must come out of the diet because of what it does, how it can contribute to a leaky gut situation, which also feeds this autoimmune pattern that we can have.  You asked what are common autoimmune diseases? I mentioned Raynaud’s. That’s one that I think is common, but it’s not something that people really pay a lot of attention to because it’s usually one of many. The saying goes if you have one, you get three because often, people are just living with it and don’t realize that there’s things they can do about it. They just think-

Dr. Weitz:            Yeah, no, it’s definitely the case that if you have one autoimmune disease, you’re more predisposed to a second or a third.

Allison:                Yeah, and especially because it usually goes untreated. It’s like well, you have it and there’s nothing else you can do. That’s what they said to me with my hormone imbalance. Your body’s always going to do what your body’s always going to do. Now I know that that’s not true. We can actually change the course the way that our body is working-

Dr. Weitz:            Or you can take injectable drugs that block your immune system.

Allison:                You could do that too. You could do that too, yeah. For sure. I, personally, we take a more diet and lifestyle approach. That’s the functional nutritional way, following functional medicine where it’s a bio individual approach, but knowing that the field of epigenetics tells us that we can influence the way our genes are working and using our environment, using our food, using our movement, using our mindset, all of these things can contribute to a stress response and different triggers and just how our bodies respond.

Dr. Weitz:            When you’re consulting with a new client and you’re talking to them, what are some of the clues that make you suspect what their triggers might be? How do you try to whittle it down?

Allison:                 I always do a really thorough intake. I build a timeline and a matrix. This is the functional medicine way-

Dr. Weitz:            This is the IFM, Institute of Functional Medicine, matrix.

Allison:                 Yes, absolutely. I have an adapted version of that, but that’s exactly where it comes from. Really extensive timeline and there’s often things in there that people don’t realize matter, because it all matters. They’re like I had my gallbladder removed, but that was 15 years ago, so that doesn’t really matter, right? It’s like, yes. I was on the pill for 25 years. That doesn’t matter, does it? Yes.  All of these things matter, and people don’t realize how all of these things add up to what brought you here today, and thankfully that you’re thinking forward enough to say, I want to change. I’m not on the right path, and there’s something else I can do, and I would like to do that. I’m looking at that. I’m looking for the traumas.

                                Again, it could be a lost job, a death in the family, a divorce. There’s always something, or it could be something like oral surgery or a lot of surgeries or a lot of infections. I’ve seen that a lot too where somebody’s like I had this mystery infection, I had this, I had COVID. It’s like okay, these are incidents where things can take a turn after. When I look at what their diet is and I see they’re having digestive problems, or they don’t think that they have digestive problems, but they have things like rashes or they have brain fog or they have joint pain, I’m seeing all this as what’s that connected to? It’s all coming from the gut. There’s always some kind of gut issue that needs work with autoimmune. I don’t know that conventionally, that’s ever looked at.

Dr. Weitz:            When it comes to after your consultation, I’m assuming in a lot of your patients, you’re doing some testing?

Allison:                 Not in the beginning. I always want to see if they have recent labs that were within the last six months. Definitely want to see because there’s information that we can learn from basic functional labs. I would like to see them, but I don’t order testing. I do, as a functional nutritionist, I don’t order testing right away because usually there’s a foundation that’s missing. That’s where I start them with, like getting them off of the inflammatory foods. The gluten, the dairy, the sugar, alcohol, if that’s an issue for them, taking those things out of the diet, making those shifts, making sure…

                                Really, it’s these three non-negotiables is are they sleeping? Are they pooping? Is their blood sugar regulated? Are they having mastery really over blood sugar? That’s where I’ll start. When I find that there’s no movement or enough movement… I always say, and I actually learned this from one of the speakers in one of the functional meetups, and I don’t know if it was Tom O’Brien who said I took it and I run with it, and it is great. If I don’t move the needle with you within the first two weeks of us working together, I know that we’re not on the right track, but I always do. Poop, sleep, blood sugar, there’s always something there.

Dr. Weitz:            How do you know they’re having blood sugar problems?

Allison:                 Because they will say that either they’re not sleeping or I look at a food journal. We do a lot of that, a lot of tracking in my world. I’ll look at that and go huh. Sometimes to myself, huh, because they’re not eating, there’s a lot of people who come in on intermittent fasting, and not that there’s not a place for it, but not for somebody who is chronically ill. We don’t fast a sick person.  I’m often trying to undo that and say, we can go back to that when we get you into a place where you’re not having these crashes, when you’re sleeping well, when you’re not having this digestive distress, when you’re not having anxiety, that’s another sign.  They’re so anxious. It’s this dysregulated blood sugar. You could just tell in how somebody presents or when you start talking to them about diet, how they get triggered by it and they get really defensive. You’re not going to take that away from me. I can’t do that, or I can’t live without that. There’s certain tells. And then after a few weeks, we will do hormone testing where I’ll take a look at where is their cortisol. They’re completely flat lining or look at their having a W.

