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Episode 10: The Secrets to Gut Transformation with Gavin Guard, PA-C

Podcast Drop Date: 2/8/23

Gavin Guard, PA-C, MPAS, CISSN, Pn1 believes that the average doctor visit is not giving patients the time and support they deserve. Gavin graduated summa cum laude from Whitman College with a bachelor’s in biochemistry before completing graduate medical school training at the University of Colorado. His main clinical focuses include gastrointestinal disorders, thyroid and hormone health, as well as metabolic disease like diabetes, high cholesterol, and heart disease. Aside from patient care, Gavin is also publishing medical literature in the functional medicine field. He wakes up every morning to help patients find lasting solutions to their health so that they can experience hope and feel restored. When not in the clinic or reading papers, you can find him spending time with his wife and two young girls or pumping iron in the weight room.

Gavin's specialties include: - Digestive concerns (IBS, SIBO, reflux, bloating, diarrhea, constipation, IBD) - Longevity and metabolic health (heart health, blood pressure, blood sugar, cholesterol, weight loss) - Mold illness and toxicity - Thyroid health - Hormones (testosterone, menopause, female hormones) - Autoimmunity - Brain fog, fatigue


Amber Warren, PA-C: Welcome to Functional Medicine Foundations podcast, where we explore root cause medicine, engage in conversation with functional and integrative medicine experts and build community with like minded health seekers. I'm your host, Amber Warren. Let's dig deeper. Welcome back, everybody. I'm here with Gavin Guard, physician assistant with Functional medicine of Idaho. Gavin Guard believes that the average doctor visit is not having patients, not giving patients the time and support they deserve. Gavin graduated summa cum laude from Whitman College with a bachelor in biochemistry before completing graduate medical training at the University of Colorado. His main clinical focuses include gastrointestinal disorders, thyroid and hormone health, as well as metabolic diseases like diabetes, high cholesterol and heart disease. Aside from patient care, Gavin is also publishing medical literature in the functional medicine field. He wakes up every morning to help patients find lasting solutions to their health health so they can experience hope and feel restored. When he's not in the clinic or reading papers, you can find him spending time with his wife and two adorable little girls. I can vouch for that. Or pumping iron in the weight room. Gavin has multiple specialties, some of which include multiple digestive concerns IBS, SIBO, reflex, bloating, diarrhea, constipation, IBD, longevity and metabolic metabolic health, optimizing blood sugar, heart health, high cholesterol and weight loss, mold, illness and toxicity, thyroid health, hormonal health, autoimmunity and brain fog and fatigue, to name a few. Welcome, Gavin. Thanks, Amber. So Gavin's been. Yay! Gavin's been a part of our team since June. This past June. We were able to swipe him from the state of Washington at least part time, where he spends time in Idaho seeing patients in person.

Gavin Guard, PA-C: So as I mentioned, the part one, the functional medicine is a diet and lifestyle focused approach. And then we layer on gut health on top of that. So speaking to that foundational diet aspect, we always follow a a model of least restrictive to most restrictive dietary sequence, if you will. So we do not start with a very for most people, a very restrictive diet right out of the gate. If they are following a totally cruddy diet. Right. We start to make fine tune adjustments, starting something with like an ancestral dietary template, kicking out more of those inflammatory immunogenic or immune system stimulating foods such as dairy gluten, soy products, to name a few. That ancestral diet also encompasses foods that are more nutrient dense as compared to the things that are just calorie high calorie but nutrient deplete. So that is like the most least restrictive change that we can make, starting with something like an ancestral dietary template.

Amber Warren, PA-C: We can you say ancestral? I'm thinking paleo.

Gavin Guard, PA-C: Yes, I intentionally didn't use that word.

Amber Warren, PA-C: I figured you did.

