Dr. Todd LePine
Appearances
The Dr. Hyman Show
Why Your Skin Is Begging You to Heal Your Gut First
You know, again, taking the history is the big one. You know, I always will ask people, what's your ethnic background? A lot of people say, you know, I'm white. No, it's like, you know, are you Irish, English, German, Jewish, Russian, whatever? Because the rosacea is typically found in light skin, fair skin people. And from a genetic standpoint, they are the ones who are more likely to have that.
The Dr. Hyman Show
Why Your Skin Is Begging You to Heal Your Gut First
It's just an interesting part to have in terms of the history. And then I'll just ask them, you know, what is it you're eating? Are you eating a standard American diet? How much alcohol are you drinking? How much stress do you have? Stress also. Caffeine. Yeah, caffeine can play a role. Spicy foods.
The Dr. Hyman Show
Why Your Skin Is Begging You to Heal Your Gut First
Yeah, those are all things which can sort of, you know, it's like adding gasoline to the fire because literally rosacea is the skin on fire in the facial area. But doing the testing for essential fatty acids, making sure that they have the right balance of the essential fats in their diet. A lot of people have too much omega-6, which tends to be more pro-inflammatory. Lack of the omega-3s.
The Dr. Hyman Show
Why Your Skin Is Begging You to Heal Your Gut First
One of the oils, I don't know if you've used it, that I've found very helpful with patients who have rosacea is porridge oil and even criminal's oil. They tend to be very, they help to dampen down that inflammatory response.
The Dr. Hyman Show
Why Your Skin Is Begging You to Heal Your Gut First
Exactly. Yeah. Putting patients on an anti-inflammatory elimination diet, you know, 80% of the time, it doesn't matter what they come in with. They're going to actually, they'll actually get better.
The Dr. Hyman Show
Why Your Skin Is Begging You to Heal Your Gut First
They, you know, getting them off of the pro-inflammatory foods and then putting in foods which are anti-inflammatory, cold water fish, sardines, wild salmon, the essential oils like evening primrose oil help to sort of dampen down that inflammatory response.
The Dr. Hyman Show
Why Your Skin Is Begging You to Heal Your Gut First
And you actually just triggered a thought because there's actually a paper that says if you have rosacea, you have a higher incidence of Alzheimer's disease. Oh, wow. So it's not just a cosmetic issue. It's actually systemic inflammation. You have a red face and a red brain that's on fire. Exactly. Yeah. I was sort of blown away by that. That's fascinating. Yeah, especially in women.
The Dr. Hyman Show
Why Your Skin Is Begging You to Heal Your Gut First
It's actually more common in women.
The Dr. Hyman Show
Why Your Skin Is Begging You to Heal Your Gut First
Yeah, I've been surprised at how many people have what I would call a relative lack of hydrochloric acid in the stomach. I venture to say that the majority of people don't have too much acid. They have not enough acid in the stomach.
The Dr. Hyman Show
Why Your Skin Is Begging You to Heal Your Gut First
And you bring up a really good point because a lot of the pharmaceutical medications, especially some of the psychotropic, so the antidepressants are like that too. The PPIs and the antidepressants, when you try to get off of them, you get this rebound process. The body tries to get back into balance. And it can be very difficult.
The Dr. Hyman Show
Why Your Skin Is Begging You to Heal Your Gut First
So you've got to go low and slow when you're trying to taper off the PPIs or taper off antidepressant psychotropic meds. Absolutely.
The Dr. Hyman Show
Why Your Skin Is Begging You to Heal Your Gut First
Yeah. Well, I had a patient who came in and she was a undiagnosed celiac, not just a gluten sensitivity. She was an undiagnosed celiac. She was Irish. And she was having a standard American diet. And she was self-medicating for her heartburn with over-the-counter acid-blocking medications. It had a lot of bloating-type symptoms. And came in. And her major complaint was her skin.
The Dr. Hyman Show
Why Your Skin Is Begging You to Heal Your Gut First
But she had all these other things. But her big thing was how I look.