Dr. Weitz:            You’re talking about salivary cortisol testing?

Allison:                 Mm-hmm. Depending, I might do salivary, sometimes I do Dutch, but it’s really easy to show them on a ZRT saliva to see those graphs where Dutch can sometimes be like what am I looking at? That can be overwhelming, and so it really depends on the person, what they’re able to handle because some people, you have the know it all clients and you have the I am so freaked out about this whole process and making these changes and we have to go really baby steps.

Dr. Weitz:            Okay. Do you do stool testing? You talked about the gut.

Allison:                 I will do stool testing, but again, not right away. I have to do all of the non-negotiables first and building that foundation but yes, I have done the GI 360, Biome Effects. Those are the two tests that I’ve done.

Dr. Weitz:            The GI 360 from Doctor’s Data and the Biome Effects from Microbiome Labs?

Allison:                 Correct. It’s only when I’m suspecting that there’s infection and oftentimes we might think that there’s infection right away, but there’s no foundation, there’s no solid foundation. To jump into, let’s say a kill, they’re not ready for that yet. We have to build so they feel like okay, yeah, I’m going to the bathroom, I’m sleeping through the night, I’m eating throughout the day, I have more energy, my brain can focus, I can work, I’m nicer to my friends and family, I’m happier, and then it’s like okay, now we can move to this stage. It’s really just a systematic way of peeling back those layers and then rebuilding them.

Dr. Weitz:            You mentioned your non-negotiables that you start with. Why don’t we go through what exactly are you non-negotiables?

Allison:                 They have to be sleeping, they have to be pooping regularly, at least once a day. Nice poops, we talk about that.

Dr. Weitz:            Now, what if they’re not sleeping? They say I haven’t slept for years. I try, I wake up, I can’t fall back to sleep.

Allison:                 We’re going to work on their blood sugar balancing. It all goes back to that. If they’re not sleeping, it’s likely because they had low blood sugar. What I might do is start off with… There’s a couple of things. Start off with let’s have a snack before bed. Snack, not a meal. I always have to say a snack is a snack. It’s not a meal. Something that’s protein and fat, small before bed so that they can sleep. That usually helps, but also bringing in mindset.  We do a lot of calming, a lot of parasympathetic, just calming the body because if you can’t calm the mind, you can’t calm the body and it’s just this vicious cycle. I give them some tools where they can hopefully fall asleep faster or stay asleep. And then of course, if they’re still having trouble, if there’s other hormonal imbalances like let’s say estrogen dominance, and it’s waking them up in the middle of the night, I’ll bring in some adaptogenic herbs to try to help them sleep.  There’s lots of tools. I guess that’s the beauty of the functional way is that there isn’t one way. There’s so many different ways, and it depends on the person and what they’re willing to do and what their body is capable of handling or what they-

Dr. Weitz:            Your non-negotiables are they have to be sleeping, so you work on their sleep, you balance their blood sugar. What are the other non-negotiables?

Allison:                 Poop. They got to poop. Have to poop.

Dr. Weitz:            What if they’re not pooping?

Allison:                 We’re going to get them pooping. That’s usually the first thing I think that that happens is we get them pooping pretty much right away.

Dr. Weitz:            How do you get them pooping?

Allison:                 We take a look at what they’re eating. It’s often maybe they’re devoid of real food. Maybe they’re devoid of fiber, maybe they’re devoid of food that they can actually break down, so we might be working on stomach acid. It’s not exactly the way they’re thinking, I need to take a laxative or I need to take fiber pills. It’s like what if you don’t have the stomach acid to break down that food so that you can absorb that food so that you can poop out that food?

Dr. Weitz:            How do you decide if they have proper stomach acid?

Allison:                 That’s a good question. Based on what their symptoms are, if they’re presenting with a lot of bloating or they’re not pooping, or they say that they have trouble eating certain foods like meat, let’s say, can’t digest meat and they want to digest meat, their stomach acid may be low. They might have acid reflux, which as you know can be an indication of low stomach acid rather than high. There’s lots of different symptoms there and honestly, anybody in the autoimmune population, I know that there’s some kind of dysfunction in their digestion.

                                Having low stomach acid is often… It’s just very common and so I’m going to make that assumption there, that they need to either bring in some stomach acid and/or digestive enzymes to help with that digestive process. That often, right away, they’re like wow, I didn’t realize that I wasn’t eating my food properly. I’m like isn’t it amazing when you actually absorb the nutrients in your food, what happens right away? You don’t need a substance, you have food. It’s wild.