Gavin Guard, PA-C: Because and I tell patients, I'm like, I'm sure you've heard of the paleo diet. I think when a lot of people hear a common diet term, they kind of get turned off some, some do. They get turned off because they may have heard on X, Y, Z, you know, newspaper or blog that the paleo diet is associated with whatever, right? There's some connotations that people think of. So I use the word ancestral, just trying to eat things that we were designed to eat. Really. That's the kind of the overall encompassing theme of something like that. And our nutritionist, they're absolutely phenomenal in helping people make those practical changes because what I tell people, I'm like on the day to day changes that you need to make here, I like to have you spend some time sitting down with Lexi or one of our other nutritionists to actually talk about how we can close the gap between what you're doing, what you're doing, and what we need you to be doing here. Yeah, And I always tell them, you know, it's I for my standpoint, I don't need you to be 100%. I want you to be like 80 ish percent consistent with this. And the reason that is a lot of times with people with GI issues, some of them are already fearful of some foods. And we see that in some of the studies. Those with irritable bowel syndrome, 13% have severe food restrictive behaviors. Same thing with inflammatory bowel disease. So I do not want to perpetuate that behavior even further.

Gavin Guard, PA-C: So, you know, we have them get a lot of times with their nutritionist to kind of walk through the practical steps to make these changes. That's kind of like the least restrictive thing that we could do there. Then we can move up to something like a low fodmap diet. I say that term and a lot of patients are like, What did you say? Yeah. So Fodmap stands for Fermentable Oligo, Disaccharides, Monosaccharides and Polyols. It's a fancy term for fermentable fiber in your diet. A lot of us are told to eat foods like avocados. A lot of these cruciferous veggies like broccoli, cauliflower, a lot of the allium, vegetables, onions, garlic, great foods, right? I don't have a beef with them. I think they're absolutely fine. But some of these healthy foods that we are told to eat and some individuals, there's an intolerance to them, there's a fodmap intolerance to them. And that can present as more gas, more bloating, loose stools, constipation. So we start to avoid or moderate restrict those foods and we. Often get benefit. It's not just me saying this. There are plenty of studies in those with irritable bowel syndrome that show on average about a 70% response rate to a low fodmap diet, meaning that you take a group of 100 people with IBS, you give them all a low fodmap diet, 70% of them will improve. Now there's 30% that don't. But in the realm of gut health, especially IBS, that is a phenomenal treatment response is phenomenal. I mean, even these FDA approved medications, Rifaximin, for example, costs some patients 1200 dollars to get that is like a 45 to 50% response rate.

Gavin Guard, PA-C: So again, diet, lifestyle, focus, a low fodmap diet, an informed treatment modality that's a little bit more restrictive. Now, I always tell patients, I say this is not lifelong. We are not doing this forever. Right? My two goals are, one, to get you to the broadest diet possible all while still maintaining symptom improvement. That's not to say we are going out to Chick fil A every day, but we are still maintaining some nutrient or nutrition pillars. But you're not fearful of eating certain foods, right? So I'm not having to follow a low-fodmap diet long term. I have them reintroduce some things. And then number two is I want you on the minimal effective dose of any supplements, any medications that you need so that you're not dependent on 20 different things that gets you to maintain those improvements. So really, this is a short term kind of extra push that we use in conjunction with all these diet lifestyle changes that we're making. So we have this ancestral dietary template, we have low fodmap template. We're trying to expand the diet as much as possible. We get them help with our amazing nutritionists. There's some other fancy diets out there, the specific carbohydrate diet. There are some other diets out there that I won't touch on too much because quite frankly, I don't use them as much. If I need to go that restrictive with someone, I'm probably missing something.

Amber Warren, PA-C: How do you I use the elimination diet a lot in my practice to kind of kick start gut health and kick start honing in on on what foods an individual patient might be reacting to. Are you using that a lot in your practice?

Gavin Guard, PA-C: Not as much. I usually use kind of an empirical something like ancestral low fodmaps sometimes something called like a low histamine diet. I think that's a great starting point. I feel like it's a great experiment that everyone should go through, even if it's somewhat restrictive, it's only short term and you could really gather some important and vital data from that of how your body responds to specific foods that you may not get from an empiric trial of like ancestral or low fodmap.

