Episode 199: GUT Zoomer Deep Dive - Functional GI Testing for Thyroid Patients

what that means in a second here. But we're going to talk about gut physiology, and we're going to talk about a test called the gut Zoomer test, which is a test I use pretty frequently, and there not only probably uses this test in her practice pretty frequently, but also is kind of an advisor with vibrant labs who's one of the is the company who actually produces the test. So Adair, welcome to the thyroid Answers

podcast. How are you today? I'm doing all so I guess the place to start is just to give every have everybody get a little bit of background about you. Who are you? What you do, and how did you get into working with vibrant labs and being here today to talk about the gut Zoomer test. Yeah,

So been with vibrant for over four years now, and did such a good job on the clinical team, they've taught me and brought me over to the marketing teams, and I'm the Product Marketing Educator, where anytime we launch a new test, I get to explain that test to not only everyone internally vibrant but also all of our clients, all of the healthcare providers who order vibrant testing. So it's my job to learn the ins and outs of all the tests.

always find them. In contrast, a functional stool test is going to look at pretty much everything within the gut microbiome, well, specifically within the colon. It's stool test stools in the colon. And so in terms of vibrance, guts humor, we're looking at 150 commensal microbes, 76 pathogens, along with gut metabolites, digestive markers, gut antibodies. It's a really comprehensive look at exactly what is going on within that, the whole gastrointestinal

tract, tube. So are you digesting? Are you absorbing? Do you have a good balance of flora? Does your is your gut barrier intact? Do you have enough Secretory IgA? Do you have enough akermansia to help balance the mucin layer, the mucus layer, that is part of that barrier. Do you have leaky gut or not? Like you have intestinal hyper permeability, for example? So it gives you a deeper insight into, you know, what's really going on, and getting into the root cause of

what could be causing the eventual disease. But also in a preventative sense, gives you insight before that happens, you can prevent that ulcerative colitis or Crohn's disease from actually manifesting.

based on the guidelines to cut out or medicate you. You will typically get diagnosed with irritable bowel syndrome or something along those lines. Your bowel is irritable. We can see some ear we can see some redness, maybe on a pathology based evaluation, but there's no pathology. There's no disease, although we would say if there's redness, inflammation, irredeem like there is something but the disease has not developed quite yet, right? So when we do a functional gi test, I should

finish that. If you go to a gastroenterologist and they do a

pathology based testing, and it's all normal, you'll get diagnosed irritable bowel syndrome. You'll probably be provided maybe some symptomatic support, and then you'll be told to come back next year, and we'll do another assessment, and we'll keep looking at these pathology based tests until we find the pathology. And then once we have the pathology, we'll either cut it out or medicate you, and then we'll

manage the condition into perpetuity. What we're doing with functional medicine, or what we should be doing at functional medicine is exactly what Adair said. Why wait for the pathology to develop if we can measure the functionality of the GI tract, is there inflammation? What inflammation markers are elevated, and what can we learn from those markers? Is there decreased digestive capacity. And what might we start thinking about as to why the digestive capacity is is

reduced? Is there already permeability starting to develop, damage the intestinal lining, the starting develop and what can we do to intervene and then, if what's going on with the bacteria in the gut, and how might that be related to your signs, your symptoms, and what we might see on an exam, and not just on a gut zoom or a test or a GI test, but how does that reflect into like a good, comprehensive metabolic panel, and especially because the People on here are people

typically struggling with thyroid related issues? I've talked I talk about this all the time, how gut based issues are such a big problem for people who have thyroid and immune regulating, regulated disorders reduced t4 to t3, conversion. People say we just woke up one day and forgot how to do it. Your cells and tissues did not forget how to do it. It's usually an adaptive response. An adaptive response to some type of inflammatory process going on, and we can dig into that fun

stuff later. But the important part here is, when you go to a a gastroenterologist with your with your GI based symptoms, they are doing a different assessment than what we're doing with these tests, I often do the tasks. And if I see something that I think needs a physical evaluation, a medical evaluation, I'll say, hey, take these results my notes to your to the gastro. I think we need to get an evaluation done here, just to be on the safe side. And they'll often say, I don't even

know what these things are. I don't run these tests. They'll do a pathology based test and say there's nothing going on. I don't know why you're here, but these we don't want something to occur, and that they're not running these tests on a regular basis, therefore they really don't have a knowledge base about what all these things mean. And so that's part of the discussion today, is, why would we do this test, and what do these things mean? You okay with all of

Well, I had a GI test done. I had this one done, or that one done, or this one done. But what? What's your stance on why this test is maybe the best test to run on somebody well, for looking at the functionality of the GI track,

time polymerase chain reaction, or RT, PCR. And in addition to that, we also do bead beating and somatic and thermal processes to get rid of any biofilms, to really get to the nucleic acids in order to identify those specific microbes. And we also use not only 16 s, but 20 3s and also

proprietary Sections and. Um, if you only use 16 s, and you give a company 20 different microbes, just running 16 s, you might end up seeing 80 different microbes, whereas when you're using 16 plus 23 plus proprietary mechanisms, you could accurately identify those microorganisms, certainly with pathogens like we they're known things like with E coli, we know exactly what to look for, and so you only need a couple of probes for pathogens.

