Leaky Gut, Foggy Mind: Connecting the Dots with Testing and Treatment

All Things Gut Health with Dr. Buddy Touchinsky

• How a Chiropractor Became the “Gut Guy”: Dr. Buddy shares how his focus shifted from treating pain to addressing root causes like gut health after reading Integrative Orthopedics by Alex Vasquez. This led to his deep dive into chronic illness and functional medicine.
• Understanding Leaky Gut and Dysbiosis: The episode breaks down intestinal permeability (aka “leaky gut”), what dysbiosis means, and how both can exist even when digestive symptoms are absent—showing up instead as fatigue, brain fog, joint pain, or skin issues.
• Top Contributors to Leaky Gut: They outline five key factors—chronic stress, poor diet, infections (bacteria, parasites, mold), chemical exposures (like glyphosate), and medications (NSAIDs, antibiotics, acid blockers)—and explain how each damages the gut lining.
• Gut-Brain Axis and LPS: The discussion covers how gut imbalances and bacterial byproducts like lipopolysaccharides (LPS) can fuel systemic inflammation and neurological symptoms, including depression, memory loss, and brain fog.
• What Testing Can and Can’t Tell You: Stool tests, bloodwork, and food sensitivity panels are covered with nuance—highlighting what’s worth the investment, what’s often overused, and why customized interpretation (not automated protocols) matters.

Transcript

dr buddy touchinsky welcome to the show great to be here always nice to chat with you and uh excited about today's topic yeah I'm excited to talk about it as well so we are going to be talking about really all things gut health from issues people may be having to testing and everything else but first before we do that you know With you being licensed as a chiropractor initially, what kind of led you from, hey, adjusting is kind of my focus to, you know what, maybe we should pay attention to more than just that. Yeah, so I came out of school. I was a back pain patient myself in high school, and that's how I got into the chiropractic and I got out of chiropractic college, just focused on neck pain, back pain, sports injuries, things like that. And I quickly realized that often that was the least of people's worries. So they're coming in for back pain or chronic pain, joint pain, and it's because they were just in overall poor condition, poor health. And then I came across a book called Integrative Orthopedics, Alex Vasquez, and it blew my mind. And there he talked a lot about gut health and digestion and anti-inflammatory diets. And as I say, the rest was history. I just kept on building from there and learning from there. Here I am today, and it's one of my primary focuses as a practitioner in our practice. I'm the gut guy. So, and of course, we got it branched out into all sorts of chronic illness and disease and health optimization and all sorts of other things. Yep. And it seems, you know, that's something that happens a lot. You know, you've got those who stay just regular chiropractic, and then you've got those who are like, man, there's so much more to the story. While they may be coming in for those acute issues, they've got a laundry list of other things that are along for the ride that you really need a bigger toolkit and arsenal to help people with. Yeah. And no one else was addressing it. So that was the other thing. It's like, okay, who can I refer to to help these people? And I'm a fairly rural area, but it's probably no different anywhere else. And it's a little better these days now that it's gaining more traction with social media and everyone talking about health and wellness. But yeah, at the time, there's literally no one to send them to. So it's like, okay, I guess it's not me. I guess I'm the man for the job. And I'll go back in and dive deep and learn what I need to learn and start helping people. And that's what's been happening. correct you know because the terms leaky gut and intestinal permeability has really only been embraced the past few years in traditional medicine they're now starting to talk about it more like some of the continuing education I'll do for like depression and all that but in the functional medicine space it's not a new term it's stuff that you know we've been doing for well over a decade so I'm first going to let you talk about what leaky gut is as well as intestinal permeability. Are they the same thing? Because some people are like, well, it's one or the other because medically, it was really more about intestinal permeability before they really valued the other side. Right, yeah, so leaky gut syndrome, I tend to think that's more like the layperson's term for it. It's an easy way to visualize what's happening. Is the gut really leaking things? If you talk to a gastroenterologist or a microbiologist, especially going back ten, fifteen, twenty years, they almost kind of mock that description. But really what it's describing, in my opinion, is that increased intestinal permeability. Now, think about it. When we eat something, we swallow it. Where we chew it, we swallow it. It goes in our stomach and then eventually into our small intestine and large intestine. And as it's going through our intestines, we need to extract our nutrients out of that. And our nutrients need to get into the bloodstream somehow. And it does that by going through the gut wall. But it does so selectively because we don't want large fragments of food or proteins or bacteria or other things that shouldn't get through that gut wall. And it's like a filter in a way, or the analogy I use, it's kind of like a screen in the window. So it's a nice day out and I want to get some fresh air in here, but I don't want the mosquitoes in here. I don't want house flies. I don't want gnats in here. So I open the window, screen lets the air in, fresh air in, but keeps the other stuff out. So you can kind of think of the gut being like that. However, due to a variety of things, which we can dive into if you'd like, those holes in the screen, it's like taking a screwdriver and now jabbing big holes through it. So now you're not only