Amber Warren, PA-C: Diet, intentionally pulling out foods to get rid of the antibodies. Your body's reacting to those foods and then re reintroducing in a very in a very specific way. Absolutely. To assess your response. And again, it might not be, oh, my bloating went away and then when I reintroduced gluten, my bloating came back. It might be we talked about this in the first episode. It might be brain fog, it might be joint pain. Yeah. It doesn't have to be these gastrointestinal symptoms that we see. Yeah, good stuff. You have really helped educate us as as practitioners on a. This topic along the lines of an elemental diet. And I your response your some of the anecdotal results you're getting are unbelievable with this elemental diet. Let's talk about that and how you implement that.

Gavin Guard, PA-C: Yeah, an elemental diet is not necessarily another set of rules or restrictions that you follow is not the typical diet. In that diet sense. What it is more so is a meal replacement strategy. An elemental diet is pre formed powder, if you will, that has all the vital calories, protein, carbohydrates, vitamins, minerals that you need to sustain. It's not a protein powder.

Amber Warren, PA-C: We're not talking.

Gavin Guard, PA-C: Not a protein powder. No, it's a prescription grade, predigested protein and carbohydrates that, you know, you mix in with water, kind of like a protein powder, but it's not. So it's special, right? So it's pre digested protein and carbohydrates into their most elemental form, hence the name Elemental Diet. Why would you do that? Well, think of it this way. If you were to go out and run a mile and you sprain your ankle, what would you do? You would rest right in the same way. When our gut is unhappy, it is Maybe it's in a disease state or a just a dysfunctional state. We should not ask it to continue to work hard for us. We shouldn't be putting this influx of foods that it may be sensitive to that has to work hard to digest, absorb, assimilate. So we need to give it a break. Yeah, we've got to give it some time to go to the Bahamas and have a nice time on the beach, if you will. Just like a nice respite. So how do we do that without driving ourselves crazy of having to fast? Because really the fasting would be the only way that we would do that. We have a lot of people say inflammatory bowel disease can ask them to fast forever. They've got to have some calories. And that's really the genesis of how the elemental diet is starting to get incorporated into clinical practice. Was looking at inflammatory bowel disease patients. So it's this prescription grade meal replacement of predigested protein and carbohydrates is all absorbed in that first two feet of your small intestine.

Gavin Guard, PA-C: Thus it gives the rest of your gut a nice little time to chill out and relax, repair itself. And so, I mean, maybe we could talk about a little bit the studies behind it. So again, it kind of came out of the inflammatory bowel disease research. For example, there was a group of 150 IBD patients, and they use this elemental diet as their sole source of calories for four weeks or a month. And I know that may sound a little intense or daunting, but remember, these are people who are severely malnourished. They can't eat anything without having severe symptoms. At baseline, 91% of them had some type of malnourishment. They were not doing well. They use this elemental diet for four weeks. Not only did they see an improvement in their symptom severity, they saw an improvement in their quality of life, their number of bowel habits. They also saw malnourishment rates drop from 91% to 21%, a delta of 70% reduction. Absolutely. From just malnourishment, from this elemental diet. So it leads to symptom improvement, improvement, quality of life, Reduce malnourishment again because our guests epi center for Nutrient absorption. There have also been some studies to show benefit in SIBO, small intestinal bacterial overgrowth and irritable bowel syndrome, as well as some joint issues and some autoimmune conditions. We see in one study in those with rheumatoid arthritis, this autoimmune joint disease that an elemental diet was as effective as oral steroids and improving symptoms, quality of life.

Amber Warren, PA-C: And you don't have to do that for four weeks.

Gavin Guard, PA-C: You don't have to do it for four weeks. There's different ways that we can use this. We can use this just as like a meal replacement for maybe one or two meals of the day. The other meals are following X, Y, Z template. We could use this as like a short reset where we use it for like 2 to 4 days and then we start to gradually reintroduce some foods after that. I rarely have it used longer than that. Maybe in some of my IBD patients I'll use it a little bit longer, maybe a week or two because they're so severely malnourished. But it's a really great tool and it really works well in conjunction with other GI therapies.

Amber Warren, PA-C: Yeah. Do you see we know the data on like metabolic issues or even just, you know, a kind of stubborn weight loss issues. Do you see the sorry, the data with that related to to gut health? What about people that just almost went like a help pushing that reset button metabolically speaking?