But for commensals, there's so many of them, we have proprietary ways of identifying exactly that organism, so we know it's very accurate and precise. In fact, our gut pathogen study showed 100% oh gosh, I can never remember sensitivity or specificity. We got 100% specificity and a 95.9% sensitivity, meaning no false no false positives. If you have it, you have it. If Scott Zoomer says you have this pathogen, you absolutely have it. There's a small chance we've missed it.

But if you if it says you have it, you have it on the test. And then terms of the other methodologies we're using, LC MSMS, liquid chromatography, tnms spectrometry, which is a

gold standard for identifying small molecules. We are using that for all of our, you know, bile acids, short chain fatty acids, fecal fats, meat fiber, vegetable fiber, and then we're doing our proprietary chemiluminescence microarray for all of our gut antibodies, so tissue transglutaminase, staminating, glad and protein, anti Gliadin, anti actin, anti LPs, and also anti Saccharomyces cerevisiae antibody or ASCA. And I can totally dive into that, but at the top, that's like a, I

some tests that are available on the market. I'm not going to mention names, but people go and get these tests on their direct to consumer tests, and they and when I have an initial conversation with somebody, they're like, Oh, I had my GI I

had a functional gi test, and I'll get a test, and it's just a bunch of bacteria on there, and they're like, this is my gut test. And here's and maybe it's got some genetics, and here's the recommendations I was given. My challenge with those tests is, A, I'm not sure how accurate the information is. B, it's just the biome potentially, right? It doesn't tell me what's how well are you producing pancreatic enzymes to help break down and

kill the bacteria and the food that's coming in? It doesn't tell me anything about FAT, FAT, FAT malabsorption or lack of absorption of fats, right? It doesn't give me an idea of the intestinal lining. Is that starting to become problematic? There's a lot of things that aren't on those tasks, that are from my perspective, are critical to helping our clients.

Just looking at the bacterial balance, looking at the bacteria there, I don't know if it provides me with as much information that biome can change pretty rapidly, many times. And so it is sometimes I think the argument as to I hear from people in in the allopathic world, like the biome changes all the time. This is, it's a ridiculous test, but the biome stuff that we see on the gut Zoomer, we get information from

it, for sure. But I'm not looking at only the gut biome. I look at the gut biome and say, Okay, why is this the biome that this person is developing, and all of those other functional tests are important. So do you see a challenge with some of these direct to consumer tests that are just providing bacteria and then providing recommendations based on just the bacteria that's there?

feeding them fruit like it can change very rapidly. And so when you want to look at what's going on in your microbiome and how that's impacting digestion, absorption and inflammation in the gut, you really want to start top to bottom and look at anything that could be going so starting again, thinking about the gut Zoomer from the top of the GI tract, from your mouth to your anus, like first you want to make sure, are you digesting your food, right? The gut Zoomer is going to look at pancreatic

elastase. It's going to look at bile acids. It's going to look at fecal fat. So are you digesting your food, and are you able to break it down in terms of fat? Fat breakdown through, through vial after that you want to see, are there a lot of good bacteria populating your gut? So for example, is it easier to build a house in Manhattan or the middle of Montana, where is

there more real estate? Right? Probably in Montana, there's more land available to build, maybe money aside, right, not thinking about that piece of it, but the fact that Manhattan is already populated, every square inch is covered in some type of concrete harder to build there. So we want a microbiome that has

lots of good microbes, commensals. We call them. We want lots of commensals, because that way, if a pathogen comes in, it's not going to find real estate, it's not going to find a place to build to live, whereas if you have low commensals, if it's like a barren wasteland, like there's nothing there,

anything can grow there. An example is that my friend went on a camping trip and use a little too much iodine to clean his water and end up wiping out, wiping out, like all of the microbes, and then got a cluster of difficile infection, because there's nothing to compete and prevent that from happening, and C diff is awful, so don't recommend doing that.

and then there was a problem with the collection. We collected a kit about a week and a half later, and we get the new test results back, and the bacterial balance, there's a lot of difference. There lots of difference there. And so I, I'm like, What is going on here? And, you know, this is maybe more than a decade ago. And so I was like, What the heck. And then I I spoke with somebody. I reached out to a biologist, and

