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Beyond Probiotics: Rebuilding the Gut Microbiome as an Ecosystem with Dr. Oscar Coatzee and Danielle Arnold  and host Dr. Ben Weitz.  

[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

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Dr. Oscar Coatzee has over 25 years experience in psychology and nutrition and is currently the VP of clinical education and practitioner support at Designs For Health. He has a bachelor’s degree in psychology and a PhD in Holistic Nutrition and  Doctorate of Clinical Nutrition.

Danielle Arnold is a clinical nutritionist and Functional Medicine practitioner and she serves as a clinical support specialist at Designs for Health, training healthcare providers in test interpretation and patient care.

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.

 

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Podcast Transcript

Dr. Weitz:  If you’re looking for clinically useful insights, not wellness hype, then this is the place for you. Welcome to the Rational Wellness Podcast, the podcast for functional and integrated practitioners who wanna practice with greater clarity and precision. I’m Dr. Ben Weitz, and each week I sit down with the leading clinicians, researchers, and lab innovators to explore the science lab testing and clinical reasoning behind modern root cause medicine.  This is a show focused on practical evidence-informed insights that you can actually use in patient care. Please subscribe to the National Wellness Podcast on Apple, Spotify, or YouTube. Please tell your friends and colleagues and if you could give us a ratings and review on Apple or Spotify, we would certainly appreciate it.  Finally, to access the show notes and the full transcript, please go to my website, drweitz.com. [00:01:00]

Today we’re going to challenge one of the most common assumptions in functional medicine, that if the gut is out of balance, we just need to add more probiotics. Many of our patients already taking probiotics.  Many have tried multiple strains, spore based strains, high dose blends, prebiotic fibers, and yet many of them still have gas and bloating and autoimmunity and metabolic dysfunction and dysbiosis on stool testing. So the real question is, are we thinking too simplistically about the microbiome? Emerging research suggests that gut repair is not primarily a strain selection problem, but it’s an ecosystem problem.  So what if instead of asking, which probiotics should I use, we started asking, What functions are we missing from this ecosystem? Today I am joined by [00:02:00] Dr. Oscar Coetzee and Danielle Arnold from Designs for Health to explore this and other topics related to the gut and the microbiome. And we’re gonna do a deep clinical dive into how to help our patients with testing and diet and supplements.

Dr. Oscar Coetzee has over 25 years experience in psychology and nutrition. He’s currently the VP of clinical education and practitioner support at Designs for Health. Danielle Arnold is a clinical nutritionist and functional medicine practitioner, and she serves as a clinical support specialist at Designs for Health, helping to train providers and test interpretation and patient care.

So, welcome Oscar and Danielle.

Dr. Coetzee: Thanks for having us, Ben.

Danielle: Yeah, thanks for having us.

Dr. Weitz: Absolutely. So, as functional medicine [00:03:00] practitioners, when we see a patient with gut health problems, how should we be approaching this?

Dr. Coetzee: Yeah, that’s a good question. You know, I think there’s a little bit, as you mentioned, a potential paradigm shift happening, you know, in the field of the microbiome and maybe some of these strains of probiotics.  I don’t think we’re currently sitting here and saying that, you know, all probiotics are not important and they don’t play a role. But I do wanna make a distinguishing balance here between what we would call keystone anaerobic strains and aerobic strains. Right? So, clinically we are not disputing the fact that several probiotics play a really important role when you’re taking them actively, but most of them are transient.

Dr. Weitz: Maybe for those listening who have no idea what an aerobic or an anaerobic strain is, maybe could you explain what the difference is?

Dr. Coetzee: Sure, absolutely. So the anaerobic strains of bacteria cannot live in an oxygenated [00:04:00] environment, so they live really deep in your gut, and those strains are really…,

Dr. Weitz:  and they couldn’t, for example, live in the small intestine, which has a lot of oxygen?

Dr. Coetzee: Correct.  And when you also have kind of bad bacteria growing in your gut, they do better in an oxygenated environment. So if you can establish the environment in your gut. That has this anaerobic area or environment, then you actually creating a very cohesive relationship for these strains of bacteria to help the other strains of bacteria work more effectively.  And then the aerobic strains are obviously the standard ones that you take in Probiotics generally, like acidophilus, biro, bacteria, and these things have an effect on us, not only mentally and immune system wise, but they need to be taken consistently because they’re transient. So once you stop taking them, they really don’t get to the point where they’re engrafting.  We are not seeing consistent engraftment from aerobic bacteria that you’re taking from a [00:05:00] lactobacillus of a big Biro bacterium standpoint. That’s more when you have a really good base of anaerobic bacteria that can do this cross feeding, cross communication. To all the other strains, so let’s call them.

Dr. Weitz: And so aerobic bacteria are bacteria that thrive in the midst of oxygen?

Dr. Coetzee: Oxygen, yeah.

Dr. Weitz: And then you’re pointing out a paradox, which we’ve all been dealing with for many years, which is that we all feel like giving probiotics the right probiotic after looking at, say, a stool analysis like the GI map and seeing that you’re low in this commensal or that commensal, and then adding it, thinking we’re adding it in just like we’re re-seeding your lawn by putting the grass seed in.  And then patients often improve and there’s benefits, but yet all the studies show that those bacteria that we put in those probiotics are only temporary visitors. None of them [00:06:00] actually are end up living there. And. That’s the case for all the bacteria that I’m familiar with. Is it the case?  Do we really know that these newer anaerobic strains that are starting to come on the market like Akkermansia eosinophilia, are they able to permanently colonize the gut? Do we know that?

Dr. Coetzee: Yeah. It’s been shown in some of the clinical trials that they will colonize the gut. They will repopulate because what they’re creating is a feeding cycle.  So let’s say you are low in a certain strain and you provide this commensal, anaerobic group of bacteria together, they will produce the byproducts to help feed the other strains, and then it just becomes a cohesive community. So there and apart from that, you know, we’ve known for many years that these keystone commensal strains, and that’s why they are called keystone, right?  Like just the stone in the middle of the arch that’s [00:07:00] keeping that arch up. They have been part of the human species.

Dr. Weitz: So, so hang on one second. So,

Dr. Coetzee: yeah.

Dr. Weitz: Most of us understand this from the perspective of a stool test. So we get a stool test, like a GI map, and there’s a section where it lists the commensal bacteria, and then there’s a subsection where it lists the keystone species.  And I think most of us think of these as species that are, have some extra level of importance. But what does keystone really mean?

Dr. Coetzee: The keystone species are the ones that literally form the foundation of the microbiome. So again, you know, like I’m trying to explain is that if you take an arch and you take that keystone, which is that stone right in the middle of the arch, you take it out, then that whole thing will collapse, right?

So look at all the other bacteria and all the other probiotics as the walls. They have an importance. But if you remove that one keystone, it’s going to be problematic. So there’s been several [00:08:00] areas of investigation and research where they looked at these keystone commensals, what they do, how many genes do they express, what is their metabolic associations?

And it’s literally approximately 80 to 85% of all the functionality in our bodies come from this. So I really like the listeners to kind of look at these keystone bacteria or these commensal species more as an organ system rather than a bunch of bacteria. ’cause they literally are essential to, to, to our health.

Dr. Weitz: Okay.

Danielle: And I would say like as, as far as engraftment that also might be a new word for some of the listeners. That means that it’s becoming part of the community. It’s able to, it’s not transient like the other ones. A lot of the. Other bacteria like bifidobacterium, lactobacillus, spore based, even spore based comes from soil.

Lactobacillus usually comes from food. So a lot of this stuff is from outside of our body. While it’s inside of our body, it’s supporting the microbiome and creating metabolites from being [00:09:00] there. But when it’s gone. I always say it’s kind of like you’re traveling and you’re spending your money in New York City when you leave your money leaves too.

It’s kind of the same type of situation when you’re taking probiotics. But with some of these anaerobic bacteria, these actually come from the body so they actually can become part of the community. So like for instance, you mentioned Akkermansia. That one, it also depends on if it’s live or if it’s not live.