Gavin Guard, PA-C: I think it's a great way to mimic a fast a lot of us if you've ever done some type of time restricted feeding short fast and maybe 14 to 18 hour fast a lot. Of people report just better mental clarity and sharpness, reduced brain fog. And that's because of how our gut affects chronic inflammation. So I think this is a really good way of still getting in some calories, mimicking that kind of fasting phenomenon. Quite frankly, I use it almost every day because I don't like breakfast. A lot of people just don't like to eat breakfast. I use it every day as a meal replacement. Yeah, I'll be looking at at labs in the morning. I'll be sipping on my elemental shake. I don't chug it, but I'll sip on that. And it's a nice way for busy folks just to get in some food without having to be fearful of how it may make them go rushing into the bathroom or scare away their partner with gas or anything like that.

Amber Warren, PA-C: Okay, cool. I love that you have you have introduced this this this idea called triple probiotic therapy to our clinic that I don't think a lot of us well, I can't speak for all our practitioners, but I certainly wasn't implementing with my patients. And I since have let's, let's go there. Yeah. Triple probiotic therapy. Why are you using it. What's the data behind it?

Gavin Guard, PA-C: Yeah. So probiotics are live organisms that exert a beneficial effect on the host. That host is us, you know, and that's the definition from the World Health Organization. There's probiotics and there's prebiotics. Prebiotics are totally separate. That's like the fiber. That's the stuff that feeds the the organisms that live in our gut. So not only is there that differentiation between pre and post or probiotics, there's four different categories of probiotics that we should be aware of, one of which has the word E coli in it. And the FDA here in the United States has said, no, thank you. We don't want to have any probiotics with the word E coli. That's E coli. Nissin 1917 is called Miraflores, available in Canada. So that leaves us down to three different probiotic categories. There is a healthy yeast probiotic category is called Saccharomyces Baladi. There's a soil based probiotic, and that is all the bacillus species. So if you look at the probiotic label, say bacillus subtilis or bacillus coagulants, that is bacterial species that are found in the soil. Why that's important is because we live in a very hygienic environment. We're not we don't have our hands in the soil and gardening as much anymore. We're not harvesting as much of our own food. And then the third category, probably the most well studied category is the lactobacillus bifidobacterium blend.

Gavin Guard, PA-C: And again, there's thousands of studies just showing there's benefit in IBS alone, not to say other GI and non GI conditions. So there's three different categories. Well, how would we use three different categories? Should we use those just one in isolation at a time? Well, what we see in two different data points that we see this benefit of using all three is anecdotally, we see a benefit of using three categories of probiotics at the same time as compared to one. And then we see research to show that more broad spectrum probiotics work much better than just one single strain or one single species. So the way that we've been using this in clinical practice is this novel concept of a triple therapy probiotic stack where you use all three categories of probiotics at the same time. And I've had a lot of patients come to me. They said that maybe they've tried a probiotic from the grocery store or they've tried it for maybe a few weeks. It didn't really make a difference. I will use that as a data point and I'll try to say, you know, Hey, Mary Sue, I know that you've tried this one strain in the past. I know it didn't work for you.

Gavin Guard, PA-C: I like us to try this triple probiotic stack will do it for 3 to 4 weeks and reassess your symptom improvement at that time. And I would say many times we do see people who failed single probiotic therapy respond well beneficially to this triple probiotic stack. So I use that quite often, just given the plethora of research to show how probiotics are beneficial. It's beneficial for GI conditions, IBS and SIBO, and you may be wondering why the heck would you give your gut more bacteria if you have a bacterial overgrowth? Theoretically, that makes total sense. Unfortunately, or I would say fortunately we have high quality research to show probiotics help with SIBO eradication. It helps clear out that SIBO and the analogy I use is kind of this like the city phenomenon where our gut is like this city. There is a constant race between the good guys and the bad guys. Yeah, right. If you got a bunch of bad guys coming into the city, like in Seattle, all the good guys are going to leave, right? So there's constant flux and we if we can out crowd the good guys out crowd the bad guys. With the good guys, we can clear out any potential bad players.

Amber Warren, PA-C: Again, that concept of dysbiosis we talked about.