I said, Hey, what do you think would create this? Because I had reached out to the company, and they're like, I, you know, they gave me a bunch of comments, but none of them seemed to land appropriately. And he he said, Well, you provide a systemic enzyme. You probably broke down the biofilm. You should be doing that before every test anyway, right? I'm like, no, like, I wasn't at the time. Nobody was mentioning, Hey, we should do

this. And so it became the thing that I started doing. I don't do a lot of the other testing companies do what you guys do to try and break down biofilm prior to collection?

sort of like a commune. But you want to, like, break that down and pull it apart. So we can actually get and identify what's in that, what's stuck inside the biofilm. Otherwise it could be

things could be hiding in there, like geese, for example. So bead beating mechanically breaks it down, you know, literally pulls it apart, sort of like chewing your food. Mechanically breaks down your food, and then enzymatically, anytime you add an enzyme, it's going to also break down those those compounds. And then third thermal processes is heating it as well. So when you heat something, it can also break it down, like it can soften vegetables when you cook them,

right? They're not crunchy now they're soft and mushy, like that's what we're doing to the biofilm. So it makes it a lot easier for it to disintegrate into a liquidy substance, so that when we do the polymerase chain reaction, when we're putting all the enzymes in there to make amplification happen, they can actually bind to the target, because it's not getting stuck.

But if. Doing a test and you haven't used some type of systemic enzyme or biofilm disruptor prior to testing, or the lab that's doing the testing isn't going through that process to mechanically break down or enzymatically break down that biofilm. You may not see what might be contributing some of the immune some of the immune based challenges that are going on, and maybe some of the signs and symptoms, right? Exactly. So

I want to talk about commensals and pathogens. Okay, because these terms may not be familiar to everybody, and the way I explain it is, commensal bacteria aren't necessarily good or bad, but they're like the neighbors. In my neighborhood, there's 114 homes here. Everybody who owns a home here

deserves to be here, okay? But if I've got one of my neighbors, likes to party a lot, likes to invite everybody over and their party until, you know, all hours of the morning every night, even though they are part of the neighborhood, it is going to potentially create a problem for me, right? And if I have another neighbor who loves to live in his their vacation home in Florida seven to eight months out of the year, and that means those seven to eight months out of the year, they're not taking

care of their property, it becomes disheveled. It doesn't look great. The grass is great, growing too high and it too can become a problem, right? So sometimes people think, I either have pathogens and that's a problem, that these commensal bacteria, which are bacteria that are supposed to be there, can't be a problem. So let's, let me have you just kind of break down. What do we consider a pathogen? What are commensals?

Are there good? Is it or am I wrong? Are commensals only good, or can they also be problematic?

limiting. But that's another conversation. In terms of commensals, you can have a probiotic commensal which provides benefit to its host. So these are probiotics like akkermansia or plus or fecal bacteria and presni or roseberia that create short chain fatty acids or create vitamins like V 12 that help us as a host to give us benefit. And then, as you said, there's also just bacteria that live in existence,

like in the neighborhood. However, sometimes they can get turned to be a more pathogenic like strain, because of what else is going on in the environment. So for example, when someone is acting out poorly, like in a elementary classroom, like it leads more kids to also act out. And sort of it sort of changes the the mental, the mentality of those microbes to be more on the pathogenic, not pathogenic side, but like on the bad side, to be more, more problematic.

Problematic. That's a good word, problematic, and also sometimes when you have too much of a particular bacteria, for example, when you have too many lipopolysaccharide producing bacteria, to me, the gram negative bacteria from the Proteobacteria phyla that causes more inflammation in the gut. Because LPS is inflammatory, it can cause endotoxemia after eating. It's actually what causes sepsis if you get an infection like in an organ outside of your gastrointestinal

tract. So the balance of microbes is also really important,

can be one of the reasons why we have some signs and symptoms correct. So in a standard allopathic approach, they're typically not looking at the commensal bacteria at all correct, from my knowledge base, they're typically really just looking at pathogenic organisms only. And I think the reason, from my perspective, that they don't look at the commensals is because they don't really have a strategy to address commensals. So we don't, we don't address them. Mm.

commensal bacteria? These are the bacteria that should be in the GI tract, most of them in the colon. But what would cause these bacteria to be dysregulated?

the gut lining. They heal and seal the gut. They help produce new cells people, they actually there's a study that showed people who had higher short chain fatty acid levels had better COVID outcomes like short chain fatty acids are really important. It is like the number one source of fuel for your colonocytes. And you don't have enough of them, your colon cells are literally starving. And eating plants is what feeds these good microbes, feeds these 10 months old microbes,

issues going on and a lot of inflammation in the GI tract. It is, it is, there is a truth to the fact that plants have some level of toxins in them, my belief is that primarily, when we eat healthy, properly raised crops, and we eat them in season, when they're when they're at when they're ripe, they have a lower level of toxicity. That's probably not problematic, but plants don't have much of a way to defend themselves. So having higher level of toxicity when they're