Dr. Weitz:            Okay. You get them pooping by using stomach acid or digestive enzymes, and that works most of the time for your patients?

Allison:                 Yes. Sometimes it’s the kinds of food that they’re eating, or maybe they’re not eating enough. I’ve seen that too, where they’re so afraid of overeating or gaining weight because now I want them eating regularly throughout the day and they are not really eating and they’re concerned that they’re pooping. It’s like you have to eat food in order to poop.   Making sure that they’re having nice balanced meals, and for some, it might have to be smoothies and pureed vegetables or just steamed vegetables, things that are soft, things that are easier to break down. It depends. It just depends on the person.

Dr. Weitz:            Okay. Let’s say you do some of these basic things, you add some hydrochloric acid, you get their blood sugar balance, but now they still have this hypothyroidism. What do you do next?

Allison:                 We’re making sure that their blood sugar is balanced, so we’re making sure that they have… When I say say balanced meals to support blood sugar balancing, that’s protein, fat, and fiber. There’s a lot of education around fiber and carbs. Everybody’s still so crazy over carbs.  I like to explain it that, think of it in terms of fiber, because all plants are carbohydrate. It depends on what plant you’re having and which ones have more fiber. Just think in terms of fiber, how can I get more fiber? Don’t be so afraid of carbs. It’s the refined carbs that we’re wanting to avoid, but not carbohydrate. Bringing in fiber, protein, fat, and fiber, and-

Dr. Weitz:            Give me an example. What’s a fiber?

Allison:                 What’s a source of fiber? We have cruciferous vegetables are really good-

Dr. Weitz:            Vegetables, okay.

Allison:                 Yeah, vegetables. Also, there’s so many different ways you can get fiber. Your leafy greens, but also things like nuts and seeds also have fiber that they’re forgotten. I love nuts and seeds and I like to, as I say [inaudible 00:28:48] up your meals and your snacks. You can always add some nuts and seeds as long as they can tolerate them. That is another test that I actually will run is-

Dr. Weitz:            Do you like legumes and whole grains?

Allison:                 Love, love, love, love, love. More things like green like seeds, so amaranth and quinoa and buckwheat, those kinds of grains. Yeah, love them. So many different ways that you can get fiber. Fruit, forgot about fruit, don’t forget fruit. So many ways.

Dr. Weitz:            Great. Let’s say your patient is still struggling with this autoimmune disease. Where do you go next? Let’s say they have rheumatoid arthritis and you’ve done some of these basic things.

Allison:                I am betting that they’re already starting to see some improvement, but I love, love, love for things like rheumatoid arthritis, anything with pain, and that’s something that is near and dear to my heart is SPMs. Making sure that not only do they have good quality fish oils that are just part of their diet, I think that that’s really helpful for digestive health, it’s really helpful for joints, brain, eyes, skin, hormones, but also I love SPMs. I wish that I knew about them when I was struggling so because they’re fantastic for helping to resolve that pain. Bringing them on board regularly, and then as time goes on, they can just have it in the emergency kit.

Dr. Weitz:            These SPMs are derivatives from fish oil that help to resolve inflammation.

Allison:                Yes. That’s the thing is that there’s so many naturally anti-inflammatory foods like turmeric, love, but the resolution of the inflammation to actually bring it to that other stage, the difference is noticeable. I love it all.

Dr. Weitz:            You see a noticeable difference. What kinds of dosages are you typically using for SPMs?

Allison:                Again, it depends on the person.

Dr. Weitz:            Of course.

Allison:                I will say two in the morning and two in the afternoon, so four. I’ve had people go up as high as eight when they had a lot of pain. The good thing is they don’t have to do that for more than a day or two, and then it usually comes down and that’s so wonderful about it. I definitely love SPMs as part of a chronic pain protocol, if you will. And then I love-

Dr. Weitz:            Yeah, go ahead. Go ahead.

Allison:                No, I was going to say, so I love bringing in… Using food as medicine and when I want people having snacks, having an anti-inflammatory tea that they can put protein powder in, they can put MCT in, they can put collagen in, whatever it is that they want to make it something more robust, but it feels really good on the hands, it feels tastes good in the body, and it just has all of these… Turmeric, and clove, and nutmeg, and cinnamon. It’s yummy and also just helps people. I’ve had people who hands were like this. It opens them up, which is amazing to see.

Dr. Weitz:            You’re saying if they make tea? What kind of tea is this? What are they putting in the tea?

Allison:                I have them make a turmeric tea latte.