If it’s live, it has a lot more propensity to become part of the environment. If it’s not live, you’re getting the benefits from the metabolites. But with. Which is a newer probiotic. That one also comes from the microbiome. It’s a really cool story how it was found. It’s, it was basically found because the researchers were like, why do some kids have peanut allergies?

And some kids have cow’s milk allergies and the other kids don’t. So they basically just, you know, isolated each of those types of microbiomes, inserted them into mice. And then, well, and before they inserted them [00:10:00] into mice, they tried to figure out what categorized what bacteria were there in present, and then isolate which ones were the most protective, most butyrate producing bacteria, which ones were missing there.

And then they isolated it all the way down to Roip and ero. Stipes tended to be. When they put it back into the mice that had those microbiomes the allergenic one and the non-allergenic one, they put them back into mice and they found that no longer sensitive to peanuts, no longer sensitive to cow’s milk allergies.

And then even further, they found that it regulated the immune system so much that type one diabetes, red mice that were supposed to go on to have type one diabetes did not go on to have type one diabetes when they were introduced this strain. So just really keystone, keystone of the keystone bacteria of a, of aeros that supports the rest of the microbiome like akkermansia, Vical, bacterium, berria.

So it’s a really big [00:11:00] foundational strain that without it, you don’t get the metabolites to feed those other microbiome.

Dr. Weitz: So for these keystone species to become permanent residents, it’s crucial that they be. Produced and then shipped cold re refrigerated, and then they’re kept refrigerated. In other words, they have to be alive.  Is that true? Because it. Bacteria probiotics are often sold as dead. They we’re told, or they we’re told they’re shelf stable. But the idea is that they’re more signaling molecules and that they’re not gonna be permanent residents, but if they’re gonna be permanent residents does this mean it’s crucial that they’re kept live the whole time that they’re kept refrigerated on shipping and everything else?

Danielle: Yeah, exactly. They come in a blister pack and what you’re talking about the non-live ones, they, those are the ones that produce the metabolites, but the live ones, [00:12:00] they have to come in a blister pack, they have to be refrigerated. You know, you can’t open the capsule. Luckily the ansip, I think it’s like 10% come.

They sporulate. So that means that if you do expose it to oxygen, the spore ba, spore based nature of it can actually protect and survive the stomach acid and survive transit time and survive production and everything like that. So it makes it a more of a robust strain.

Dr. Weitz: So it’s a keystone, but it’s also a spore based, huh?

Danielle: Yeah, it’s spore. It only forms spores at like 10%. 10% of them actually spor form spores. So if you have like a billion, then it’s what? What’s 10% of a billion will actually be spore forming.

Dr. Weitz: Interesting. Where is the spore form? Bacteria that we used to are basically various strains of bacillus.

Danielle: Mm-hmm.  Exactly. Okay.

Dr. Coetzee: Yeah. And in addition to that pen, you know, if you’re talking about the fact that it’s being kept live, you know, the what? What we are also looking at as a company is what [00:13:00] exactly. Is feeding each one of these individual strengths, right? Because we always used to just think it’s polyphenols and it’s generalized.

So actually the microbiologists that we are working with have been very surprised. And so have we, you know, some of our assumptions and some of our hypotheses might not have been what we thought it was. So what we did is we took a lot of our polyphenols and greens and reds products and the microbiologists started to looking at which ones would keep these guys excited and kind of feed them.

And we’ve discovered that several. You know, greens and reds products, you know, would be very specifically feeding the NRO tippy strain. And we are looking at the research currently of all the other strains. ’cause what we are finding is that they’re not all just feeding happily of all the kinds of fibers.

They’re very unique in what they want. So in the long run, what we are really trying to achieve is not only provide the patient or the practitioner with the opportunity to give something that can engraft, but we are also giving them the [00:14:00] fertilizer and the feeding mechanisms to do so. And you know, on that point I’ll you know, Danielle and I just published a very interesting case study on one of the cases that we looked at where we integrated.

NRO Steppe, CC LB 1 0 1, which is the strain that that Danny was talking about. And we went in there to kind of, you know, put together this case with a person that has food allergy and this person had daily allergy and gluten allergy. She took this product and, you know, with the mice and animal studies, like, why not?

Right? And this person completely was able to eat dairy and gluten without, you know, any of the severe side effects. But at the same time, we did a pre and post stool test, you know, like your GI MAP test. And what we found is that somehow the akkermansia actually was at a very detectable low level.

And somehow the NRO steppe fed the akkermansia to become normal within 12 weeks. And you would think Interesting. What’s the connection there? And then in addition to that, was the most incredible [00:15:00] finding, Ben, was it literally crowded out some very advanced overgrowth opportunists. Which where in the old days, as you know, we kind of will do an antimicrobial or whatever to bring down the atic, you know?

Right. That, of that opportunist. But this thing somehow crowded it out. And I think it was, what was it, Danny Pseudomonas or Morgan Ella or something to that effect.

Danielle: Yeah. I always call them the rootes bacteria. It was those

Dr. Coetzee: one. Yeah. It normalized it. So our hypothesis now with further studies, and we are gonna go deeper and do more of these is that it’s actually clearly repopulating figuring out what the bad guys are, start to outc crowd them.

And you know, we came up with this theory of why it might have been feeding the NRO stickies, which Danny can go into if she wants to. But that’s what’s so interesting about this, right? So we write that this frontier of amazing information that we can, and this is my analogy, you know, to your listeners traditional probiotics to me is a bouquet of flowers that you put in a vase.

Looks [00:16:00] beautiful. It smells good. It does the psychology that you wanted to do. What we wanna do with these things is have you grow your own flower garden so that you can snip your own flowers and put ’em in a vase and you can keep regrowing them, but you can’t just leave the flower garden outside, right?

You need to bring these additional elements to feed them and nourish them and care for them. And that’s where these other let’s call it prebiotics and associated polyphenols come in to, to feed them. Danny, do you want to go into the little feed cycle that we hypothesized on?

Danielle: Yeah. So, so how did the Roip feed the Akkermansia?

Yes. So they’re part of the same anaerobic tribe, I guess you could say. They’re all anaerobic bacteria, so what Roip is very well named bacteria. It’s anaerobic, so it drives down the oxygen through. Creating butyrate. When you burn butyrate, you drive down the oxygen. That’s kind of how the mechanism of how that happens, and that is able to create a lot more metabolites to feed the akkermansia to come back.

There’s [00:17:00] also more mucin creation, which akkermansia a lot of people think, oh, just take polyphenols. Akkermansia loves polyphenols. That’s actually not the connection. Polyphenols feed the mu two genes. They turn on the mu two genes in our goblet cells to produce more mucus akkermansia eosinophilia, also very well named, only likes mucin.

So feeding the specialized cells that feed. It was what the butyrate was also doing, and then the crowding out of the bacteria, how that worked as well too. Like, Dr. Coia had mentioned the bad bacteria love oxygen. So if we’re driving down that oxygen, you’re basically like choking them out and so they can’t live if you and we, that, that was the only intervention that we used in this case is aero stipes.

We did not use anything else and we had so much good movement, which you would use like a dysbiosis protocol and, you know, some prebiotics and probiotics and all these things, but just this one bacteria really changed the [00:18:00] entire playing field, the entire ecosystem for this person.

Dr. Weitz: Yeah, it’s kind of interesting In no world of functional gastrointestinal disorders in in the functional medicine world, a lot of practitioner, it’s common for us to use like a four R or a five R program. Mm-hmm. Like you’re talking about where we’ll do a stool test and maybe we’ll see a pathogen, or more likely we’ll see dysbiosis or maybe we’ve got a positive SIBO breath test and so we’ll use antimicrobials of various combinations to reduce the bacteria that are overgrown or that are shouldn’t be there or are in higher numbers than they should be.

And then we’ll follow that with probiotics and prebiotics and gut healing nutrients. And that’s something like that as part of, you know, along with maybe a few other things here or there, you know, motility agents or gut immune system support is. [00:19:00] Part of a functional medicine protocol for GI disorders.

And there’s a few practitioners out there have been saying no, just use probiotics and the probiotics will crowd out the bad guys. And I’ve tried that protocol using even a combination. Like there’s one prominent practitioner who says, well, you just have to use a lacto bifido strain and you have to use a sac bullard and you have to use a spore base strain.