not ripe protects them. In nature, we have a tendency to pull our our crops way before they're ripe, we force ripen them in a factory somewhere, so they look beautiful and we can then we eat them. But that doesn't necessarily mean that the toxicity of the plant is is gone because we force ripened it. It may still have a higher level of toxicity, but even

those toxins in the plant have a benefit. In a healthy GI tract, they are like exercise for the immune system of the GI tract, if you're not constantly stimulating the immune system to some degree low level, the immune system gets weaker over time. So these plant based foods, healthy in season, appropriately ripened, can have a positive effect in beefing up the immune perspective, immune system, from my perspective, it's like lifting weights, you could argue, Eric, why would you

ever lift weights? If because weight lifting breaks your muscle tissue down, correct? It does. It creates, breaks it down, creates low grade inflammation, but that low grade inflammation then helps me build a bigger, stronger muscle tomorrow, so today, if I have to lift something heavy, I actually have the ability to do it. If I never did anything to strengthen my muscles, I wouldn't be able to do it, and I'd probably get injured. Is that fair?

create a big change in your gut biome. And if you are more plant based, and that was and you already had inflammation and dysbiosis and other things creating disruption there, minimizing some of those plants and plant toxins might calm the inflammatory process at least temporarily, but I do agree that. Short chain fatty acids are critically important, and we'll talk that more about that in a sec.

situation. Because if you're about to be food for a bear, there's no reason to digest our food in terms of prioritization, the goal number one is get rid of get out of the danger zone. And so when that happens once or twice a month? Like, no big deal. But when it happens all day, every day, and I have lots of clients who are stuck in fight or flight,

adaptive response. And so many of our clients are under an excessive stress load, and somebody might say, but you know, I had the same stressors. Then this happened, and now I'm back to the same stress load. I can't handle it right, because you had an excessive stress load. You were managing it. You were in homeostasis. But then that extra stressor pushed you into cell stress response, and that shifted you into Allostatic regulation. You up regulate, start up regulating the

sympathetic nervous system. Brain gets more wired, more as you said, more energy, more blood flow goes to the brain and the muscles so we can run. What gets down regulated, gut physiology, sex hormone regulation, detoxification pathways, these sleep, like all of these things that make us feel wonderful, get down regulated, right? And we ramp up the the immune the defense mechanisms and the hormone that helps us regulate the shift from homeostasis to allostasis is

thyroid hormone. By decreasing the conversion of t4 to t3 in the cells that are perceiving stress and danger, we actually slow down mitochondrial function. We stiffen cell membranes from a protection standpoint, and that doesn't make us feel good, but that allows that lower t3 state actually activates the cell defense mechanisms inside the cells. So we often look at the low t3 and somebody's like, oh

my gosh, your body can't convert t4 to t3 anymore. That is such nonsense, in my opinion, that is the adaptive response and adding more thyroid hormone in that situation, especially t3 Yes, you can give a temporary hit of improvement, but actually can increase the oxidative stress in the inflammatory process that's going on, up regulate the sympathetic nervous system and down regulate the parasympathetics. So I fully agree that stress, right, real or perceived, right? Everybody

thinks it's just emotional. So it's what you think about, your work, your relationships, right, your partner like what you worry about, right on a daily basis. And so many of us, I think, are in chronic perceived stress, and we don't even realize it.

COVID. The COVID comes. Everybody goes inside, people, some people stressed, worried, my oh my gosh, my money. What am I gonna do job? Other people are going, This is awesome. I can work from home. I'm moving to the beach. I'm gonna start investing in these different things where they need me and that person under the same stress situation thrives, right? So it's it's really not the stuff as much is, is, can I

manage it, and how do I perceive it? That's so I always tell people the mindset is one of those top things that create stress. Number two, for me, is somebody's habits. What do they do, day in, day out, right? Those things that their habits Make, make or break them. Okay? Number three is sleep fitness. To me, prioritizing Sleep, sleep, good sleep. Habits, good sleep behaviors. Good sleep schedule is critical. Number

four, diet, what we eat feeds our microbes, right? We've got more microbes than we got genes, so if we don't feed us, well, we're not just feeding us for taste and wow, that makes me feel happy, but we have we're feeding the microbes. So what we feed them, determines what grows. And then my fifth, like foundational, what I call fitness factor, is physical

fitness. Because we, I'm sure you know this physical movement, physical exercise at the right amount, not excessive, but the right amount can have huge impact on our overall physiology, from neurotransmitters, hormones and gut physiology. So those are my foundational five. I've got 13 other ones I work through with clients from, hey, what's your relationship like? What's your what's going on with your finances, like those, all of those things create our body's perception of danger

feel better, I function better. And then two, three months off supplement support, they're like, having problems again. What we see on these functional gut tests is the result of your habits, your behaviors, your lifestyle and all those things. So yes, we often have to intervene and help this kind of reset itself. But we also, if we don't change the environment, the perceived environment, we don't we don't wind up changing

the terrain. And if we don't change the terrain, why would we expect 90 days after all my supplemental support that the problem isn't going to come back. Would you agree?