Dr. Weitz:            Turmeric tea latte. Okay.

Allison:                Yeah. It’s absolutely delicious. What I also love about it is people sometimes have sensitivities to certain herbs or foods, and so because you’re making it yourself rather than a package, not that there’s anything wrong… There’s a lot of really great products out there, and not that there’s anything wrong with that, but if you have to… I can’t do this one spice. Okay, fine. Omit it from the recipe, but you can still have these anti-inflammatory herbs. You’re having it with a high protein, you can add fat to it or not, you can have it just as a tea or you can make it a more robust snack and it’s more bang for your buck, I think.

Dr. Weitz:            Okay. I’m not sure where to go next. What else do you want to say about autoimmune diseases?

Allison:                I think that they can all be… I don’t think that they’re a life sentence. I feel like when you have the tools, every single autoimmune can be, I don’t know what the word is. You can mitigate the symptoms. You have the tools where the flare-ups are going to be fewer and farther between, and if something comes up, you know why. Because I didn’t sleep, because I ate that crap I wasn’t supposed to be eating, because I forgot to eat, because I had that really stressful event happening with my family, and that was my trigger, but I know what to do.  I have different supplements, I might use foods, I might do mindset things I might, do all of the above. It’s not one thing. It’s not one thing that got you here. It’s not one thing that’s going to get you out of it. I feel like once upon a time, I maybe was afraid of a lot of these conditions that I didn’t experience, I didn’t know what they were, but now I know because I understand how the body works. I know that get them pooping, get them sleeping, get their blood sugar balance, and I know that everything else, once they’re functioning optimally…

                                Because look, if you’re not pooping, you’re not sleeping, and your blood sugar is imbalanced, then your liver is not working properly, then you are not detoxifying toxins and hormones, that backs up… It backs up, backs up, backs up, backs up into all of these other issues, neurological, and hormonal, and mood, and structural. If everything is backing up and then you’re creating leaky gut or if you’re having structural issues, it’s creating leaky gut, which then creates inflammatory and immune issues. It is just this vicious cycle.  If we get everything working properly, metabolizing properly, then it’s more of a ripple effect of positive benefits instead of going down this everything’s falling apart, which is I think where most people go. That’s definitely what was happening with me until I had this… It can happen really quickly for people, even if they’ve been struggling for 20 years with these things, we can get them into a place of relief and getting their livelihood back, 100%.

Dr. Weitz:            That’s great. Any final thoughts for our listeners and viewers, and then give your contact information?

Allison:                I would say do the work yourself in knowing what your non-negotiables are. Meaning when you go to a practitioner, know that you are taking care of yourself and advocate for yourself. Are you doing the sleep, poop, and blood sugar balancing? If you are working on that and you’re stuck, then work with somebody on how to get around that. Just know that your body wants to heal and there’s probably things that you didn’t know that haven’t yet been uncovered or nobody asked those questions, and that’s what we do in the functional approaches is we ask those questions, we ask all of these other questions.  It helps for you to know yourself and just know that anything is possible as long as you advocate for it, and also are willing to think outside the box and take some steps that might not be so comfortable to get to the other side of this complex thing by doing these simple things and your body and life will feel much better.

Dr. Weitz:            That’s great. How can listeners, viewers find out about working with you or signing up for some of your… You have some courses available?

Allison:                Yeah. I have a gift for your listeners. If they go to allisonsaman.com, and we’ll put that below, I have my roadmap to roadmap to chronic illness recovery. Essentially, it’s the five steps that I took. It took me 10 years to figure it out. It won’t take you 10 years to figure it out, but the five steps that will help you with these non-negotiables that you can do today or to tomorrow to move that needle within the next week or two where you’re starting to see change and it covers all the things that we were talking about. I feel like that would be the first great step.  I’m Health Allie on social media, Instagram, YouTube, Facebook. I would love to just hear how it works for you, what’s going on for you, and what you found to be most valuable.

Dr. Weitz:            That’s great. Thank you, Allison.

Allison:                Yeah, thanks so much for having me.

Dr. Weitz:            You’re welcome.

                                Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would appreciate it if you could go to Apple Podcasts or Spotify and give us a five star ratings and review.  If you would like to work with me personally to help you improve your health, I do accept a limited number of new patients per month for a functional medicine consultation. Some of the areas I specialize in include helping patients with specific health issues like gut problems, neurodegenerative conditions, autoimmune diseases, cardiometabolic conditions, or for an executive health screen and to help you promote longevity and take a deeper dive into some of those factors that can lead to chronic diseases along the way.  Please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at (310) 395-3111, and we’ll set you up for a new consultation for functional medicine. I look forward to speaking to everybody next week.