And if you use that combination of all three of those, it’ll just eliminate SIBO and crowd out the bad guys. And I never found that to be effective. And I’ve tried it and I think most of us. You know, I know a lot of the practitioners in the SIBO world like Allison and Becker, and none of us have really found taking probiotics to really do that.

They always seem to make SIBO and some of these [00:20:00] other functional gut disorders worse. But yeah, using a keystone strain sounds like this might be something really novel that has properties that taking traditional probiotics doesn’t.

Danielle: Yeah, I think that’s one thing I kind of learned early on is just that the sibo, if you throw in probiotics, you’re gonna make a lot of things worse real quick, and you’re not a patient real quick.

Dr. Weitz: Right.

Dr. Coetzee: Yeah. Look and Ben, I think we’re all part of this week. Look, we are all in the functional space. We all, you know, and I’m sure you’ve been in practice for many years looking at your many

Dr. Weitz: years.

Dr. Coetzee: Yeah. And the amazing work, I think

Dr. Weitz: 37.

Dr. Coetzee: And you know, I’m a big I’m a big believer in the five R program, but it’s just like that re inoculation phase, we just assumed that it re inoculates it, it really doesn’t.

Right. And

Dr. Weitz: right.

Dr. Coetzee: And maybe the listeners don’t understand, so why? Well,

we’ve

Dr. Weitz: been hoping that the signaling helps restore the microbiome, even though we know they’re not gonna be permanent residents.

Dr. Coetzee: And,

Dr. Weitz: you know, we’re hoping maybe with the [00:21:00] Spora base, because they’re encapsulated and they’re gonna get all the way into the colon, that’s gonna have some special, you know, benefits.

Dr. Coetzee: But you know what, maybe. Maybe there were some of those things that happened because we didn’t test their anaerobic status. Maybe they were good in Akkermansia, frow and Rose Bia and anaro stipes you know, bacteria. And therefore these probiotics actually helped. But for the group of people that are low in those anaerobic keystone commensals, none of that stuff will work because you do not have the feeding cycle.

You do not have, and I think one of the analogies that, that Danny and I always use is we use the phone and the chip card, right? Like the, all the other probiotics is the phone. And without that sim card, it’s really not worthwhile. So the keytones are that SIM card. And the other way to look at Keytones is maybe for the listeners to look at earthworms, right?

Like the earthworms in the soil. And they live at different levels of pH and oxygenation. They [00:22:00] really the reason that all this stuff is happening on the topsoil. And I think that a lot of these other things are just topsoil discussions. And that’s why, you know, we are only talking about one strain.

There’s more strains coming. But the listeners might want to know what, well, why haven’t we done this before? Right? Why hasn’t this been out before? And the reason is that the technology never existed to be able to extract these anaerobic bacteria ’cause they’re anaerobic, right? They don’t live in an oxygenated environment.

So,

Dr. Weitz: and it’s a real challenge to have a lab that can produce these. Correct. Because even a little bit of oxygen will destroy the production right.

Dr. Coetzee: Yes. And so, so there’s been some heavily scientific advancements in that area for probably way above my brain scale. I always talk to to tell people that these people are the people with five pens in their pockets.

They really understand everything, you know, from a lab standpoint, but they have been able to extract these microbes. Now, what’s also unique in this is not coming from a bunch of [00:23:00] different delivery systems. This is coming from single donors, right? So, you know, you’ve heard of the fecal transplantation success that people have on c diff.

Dr. Weitz: Yeah,

Dr. Coetzee: right? I’m not saying that’s the answer to everybody, but imagine that you can have a keystone commensal bacteria that comes from an extremely healthy donor. So his ecosystem is communicating. So he’s fpr and all the commensals are already trained to work together, and you can put that in another person without adding the fecal side of it.

That would be amazing. Right. So that’s kind of where, in layman’s explanation where this thing is heading.

Dr. Weitz: Yeah. It’s interesting there’s one company that has produced the poop with dead bacteria and put it in a capsule and I guess it’s like a bunch of signals that is a benefit to the gut as well.

Danielle: Yeah. I met them at a four M and I think I met the, [00:24:00] one of the scientists antibiotic.  Yeah. And they’re basically benefiting from the metabolites that are coming from kind of like the dead akkermansia. They’re benefiting from the metabolites of that. But they have trouble scaling. They have trouble scaling because how are you gonna get so many good poop donations to turn to, to kill and then give to another person?  So because they have that trouble with scalability, they’re always looking for healthy donors and they kind of get capped at a certain point.

Dr. Weitz: So this strain that that is now out on the market from Design for Health. What is it called again?

Dr. Coetzee: ROIs.

Dr. Weitz: ROIs. Is the GI map going to be, is that gonna be available as part of the GI Map stool test?

Dr. Coetzee: It’s funny you asked that. Yes. We’ve, you know, we have a very close relationship with Diagnostic Solutions Laboratories and that is actually going to become part of the anaerobic.

Dr. Weitz: How did I guess

Dr. Coetzee: that? Yeah, exactly. [00:25:00] So good move, good guess on that.

Dr. Weitz: Great. So what are some of the things that help the NROs to to flourish?

Is it prebiotics? Is it polyphenols? Is it both?

Dr. Coetzee: Denny go with that one.

Danielle: Yeah, so we, like Oscar had mentioned, we, we hypothesized that, you know, polyphenols and maybe some resistant starches or something like that would feed it. So we had given all of a sample of a bunch of our products that had these type of constituents in their products to the microbiologists.

And he had run a test and you know, it’s a lot of them registered on the Richter scale of definitely helping. But one of them was just off the charts. It was our Essentia Greens and Reds product. That one just ev it was even I wanna say, and correct me if I’m wrong, Oscar, but I wanna say it was even better than their glucose, you know, ’cause glucose would automatically feed it and have it grow.

Was it better or was it a little bit

Dr. Coetzee: [00:26:00] less? No, it wasn’t as good as the glucose. Okay. But what was surprising to the microbiologist was how close it was. Mm-hmm. And. And so, so here’s the next step, Ben. You know, our essential Greens and Rates product clearly is a bunch of, you know, it’s got a

Dr. Weitz: lot of stuff.

Mm-hmm. Do you have any idea which of the essential things

Dr. Coetzee: that’s the next step? That’s what we are working on now, investigating and extracting each one of those particular entities and seeing how they feed so that eventually we can come up with, Hey, it’s this, and this that feeds this strain this and this that feeds this strain.

Or like a

Danielle: symbiotic or something. Yeah. Mm-hmm.

Dr. Coetzee: That’s the beauty of the relationship currently with what we’re doing in the research. But basically, if you were to take the essential greens and rates with the nano step product, we know that’s going to feed that strain to engraft and then do cross feeding and have the results that, that we would what, what want you to see.

Dr. Weitz: And so, this Keystone Strain is a butyrate producer and we know the importance of butyrate. Can you talk [00:27:00] about the importance of butyrate for gut health?

Danielle: I could talk, like, I could talk about it all day, but because you could have like a whole podcast just on butyrate. But butyrate is a great, and

Dr. Weitz: by the way, other short chain fatty acids that are kind of the forgotten sisters, right?

Like propane and acetate, acetate,

Danielle: propane acetate, yeah. And propane eight and acetate. They kind of go systemic a little bit more. Butyrate stays a little bit more in the colon. That’s why there’s so much focus on butyrate is because it does you know, seal up the tight junctions. It also stimulates that mucus production as well too.

It also activates mu two genes to do that. It also supports immune regulation as well too. So it’s an HDAC inhibitor, which means that it can turn on and off genes and some of the genes that you want to turn off, it can turn ’em off. So, what is

Dr. Weitz: HDAC?

Danielle: HDAC is his stone. DAC delay.

Dr. Weitz: Okay.

Danielle: And I don’t know, I [00:28:00] don’t know what the last part is, but it’s a histon deacetylase inhibitor.

Okay. I think that’s all of it actually. I think I got it. Yeah. So, so basically it just can turn, can silence some genes that you would want, turn on some genes that would regulate the immune system like upregulate, tregs, upregulate some cytokines that you would want for inflammation. Turn down some cytokines that, that actually cause a little bit more inflammation that is kind of out of control.