The Dr. Hyman Show
Why Your Skin Is Begging You to Heal Your Gut First
So, you know, it's, it's, you know, people are vain and people's attention. Exactly. Right. And, and then when I, uh, did a dive into, uh, her, uh, testing, you know, it turned out that she was deficient in her essential fatty acids, especially the gamma linoleic acid. Um, she, she had a lack of stomach acid because of the PPIs. You can actually measure a test.
The Dr. Hyman Show
Why Your Skin Is Begging You to Heal Your Gut First
Uh, blood test is a commercially available test called gastrin and, uh, gastrin levels will go up when you block acid. Um, and, So, and that's actually one of the tests that I actually like to use when I have patients where I'm trying to get them off of a PPI, because the higher the gastrin level, the more difficult it will be to get off the PPI.
The Dr. Hyman Show
Why Your Skin Is Begging You to Heal Your Gut First
And that's sort of like, it'll tell you how easy you can get off of it. These acid blockers, that's the PPI, right? Exactly. And then she also had low vitamin D levels. I mean, we spend a lot of our time clothed and indoors, so we don't get way enough sunshine. That's one of the big things.
The Dr. Hyman Show
Why Your Skin Is Begging You to Heal Your Gut First
And low vitamin D, you don't just fix low vitamin D. This is one of my, I get up on my soapbox all the time with here, is you don't just fix low vitamin D by, taking vitamin D. Vitamin D deficiency is basically a sunshine deficiency.
The Dr. Hyman Show
Why Your Skin Is Begging You to Heal Your Gut First
There are certain times when there can be other causes, like you might have fat malabsorption that can cause low vitamin D, or you may have problems with the synthesis because of lack of skin oils, which when you get exposed to the sun, But by and large, low vitamin D levels is related to sunshine deficiency. And low vitamin D is not the problem. It's a symptom of another problem.
The Dr. Hyman Show
Why Your Skin Is Begging You to Heal Your Gut First
And the immune system is also benefited by sunshine exposure, healthy sunshine. I think you said you enjoy going to the tropics now and then, Caribbean, Hawaii, whatever. And we also feel good. This is another thing that I find fascinating is that there is a – a condition which is called sunshine addiction. You know, these people who are like suntan addicts?
The Dr. Hyman Show
Why Your Skin Is Begging You to Heal Your Gut First
Well, it turns out that our bodies actually produce endorphins when we are exposed to the sun. So there's a feedback mechanism. That's incredible. Oh, yeah, yeah. There's a compound that's called pro-opio-melanocorticotropin hormone. And what it means is that our bodies give a reward when we're in the sun. So we feel good. We make us want to get the sun. Oh, that's interesting.
The Dr. Hyman Show
Why Your Skin Is Begging You to Heal Your Gut First
That's why I love going in the sun. Exactly.
The Dr. Hyman Show
Why Your Skin Is Begging You to Heal Your Gut First
Exactly. And the interesting thing is it actually, you can get addicted to the sun. And it's like you can get addicted to food. I mean, your body needs food to survive and your body actually needs sunshine to survive. So, nature has built in these feedback mechanisms so that it encourages us to do it. That's incredible. Yeah, isn't that wild?
The Dr. Hyman Show
Why Your Skin Is Begging You to Heal Your Gut First
Well, I did a lot. I mean, I had her work with our nutritionist and got her off of her standard American diet. I treated her bacterial overgrowth. She had a significant SIBO test. So I treated that primarily with herbs. A lot of people will use antibiotics, things like Rifaximin or Xifaxim for SIBO. I actually find that I do just as well using antimicrobial herb preparations.
The Dr. Hyman Show
Why Your Skin Is Begging You to Heal Your Gut First
I supported her stomach acid using Betaine HCL. Some patients don't respond to that. They don't tolerate it as well. So sometimes I'll use things like apple cider vinegar. And then got her fatty acids up, gave her a little bit of borage oil and a combination of that. And then also just told her to get some healthy sunshine.