be thinking about, like, why? Like, I always say, Look, if you have decreased pancreatic enzymes, I can give you digestive enzyme temporarily, but we got to figure out why. So what are the things that you would suggest just generally, when you see reduced digestive capacity? What are the things you want to help inform your clients of like, Hey, here's things we need to consider, or that you're instructing a clinician who's coming for you. Of like, hey, how do I interpret

this thing? Yeah,

everything tastes amazing. You're really in the moment. But if you're just eating food to get to the next thing, or you're eating while doing something else, like working or studying, which is the worst, like, are you really there with the food? No, it's just going in the body's like, I don't what are we doing right now? Are we thinking? Are we working? Are we digesting and so making mealtime a time to just nourish your body and paying attention? Some people call this mindful eating.

So smelling the food, I don't know if your mouse ever started watering after you smell cookies out of the oven. Like that's your body getting a head start on digestion, so smelling the food, really tasting the food, noticing textures, eating more slowly, putting the fork down between bites, if you have a hard time eating slow, maybe eating with a non dominant hand, or using chopsticks, eating with other people, having

conversation, anything to slow down the eating. So it takes longer, I know in a lot of Mediterranean countries, they'll have like, meal time last two hours, and it's a social event. Everyone's happy and enjoying life like that's what a meal should be. It should be a time to nourish your body. So if that's not what your meal time looks like, that would be a great place to start. And then the other component is eating

about the same time every day, so you. Get into eating rhythm, that circadian rhythm and alignment with when your body anticipates food, so you have the best ability to digest, absorb and assimilate those nutrients and utilize them for repairing toward muscle tissue or restoring your your immune system, for example. Yeah,

should start to break it down. And the downstream impacts of digestion are really based on the acidity of the kind the stuff that's leaving the stomach to come into the small intestine. There's sensors there that tell the gallbladder, hey, you got to release some stuff. Pancreas, you got to release some stuff here. If you're just gulping, gulping down, throwing some water down on top of it. And that, I guess, would be the other thing I would say is, hey, don't be drinking if you're

thirsty. When you're eating, you're probably not chewing your food appropriately. So do you agree with those pieces as well? Absolutely.

how many patients who I've worked on my gut. I've done this, I've done that, I've done that, and we look at their oral fitness through a questionnaire. I'm like, Alright, there's some oral there. You're got some areas here. We should get checked out. And then if we do run a test and that, here you go, oral bacteria popped up. I don't have any tooth problems. I

don't have any pain. I don't guess what. You got antibodies to these oral bacteria, which means they are creating a reaction, and that also so the oral cavity becomes really critically important.

regular x ray. The second dentist did a cone beam. And sure enough, in that pocket was a whole bunch of infection in there. And I'm like, That's why you can't get your immune systems stable. That's why your thyroid gland is under attack. That's why you can't convert t4 to t3 Well, what do we do? We do? You got to get cleaned out like this. And so it's been a process to do that. But things are oftentimes hidden, even

where we don't have signs or symptoms. I don't want to, I want to stay on this kind of theme so we're chewing and we need to have appropriate stomach acid. The gut Zoomer doesn't have a an assessment specifically for stomach acid production.

might it. What should it? What should the range kind of look like, and if it is low, what are the common strategies and what are your thoughts when that when that value is low?

that's indicating. To mean that something is not allowing the pancreas to release the amount of digestive juice it needs to break down your food. So why is that usually stress? Maybe something's going on with the immune system in the pancreas, or

controlled by the amount of T available, t3 so if you have low t3 in the GI tract or and or circulation, that sphincter muscle may not open up as well as it should. And if you have estrogen, excessive estrogen, estrogen metabolites, estrogen dominance going on, estrogen will also cause that sphincter to be tighter, so it reduces the release of enzymes into the GI tract. The amount of circulating t3 also plays a role in how much pancreatic enzyme is going to be produced in the first place,

because you need t3 to support that. So there's lots of mechanisms there, and there's one other one that I I've consider, and that is, if somebody's in a cell stress response, and they've got glucose resistance, and they're struggling to produce appropriate levels of insulin to regulate it. There are there is research that what can happen is some of the pancreatic cells will become insulin producing cells, even though their primary function is to make pancreatic

enzymes. The pancreas will say, Look, we we can't deal with the glucose in the that's in the system. Now we need more insulin to deal with it. And so since food, more food coming in isn't a priority, let's hijack some of these cells and we'll make them insulin generating cells. And what goes down is the pancreatic enzyme output. So those are some of the things from my point of view.