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Dr. Ben Weitz discusses Small Intestinal Bacterial Overgrowth.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on my WeitzChiro YouTube page.] 

Podcast Highlights

Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure.  Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.

Podcast Transcript

Dr. Weitz:            Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting-edge health information. Subscribe to the Rational Wellness Podcast for weekly updates, and to learn more, check out my website, drweitz.com. Thanks for joining me, and let’s jump into the podcast.

                                Hello, Rational Wellness podcasters. I wanted today to talk about small intestinal bacterial overgrowth and IBS and give my take on this important topic in the world of functional GI disorders. Now, we have had and will continue to have a number of interviews with various experts, and the bottom line is even though there’s a science behind everything we do, there’s also an art, and there is a difference of opinion about what is the best strategies for treating many of these conditions. And so I wanted to give my take on SIBO.

                                Now, SIBO is believed to be the cause in a majority of cases, 60 to 70%, according to studies published by Dr. Mark Pimentel, of irritable bowel syndrome, abbreviated as IBS. Now, irritable bowel syndrome is the most common gastrointestinal condition occurring in up to 50% of the US population. Now, what accounts for the other, say, 30 to 40% of cases of IBS that are not caused by SIBO? Well, some of these are caused by SIFO, which is small intestinal fungal overgrowth. They can also be caused by dysbiosis of the microbiome.  They can be caused by parasites, food sensitivities, and a number of miscellaneous other conditions related to the health of the gastrointestinal tract. Now, what are the presenting symptoms for IBS? We have gas and bloating, or gas or bloating, stomach or abdominal pain, constipation, diarrhea or alternating diarrhea and constipation, as well as a host of secondary symptoms including nausea, fecal urgency, meaning you have to go to bathroom right away, skin rashes often described as rosacea or eczema, acid reflux, upper abdominal pain, fatigue, depression, brain fog, and a series of other symptoms that may or may not actually be related to SIBO.

                                Now, the best way to diagnose SIBO is with a SIBO breath test. Now, let me just explain what happens in SIBO so you can understand what is the benefit of the SIBO breath test is that the small intestine usually has relatively low levels of bacteria lining the small intestine, and there’s several reasons for this. One of the reasons is because the small intestine is where the majority of nutrients get absorbed. So if you had a large number of bacteria that could potentially interfere with absorption of nutrients and that would not be a good thing. Second of all, the large intestine, the colon, is a very extensible organ. It could expand quite a bit.

                                And so if the bacteria and this does happen, if the bacteria in the large intestine produce a lot of gas, that gas forces these large intestine to expand, and that’s not a problem. But the small intestine is a smaller tube, and it doesn’t have the extensibility that the large intestine does. So if a bunch of gas is produced in the small intestine, it will often lead to stomach abdominal pain because it’s uncomfortable to try to expand that. And also just a sense of uncomfortability about the gas and bloating, and patients often feel like they’re overly full, et cetera.

                                So, in SIBO, you have an excess amount of bacteria lining that small intestine. And when you eat foods that contain fermentable fiber, those bacteria produce gas. Depending upon what type of bacteria or microorganisms are lining the small intestine, you can get hydrogen gas. You can get methane gas or hydrogen sulfide gas. And there are different microorganisms that account for each of those gases, with the methane gas being created by archaea, and archaea are actually primitive microorganisms there. They’re actually not bacteria, though they’re similar to bacteria.

                                And so we often refer to the type of gas produced as a way to explain what form of SIBO, which tells us about the type of microorganism, which helps guide our clinical judgment as to how we can treat these conditions because different antibiotics, antimicrobial herbs, other substances that can help to reduce the population of bacteria that produce hydrogen or hydrogen sulfide or the archaea that produced the methane. We also now recognize that the methane is produced… could be produced in other parts of the intestinal tract, including the large intestine.

                                So we now describe that the… we now describe methane SIBO as IMO, intestinal methanogen overgrowth. So the best way to test for SIBO is to use a lactulose SIBO breath test. Now, there are different substrates that can be used, and there are some practitioners that recommend glucose or fructose. And one well-known practitioner I’ve interviewed typically recommends all three lactulose, glucose, and fructose to be used. So the patient has to complete the SIBO breath test three times. Now, originally, we would do the SIBO breath test for three hours. Now, it is often recommended to do it for two hours, but a lot of practitioners still feel that doing it for three hours is more beneficial.