So it’s a really po powerful molecule, which is why it’s so focused on and it’s also something that we can measure, you know, so that’s why we have so much data around all the things that butyrate can do.

Dr. Weitz: Okay. So, what about conventional probiotics? They still have benefits, right?

Dr. Coetzee: Of course.

Yeah. I mean, if you’re, look, if you look at, let’s just go into a certain area of specialization, let’s go into the mental health sphere, okay. And you go look at some of the research on, you know, some of the strains of bacterium and lactobacillus and [00:29:00] how they affect people’s mental health status. 100% effective in that particular area.

And that’s an area that I kind of work on, as you mentioned earlier, with the psychology and the nutritional psychology. And

Dr. Weitz: there’s actually very specific strains that have very particular benefits.

Dr. Coetzee: Yeah. Well, if you’re talking about one, I don’t know if the one that you’re referring to is the bifidobacterium Longum 1714 strain.

That’s the strain that I’ve used at, you know, at length for anxiety and depression. I think several of the long-term strains play a role with that. And then obviously several of the other strains of lactobacillus and bifidobacterial in combination has shown radical improvement in mental health.

But again. You gotta keep taking it, right? It’s not necessarily going to improve the situation if you stop taking it. But I guess that’s, no, not really. If you have to take a probiotic to make you feel better mentally for the rest of your life compared to maybe a psychotropic drug, I think most people will offer the probiotic.

I don’t think that is a really bad [00:30:00] scenario. Right?

Dr. Weitz: Absolutely

Dr. Coetzee: not. Yeah. Yeah. So I, so, so the key thing that we trying to say is that probiotics are phenomenal things, right? I mean, there’s a gut-brain connection. There’s, like Danielle was saying with the butyrate, the association there’s dendritic cell connection.

We don’t even know the tentacles of where it goes. So we don’t wanna sit here and minimize all the aerobic bacteria. It’s just that we’re saying like, maybe if you get your anaerobic status at the higher level they might even make those probiotics work even better. You know, and more effectively.

So I think there’s a tremendous space for that. There’s also EPO as you know, you know, with Diarrhea Without a doubt, that is an effective probiotic, you know, when it comes to that level. So I am certainly not moving away from the probiotic space, but if I’m working with long-term gi intense malabsorption, long-term sibo, nothing has worked.

Dr. Weitz: Right. We

Dr. Coetzee: find consistently that iCal, bacterium Press, akkermansia, rose, BI, [00:31:00] and Aristas are low. That’s just factual if you want. Yeah,

Dr. Weitz: we definitely have. Especially practitioners who are been practicing a long time sometimes track some of these more difficult patients where nothing seems to be working.

And I, I think a lot of practitioners start looking for other things. They look for mold, they look for Lyme disease, they look for mast cell activation.

Danielle: Yeah. And I find that a lot of times when you have like that financially burdened patient, you know, the more you can simplify their protocol. Sure.

The anaerobic bacteria kind of are like a jack of all trades. You know, they work on the immune system. So your secretory iga a, they work on zonulin, they kind of seal up those tight junctions, and then they also support bringing the good bacteria back and kicking the bad bacteria out. It’s kind of like.

If I have someone that doesn’t have a lot of money, I’m gonna go with the best bang for the buck. And that’s usually an anaerobic bacteria.

Dr. Coetzee: And Ben [00:32:00] actually, something just came to mind to me is that, you know, if you look at lactobacillus right, it produces lactate, right? And er actually feeds off lactate.

That’s one of its main food sources. And if you look at Al Bacterium, pros needs ca it likes to eat acetate and then the acetate converts to butyrate. ’cause FPR is a big butyrate producer. So when you start looking at that and Akkermansia by itself is basically the product producer of prop and what am I leaving out to LA Lactate?

Correct. Something other species are obviously utilizing some of that for their energy source. So it becomes an endless pool of, I’m producing you feeding, I’m producing you feeding. And then these other species, I think what we are going to learn in the future is that they actually produce some of the substrate that help these guys.

On a consistent level. So when you’re eating a probiotic and you’re having lactobacillus or whatever in there, it’s actually producing the food to feed the anaerobes. So there is no negative, in my opinion, in the long term if [00:33:00] we can figure out exactly what’s communicating with what, and maybe that’s the signaling molecule that we always thought that was there.

Maybe it’s just the byproduct of what, how they feed each other and work as a community

Dr. Weitz: And we can now measure these short term fatty acids as add on to the GI map stool test. Does. Is that something that’s helpful in this situation?

Dr. Coetzee: Yes. As a matter of fact, we’re going to do a clinical trial on, you know, a certain amount of people that fall into the criteria of an inclusion that are very low in these opes with very specific IBS symptomology.

And absolutely we are going to do GI Map plus the add-on. For the butyrate and the acetate and the proprio, that’ll only be helpful because then we are really gonna learn right at the elevation and the increase of each one of these particular strains. So that’s the exciting part for us as a company.

You know, we are not just a nutraceutical company. We’re now actively involved in the scientific investigation and the publication of some of the work that we are [00:34:00] doing. And yeah, it just gives us a better a better knowledge base and get a little bit of away from the the shotgun science theories, you know, that we’ve built a lot of our industry on.

And I think you agree that all of us as nutritional experts, we do kind of practice hypothetical. Medicine, right? Because we are trying this with this because it makes sense.

Dr. Weitz: Well, what we like to say as evidence informed.

Dr. Coetzee: Mm-hmm. Yes, exactly. I think we just want to get a little bit more specificity in that so that the patients can get better outcome and maybe the listeners don’t know that people why if Fi kb bacterium pros and Roseberry and Akkermansia are so normal to us, why are we low in it?

And literally again, it’s the environment. Glyphosate, antibiotics, protein pump inhibitor use, the standard stuff that puts us in the IBS status is really driving, you know, the low status of this because I’m sure, Ben, you look at a lot of GI maps, I’m sure you see very few that don’t have at [00:35:00] least one of those anaerobes low.

Dr. Weitz: Yeah. Very common.

Dr. Coetzee: Yeah,

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Dr. Coetzee: No, it activates it, it activates this hypoxic inducible factor.

Right? So it’s literally changing the environment of the oxygen. And then with the lack of [00:37:00] oxygen, these other buggers die. Oh, interesting. Mm-hmm. Right. So it’s not an antimicrobial, but the microbes that are bad, they don’t like that environment. So you really kind of like spreading that environment.

You’re making it too acidic or deoxygenated for these guys to live in harmony. So it’s literally you’re changing their environment and their zip code, and. Leave, you know, because

Danielle: you Yeah. It’s a true way to crowd them out, you know, ’cause the crowd out theory, you have to use that a lot in children ’cause you can’t use a lot of antimicrobials and things like that.

But it’s a true crowd out in p theory working in practice because you’re stealing the oxygen from the environment that the bad guys like.

Dr. Weitz: And is Fungus playing a role in this, like candida? You know, Dr. Rebar is a friend of mine. He’s a functional gastroenterologist in Los Angeles and he sees a lot of patients with sibo.

Who he finds that fungus is playing a big role in that and he’ll use antifungals and get benefits and [00:38:00] he feels that the fungus is changing the environment that facilitates the microbes that cause si

Dr. Coetzee: Yeah. I, you know, that’s even called CFO right now, small intestinal, fungal yeah. Call it.

Yeah, I don’t know enough about that yet, but I will say that if you look at nature and you look at soil and you look at the fungi plays a positive role there, right? So I think as a community of professionals, we gotta be, and I’ve been guilty of this myself, we gotta be careful in trying to destroy all fungi, right?

Oh

Dr. Weitz: yeah. We haven’t gotten to the point of looking at the micro fungo or, but I’m sure there’s probably a range of healthy fungus that should be there for healthy gut.

Dr. Coetzee: I mean, you literally cannot have plants growing and soil growing without fungi. You know? It’s a very important part of the feeding system of how plants grow, right?