The Dr. Hyman Show
Why Your Skin Is Begging You to Heal Your Gut First
It doesn't necessarily mean that you need to go out and sunbathe or go to a sun tanning booth, but just getting healthy sunshine can help with down-regulating the immune system. And interestingly, you know, just off topic, but with COVID, there are some really interesting studies that giving high dose vitamin D helps with COVID infections.
The Dr. Hyman Show
Why Your Skin Is Begging You to Heal Your Gut First
And so COVID actually, or vitamin D, when it's at high enough levels, actually helps to keep the immune system in balance. It keeps it from getting over.
The Dr. Hyman Show
Why Your Skin Is Begging You to Heal Your Gut First
Exactly, exactly. It's like a hormone. And it's also, it actually acts like a steroid too. It's a cholesterol molecule moiety. And I oftentimes, if I'm coming down with a cold or a flu, I'll up my dose of vitamin D, especially in the winter. Absolutely.
The Dr. Hyman Show
Encore: The Root Causes and Fixes for Brain Fog
I've seen patients where they'll get brain fog when they're in a certain building. They'll get brain fog after they've had a certain meal. Certain foods may trigger brain fog. And it is something that I think is intimately connected to the gut. I think the, and I'll talk about that in this particular case, is gut fermentation is oftentimes a cause for brain fog.
The Dr. Hyman Show
Encore: The Root Causes and Fixes for Brain Fog
I mean, it's like bugs fermenting the food you're eating, creating all these nasty byproducts.
The Dr. Hyman Show
Encore: The Root Causes and Fixes for Brain Fog
And I don't know, Mark, if you've had patients who've had, this is a really interesting thing because I have patients come in and they say, I feel like my gut is just like bloating and I'm fermenting and that's exactly what's happening. So there is a condition. I just recently had a patient who had auto brewery syndrome. Yeah. So you have your own like beer factory.
The Dr. Hyman Show
Encore: The Root Causes and Fixes for Brain Fog
So when you want to make beer, what do you do? You take sugar and you add yeast to it and you can actually produce alcohol. And I've had a couple of cases where it was missed. And it's actually not just the recent findings. It's not just yeast in the gut that do this, but also Klebsiella bacteria. So both bacteria and yeast can actually produce these compounds, which are toxins. Alcohol is a toxin.
The Dr. Hyman Show
Encore: The Root Causes and Fixes for Brain Fog
That's why when you get drunk, you're intoxicated. And you actually produce alcohol and other toxins which affect your brain.
The Dr. Hyman Show
Encore: The Root Causes and Fixes for Brain Fog
Maybe in your stomach. Well, it's manifesting in the head. That's the whole thing. And we have these artificial boundaries between the brain and the body and the mind. And they're all interconnected. And brain fog is a real phenomenon. And then you have to sort of figure out what's doing it. The other thing that is interesting that I see with some people with brain fog is just gluten and dairy.
The Dr. Hyman Show
Encore: The Root Causes and Fixes for Brain Fog
And I tell patients that one of the most addictive foods is pizza. And the reason for that is that pizza has gluten in it. It's true.
The Dr. Hyman Show
Encore: The Root Causes and Fixes for Brain Fog
I tell you, it's one of the foods that I'll occasionally indulge in, but I don't have it that often because it's not the best food for you.
The Dr. Hyman Show
Encore: The Root Causes and Fixes for Brain Fog
Exactly, yeah. But the two foods which are interesting is that gluten and dairy both get broken down. The proteins in those get broken down into caseomorphins and gluteomorphins. And casein morphins are the ones from dairy and gluten morphins are from gluten. And those have morphine-like effects. So you literally become a little high. You get a little high. You get a little foggy in the brain.
The Dr. Hyman Show
Encore: The Root Causes and Fixes for Brain Fog
And it also can cause cravings. And it can sort of make you sleepy. You know, you eat it and then you get a little sleepy from it also. And that's, you know, when children drink breast milk, they go to sleep after. You know, they conk out. I mean, that's because of the morphine-like action in milk. Yeah. So that's true.