letting fresh air in, you're letting the bugs in as well. So in terms of the gut, now you're letting protein fragments, stuff from our food and air, bacteria, bacterial byproducts, like something called LPS, for instance. And then now we start to have other problems because of that. Yep, yeah, absolutely correct. And I think it's important that we reference, as you said, it is selective things should be getting through into the circulation, not all these other things that are ultimately getting through and that's creating a lot of issues. And before we really dive into it a lot more, let's just step back. Do you have to have digestive issues, constipation, diarrhea, You know, heartburn, bloating to have a leaky gut. Often people will, but sometimes people do not. And I think of a case I had early on. It was a forty year old gentleman who owned his own business and he was having issues with sleep. He had low testosterone. He was having joint muscle pain. weight gain, and he swore up and down, no, I don't have any gut problems. And when we ran some of the testing that we did back then, it showed major dysbiosis, major bacterial overgrowth. I think he had a parasite, Giardia, if I'm not mistaken. It's going back about eight, ten years ago now. And lots of inflammation, it's calprotectin. It wasn't in IBD zone of like three, four, five hundred plus. But it was over a hundred. So it shows his gut was fairly inflamed. And I think that was leading to a lot of the issues that he was he was complaining of at the time. But he's like, no, I have an iron stomach. I do fine. I feel fine. So he wasn't he said he denied having any gut problems at the time was kind of questioning. Well, why are we doing this gut test? But good thing we did. correct. Yep. Because while many people will have gut issues, I often tell people, look, man, if you've got joint issues, if you've got skin issues, acne, and you don't have room to arthritis, you know, there's no severe degeneration upon imaging. It's like, you know, the foods you're eating and the health of your gut plays a massive role in that because it does extend beyond just those digestive issues that many people have. And You know, I do want to quickly, you know, dysbiosis for those that have never heard the term. It basically is you get a imbalance in bacteria, you get bacteria where you shouldn't, where they shouldn't be, or they get to excessive populations beyond what it should be. So if you think about like a city or a state, right, there's healthy populations. You don't want everyone to be an attorney. You don't want everyone to do one job. So you make up the right ecosystem and that ultimately gives us the byproducts and the health benefits. that we would like to have. I'll give you another analogy that I really like. It's like having a garden. You only got so much space in there and you want to make a salad. So you want tomatoes, you want cucumbers, you want bell peppers. But if like one season that happened to me is I must've got a lot of tomato seed drop on the ground from the season before and was overrun with tomatoes. Well, even though tomatoes are good, you want more than tomatoes. So same thing with our healthy gut microbiome. We want a variety of different bacteria because they all have their own unique function that helps the body. Yep. And so what are, you know, now that we've kind of introduced dysbiosis and that whole side and leaky gut, what are five things that contribute to leaky gut that we routinely see with individuals? Got it. So I would say stress is probably one of the major contributors. And in fact, there's research showing that professional athletes tend to have a higher incident of gut issues. And it's because they're always training hard. They're always in the spotlight. Sometimes they're probably over training and there's just a lot of, a lot of stress placed upon them. So stress senators, probably some mechanisms there through cortisol can disrupt the microbiome and then lead to a breakdown of, of those gut walls. Number two would be the wrong diet. So lots of processed foods, a heavy emphasis on especially processed grains, excessive sugars that changes the makeup of the microbiome. And that can lead to a breakdown of that of that gut wall leading to leaky gut syndrome. Another one may be some sort of infections. You get exposed to something. So it could be through foodborne illness. It could be just something that you ingest. Because no matter how much we clean or cook our foods, there's always going to be some sort of contamination on there a little bit, some microbes, whether that's bacteria, viruses, yeast, or parasites. So that can disrupt it. Or sometimes mold and mycotoxins can cause a he got syndrome. So help me out here. What are two more to round out the five? What do you got? Yeah, well, we'll add some more in. Let's quickly do right. So you mentioned grains. So a lot of people were like, oh, you know, but we've ate grains for like, as long as basically civilization has been around. So why are grains starting to be an issue now, or at least in the recent past compared to, you know, thousands, millions, however long people think people have existed. Part of it is, and I've had people share this with me, that they can go over to Italy, for instance, and have pasta and bread and do just fine. But here in the States, they eat the same foods or seemingly the same foods, and they have problems with gut pain, gut problems. um two theories there one is that they tend to uh use more yeast and let the flowers uh ferment a little bit more when they're making something like like a sourdough bread for instance so you're not getting necessarily like a raw bread product or a raw grain product like here I'm told they'll take like these, these bread molds and inject them with air and pop them up that way. So they're not yeast risen. And so that could cause the gluten, which is the chewy part that makes bread chewy and kind of hold together. And often what causes gut issues isn't digested or fermented or broken down quite as much in the Second theory is what we