                                I prefer to do the newer Trio-Smart 3 Breath Test as compared to the older two-breath tests that measured hydrogen and methane. The Trio-Smart 3 Breath Tests also measures hydrogen sulfide, and I feel if we don’t do that, we’re missing out on 10 to 15% of cases of SIBO that are caused by hydrogen sulfite. Now, the old way was to do a two-breath test, and if you had a flat line of methane and hydrogen all the way through, that was considered positive for hydrogen sulfite. I don’t believe that that was really validated as an accurate way to test for hydrogen sulfite. And I think that some data comparing that with the results from the Trio-Smart 3 Breath Test indicate that that’s not an accurate way to do it.

                                However, there’s still still controversy. There are people who don’t believe in the effectiveness of the 3-Gas Breath Test at Trio-Smart, but I feel that there’s been enough research by Dr. Mark Pimentel and others to show that that breath test actually is the most accurate. And I also don’t think there… Since the reason for doing a two-hour breath test only is that anything after 90 minutes, at most a hundred minutes, certainly anything more than 120 minutes is going to be testing gas that’s produced past the small intestine in the large intestine. And we’re trying to just measure the gases in the small intestine. So I think that we only need to use the two-hour SIBO breath test. And I also believe that the lactulose is by far the best substrate to use.

                                For one thing, the glucose is not that beneficial because it’s usually absorbed in the proximal part of the duodenum, which is the first part of the small intestine. And very few patients have SIBO in that part of the small intestine. SIBO is way more common in the distal part of the ileum, closer to the large intestine. For most patients, fructose is also not needed, though there are a percentage of patients who have fructose intolerance, but that’s different than using fructose as a substrate for the SIBO breath test. The data shows that the lactulose is the most effective, and I think that’s the one that has guided me with my patients and been the most helpful.

                                Now, I also feel that most patients that see me for gut symptoms, like the symptoms related to SIBO, should also have a stool test so we can examine the microbiome and also look for parasites, fungal overgrowth, dysbiosis. And the stool test that we use also gives us some information about whether or not they’re secreting enough pancreatic digestive enzymes, whether or not they’re breaking down their fats, whether there’s inflammation in the gut, and how well the gut immune system is working as measured by Secretory IgA levels in the stool. And these are very helpful because they can help with part of our treatment as well.

                                For example, if the patient has low gut immune system function, then it’s going to be difficult to eradicate the SIBO even if we use the right agents that kill the bacteria or methanogens because we need the immune system to be participating in that. Anytime you have an infection, you need your immune system to participate in that, as well as whatever you do externally to stimulate the immune system. And also, when we think that the form of SIBO related to methane gas is now described as IMO or intestinal methanogen overgrowth, part of that explanation is that it doesn’t just exist in a small intestine.

                                So if we’re going to have any sense of whether or not there is an increase of methanogens in the colon, a good stool test that includes looking at methanogens is… specifically Methanobrevibacter smithii in the colon is going to be helpful to help us diagnose that. So I do think that a stool test can be part of properly diagnosing IMO. Now, how do we treat IMO, or how do we treat SIBO in my office? Well, first of all, it depends on the form because we use antimicrobial herbs and other nutritional agents, and we typically find that there are different… antimicrobials are more effective for one type of bacteria than another.

                                And like I said, there’s different bacteria that produce hydrogen versus hydrogen sulfide. And then we have the primitive microorganisms known as methanogen that produce the IMO. And we, through trial and error and talking to other experienced SIBO practitioners, know which antimicrobials are likely to be the most effective, the most tolerable, the ones that have the least side effects, and the ones that can get the patients better as quickly as possible for each form of SIBO. I find in my office that we typically have to do two to four months of antimicrobials, and we like to rotate the antimicrobials monthly so the bugs don’t get use to the antimicrobial natural agents that we use.

                                We will often make some changes to the diet at the same time. I may recommend a full low FODMAP diet, a modified low FODMAP diet, a specific carbohydrate diet, or we may just remove certain foods like gluten, dairy, beans, et cetera. It depends on the person. But we typically will make some dietary changes, though not always. And there’s many things that go into that, but looking at the whole patient and trying to understand what’s going on and what’s best for their overall health.

                                Now, we also know that a significant percentage of patients with SIBO, and this is from Dr. Pimentel research, that the SIBO was caused by a lack of intestinal motility. Typically, what will happen is the patient ends up with a bout of food poisoning, meaning they get a bacterial like E. coli or Campylobacter jejuni that causes food poisoning. The patient has a immune reaction to those bacteria, forms antibodies. Those antibodies then cross-react, meaning the antibodies designed to attack the E. coli attack structural proteins in the intestine that look similar.

                                And those structural proteins help to control the migrating motor complex, which is the part of the small intestine that leads to what are called cleansing waves. So when you eat, you have peristaltic action. You get this wave of contraction that goes through the digestive tract that helps to move the food through as your body slowly digests it. But there are cleansing waves that occur when you have a need for at least three or four hours that are these peristaltic waves that help to keep excess bacteria from building up in the small intestine.