The Dr. Hyman Show
Encore: The Root Causes and Fixes for Brain Fog
has to go through the liver. And the reason for that is to filter all of the toxins that are there. So there's a lot of immune cells, the copper cells in the liver, and a lot of filtering processes and detoxification takes place in the liver prior to the blood from the gut then going into the systemic circulation.
The Dr. Hyman Show
Encore: The Root Causes and Fixes for Brain Fog
So sometimes you'll have, in addition to a leaky gut, you'll have problems with detoxification in the liver itself. And that's, you know, an example of that is the condition of hepatic encephalopathy, which is a brain fog. That's, that's essentially.
The Dr. Hyman Show
Encore: The Root Causes and Fixes for Brain Fog
I learned, I learned, and I think I mentioned this before, and it was one of the things that really stuck with me is when I worked at the VA hospital, there were a lot of alcoholics. And when you're an alcoholic, you basically turn your liver into a pickled liver. You trash your liver. You trash your liver. And then you're not able to detoxify.
The Dr. Hyman Show
Encore: The Root Causes and Fixes for Brain Fog
And I would typically see this over and over where patients had cirrhosis of the liver and their liver was not able to detoxify. And then when they would eat foods, especially high protein type meals, they would get hepatic encephalopathy and literally go into a coma.
The Dr. Hyman Show
Encore: The Root Causes and Fixes for Brain Fog
Totally, totally connected to the brain. Absolutely. And in some cases, there have been cases of people actually having psychosis from
The Dr. Hyman Show
Encore: The Root Causes and Fixes for Brain Fog
gut dysfunction yeah you mentioned auto brewery syndrome i remember reading a case of a woman who was arrested for driving under the influence and it turned out she wasn't drinking but she had a high blood alcohol level that was coming from her gut yeah yeah it is yeah and it's it's a very real phenomenon you have to think about it and the way that you actually test for that is you you can it's actually quite simple is you just have somebody do what i call a pancake challenge you basically some pancakes full of carbs but throw some maple syrup on it eat it
The Dr. Hyman Show
Encore: The Root Causes and Fixes for Brain Fog
and get a blood draw at point zero, eat the meal, and then half an hour later, check your alcohol level.
The Dr. Hyman Show
Encore: The Root Causes and Fixes for Brain Fog
So infections. Infections can do that. Another one that is- Tick infections. Oh, absolutely. Tick infections. Yeah. Oh, those are, yeah, those, I would say that that's in addition to brain fog, you get a lot of cognitive dysfunction too.
The Dr. Hyman Show
Encore: The Root Causes and Fixes for Brain Fog
It's more severe. It's much more severe. The one thing that I see a lot is allergies. I call it the allergic brain.
The Dr. Hyman Show
Encore: The Root Causes and Fixes for Brain Fog
And you can have food allergies that can potentially do that, or even environmental allergies or mold. And the high levels of histamine, because histamine is actually acts as a neurotransmitter. And I've seen this in a number of patients. I've had some patients with another condition, which we're seeing more and more of is mast cell activation syndrome.
The Dr. Hyman Show
Encore: The Root Causes and Fixes for Brain Fog
It's sort of a buzz, you know, diagnosis now, but it's a very real phenomenon. And And that is related to the mast cells, which are the types of immune cells in the body and the interstitial, the sort of the spaces between the cells where they reside. And they release lots of histamine. And if anybody has ever had hay fever, you see that typical picture of hay fever.
The Dr. Hyman Show
Encore: The Root Causes and Fixes for Brain Fog
You're like this, like half asleep and like they're walking through a fog. Hay fever is an example of that. brain fog. And antihistamines can actually have a benefit with that. Naturally, things like quercetin and nettles can also be very helpful. And you probably have used it. This is something that I use.
The Dr. Hyman Show
Encore: The Root Causes and Fixes for Brain Fog
I've been using more is the drug chromolin sodium, which is I've had some amazing success with that in more difficult cases. I wouldn't necessarily go to that for my first choice.