Gavin Guard, PA-C: Dysbiosis is constant balance and flux of the microorganisms. So probiotics are helpful for IBS, bacterial overgrowth. They actually secrete anti-inflammatory and antibacterial antifungal properties. So even though there are probiotics, there are some. Antimicrobial nature. And so it's helpful for seeable. Ibs is helpful for things like allergies, skin conditions is helpful for mood sleep, some hormones, which I'm sure we'll talk about later on. Anxiety, depression, brain fog. So kind of widespread effects there.

Amber Warren, PA-C: So cool. One of my favorite uses for this, one of the three that you talked about Saccharomyces Baladi to use is actually so helpful for diarrhea, even acute onset of diarrhea. Right? Like almost like a viral GI issue. And then it's a really gentle mold binder. So a lot of my patients that come in, you know, they're still trying to remediate their home. We think there's mold on board. You start Saccharomyces vilardi and it can help the gut gut health, but also help start to bind up mold in the body.

Gavin Guard, PA-C: Yeah, and it doesn't make sense. Why would you give your body fungus? Yeah, more or less when you may have mold colonization again, because a lot of these probiotics have antibacterial properties to them. And that's where we have really nice, well designed clinical, randomized clinical studies showing benefit. And that trumps any theoretical or mechanistic thinking.

Amber Warren, PA-C: Absolutely. So if we believe in that data, kind of the city analogy that you were talking about, which I explain it, I explain it very similar to similarly to that we just have to repopulate the good to crowd out the bad. Where's the use or where do you start to bring in some of these antimicrobials, Right. Like herbal antibiotics, if you will, to help somebody kill the bad guys or help someone with gut health.

Gavin Guard, PA-C: Yeah. Like where in the process. Yeah. In your.

Amber Warren, PA-C: Treatment.

Gavin Guard, PA-C: So there's kind of divvy that up. There's prescriptive or pharmaceutical antibiotics. We've talked about rifaximin. It's a non absorbed antibiotic. I mean it doesn't have some of the downstream detrimental effects of some of these antibiotics do. There's rifaximin that's really expensive for a lot of people if it's not covered by insurance, up to 1200 bucks for like a two week supply. There's things like Neomycin as an adjunct to that. And then we have herbal antibiotics. And again, these are natural agents that not only have antibacterial properties by antifungal anti parasitic antiviral. And we show that in the case of SIBO, for example, that they have pretty equivalent efficacy to things like this prescriptive rifaximin that's FDA approved. So this is things like over oregano and berberine and some garlic and we use how I usually use them at least is through this kind of low dose of kind of a more broad spectrum blend of them. And I use it a little bit longer. So instead of the antibiotic being like the atomic bomb on the microbiome, you know, usually a57 day course, it just completely eradicates things. Think of if you had like this kind of a bush or a hedge in front of your house that, you know, normally our microbiome is kept to a appropriate concentration.

Gavin Guard, PA-C: It's when that hedge or that bush starts to become overgrown now is covering the windows and it's just crowding out all the good plans. That's when it starts to drop your real estate value in the same way when our microbiome starts to become overgrown dysbiosis or bacterial overgrowth. We've got to trim that. And I find that using more low dose, longer term things like herbal antimicrobials usually work better because they're gentler on the system. Yeah, they're usually better well tolerated and they have more of this broad spectrum effect. I usually don't start with this, and here's why. We have more research to show diet lifestyle changes. Probiotics. Just the quantity of research shows more benefit as compared to the few studies that we have with rifaximin anti microbial. So I usually start with things like diet, lifestyle, probiotics. And we also see again, probiotics have antibacterial properties and multiple data points show that probiotics, when administered with antibiotics, improves the eradication rate of antibiotics. We see this time and time again with.

Amber Warren, PA-C: Something like say that again.

Gavin Guard, PA-C: Yeah. So when you administer will take studies. Yeah. Someone who has maybe SIBO or maybe someone who has like a bacterial growth, like H. Pylori, we administer antibiotics and then we'll take another group, the same people, but we'll give them antibiotics plus probiotics to see if there's a greater benefit.

Amber Warren, PA-C: Yeah.