But I think what happens, and I think this is just again, the environment. If you have the right status of oxygenation [00:39:00] versus non oxygenation, the amount of fungi that’s supposed to be there will be there, right? Because they know how much of them. But if you change the environment where the fungi can kind of feed, then it becomes a different thing.

I’m even willing to go as far as saying this, and this is just my theory, right? These kinds of strains of bacteria can be so effective that even people that don’t eat perfect diets and maintain this perfect lifestyle that we trying to promote as healthcare professionals, because they’re just not in it as much as we are, I think they can still have benefit from this.

You know what I mean?

Dr. Weitz: Of course. Who knows what the perfect diet is.

Dr. Coetzee: Yeah. Yeah. But I’m talking more about the fast food McDonald’s kind of thing. Oh yeah,

Dr. Weitz: sure.

Dr. Coetzee: You know, those people are gonna be low in those opees. Yeah. If we can even the,

Dr. Weitz: they’re gonna be low in everything.

Dr. Coetzee: Replace them.

Yeah. And except for

Dr. Weitz: body fat.

Dr. Coetzee: Yeah, exactly. Exactly.

Dr. Weitz: What do we know anything [00:40:00] about some of the other micro organisms like Archaea that are the methane producers in sibo, are they playing a role in any of this?

Danielle: So the archaea, they are a commensal bacteria, so they do play a role. So what the archaea does is they support the mucosal layer, right?  The akkermansia eats off the mucosal layer so you don’t also knowing that they are part of that SIBO pattern when elevated, you don’t also just wanna kill it off because you see it close to the ref, you know, top of the reference range. You want it to be there, you want it to be present because it is part of a healthy microbiome, just like we’re talking about, you know, some fungus or part of a healthy microbiome, but you want it within a healthy reference range because it does support the mucosa.

Even dis fibrile. That one also creates some sulfur that are important to the musa as well too,

Dr. Weitz: right? That’s one of the organisms that Dr. Pimentel is identified as a cause of [00:41:00] hydrogen sulfite, sibo.

Danielle: Mm-hmm. Exactly. Yeah. So when that is elevated, that’s also a commensal opportunistic bacteria. It can become an opportunistic when it’s out of range.

So you definitely wanna keep those in check. And when they’re out of check, that’s when you get the symptomology of like the bloating and a lot of the SIBO patterns like IBS alternating diarrhea, constipation with some of those things.

Dr. Weitz: And what about the role of the mucus? We understand that the mucus is an essential part of the mucosa.

On the other hand, it’s also sort of a biofilm that. Makes it easier, safer. The organisms, the microorganisms like the ArcHa and the bacteria that cause SIBO to grow and trying to eliminate sibo. We’re often trying to break up the biofilms, which I think part of that means breaking up the mucus layer.

And in fact, even Dr. Pimentel is working on a new [00:42:00] antibiotic that includes NAC because it breaks up mucus.

Danielle: Yeah, NAC is definitely a dem mucolytic. NAC is something that I definitely use as a biofilm buster as well too. But the mucus layer in, in my. View of the entire picture is kind of like a physical barrier that kind of protects you.

If you have wide open tight junctions, like a lot of zonulin signaling to the tight junction receptors then that mucus can protect you. But if you have a thin mucus layer, then you’re gonna have just, you know, things getting from the gut into the bloodstream that shouldn’t be there. So it’s I call it like a slowdown zone.

Everything has to slow down there. That’s where the immune system lives. It touches everything. It makes an immune response or it checks it out and says you can go on through. So it’s a really important part of our microbiome.

Dr. Weitz: So you don’t want too thin a mucus layer, but we also don’t want too thick a mucus layer because it will be producing [00:43:00] this biofilm that might be making it easier for some of these negative players to flourish.

Danielle: Yeah, exactly. Always in balance.

Dr. Weitz: Alright. So what do we know about different foods that are gonna feed into the short chain fatty acid production and the, and these com important commensal, keystone species?

Dr. Coetzee: Stay tuned. You’re turning a lot. Well, look at this particular point. You can’t go wrong by just having diversity of colors and fiber and polyols and proper sugars, right?

The, these things require proper sugar exposure over a period of time. We also looking at some of the sugars and how they fed, you know, we are actually investigating allulose as one of the feeding sugars, you know, in this ’cause it comes natural in some of these fruits and vegetables. But we don’t know exactly yet.

So we are just going by the generalized approach of, hey, you know, if you diversify. The polyphenol fiber intake, you’re [00:44:00] definitely gonna feed some of them. That’s gonna help the other one feed itself. So it’s not a negative as long as it stays within the parameters of not affecting that person dramatically.

’cause Right. If you increase fiber a lot with the average individual with gut issues, it’s gonna get worse. Right. Right. So we’re not trying to

Dr. Weitz: fiber such a Yes.

Dr. Coetzee: Yeah.

Dr. Weitz: Tricky thing. We all know we need more fiber. We, most people eat very little fiber. Plays a role in reducing risk of colorectal cancer and keeps things moving and is important for motility and as prebi, but too much fiber seems to cause bloating, especially in patients with gut problems and can feed sibo, et cetera.

So then we toy with different types of fiber and you know, there’s certain types of fiber that have been shown to be beneficial for SIBO and other forms that are not. So, it’s fascinating the whole concept of fiber and which [00:45:00] fiber should we consume, but I think in general, if we can have more fibers and different kinds of fibers, it’s probably gonna be beneficial as long as it doesn’t increase symptoms.

Dr. Coetzee: And I’m sure you’ve spoken about this to your listeners, but you know the average American is taking in about 17 grams of fiber a day, right? And

Dr. Weitz: Yeah. Or less.

Dr. Coetzee: Yeah. Yeah. And our theory is look, I mean,

Dr. Weitz: probably 15 of those grams are from the wrapper.

Dr. Coetzee: Yeah. And you know, I think 50 or higher, right. But nobody can go there immediately if they haven’t done it because it’s just gonna create,

Dr. Weitz: That’s very difficult to get to.

Dr. Coetzee: Exactly. But if you go ancestrally and you look at some of the history and what people ate the theory, sure it was between 50 and 80 grams because sometimes people had to eat fiber ’cause I was starving. So it was the only thing that could satiate them. So I definitely think our microbiomes are highly affected.

So if there’s one key component that I can tell everybody on this call is you need to increase your fiber [00:46:00] to reestablish these strains. I will say this, that I think the body is intellectually designed like Danny was saying. To reinstitute these bacteria. So if you give it the opportunity, it’s gonna go.

And I think again, for us, what we are learning the most is that it’s almost like it has its own intelligence. And if you leave it up to them, they’re gonna sort out all these bacteria that might be overgrown, producing methane and hydrogen. It’ll sort itself out if that environment has enough pre and post feeding potential and engraftment.

That’s literally what I think is we are gonna, what we are gonna see happening in the future, which is encouraging because it takes a little bit of the guesswork out of our hands, right? It’s here’s what you need, go do your thing so that all the other probiotics and things can be more effective.

Dr. Weitz: So this new probiotic where should we be using that? Let’s say. I have a patient that tests positive [00:47:00] for sibo. Is that something I might consider using in place of antibiotics or antimicrobial herbs to start with?

Dr. Coetzee: I think so. You know, early days, right? So, you know, you as a practitioner will, will kind of see what we’ve been seeing.

I’ve been using

Dr. Weitz: experiment a little bit.

Dr. Coetzee: Yeah. I’ve been using this an anaerobic strain in my practice now for six months. And I’ve literally seen, we’ve only published one case, but I’ve literally seen this consistently. Like I can see the crowding out scenario taking place, you know, even though that’s not the perfect word for it, right?

You’re changing the hypoxic environment. I think once you add the other ones in and you have the complete game plan you know, these five strains or these 45 strains, 85% of metabolic function in the body. I was just looking at a study two minutes ago before we got on the call where there was an investigation on Akkermansia by itself.

On advanced stage type two diabetics and just giving Akkermansia and it’s ra it radically improved [00:48:00] hemoglobin A1C.

Dr. Weitz: Yeah, they I know there was a study done using Akkermansia specifically for diabetes, right?

Dr. Coetzee: Yeah. So, you know, clearly we’re, there’s the Metabolism Association and everybody’s always talking about GLP ones.