The Dr. Hyman Show
Encore: The Root Causes and Fixes for Brain Fog
What did you find? Well, he actually came into me and he had already seen a variety of different doctors. And the background is that the gentleman as a child had lots of allergies and asthma. So he had ear infections, bronchitis, also developed some sinusitis type symptoms. So he had multiple rounds of antibiotics and
The Dr. Hyman Show
Encore: The Root Causes and Fixes for Brain Fog
I always emphasize to patients that when you have an immune dysfunction, look for the gut because 60 to 70% of your immune system is in the gut. And just like with what's going on with the COVID virus or the COVID-19 syndrome that we're seeing by coronavirus. is it's not the virus or the bacteria itself that causes the problem. It's our immune system's response to it.
The Dr. Hyman Show
Encore: The Root Causes and Fixes for Brain Fog
And in general, we want to have a, I call it a balanced immune system. So we want our immune system to be idling. So basically just sort of sitting there and I'll say, we're enjoying planet earth. We're going out for a walk. We're not reacting to the- Not underreacting or overreacting. Exactly. Underreacting or overreacting. And when you overreact, we call that an autoimmune disease.
The Dr. Hyman Show
Encore: The Root Causes and Fixes for Brain Fog
When you underreact, we call that AIDS. Yeah.
The Dr. Hyman Show
Encore: The Root Causes and Fixes for Brain Fog
So AIDS or cancer. AIDS or cancer.
The Dr. Hyman Show
Encore: The Root Causes and Fixes for Brain Fog
Right. And I think, you know, we talk about like, you know, a weak immune system or a strong immune system. It's really, I think, an intelligent and a balanced immune system. That's how I like to think about it. And that's, you know, related to immunotolerance, which is what the gut does. So when we have a healthy gut, we have an immune system that is tolerant to lots of things.
The Dr. Hyman Show
Encore: The Root Causes and Fixes for Brain Fog
And you can eat certain things. You can go out in the environment. You're not going to react to dog dander and all these other things. There are some genetic... Some people have genetic predispositions towards being more atopic or allergic. But having a healthy gut, especially early on, the priming of the gut is so critical. You know, having a vaginal birth, being...
The Dr. Hyman Show
Encore: The Root Causes and Fixes for Brain Fog
uh, breastfed, uh, not introducing, uh, certain foods like gluten early on in, in, in living on a farm, living on a farm, exactly. Being exposed, exposed a lot of, and, and crawling around in the dirt and literally putting dirt in, you know, I would call it, you know, your, your body's immune system samples planet earth. Planet earth is a very dirty place.
The Dr. Hyman Show
Encore: The Root Causes and Fixes for Brain Fog
There's lots of bugs and all kinds of things in your body learns to be immunotolerant. And one of the things that is really, I also focus on is part of the immune system is called the Treg cells. The Treg cells are like the conductor in the Boston Symphony Orchestra. So you've got, you know, the wind section over here and the horns over here and they keep everything in balance.
The Dr. Hyman Show
Encore: The Root Causes and Fixes for Brain Fog
And the Tregs are really, really critical. And what we're finding- Regulatory cells. They regulate. They regulate the whole, you know, the whole balance of the immune system. And the Tregs that we find out, the Tregs, Two things that are really simple that people can use to upregulate your Tregs to keep things in balance are fibers, fibers in the diet.
The Dr. Hyman Show
Encore: The Root Causes and Fixes for Brain Fog
Fibers are the key things that help with regulation of that. And then also, which I use quite a bit in the patients that I see is vitamin A. Vitamin A helps to downregulate the immune system and helps to keep the Treg cells in place.