That's totally inappropriate for you, right? There's reasons why that TSH means be suppressed. Same thing when we look at these tasks, right? And we look at this gut Zoomer, and we see these things a lot of those patients, and I'm guessing you would do the same thing. There's decreased pancreatic enzyme output. Let's support with a pancreatic with a digestive enzyme right now. But that's not the long term strategy. The long term strategy is to get the pancreas to actually release

this stuff more appropriately. Absolutely,

gets recycled. Is that happening? And then we also look at fecal fats to see and affirm like if there's fat, if there's elevated fat in your stool, if you have floaty stools and oily stools, it indicates you're not able to digest and absorb your fats, your fat soluble vitamins, your omega three fatty acids, the stuff that helps with proper like healthy skin and eyes and brain development. So it looks at all of those things as well. So

circulating. And my opinion, you correct me if I'm wrong, we're looking at the primary bile acids are what you're when you eat, your liver releases bile acids that are already ready from your gallbladder, and then those bile acids are being recycled five, six times through the meal. And most of those

primary bile acids are being cycled through the system. We're looking at the primary bile acids on there are ca and CDCA that are on that form, there's a very small percentage of primary bile acids that make it to the colon, about 5% of the bile acids. And then we're looking at the secondary bile acids. And to me, what this really gives us tonight, idea when we look at the bile acid metabolites is, how well are those bile acids

being resorbed? Am I getting too much moving down that track and getting into the colon, and then it gives us a little bit of a story about what's happening with the colonic bacteria and how they might be converting those and there's another little nuance that's important here, and I won't get too technical on it, but I write hormone plays a role in which bile acid

percentages we see on there. So when I see somebody based on their medication, I might see an alteration in the percentage of ca or CDCA, and that's being influenced by the amount of t3 that's getting to the liver, because that changes those a bit. So that's how I look at it. So when patients say, but my bile acids metabolites look good, I'm like, that's part of the picture. But the thing that I were more concerned about to

say, hey, is there fat malabsorption issues here, and bile issues and pancreatic enzyme issues, is we look at those fecal fats, right? Because if you're if you're eating fat, sometimes people say, Well, maybe I just eat too much fat. I don't know if that's necessarily the case, but a lot of people just don't have great bile flow. I mean, just and if we look on that test and we see low pancreatic enzyme output, then there's a good chance that we're going to have some fat

malabsorption, correct? Yeah,

cells. That bile acids actually help maintain those intestinal tight junctions. We're going to talk about something else that's really important on this task, that helps us get an idea of intestinal tight junctions, but those that bile helps regulate healthy tight junctions. So if you don't have good bile flow, and you have fat malabsorption, more than likely you're going to start breaking down the intestinal barrier and leading to potentially what we call intestinal permeability, or

leaky gut. Those those bile acids at the end of the GI tract also activate some of the things on the inflammatory panel, the beta defenses and other things to help deal with the bacterial overgrowth and prevent it. So if you don't have good bile flow, you don't kill bacteria coming in from your food or your oral cavity at the top end of the GI tract, and you can't control the bacteria as well at the bottom end of the GI. Eye track. Did I miss anything? I think you got it all right, fantastic. So

let's talk short chain fatty acids. What are these things and why are they important?

acids. You can also have putrefactive, not short chain fatty acids, but the proteolytic versions, where it's breaking down protein, like fermenting protein, and those are not as good, but the short chain fatty acids from carbohydrate sacral lytic fermentation that's going to create these byproducts that are very beneficial to the body, and helps heal and seal the gut, helps repair the gut barrier, helps signal to the immune system. Just in general, really good things.

mechanism to the immune system. Interestingly, there's a direct lymph connection from gut to thyroid for everybody, just so you know, if problems in the gut can directly impact the thyroid from a lymph perspective, not just a blood perspective, but a lymph perspective, but the short chain fatty acids are a huge driver to Reg, to up regulate what are called the T regulatory cells. So if you have an immune inflammatory process that gets started, we want that to happen. We want the immune system to

defend us. But if you don't have healthy short chain fatty acids, the off switch may not be there to calm the whole process down. So once that thing gets turned on, if you don't have the right bacteria, you don't have the right diet, the right bacteria to produce these short chain fatty acids, you may initiate immune response, but it may be hard to turn that off. You okay with that? You saying that? Yep, that

fibers and convert them into short chain fatty acids. If those are down regulated, you could eat all the plant matter in the world, and you're not going to produce the appropriate

short chain fatty acids. Are you okay with that?

grandma could, you could cook it in your own house. Like, that's, that's the food that fuels and feeds us. It's not the convenient stuff that lives on a shelf for 12 years. And

dysbiosis in the gut. So we want it optimally to be at that normal level and not on either side, although it's probably easier to treat the high side, because you identify what it's fighting against and then get rid of that or adjust the diet, lifestyle, all the things to balance it back. It's a little bit harder to bring it up if it's low, because that's usually indicating you've been under stress for a long time, and it takes a while to bounce back.