These keystone commensals will activate the five to six areas in our guts that actually produce natural GLP ones. So it might be the best alternative eventually for us to move into that space for it. Now, am I saying that this is the answer to everything? No, I think you should still take a digestive enzyme and B vitamins and vitamin D and you know, all the other nutraceuticals that we are talking about.

But I do think that we’re on top of, as I said in many presentations, the paradigm shift for the industry as such.

Dr. Weitz: Alright. So what else do we want to talk about in terms of gut health?

Dr. Coetzee: I don’t know.

Danielle: I was just gonna touch on one other thing about, you know, the, because you were asking about specific fibers, I think and like [00:49:00] Yeah.

When we were talking about fibers going low and slow, like Oscar said, don’t go straight to 50. Right. But I always say go low and slow. Resistant starches have been shown to feed fatali, bacterium, protia. That one can you definitely wanna go low and slow with, okay. If you’re going to supplement a resistant starch type of.

Supplement because if you, I, and I only get people,

Dr. Weitz: so just explain what a resistant starch is for those who don’t know.

Danielle: Yeah. So a resistant starch just means it’s resistant to digestion. So that means it makes it all the way down to the colon, and then the microbes can then like ferment or break down those and use it as f as a food source.

So that means that they get food. When you give resistant starches, they actually get some scraps down there, and those scraps are very beneficial to them because then they can create the butyrate, the acetate, the ate but a lot of times eating resistant starches can be very difficult for a lot of people.

So I do tend to supplement that a little bit more for people and thinking about the foods from [00:50:00] resistant starches. Cold rice, you know, like, so if you’re a bodybuilder and you’re kind of, you know, food prepping, that’s easy. But

Dr. Weitz: so, so resistant starches can occur from cooking cool potatoes or rice and then cooling it.

Danielle: Mm-hmm.

Dr. Weitz: And then that’s when you get the resistant starch.

Danielle: Yeah. Something happens within the cooling part of it that I wish I could

Dr. Weitz: go off

Danielle: on

the

Dr. Weitz: mechanism. I think it actually do with the carbohydrate chain and the way it gets modified.

Danielle: And then that makes it a resistant start. So those are pretty easy.

You know, those are pretty accessible. Cold, sweet potatoes, cool rice. A lot of the, a lot of other ones are like Jerusalem artichokes. My husband and I laughingly call them far toch chokes because they will make you a little bit gassy if you’re not, if you’re not used to these things. Right. But they’re delicious.

They’re a great replacement for potatoes, like if you’re trying to lower your glycemic load. Resistant starches are a great thing to do as well too for glycemic load. [00:51:00] So, Jerusalem artichokes are also known as sunchokes. Those are great. Kind of blanking on some other ones, but those are the big ones.

We top

Dr. Weitz: mind a of people are using partially hydro hydrolyzed Gugu.

Danielle: Gugu, yeah. Mm-hmm.

Dr. Weitz: Partially hydrolyzed P hg.

Danielle: Mm-hmm.

Dr. Weitz: That’s the one form of fiber that’s been shown to be beneficial for sibo, for example.

Danielle: I think sun sun fiber is also like the name of

Dr. Weitz: it. Yeah, that’s the same thing.

Danielle: Yeah, exactly.

And then green bananas, green plantains, those are also, so there’s also green banana powder that you can like bake with and things like that. Oh, okay. So that’s also a way, Kova is another resistant starch. So there are ways to feed that super, because fecal bacterium is one of the highest butyrate producing strains I think.

And then ROS is one of the highest butyrate per strains that we’ve encapsulated so far.

Dr. Coetzee: So I have a question for you, Ben. You know, yes. That you talked about SIBO and doing as many GI maps as you’re seeing, apart from the [00:52:00] obvious things like the methane producing bacteria, whatever. What are the patterns that you’re seeing from the stool test standpoint, maybe with the anaerobes or the opportunists?

Is there any kind of pattern that you’re kind of seeing clinically that stands out to you? You know.

Dr. Weitz: Well, we certainly have the patients who test negative SIBO on a breath test, and then they were left with dysbiosis and there’s certain strains that seem to come up a lot like the staff and strep and,

Dr. Coetzee: correct.

Yeah. Yeah.

Dr. Weitz: And, you know, wonder, you know, is everybody have that or is, you know, how accurate is that? A lot of times see Bacillus High and then I usually ignore that because mm-hmm. You know, we love bacillus ’cause it’s our spore base strains, so I figure that’s probably not a player, but I don’t think anybody’s really mapped out the specific symptoms with specific types of dysbiosis.

So I just know I have a patient that has. [00:53:00] Constipation or they have bloating or they have stomach pain and we’re looking for a cause and the Sibos negative. So we see dysbiosis or maybe we see some candida or we see some h pylori and then we eliminate that and at least half the time it’s really beneficial.

And the other half of the time you’re still trying to figure out what’s going on.

Dr. Coetzee: Yeah, no, a hundred percent. But you would agree that in the amount that you look at, I would tell you clinically, and I look at a lot of tests, I would definitely say that, and that might just be because the population that we work with is an ill population, right?

So I’m not saying this is the general population in the world, but I would say 85% of my GI MAP GI spotlight test, which is the same test, have compromised ANA analogs, at least one. That’s 85%. Now, I would love to see what the general healthy population provides, but [00:54:00] there’s definitely a systemic issue with the opes when you’re looking at any gut, whether it’s the streptococcus and staphylococcus, which is elevated, which could somehow tie into a HypoChlor or a low stomach acid, you know, association.

But those are the patterns that Danny and I just always talk about. It’s like amazing to me how many people are walking around with compromised opes and it’s literally like an organ system. It’s like a lung or a kidney, right? It’s like something you need to have in your body. So it’s a bit of a wake up goal, you know?

Danielle: Yeah. Yeah. And I would say that the thing that drives that 85% up is probably, akkermansia is one of the lowest ones that I see across the board. I see

Dr. Weitz: that often. Low.

Danielle: Yeah. Yeah, effectively low. And I try to explain to practitioners, ’cause I am in the clinical support, trying to help them navigate the results of these tests.

So a lot of time, and I’ve dove pretty deep into Akkermansia and a lot of times Akkermansia, I always say it’s the mother, Theresa, it always like comes to the rescue. So if you have like a low fiber diet, [00:55:00] Akkermansia, remember is musil mucin loving. It only eats the mucin. So when you have low fiber and the other bacteria can’t get the fiber that they need to produce the metabolites or survive just in general, the Akkermansia says, Hey, I can eat the mucus, I can create something for you guys to survive off of.

So then it eats eats, until the goblet cells can’t really keep up with it. And then it. Then it dies off because it runs out of steam.

Dr. Coetzee: So compensation is what you’re saying? Mm-hmm. Yeah. With the compensation mechanism, right?

Danielle: Yeah. Kind of like self sacrifices itself.

Dr. Weitz: Yeah. I have to say so far using the Akkermansia products on the market I haven’t seen that very often, increases the akkerman on the stool test.

Danielle: No I’ve tried it for six months. It’s very expensive too. So, typically what I’ve seen to move the needle on Akkermansia is like polyphenols, tri Butrin, or even now I’m sprinkling in [00:56:00] Ansip because that’s just a butyrate producer. Once you get that in there, you don’t have to take the butyrate.

Right. But I’ve seen that move the needle. It takes about six months if you’re at effectively low levels that can get it to come back. But I have seen really good hba one C numbers with Akkermansia. Like I’ve seen their hba one C numbers just finally move after they haven’t moved for a while.

So that’s some positive that I’ve seen from supplementing it. That’s, it wasn’t what I wanted. It wasn’t what I was going for, but it definitely helps.

Dr. Weitz: And insulin sensitivity and diabetes is just so common.

Danielle: Mm-hmm.

Dr. Weitz: Definitely. Or at least pre-diabetes.

Dr. Coetzee: Yeah. Yeah.

Dr. Weitz: I mean, it’s rare actually, when you see somebody who’s glucose is 80 or something.

Dr. Coetzee: It is definitely.