Gavin Guard, PA-C: And this is placebo controlled, so we're kind of ruling that out. It's the people that we give probiotics on top of the antibiotics that we see higher eradication rate of that bacteria that shouldn't be there. In other words, there's a greater efficacy of that antibiotic when you give probiotics along with that and only that, we see that there's a lower side effect profile of the antibiotics that you're always looking for diarrhea, that's a common antibiotic induced side effect that you get. And probiotics can mitigate or blunt that side effect profile. So I like to use them together if we can, because of some of those studies showing benefit there, reduction side effects and it usually just works a whole heck of a lot.

Amber Warren, PA-C: Better. Yeah. What do you say to your patients? I get this a lot. That the research on probiotics. That sounds great in all amber, but I really want to try and get these beneficial bacteria from food.

Gavin Guard, PA-C: Yeah. So you're talking about probiotics from food?

Amber Warren, PA-C: Yeah, Fermented foods. Pre and probiotic foods.

Gavin Guard, PA-C: Yeah. That's. That's certainly an option and something that one could start with if their symptoms are mild in nature or something that we could use more of a maintenance plan to extend those benefits that we would get from supplemental probiotics. A few different points here that I would want to bring up is one, is the dose, right? The dose that we use for something like a category three probiotic, that lactobacillus bifidobacterium and we sometimes I'll use 50 to 100 billion what are called CFAs or colony forming units of that per day. Try to get that from kimchi or sauerkraut or kefir. Yes. Some of the foods that have higher probiotics, you're looking at eating like 20 cups of kimchi per day. Yeah, that's not going to be fun nor practical. So for just from a dose perspective, probiotics can help with with or on top of the diets changes that we make.

Amber Warren, PA-C: They're synergistic effects.

Gavin Guard, PA-C: They're synergistic, and we're just going to get more of a a therapeutic, clinically effective dose there. Yeah.

Amber Warren, PA-C: Yeah.

Gavin Guard, PA-C: The other point is some of these probiotic containing foods also have things that may be detrimental to your gut health and that one would have to account for when deciding, do I use this or do I not? For example, like we talked about, some people are fodmap intolerant. They're intolerant. It gets they get these side effects or symptoms from these fibrous foods like sauerkraut. Yeah, right. Sauerkraut is a bunch of probiotics, but it also has a bunch of cabbage and people with IBS. A lot of them do not do well with more fiber. I just had a patient this week. She had diagnose IBS for 30 years.

Amber Warren, PA-C: Oh my goodness.

Gavin Guard, PA-C: 30 years. She was told as she was constipated.

Amber Warren, PA-C: Yeah.

Gavin Guard, PA-C: We told her and people were telling her, eat more fiber and here's a fiber supplement. So she was eating like all the broccoli, all the cauliflower in the world fiber supplement. I noted that she had a bunch of gas and bloating, and she's been taking these things for a long time. I simply had the first point. I just said, Hey, let's go on a low fodmap diet. Let's stop the fiber. And four weeks later, her symptoms like 90% improved 30 years just by reducing fiber.

Amber Warren, PA-C: And she's still she's not constipated, not bowels are still moving.

Gavin Guard, PA-C: Yeah, that's the thing with fiber it's that's another discussion. But fiber is not as great for constipation as we would hope for or we would think. And some people it does well, some people it doesn't. There are some things I would look forward to see if that's the case or not. Some of these foods are higher fiber. People do not do well with them. They're also higher in some histamine, which is another element of what gets built up in the food when it gets fermented, you know, wine, chocolate, a lot of these fermented foods, kimchi, sauerkraut, kefir. I asked people, how often are you eating that? A lot of people say not enough. I'm like, Well, no, I'm actually looking at this could be too much. Yeah. Because sometimes that could lead to the the diarrhea, the the abdominal discomfort, the bloating, the fatigue. So I would say if you can get it from your diet, but just be mindful of those things and to really get a clinically effective dose, you likely need to supplement with it.

Amber Warren, PA-C: Yeah. Okay, good. That's a great response. You use a lot of what are called IGG immunoglobulins in your practice to heal leaky gut kind of this concept of this increase intestinal permeability. How do those work? Why are you implementing a lot of that in your treatment protocols?