The Dr. Hyman Show
Encore: The Root Causes and Fixes for Brain Fog
Brain fog is really a symptom, sort of like cough. Cough can be caused by a cold, bronchitis, pneumonia, post-nasal drip, asthma, a whole bunch of things. You've got to figure out, okay, what's driving it? There is no ICD-10 code for brain fog. You might call it altered mental status, but oftentimes it's transitory. That's the really interesting thing.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
We now believe that, and you sort of brought this up as part of the introductions, is that we now believe that food poisoning starts the whole process. So you... And eating is part of it. You know, back in the day, meaning like 40, 50 years ago, when we were in... kindergarten, we would sit in a sandbox and eat the sand. Now we eat salad out of a bag until we go to Club Med.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
And for the first time in our life, we see salmonella or we go somewhere and we get traveler's diarrhea or we get food poisoning or whatever. We start to explore the world of food. But food poisoning triggers this. And we now have identified the toxin in food poisoning, the CDTB toxin.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
that trips off some antibodies in the human body that then cause your nerves of the gut to fail or to be impaired. And so when the flow of the gut is slowed by this impairment, bacteria build up. And there's two bacteria that just flourish when it's a little more swampy. So I used to watch Survivor shows on TV on Discovery Channel. You've probably watched those.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
And they always say- I like The Lost.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
It's a little bit different. There's a little more raunchiness. With Survivor, you're just kind of trying to make it to a road somewhere. But the point was that he always, this guy on the Survivor show, would always say, if the water's not moving, don't drink it. If the water's flowing fast, drink it because it's cleaner. And the same thing with the small bowel. If the small bowel stagnates,
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
it becomes swampy and bacteria grow in it. And the same thing is happening in the human small intestine. And so it's a sequence. So food poisoning, the antibodies, and then you develop the bacterial buildup.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
The interesting thing about contrasting IBD to IBS, so the antibody that we discovered is an autoantibody that is directly related to the pathology. So the higher that antibody is, the sicker you are. The antibodies in IBD are markers of IBD. They're not directly implicated in the pathophysiology. The antibody to vinculin that we discovered is directly related to the pathophysiology.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
We can make rats have IBS just by giving them this toxin. And so that's very cool because it allows us to study new drugs and new therapies coming in.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
Well, the four horsemen of the apocalypse of IBS are Campylobacter, Salmonella, Shigella, and some E. coli, food poisoning type of E. coli, pathogenic E. coli. Giardia can do it too. It turns out it has vinculin in its structure. And so maybe that's how you get the antibodies from Giardia. The viruses are less likely to precipitate IBS.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
So the four horsemen, Campylobacter salmonella, Shigella, and E. coli. So that's... And it occurs about starts to occur about three months after you get sick. Patients will remember. Some don't remember. And they'll say, you know, they have a couple of days of diarrhea and they don't pay much attention to it.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
But they remember going on a trip to Hawaii and they end up in the hospital with bloody diarrhea. And then ever since then, nothing's been the same.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
Well, so based on culturing the bowel, we've been able to isolate that 60% of IBS is SIBO. The other 40% is a mixed bag. So for example, and you probably talk about this now, Ehlers-Danlos syndrome, POTS syndrome, we're starting to recognize those illnesses as characteristically GI-centric, at least in their early presentations as well.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
So some of the leftover 40% have Ehlers-Danlos syndrome or POTS, or some of them are celiac that we've missed. Some of them are food sensitivities. Some of them are histamine sensitivities. Some of them are So it's a mixed bag of a number of other disorders. And some of them are fungal overgrowth. So we see that in about 6% to 10% of that 100 pi. So there's still more to unpackage.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
We're not ignoring the other 40. We're trying to figure the rest out. But it's a little bit more. harder to unravel.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
Yeah, I mean, Dr. Satish Rao in Georgia has done a lot of the seminal work in this. But more recently, we've done shotgun sequencing of the small intestine, and we've been seeing this fungal overgrowth.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
No, shotgun sequencing means we sequence every single piece of DNA we can find and then characterize it and see what organisms it represents. And it represents fungus about 10% of the time. And that when the fungus is higher, the patients are experiencing more abdominal pain and more diarrhea.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