                                And when these get damaged, you’re more likely to end up with SIBO to have an increase in those bacteria. So we will often use a natural prokinetic, something that helps to reset the motility as part of the treatment protocol, and we may use certain nutritional agents that help us to break up biofilms. Now, what are biofilms? Well, we know that bacteria and other microorganisms, fungi, methanogens, tend to produce a biofilm. So if you’ve ever seen in a stream where you get this moss buildup, that’s like a biofilm.

                                And so the bacteria surround themselves with this biofilm, and it’s a way to ward off the gut immune system. The bacteria want to continue to thrive in your intestines whether we want them there or not. And so that’s part of how the bugs are able to sustain themselves, and we may need to break down that biofilm to help the antimicrobial herbs to get in to kill those bacteria or methanogens.

                                Now, another thing that helps to keep the population of bacteria down in our small intestine are hydrochloric acid, which is produced in the stomach, bile, which is produced in the liver, started in the gallbladder and released into the small intestine, and pancreatic enzymes, and all three of those can help reduce bacteria in the small intestine. So if we see on a stool test or we have a sense that one or more of those are depleted, then adding in some HCL, some pancreatic enzymes, and or some bile may be an effective part of our SIBO eradication program.

                                Do we or do we not use probiotics for treating SIBO? Now, there is some data showing that certain specific strains have been found helpful in killing certain bacteria. And Dr. Jason Hawrelak from Australia, who runs the Probiotic Advisor, has cataloged some of these studies, and he feels that the use of specific probiotics is often an effective part of his protocol. There’s another popular podcaster in the functional gastrointestinal world. You may or may not know who I’m talking about, but he recommends probiotics as first-line for reducing SIBO, and he recommends three different types of probiotics, a lacto-bifido blend, a saccharomyces boulardii, and a spore-based probiotic.

                                And he finds that that’s very effective. I don’t. I have found that using some of those probiotics, specifically lacto-bifido blends, tend to increase the population of bacteria that we’re trying to eradicate. So adding more bacteria while we’re trying to reduce bacteria may not be the best strategy. And a number of the most prominent SIBO practitioners who I know and have spoken to, either at conferences or personally, also do not feel that using probiotics are helpful. Now, I have experimented with using spore-based probiotics during the initial killing phase for SIBO, and at some points, I feel they’ve helped. At other points, I feel they haven’t, or they’ve been neutral.

                                There are a number of people who recommend these spore-based probiotics, and one of the reasons for this is because these spore-based probiotics supposedly will not open up until they get through your small intestine and get into the large intestine, and that’s when they’re designed to open up. So, therefore, theoretically, they won’t contribute to more bacteria in your small intestine. But I have found that they don’t seem to be particularly helpful, and I’m already prescribing a number of natural agents for my patients to take during the initial phase of SIBO eradication, what we might call the killing phase or the remove and replace phase if we go with a Four R or a Five R Program that Dr. Jeffrey Bland came up with.

                                And I do think that, in general, that general strategy continues to make sense. And I know that’s controversial, and other practitioners have told me they don’t believe in that, but I have found that to be very helpful, and I think that that overall strategy continues to work. So I usually wait on probiotics till we get to the restore and reinoculate phase. So we may want to stimulate the gut immune system using specific type of non-dairy immunoglobulins. And as I mentioned, if the gut immune system is not participating, it’s going to be very difficult to eradicate these… the SIBO.

                                So not only do we need the proper antimicrobials, but we will need the gut immune system to be working. And so, we’ll use several strategies, one or another strategy, to help during this phase if the stool test seems to indicate that that’ll be beneficial, typically find that it’ll take two to four months of antimicrobials. I know other practitioners, say, one month, some will blast every possible natural agent all at the same time. Some will combine natural agents with prescription antibiotics like rifaximin. I prefer to use natural agents and to use two or three at a time and to rotate it monthly.

                                And I find that not only is that helpful… Now, of course, look, I wish we could eradicate it in a month. I have found that if we try to be too aggressive that too many of the patients come back with a lot of side effects and are unable to tolerate the treatment, and that’s not beneficial. So I would rather do it more gradually and give ourselves the amount of time we need, which is typically two to four months. Then, once we’re done with that phase, we go into the restore, reinoculate, and repair phase using prebiotics, gut repair nutrients, and probiotics, and often also using polyphenols. And we often will like to continue to utilize a pro natural prokinetic because we want to keep that motility going.