Gavin Guard, PA-C: Yeah, I'm not quite sure if we know exactly how it works. There are some theories out there. So what are immunoglobulins? Well, like I've talked about before, hinted to our immune system secretes things called antibodies and that normally attacks things that shouldn't be there. Infections, for example. It kind of glom onto it and then it tags it for destruction or it just destroys it right then and there. Now we can use these things called immunoglobulins, which are more or less pre formed antibodies. One of the hallmark causes or etiologies one of the like what does it cause what's going on here with IBS, for example, is immune system dysfunction. There may be an autoimmune component, it just could be because our immune system is kind of going haywire or there's some type of shift going on here. And that's where immunoglobulins really come into play after we've corrected for things like dysbiosis or maybe if someone's still having symptoms, it's an immune system issue. And so we use these immunoglobulins and the analogy I give to people is imagine if you were to ingest these glass shards, these fine glass shards, you ingest them, it totally just wreck your gut, right? It would be very harmful to our gut. That could be what's going on when you have a bunch of these bacterial toxins that is produced inside you, this bacterial imbalance that's producing toxins like Lipopolysaccharide, for example, they go in and they stimulate your immune system.

Gavin Guard, PA-C: They directly damage the gut. Every year. Now, what if we were to dip those glass shards in something like wax? Cool it. Right. So we're kind of adding this protective coating or layering on top of it. Then we ingest it. It's going to make those toxins, those glass shards, less detrimental. That's exactly what we're doing with immunoglobulins. So there Doctor Weinstock is a GI dog, has kind of pioneer this work in immunoglobulins. It was once a pharmaceutical super expensive, has now since become over the counter you're looking for like immuno line IgG immunoglobulins as an example there and he's shown some really nice benefit in EIB's people who've used a bunch of therapies for irritable bowel syndrome pharmaceutical diet supplemental. They had not seen any benefit. So these are refractory patients. Patients are really frustrated because they've tried all these things. Still hasn't seen any benefit. They add an immunoglobulins onto their treatment plan and what they saw was about a 70% response rate. Pretty phenomenal in these people who were not responding to anything before. So I really use this when I'm considering, okay, maybe this is the immune system, right? Maybe this isn't necessarily inflammatory or a diet mismatch or they're just stressed out. Maybe there's this immune system dysfunction going on. The immunoglobulins have been super helpful in that.

Amber Warren, PA-C: Yeah, that's good. Good. So triple probiotic therapy, elemental diets, IgG immunoglobulins. What else are making really are you seeing make really good headway for patients.

Gavin Guard, PA-C: Yeah I mean there's why I like GI care is that there's so many different therapies and protocols. Yeah and not even protocol. I mean it's just like different ways you can layer in all of these therapies and it's usually not just one. Sometimes you hit it right off the bat like, yeah, you got celiac disease that was never diagnosed, go gluten free.

Amber Warren, PA-C: And then you're the hero.

Gavin Guard, PA-C: Yeah, I mean, even then a lot of gluten celiac disease patients go gluten free, still have symptoms. That's a whole nother discussion. So, yeah, we have a lot of different therapies here. We have enzyme support. We've talked about exocrine pancreatic insufficiency. They need enzyme replacement people who just feel super bloated. Maybe they're older, have some other autoimmune condition that makes me think that they have it insufficiency of hydrochloric acid enzyme production. So we give them broad spectrum enzymes, hydrochloric acid replacement. We see things like pro kinetics breaking that word down, so pro to foster and then kinetic movements. So we're trying to foster healthy movement of the gut. Again, pharmaceutical supplement options here. There's fiber we've talked about. Maybe that's not so great with constipation. Sometimes it is needed and it could actually be helpful for diarrhea, too, even though some people don't do well with fiber, some people do need it. So I know that maybe that sounds contradictory, but again, it's just you needing to get with a good practitioner that understands everything about your case. Really get all these data points to make informed treatment decisions.

Amber Warren, PA-C: What's your thought on using a bunch of magnesium citrate for constipation?