So there is a subclass of these patients that it is fungal, but it's smaller than some would like to believe, but larger than those who are naysayers, as you've probably heard. And so it is there, it's real, but it's a little more challenging to identify. There's no breath test for it. You got to go in and chase it. And that's the challenge.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
chase it by doing stool cultures or well chase it it could be by stool but if you want to find small intestinal fungal overgrowth you got to get into the small intestine and that's that's really sampling you have to have endoscopy and all that that's how dr rao identifies it yeah and and any particular species of fungus or is it sort of a broad array
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
So what we found in this, quote, shotgun sequencing is candida albicans is a big part and a little bit of candida glabrata. And there's a few other, malassezia and all these other organisms that are very minor, but they generally aren't at a high number that we think are as consequential as the first two I mentioned.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
Well, generally in... allopathic medicine, we try an antifungal. There are natural antifungals as well. And you're probably better versed in those than I am, but we do use fluconazole. We do use nystatin. Occasionally we use more radical, more advanced antifungals, but those are the typical first two choices.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
Yeah. So first of all, we helped develop the first three gas breath tests. So just full disclosure, but it's changed my practice because there are patients who fell through the cracks without knowing hydrogen sulfide. So unpacking each, the hydrogen positive breath test patients are generally, we actually just published this paper, it came out literally yesterday. There are two bugs, that's it.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
That caused the hydrogen overgrowth. It's Escherichia coli, the non-pathogenic one, and Klebsiella pneumoniae. Those two characters, when they come into town, everybody leaves because they're so opportunistic and bullies. And we think they produce even toxins to the other bacteria around them to try and get rid of the bacteria.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
So it's like you've got a gang that comes into the small town and everybody leaves. So it's a disruptor of the microbiome and then they rise very high in number. So that's the hydrogen one. The second category is the methane or methanogens. And those characters live both in the colon and the small bowel.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
And we have a paper coming out showing exactly where they're living and it's pretty universal in a lot of these patients. So hence we call it intestinal methanogen overgrowth and not SIBO methane, because it's not just the small bowel, it's colon also. And when they produce methane, it gives you a lot of constipation, a lot of gas, and you can't pass the gas. And these people are quite miserable.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
And then the third is the hydrogen sulfide, which is the new kid on the block, which has changed my practice because some of those patients we didn't know. Breath test is normal. Everything looks fine. And then the hydrogen sulfide is positive. We get rid of it. And all of a sudden they feel better than they have in their life. And.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
And for some reason, when you get rid of hydrogen sulfide, it doesn't come back so quickly, which, which is beautiful. I have patients who've gone a year, just one treatment and they're done. And so I'm really excited about that. So, I mean, I could talk about the treatments if you like now, or.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
Yeah, so I mean, if I have an IBS patient with diarrhea or a patient with diarrhea and bloating, My practice now, I do the antibodies because I want to be able to say, was it food poisoning or not? And if the antibodies are really high, it makes it harder to treat. But also, you travel, you better take prophylaxis because you could get into further trouble with these antibodies going higher.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
So I universally do that.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
I give Zyfaxan prophylaxis. That's what I do in my practice. And a lot of the GIs now do that. Because if the antibody goes higher, the damage to the nerves of the gut is more intense or the effect on the gut is more intense. And at least that's what we're seeing in our clinic. So we're very careful with those patients who have the antibodies positive.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
When it comes to, then we do the three gas breath test in all of our patients. And if it's hydrogen and you, we all know Rifaximin got FDA approved for IBS with diarrhea on the basis that IBS was in part of microbiome disease. And now we understand that microbiome condition is SIBO. So I give Rifaximin for that. If it's methane, we have one double blind study that we can lead to.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
And it's rifaximin plus either neomycin, which is what the double-blind study covered, or rifaximin and metronidazole. And then the third category is hydrogen sulfide. And we give rifaximin, but we give it with bismuth because bismuth is an anti, it blocks some of the synthetic functions of hydrogen sulfide in the sulfate-reducing bacteria.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
Point is, the hydrogen sulfide goes down, the bacteria are reduced, and therefore the patient's normal bacteria take over and things get better more permanently in that group, it looks like.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