Danielle: And then I wanted to speak on like something that you all were kind of talking about when Oscar was asking about some of the patterns that you saw. Sometimes some of the bloating, like, I guess some of the clinical pearls that I’ve seen is the pseudomonas are in Gosa or the pseudomonas and or the morgane.

Those are really [00:57:00] problematic strains. Those, I say they’re rude bacteria ’cause they cause a lot of symptoms. But the pseudomonas in particular can, whenever someone tells me they have food fear, they can only eat five foods or something like that, I immediately know that their pseudomonas is gonna be high because that actually crowds out some of the brush border enzymes that help you break down foods like dairy or gluten or some of or some of the other complex proteins I guess.

So a lot of times people are like, I’m good with red bell peppers one day. And then the next day it’s like, I can’t eat yellow bell peppers. Like, what is it? I usually know that pseudomonas is gonna be. High on the test.

Dr. Weitz: I see e coli often elevated in patients with sibo, and we know that’s potentially one of the organisms.

A big question is, can a stool test help us to possibly diagnose sibo? And I’ve talked to Dr. Pimentel a number of times and he’s very clear that there’s no way that a stool task can, but I think [00:58:00] potentially it should be able to help, especially since two of the forms of sibo. The methane SIBO is now called emo, and the hydrogen sulfide SIBO is now called ISO because of the fact that they don’t just exist in a small intestine, but they also exist in a large intestine.

How else are we gonna get a good clinical picture of what’s going on in the colon the large intestine without a stool test? And if the stool test shows elevations of some of those organisms, it would certainly make sense that could indicate that the patient might have sibo.

Danielle: Yeah, I’ve definitely seen SIBO test side by side, where you get the breath test and then you have like a GI map and you’ve Yeah, you’ve.

You, you know, you’ve been lucky enough that, that you have a doctor that’ll run both of those. And I’ve definitely seen a pattern of SIBO on a GI map when [00:59:00] you have the presence of the positive breath test. And that is like the methane producing bacteria or the dis fibrile enterococcus you know, some of the LP s producing bacteria, and I’d like to speak sometimes on like when you get a negative SIBO breath test, but you have SIBO type symptoms and you have this pattern on a GI map of like a lot of lipopolysaccharides in the last three years of research, we’ve noticed that histamine producing bacteria actually contributes to a lot of those IB slike symptoms that are more correlated with sibo.

So a lot of times when you clear out those histamine producing bacterias, like cita backer, pseudomonas, morgane, a lot of those even if you give them a, like, what is ours called? The it’s like a DAO enzyme. So if you give the DAO enzyme within 48 hours, sometimes people feel relief from those IBS symptoms because you’re finally allowing them to clear out those histamines that the histamine producing bacteria are creating because you only have so much capacity to do it [01:00:00] on your own.

Dr. Coetzee: You know? And then the other side of this, obviously, that’s the deeper side, but I think the obvious thing that I always see is just low digestive insufficiency.

Danielle: Mm-hmm.

Dr. Coetzee: Right? Yeah. Last stage one seems to be under 500. I like to see it over 500, not 200. Right. Right. I

Dr. Weitz: use that same marker.

Dr. Coetzee: Yeah. And, you know, insufficiency, dysbiosis in insufficiency, di, digestive dysbiosis, however you want to call it.

I see that as a very common thing. Mm-hmm. You know, abnormally common, and then you add that to the elevated streptococci and staphylococcal, and then you’re dealing with this low stomach acid low digestive pancreatic Eli stays functioning and you improve that and boom, you know, you move the needle.

So it’s sometimes I think we tend to go a little too deep you know, in the investigation of this. Yes. When sometimes the overt approach is right in front of us.

Dr. Weitz: And to bring up the pancreatic enzymes, are you typically using the digest enzymes?

Dr. Coetzee: Yeah. Or the version of our more specific pancreatic [01:01:00] enzymes.

What are they called again? Danny

Danielle: Pancreatic enzymes. Complex.

Dr. Coetzee: Complex. Yeah. Yeah. Which is a little bit more potent.

Danielle: It’s

Dr. Coetzee: much more

Danielle: potent and it doesn’t have hcl l so some, I use that one if there’s h

Dr. Weitz: pylori present. That’s one of the things I like about the digest enzymes. It has a little bit of HCL, it has a little bit of bile.

Danielle: Mm-hmm.

Dr. Coetzee: Yeah. Al the,

Danielle: yeah, this one is just missing. Yeah, it’s the same, more potent, but no HCL, the pancreatic enzymes

Dr. Weitz: Have you found herbal bitters equally effective or not as effective? Or is that something you’ll add in as well? Because I sometimes will try the herbal bidders and I’ll either add it in or try that instead of the enzymes.

Dr. Coetzee: I’ve had success with betters in the past. Yes. Okay. So I would definitely agree with that. And I think it’s probably a little bit more of a natural way to drive that natural stimulation. Right.

Dr. Weitz: Yeah.

Dr. Coetzee: So yeah, I mean, I’m completely open, you know, to, to that from my, like you, anybody in this industry, we certainly experiment, you know, with things to have improvement, right?

Anything from celery juice, for blood [01:02:00] pressure to cabbage juice for stomach ulcers, you know, I’ve seen improvement in those categories. It’s kind of amazing if you, but now I’m starting to wonder if those. Juices are maybe feeding the microbiome somehow that’s doing a better job on their side of things.

Dr. Weitz: Or maybe nitrates. Nitrates,

Dr. Coetzee: yeah, exactly. Exactly.

Dr. Weitz: Because now we know about the benefits of nitric oxide.

Dr. Coetzee: Yes.

Dr. Weitz: All right. So, where do gut healing nutrients fit into this? Things like but like, like, l-glutamine and slippery elm and these herbal products.

Dr. Coetzee: I think it has a tremendous place, right?

I don’t think you get away from that stuff. You always want to do what you can to assist. Like for instance, even though we have a, an incredibly strong butyrate producing. Anaerobe. Sometimes I’ll still give a person Tri Butrin in the initial phases, especially if they’re extremely low in it. And any of, I have discussed [01:03:00] this many times as far as the slippery alm, aloe vera licorice those mucous kind of, ingredients, it’s still extremely important to lower the inflammation and ease the entire GI tract.

So I consistently use that. Another thing that we use a lot is serum bovine immunoglobulins for the binding of the LPS, you know, when you’re kind of, doing an antimicrobial. So I think it’s a place for all of that, right? Not specifically saying, Hey, this is the protocol for everybody with these patterns.

I think that’s kind of where you, you need to do these individuality interventions, which is what I’m. You know, clinically doing a lot more than what I used to do. I always try to do five, 10 years ago, this is the protocol for SIBO and this is the protocol for sifo. And you know what it’s like then, you know, 60% success rate, two people have right.

Opposite reaction.

Dr. Weitz: Right.

Dr. Coetzee: And then you have to sit there and scratch your head and figure out what’s going on. I don’t know if you have anything to add to that, Danny.

Dr. Weitz: Well, what I have a question is there any data to indicate that these [01:04:00] keystone species can play a role in benefit patients with IBD with Crohn’s or ulcerative colitis?

Dr. Coetzee: Can I give you an overt clinical study right now? Off the top of my head, no. But in the deep dives of some of the literature, in huge amounts of animal studies, without a doubt I think it’s early stage. I don’t know. Danny, was there

Danielle: anything there was there, there was some colitis colitis studies for in mice that the anaerobes actually kind of reverse the colitis lower the inflammation just because of the butyrate nature and how much butyrate you’re producing.

It does lower the inflammation, it does lower those cytokines and everything like that. Another big one too with where I think it would work with sibo going back, you know, a little bit ago when you guys were asking about SIBO and anaerobic bacteria, the ansip was used in a sorbitol intolerance case as well too.

So a lot of times the sugar alcohols are some of the problems with SIBO as well too. So, what [01:05:00] Roip did is it actually restored the sorbitol dehydrogenase enzyme that helps you break down sorbitol. So in my hypothesis, I think it would definitely work in SIBO cases just because we’ve seen it in research in others other sugar alcohols.

Dr. Weitz: So you’ve seen that would benefit other sugar alcohols as well, besides orbital?