right? I want them coming. That tells me that your immune system is appropriately responding if you have a lot of inflammation and you have low Secretory IgA, I'm worried that you don't have an immune system that's capable of dealing with it, and we really need to help out. And not only does the secretory IgA influence your gut physiology, but all of your mucous membranes, so all systems, nasal passages, oral cavity, eyes,

pelvic area, right? Like everywhere where you have these mucus memories, these coatings, these protective coatings of that kind of as a barrier from outside to inside. The Secretory IgA system is the police force there, right? So if they're weak, you're more susceptible to chronic organisms getting into the system and becoming latent or active or acute or replicating infections. But more oftentimes, what we'll see is that these are people with chronic, latent infections.

They're not in a replicating mode where, like, oh my gosh, I got a fever, I got chills, I got all that. But they have chronic health, low grade health issues, because this the organisms are like, nobody's stopping us. Let's go. I would do the same thing, right? Well, there's no nobody to stop me from walking on the private beach. Great. I'm going to go on the private

beach. Why not? Right? So Secretory IgA is critically important from an assessment, when we assess that, because that really does tell us, like, the state of the immune system, right? It does, yeah, there's, we're going to come back to maybe rechecking this and maybe some strategies here. But Zonulin, there's a lot of discussion about Zonulin, fecal Zonulin versus Zonulin antibodies. Some people say fecal Zonulin is not a good marker of intestinal

permeability. They say you gotta run blood tests and antibody tests. Other literature says fecal Zonulin can be used what's vibrant stance. I would say they would believe that it has, that it's can be used as a potential marker of intestinal permeability. But why did they? Why do what's the, what's the general thought process regarding fecal Zonulin? Let's start with what is fecal Zonulin, and if it's elevated in

the stool, what does that mean? And how does that maybe differ from blood testing, if you're if you're good with that,

opened. So there was recently been depending on how long it takes you between stools, it recently has been leakiness in your gut. The reason we would also do a blood based test is because we look at Zonulin antibodies, and Zonulin antibodies provides a snapshot, or, sorry, a report card of how

long and how often Zonulin has been elevated. So whereas, like Zonulin, just Zonulin, and a blood test will tell you if it's actively elevated, like a fasting blood sugar, like, what is it right now, a anti Zonulin is going to give you a report card. If it's IgA, it's like the last week. If it's Iggs, maybe the last couple of months, it'll tell you how often it has been

elevated over that time period. It's like hemoglobin a 1c it gives you a past perspective, yeah, and they can both be helpful in hand, but if you have elevated Donald in your stool, it means you had elevated Daniel in before you in creating that. All, yeah,

have less breakdown of the barrier. If we don't do that, whether you have a positive antibody test or not, you're probably going to have one, right? Is that fair?

my opinion, the gold standard. And I think it's 8020 I try to explain 8020 80% good habit, 20% bad behavior. If you do that consistently with all what if I talk about all the fitness factors, you're probably going to be fine. If you have 20% good habit and 80% bad behaviors, you're in trouble. You're going to have problems. So fecal Zonulin, if that's elevated, that tells us we're running the risk to develop more intestinal

permeability. And let's talk about what that might mean for activating the peripheral immune system or inflammatory system,

barrier. But if we get higher levels of peptides crossing the barrier, that can start to trigger more immune type reactions, if we have LPs, you talked about, that's the coding of gram negative bacteria. You have gram negative bacteria, it's supposed to be in the GI tract, but the gram negative bacteria, if particulate of gram negative bacteria, or the bacteria itself, crosses that barrier, the immune system is going to become activated. We call those pimps, pathogen

associated molecular peptides. If there's damage to the intestinal tissue, and part of that enters into the bloodstream. We call that damps, damage associated molecular peptides, and those things activate the immune system. The damps say, Hey, it's me the gut that's damaged. The immune system goes, Oh, we gotta go to the gut. If there's tamps, they go, those bind to the immune cells and say, Hey, this is the thing we're looking for. Go find it and kill it. From a thyroid

perspective, I want to make sure everybody hears this piece. We think that a lot of times thyroiditis, you'll see it written up because it's gluten, and you eat gluten and it causes cross reactivity or molecular mimicry. But what we would often not talk about, I talk about it a bunch, is that the thyroid cells themselves have pattern recognition receptors. That

means not on immune cells. Immune cells, these PAMPs and damps, these danger particles attached to the immune system, to immune cells to activate the immune system, to tell it what's the problem and where the damage is, so they can help. But the thyroid gland has pattern recognition receptors, and this is why I said I said I don't think thyroiditis is a mistake.