Gavin Guard, PA-C: Yeah, it works absolutely wonderful for a lot of people. Isn't osmotic laxative. So what that means is it draws water in the large intestine into the inner lumen or the inner part of the intestine to help with a healthy stool frequency and consistency. It's dirt cheap. There's really no side effect. Yeah, I mean, other than diarrhea and going overboard, of course. But that's a really great therapy to.

Amber Warren, PA-C: Get it going. Yeah. Awesome. So many good just approaches and what works, What doesn't, What's what's working within your practice? You answered wonderfully last time I asked this question. At the end of each one of my interviews, I like to say, Hey, Gavin, what's the if you had to say one piece of advice that may or may not relate to specifically what we just talked about that moves the needle the most for your patients, you just see the best outcomes. What would what would that be in this case?

Gavin Guard, PA-C: Yeah, I mean, apart from just GI specific care, I think people just have to get used to do hard things. I think we as a society, we have become weak. We've become too comfortable. I mean, I feel a little guilty saying that now in this, you know, climate controlled room and this comfy chair. I know, but we have become way too comfortable. We don't have that climate change. We're not used to cold and heat exposures anymore. A lot of us have become sedentary. We're not exercising and pushing our body to its limits. We're not used to not having a constant slow drip of food. We're not used to that fasting exercise. Hunger cues. Yeah, hunger. Like we as a species, we used to be hungry a lot of the time. We were exposed to cold, we were exposed to hot. We we did hard things. I think unfortunately now we've become. I'm too comfortable. So I think if if one could think about and truly reflect on this, what are some things that you can implement that can challenge you? And I think, you know, unfortunately now we're becoming so challenged, just like with stress. And that's we just and there's a mismatch there as we're putting too much stress on our body than what we're able to handle on the other end of the spectrum. A lot of us have just become too comfortable. I watched this series Limitless with Chris Hemsworth, where he goes and does all these challenges of like heat and cold therapy and a lot of these, you know, exercise and strength feats. And it was kind of interesting get me thinking about like, och, these are things that as a species we should be doing to this day to really I mean, it just changes your framework of one fragility to one of resilience. And I think the more and more you do it, you start to be thankful for the body that God blessed us with. I mean, really, we're designed to do some incredible things. And I think we ought to express that more often.

Amber Warren, PA-C: Yeah, yeah. It's that concept of stress isn't inherently a bad thing. It's when you're not building resiliency to that stress or deactivating the nervous system. And that stress isn't going away. You're not building in that rest. That's when it becomes a bad thing. Absolutely right. We have to be resilient to stressors. Yeah, I love that idea of, you know, like the cold therapy, cold showers, cold plunges. That's one way that you.

Gavin Guard, PA-C: Can just simple things you could do there.

Amber Warren, PA-C: Oh, my gosh. And what that does for mental toughness, I mean, let's do a whole podcast on just how you increase that resiliency and do the hard things to train your body and then, you know, breaking down mechanistically how that benefits the body with up regulating detoxification and balancing cortisol. And I mean, there's so much to unpack there.

Gavin Guard, PA-C: Yeah, there's a great book. If people want to kind of get dabbling into this. I think it's called Wedge by Scott Carney, where he talks about some of these ancestral stressors and how they can help us become more resilient. So I'd encourage you to give it a try. I started doing more sauna therapy while I'm here. Sounds great. I think it's you know, you look at some of the studies out of the Nordic countries where everyone has a sauna, dry saunas, and, you know, those getting up to 180, 190 degrees. There's also infrared saunas, which are another great option there. We have that or Meridian Clinic. Yeah, but there's great studies to show reduction in cardiovascular disease. There's vascular benefits here. There's going to be a lower rate of things like Alzheimer's and dementia. So I've been incorporating that in my, you know, kind of weekly routine. I've been taking some time off exercise, but I think it's been a great stressor to to engage in.

Amber Warren, PA-C: Yeah, that's amazing. Oh my goodness. Och, well that's such a great thing to end on. Thank you so much for your time today, Gavin. We'll look forward to having you back on.

Gavin Guard, PA-C: Yeah, Thanks, Amber.

Amber Warren, PA-C: Thank you for listening to the Functional Medicine Foundations podcast. For more information on topics covered today, programs offered at FMF and the highest quality of supplements and more. Go to Fun Med Foundations dot com.

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