Danielle: Yeah that’s just my crossover hypothesis of like, it worked here, so let’s see if it works here. We don’t have any studies on any, anything else, but that’s where we go running off with our hypothesis, our evidence driven.

Dr. Weitz: Interesting.

Danielle: Approaching

Dr. Weitz: And we know that the Western populations have very less diverse microbiomes.

Danielle: Yes, definitely. Because they’re eating like the sad diet, the standard American diet, which is very low in fiber, very high in fat like Akkermansia. That’s another reason why I think we find it low all the time, is just the standard American diet impacts it because.

If you are on a keto diet or a high fat diet, or [01:06:00] even a FODMAP diet, which is not part of my argument right now, but Akkermansia doesn’t like high fat diets, it will die off. So I think that’s also why we see a lot of microbiome shifts is just the standard American diet with low fiber and high fat,

Dr. Coetzee: which brings into discussion keto dieting long term.

Right, right. Potentially. Yeah.

Dr. Weitz: Yeah. And sometimes patients with severe gut symptoms end up in these very limited diets where maybe they’re even following carnivore.

Danielle: Mm-hmm.

Dr. Weitz: Yeah. Then they can’t get off ’em because as soon as they start to eat anything with fiber they immediately get symptoms.

Danielle: Well, good news. Ben Anies works really well with a carnivore diet because you have a lot of lactate. You know, you produce a lot of lactic acid, eating a lot of those meats and things like that. So what that does is it feeds the anies. The anies can then create metabolites. So in that population, putting, giving them ROIP gives [01:07:00] them the best advantage that they can.

If especially ’cause you know, and I know a lot of people that have fixed so many of their autoimmune conditions going carnivore, but staying on it long term, it’s an elimination diet. You shouldn’t stay on an elimination diet forever. You know? So,

Dr. Weitz: but a lot of ’em can’t get off of it because they get symptoms.

Right. Yeah,

Danielle: definitely.

Dr. Weitz: And by the way, the same thing happens with being on a low FODMAP diet for a long time.

Dr. Coetzee: Mm-hmm. Couldn’t agree with it more. Mm-hmm. Very concerning to me. Any kind of. Restrictive diet long term and, you know, even the antifungal diet, right? I mean, how long do you wanna put a person on antifungal diet or a FODMAP diet before it becomes problematic?  Because I believe a lot of those FODMAP foods a actually are very potent feeders of these organisms.

Danielle: Yeah, definitely. There, there are a lot of sulfur producing, you know, like you’re removing garlic, you’re removing onions. Like that’s really important for phase two of the liver, you know, sulfur conjugation.  So, you don’t wanna remove these things forever. They’re really beneficial to our health. And Dr. Zi always says you’re removing the symptoms, but you’re not removing, like the [01:08:00] underlying issue with the FODMAP diet. You need to remove the underlying issue so then you can bring these foods back in.

Dr. Weitz: Right? Yeah. I try to use it in a limited period of time while we’re trying to kill off some of the problematic bacteria and microbes. Mm-hmm.

Dr. Coetzee: Yep.

Dr. Weitz: Alright. So I guess we’ll bring this to a wrap. Final thoughts for our listeners and viewers?

Danielle: I would just say if you can eat as close to nature as possible if you can pick it, if you can grow it if you recognize it, then your body recognizes it and your gut recognizes it and it can, you know, it benefits you, it benefits your gut, your, when your gut’s happy, you’re happy systemically

Dr. Weitz: and yeah.

Dr. Coetzee: And when you, we’ve been on a FODMAPs diet or whatever and you’re reintroducing foods and it’s not going your way immediately, you know. Just keep at it. Right. Because you need that

Dr. Weitz: Right.

Dr. Coetzee: Confusion and stimulation and [01:09:00] diversity to really heal the GI tract. I’m a firm believer that you’ve only fixed the gut until a person can eat anything.

Dr. Weitz: Yeah.

Dr. Coetzee: Without a side effect.

Dr. Weitz: Right. I usually have, if a patient puts back a food and it has a problem, I say, that’s okay. Let’s put that aside. Let’s keep that out. Let’s go on, add some other foods and one by one, see what’s not aggravating you, and let’s try to get the diet as diverse as possible.

Dr. Coetzee: We’re on the same page, man.

Dr. Weitz: So, practitioners, if they call into design for health, they can ask you guys for questions.

Danielle: Oh, definitely. If they have any kind of, you know, we’ll look over their GI spotlights, their metabolomics, their genomic spotlights, the tests that are from Designs for Health. But if they also have like a GI map that seems difficult or a Dutch or something like that vibrant wellness even.

We’ll go over those as well too.

Dr. Coetzee: Let me just help you out. Yeah. Danny is a very humble, very smart individual as you can clearly see from tonight’s interview. So, so Danny is the director [01:10:00] of clinical support for Designs for Health. She’s in charge of the entire Spotlight team. She’s the one that is really training and assisting all the clinical support people to get to the level of information that she has.

So if you’re a practitioner, my suggestion is set up an appointment with this lady and pick her brain because she will enlighten you two levels. That would be astonishing. Right. And if you think you know everything, do an appointment. She’ll you know, because we are at this point where we’re kind of on the cutting edge of some of the research, so that we have definitely got more information currently at our disposal as a company and research than most people have in this space.

Not that we are saying that we know everything, we just want to share where we going. Involve a lot of our practitioners. So just before we go, Ben we have this thing that we like to do with our practitioners. So let’s say hypothetically, Ben, you have had a patient that you had great success with, right?

On a [01:11:00] diet or an intervention or a nutraceutical, and there’s some pre and post you know, biometric data, GI map, pre and post and symptom improvement. We’d like to help you publish it. Like we are really a big believer in that this industry needs more NF one case series trial because it’s validation of protocols, right?

And you know, how we improve as a, as an industry. So, you know, we are very open and inviting to practitioners wanting to reach out to us. If they have a unique story to tell, we can help them get published.

Dr. Weitz: Well that’s great. I might take you up on that. ’cause I actually had my own health crisis with a fractured femur and a non-union and eventually got it to heal.

And I definitely think taking a 45 milligram MK four was part of healing along with the right amounts of vitamin D and boron. And

Dr. Coetzee: yeah, reach out to me on that, you know, and we’ll have a chat about that because we [01:12:00] also make our docs the first authors, right. So that way you can get out in the world.

We’ve done about, I think we’ve published about 12 case reports in the last five months.

Dr. Weitz: Okay. That’d be great. I’ll hit you up on that.

Dr. Coetzee: Sounds good. Well, it’s been a pleasure, man speaking

Dr. Weitz: Absolutely. In this product. Tell us the name of the product again.

Dr. Coetzee: I cannot yet. Okay, so

Dr. Weitz: it’s not on the market yet.

Danielle: Well, we can say Roip.

Dr. Coetzee: Yes.

Dr. Weitz: Nips, yeah.

Danielle: Mm-hmm. Yeah, the

Dr. Coetzee: Roip. We can, so if you go onto our website and you type in Erota like au, A-N-A-E-R-O, stipes, S-T-I-P-E-S. Okay. ROIs k. You will see it right there. This is, and

Dr. Weitz: what is the dosage and what is the strength and how much do should we be recommending to

Dr. Coetzee: patients?

One, one CAPA Day is all we’ve been using with Okay. Body, because it seems to, again, it’s not volume, it is the seed to feed

Dr. Weitz: and it’s gotta [01:13:00] be kept refrigerated.

Danielle: Mm-hmm.

Dr. Coetzee: Yep. Yeah. Yeah.

Dr. Weitz: Great. Excellent. Thank you so much.

Danielle: Yeah, thank you.

Dr. Coetzee: Speak soon, Dan. Thank you for having us. Take care.

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Dr. Weitz: 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 very much appreciate it if you could go to Apple Podcast or Spotify and give us a five star readings and review. As you may know, I continue to accept a limited number of new patients per month for functional medicine. If you would like help overcoming a gut or other chronic health condition and want to prevent chronic problems and want to promote longevity, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111 and we can set you up for a consultation for functional medicine and I will talk to everybody next week.