We haven't sorted out or had time to sort out the different diet approaches, but I envision smarter people in diet will come up with a way. What we do now is what we call low fermentation eating. So we don't use low FODMAP in our practice because we're
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
you can't do it indefinitely, but low FODMAP will reduce the amount of calories you're providing to bacteria and therefore they'll ferment less and that might help. But long-term low FODMAP, hurts your microbiome and can cause nutritional deficiencies. So you can't stay on the full low FODMAP indefinitely.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
Yeah, fermentable oligosaccharides, monosaccharides, et cetera. And basically it's too restrictive. But you've probably, most people have probably read about low FODMAP diet. It's very popular in the last few years. But we use what's called low fermentation eating, not as restrictive.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
And the philosophy of that was with a low fermentation diet, you can go to any restaurant in the country and you'd find a meal. So it's, you know, you don't want to be the person at the table just because you have IBS. That spends 10 minutes with the, you know, trying to explain your dietary restrictions on a low FODMAP diet. So, you know, that's part of the reason.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
We want our IBS patients to feel as normal and as socially non-isolated as possible. And that's part of it.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
So it's basically restricting non-digestible carbohydrates. So low fiber, no dairy, and then none of the artificial sweeteners because of course they're easily fermentable. And then spacing your meals. So you don't eat for five hours between meals because the damage of the nerves, we talked about that earlier, the damage to the nerves causes a reduction in cleaning waves of the gut.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
So the cleaning waves only occur when you're not eating. So your gut is sort of like got two computer programs, eating mode, cleaning mode. If all you do all day is spend time in the break room, taking a bite of a bagel that's in the break room, you never go into cleaning mode. So in addition to the construct of what to eat, we tell you when to eat and to try and space your meals up.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
Well, you know, I may be punished for saying something like this, but Everything has fiber in it now. Even Cheerios, they put fiber in it because it prevents colon cancer and it's colon health and all this stuff for 20 years. How much have we heard about colon health and fiber? A lot. What have we got now? We've got colon cancer happening in the 40s and we're doing screening colonoscopy at 45 now.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
I'm not saying it's fiber causing that. But all the fiber we've been pounding and the cardboard we've been eating hasn't really done as much as we thought it might. So I'm a little unclear about fiber. But from the point of view of bacteria, you put more fiber, you're gonna have more of the bacteria. If you had bad bacteria to begin with, there's gonna be more of them.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
And for a healthy person whose microbiome's healthy, no problem. But not for these patients with these microbial conditions.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
Well, I can answer that in two or three ways, but I'll try to touch on a little bit of each. We looked at rifaximin before and after treatment, the small bowel. And when you get rid of the bullies in the town, all the inhabitants of the town come back. So it goes opposite of what people think. We're not, you know, being cataclysmic. It's getting rid of the E. coli and the Klebsiella and SIBO.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
That allows the regular bacteria to reflourish, repopulate and take over again for a period of time. But remember, the problem is those cleaning waves are not working. So it is possibly going to come back. It depends how badly damaged. And that's where that antibody comes in.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
Because if the antivinculin, which is that autoantibody for the autoimmune disease of IBS, is very high, the neuropathy is more high or more intense, and you're going to relapse or reoccur more frequently. So that's where we're able to have some further strategy. But first of all, take the antibiotics. They actually repopulate the town counter to what you think.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
We've never seen antibiotic resistance to Rifaximin so far, knock on wood. It's a very unique chemical drug. And then we get them on the low fermentation eating diet. That's what we do. And for those where the antibodies high or those who relapse, we do put them on a prokinetic. So they space their meals. Everything's going right.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
But we want to stimulate those cleaning waves at nighttime because that's the longest time you're not eating and make you clean up as much as possible at night so that the bacteria don't have a chance to come back. So we don't do all three things for everybody. It depends on, you know, if somebody relapses in two years, we don't need to put them on a drug every day to prevent.
The Dr. Hyman Show
Mold, Lyme, Gut Health, and the Mystery of Histamine Intolerance
But if they relapse every three months, then we can stretch it out to a year by adding the prokinetic or doing more aggressive diet strategies.