I think it's a, it's a it's an adaptive response, because if those camps or damps bind to the thyroid cells themselves, the thyroid cell now becomes an immune like cell and initiates the release of inflammatory cytokines, inviting more lymph. Sites into the thyroid gland and creating more damage. It's not broken physiology, because it can that process can turn back off. But if you think about it from my perspective, if the cell that's under stress and danger is trying to down regulate its

metabolism, it can do it locally. If there's lots of cells and tissues in a systemic inflammatory or danger perspective, how does the body slow down the metabolism? You slow down the production of the primary hormone that drives metabolism and that occurs at the thyroid gland. And this is why I say thyroid physio, thyroid gland hypothyroidism, and is oftentimes recoverable, but we have to address the

things that are creating this immune activation. And you're right, those immune inflammatory chemicals, those damps, those PAMPs, they can create other tissues to be damaged in time. But a lot of times, I don't think of it as just like, okay, the immune system is going to damage the tissue. I think it has something to do with alterations of the local proteins, structures because of some of these things, damage

being done. And then the immune cells kind of scooping up a debris field and going, oh, there's an organism here, or a piece of something and a piece of tissue. I knew what the tissue was. I don't know what these two things are combined. And now, because that leaky gut and that LPS being out, now the immune system says, Well, I'm going to react to what, what was connected to that piece of material. Yeah, totally. So we're going to wrap this up, because I'm sure you've got

other things to do than listen to my boring voice, right? But there's, there's one more thing I want to cover on the test, and that is fecal anti Gliadin. Mm, hmm, okay. Now a lot of people are who've already been in the functional medicine space, are gluten free, dairy free, and they get a test done like this, and it is positive, and they're like, I am not eating wheat. How can that be? How would you explain that to somebody, why their fecal anti Gliadin might be elevated despite not

consuming it? Because that in some people's mind, until I explain it to them, they think the test can't be valid because I don't need it. Oh,

in gluten. So you really have to ask, Do you have a dedicated gluten free fryer if you're going to eat anything that's been fried out, period, full stop. Also, just things can happen in a kitchen, like, if it's not your kitchen, you would, you don't know. You really don't know. Other times there's just lack of understanding of what is gluten,

what's not gluten. And then we also, you know, I've had a client who, I had a client who lived just down the road from a wheat field and was inhaling gluten antigen all the time.

possible. Oftentimes, when someone is reactive to the non gluten wheat peptides on vibrant wheat Zoomer, they also have reactivity to other grains like corn, rice, etc,

right. And there's multiple breakdown products of wheat. So the important part is, if you feel wheat reactive, but this component is normal, it doesn't mean you're not reactive, right? We'd look at, right? Might be better to look at an antibody test, yes. And we'd look at maybe the breakdown, all the breakdown products, and see, are you reacting to other components of wheat, but not this Gliadin piece that you're looking at here, like

benefit from knowing what's going on in the microbiome. And then in terms of when to test, I would definitely not do it right after a colonoscopy, because that will wipe out everything in your gut, so wait at least two weeks for the microbes to grow back. And as a side note, after a colonoscopy is a great time to feed your microbes, all of the healthy things, so they grow back in the way you want them to, as opposed to eating a poor

diet, which then would continue to decimate them. So not right after colonoscopy, and then I would do it, eating your normal diet. Some people, some providers, will say, avoid anything that could possibly contribute to a change in the gut. But you want, you want to do a baseline, or you want to do like in your normal, like, you know, like washout, or just like eating your normal. What does that look like? So I would say, maintain your normal routine, what you're currently doing. I

would not change anything. Personally for my clients, they just eat normal. Um. And that will give you the best insight into what your current diet, lifestyle habits, what impact that's having on your gut microbiome. And

if somebody's testing, they're doing the test. Are there supplements that are going to interfere with the test that they shouldn't take? And if somebody's coming in, I'm taking this probiotic, that probiotic. I'm taking this. I'm taking that, taking this. Do you have them stop those things, or do you have them take those things? I'd like to get your opinion on

results. And it might say it looks great, but that means maybe you need to be on digestive enzymes the rest of your life, or taking that pro probiotic the rest of your life. But that's really not sustainable. We want you to be in homeostasis without the need for extra stuff. It's a supplement. Because it's supplements. It's not a long term thing you have to do all the time. So I love, like, just baseline, no supplements.

need my digestive enzymes. I'm then I may. If they're not willing to not do those things, I'm like, Great, take it, because I want to show them that what they're doing isn't having the intended impact. I They think it is right. And so typically I'd say, Look, don't take anything week or so, and then we'll get the stool test done. Just eat your normal diet. We don't need all the extra support in there. And let's just see where you're at. But if somebody says, I can't live

without it, great, take your stuff. Let's see how it changes. See how if it makes the test look perfect, then we know there's problems, and what you're doing is managing it. But then we have to talk about whether you want to recover, you just want to manage but many times, the reason they're coming to you or is because they they're managing their symptoms with supplements, but it's not really restoring a functional, healthy,