                                And for some reason, it takes in my experience and discussions with some of the other top SIBO practitioners, unfortunately, six to 12 months to restore that motility once it’s been damaged. Now, how do we know that motility has been damaged? In clinical practice, we don’t really have a good test for that. So there are some ways that clinicians have tried to have patients, for example, consume charcoal and see how long it works its way through the digestive tract. But until we get a good test for measuring intestinal motility, I think it’s safe to assume that most patients are having some issue with intestinal motility.

                                Prebiotics are specific nutrients that help the healthy bacteria in the microbiome to grow. Most of these patients have damaged guts. So we need to use typically a formula of gut repair and nutrients. And these will include one or more of the following nutrients, L-carnitine, zinc carnosine, and Acetyl-D-Glucosamine, L-glutamine, specific botanicals, typically what we call mucolytic herbs like deglycyrrhized licorice, aloe vera, slippery elm, marshmallow, okra extract, and cat’s claw. And I typically find two to four months of the restore, reinoculate, and repair phase is usually sufficient to get the patients feeling a lot better.

                                Now, what about some patient… Oh, another very important part of the restore, reinoculate, and repair phase is we want to bring back in most of those foods that we remove from the diet. So if I put the patient on a full low FODMAP diet, many of the low FODMAP foods are super healthy. Cruciferous vegetables like broccoli, cauliflower, brussels sprouts, legumes, other foods with fiber, many other healthy vegetables, avocado, et cetera. So I think it’s very important for people to be healthy to have a diverse diet with a range of different vegetables and nutrients.

                                So I very much encourage my patients to slowly test back in all the foods that they’ve taken out. Now, I also encourage them to test them in one at a time so we can test if that patient is still having a reaction to that food. And people do have reactions to certain foods, and this may just be their own immune system. But even if we’re unable to bring a food back in, in the future, we would like to continue to retest it because, ideally, we would like everybody to have no restrictions on what foods they need to eat. Now, it’s not a bad thing, I don’t think, to take a few foods out like gluten. I do think there’s a number of reasons to think that gluten is potentially harmful for many people.

                                Now, there may be a percentage of people… I do believe a percentage of people can tolerate gluten without any harm, but that’s one of those foods that I think it would be okay if you remove permanently from your diet. If you feel like you don’t react well to gluten, or you’ve had testing that shows that your body doesn’t react well to it. But otherwise, we would like you to have a very diverse diet, and we want you to have foods like legumes, which are such a great form of fiber, especially soluble fiber that helps to reduce your risk of certain diseases like colon cancer. And also, soluble fiber, we know helps reduce your risk of cardiovascular disease by helping to pull some of the unhealthy cholesterol out of your system, like oxidized LDL, et cetera.

                                So that’s basically the type of approach we will use with a patient. But everybody’s individual. It depends on many things. It depends where exactly what their symptoms are exactly what their testing shows. There may be other confounding factors. Do they have other conditions, autoimmune conditions? Do they have other gut problems, et cetera, et cetera? Patient could have an overgrowth of H. pylori. They could have a parasite. We may feel that that is the number one thing that we want to do is get rid of that parasite before we even try to address the SIBO.

                                And so it may take working through several layers of gut dysfunction, like using the metaphor of the onion where you peel off the first layer, then you get to the second layer, you peel that off, and eventually, you solve the problem. And I do think that there are a number of patients that have levels of gut problems, and we may need to work through each of those. And that’s another reason for doing a good functional medicine-oriented stool test as well as a SIBO breath test. Sometimes, an organic acids test, which may be better for picking up candida and fungal overgrowth than the stool test.

                                Some practitioners recommend to get a better stool test to have the patient use biofilm-busting agents for a week or so prior to doing the stool test. But this has not really been tested out by the stool test company, and I, at the present time, don’t recommend that, though I would love to see a study on that to see if there’s some efficacy for it, and it certainly makes some sense, and I doubt it would be harmful. So anyway, I hope I’ve given you some insights into how I treat patients with functional gastrointestinal disorders like SIBO, which we believe is the main cause of IBS in my office. And thank you, and I’ll see you next week for another exciting episode of the Rational Wellness Podcast.

Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would appreciate it if you could go to Apple Podcasts or Spotify and give us a five-star ratings and review. If you would like to work with me personally to help you improve your health, I do accept a limited number of new patients per month for a functional medicine consultation.  Some of the areas I specialize in include helping patients with specific health issues like gut problems, neurodegenerative conditions, autoimmune diseases, cardiometabolic conditions, or for an executive health screen, and to help you promote longevity and take a deeper dive into some of those factors that can lead to chronic diseases along the way. Please call my Santa Monica, Weitz Sports Chiropractic and Nutrition office at 310-395-3111, and we’ll set you up for a new consultation for functional medicine, and I look forward to speaking to everybody next week.