use on our crops here. So glyphosate is used a lot more here than overseas. And some people will make the argument that it's not really a grain or a gluten issue that we have. It's more of a glyphosate issue or commonly known as it's the main ingredient in Roundup. Yep. And we can actually just put that down as number four. It's the chemicals that are being sprayed on foods and some of the stuff, even in the processing of foods, you know, beyond just ultra processed foods, but just kind of the whole growing process alone has a lot of things that can contribute to leaky gut. And then number five. You know, I even just go on the medication side. There's a lot of medications that, you know, with starting chiropractic, right? You had a lot of patients who did ibuprofen. They did other things and that's known to impact the lining of the gut. But then you've got those who do have heartburn. And so they are doing Nexium or Prilosec. They're doing all those acid blockers. But when you do that, you also disrupt the gut microbiome. you impact your ability to produce and really activate your digestive enzymes. Because what people don't realize is that stomach is supposed to be insanely acidic and it's like a furnace. Like stuff gets in there, it should be burnt up. And with the right acidity, that's where you actually activate and release digestive enzymes. You're able to do things with like B-Twelve and all that. And if it's not appropriate, appropriate that gives people issues so we can make that number five but we can make the list keep going but I think that's probably good yeah not to mention antibiotics as well and I think what do they say a one course of amoxicillin which is pretty plain jane antibiotic that everyone gets when they get a sore throat or something like that a minor infection can disrupt the microbiome for up to two years and I've seen some microbiologists say it never becomes it never goes back to the way it was before that course of antibiotics. So imagine if you're put on a Z-Pak every time you get sick and it's multiple times throughout the year. And we see this with young kids all the time where I think the most extreme case of this was a two-year-old that had been on like ten to twelve courses of antibiotics, tubes in the ears, adenoids removed, still getting infections every other month it seems. And so, yeah, completely wiped out their microbiome. Yep, and that stuff we see all the time. Like you said, we see it in kids with ear infections. People are like, oh, my kid's got it. It's like, please stop running for the antibiotics because those doctors will put your kid on it time and time again. And ultimately... developing immune systems, a fragile immune system, and you can really set a bad path forward. And that leads to that dysbiosis and the inflammation. Briefly though, you mentioned LPS earlier. So that stands for lipopolysaccharide. Do you care to spend about a minute discussing what it is and how lipopolysaccharide and maybe other byproducts or metabolites from bacteria production in the gut can negatively impact beyond just the gut. Yeah, so LPS, lipopolysaccharide, is a bacterial byproduct that comes from, I believe it's formed mainly from when we eat saturated fats in our diet. So that's why I sometimes question people that go on carnivore prematurely without trying some other things first, because if they have leaky gut syndrome and then they add a lot of saturated fat on top of it, it could cause problems. But even in the context of the average person following the average diet, if you have a lot of LPS or other bacterial byproducts that are forming and they get in through that gut wall, so now they're getting into the bloodstream. and there's something that's in the bloodstream that shouldn't be there. So anytime that happens, so you can think about getting a puncture wound or a cut and you get some bacteria or some dirt in there, what's going to happen is your body has to deal with that. It sees it as a foreign invader. It shouldn't be there. So it starts to have the immune system spring into action. So now you've got these white blood cells that are released to the area. There's platelets. There's a lot of different reactions that happen at that level. And if it happens on occasion, like when you do get a cut or when you get an injury or maybe you do get some bacteria into your body, that's going to be there and you need that immune system However, when that's happening with every single meal and every single snack that you eat, now you're getting this more consistent immune response. So inevitably, inevitably there seems to be some friendly fire there and it can, you can develop auto antibodies. So then those, those things can affect pretty much anything in the body. And I've had people with all sorts of issues from Hashimoto's thyroiditis to brain fog, to brain, to tremors. to joint muscle pain like you see with rheumatoid arthritis for instance fibromyalgia um I mean I mean you name it it can affect different depends on what tissues it affects and it's different for everyone but you get that response because you're constantly getting exposed to that through that leaky gut mechanism and uh and then just in general can cause just systemic inflammation because the immune response especially that early immune response that's non-specific is That's what inflammation is. And that can affect you anywhere, especially if you have like your problem areas. Like if you have already have a little bit of joint damage, cartilage damage, like say in your thumb, and this is happening because of your leaky gut, well, you're going to be more likely to have pain in that pain in that thumb. Yep. And this really kind of falls underneath that category that the research is starting to more acknowledge. It's that chronic low-grade inflammation and chronic low-grade infections. For so long, people were like, man, I don't have an infection. If I did, I'd know it. I'd be running a fever and everything else. But we do see those chronic low-grade infections where people don't run fevers or that chronic low-grade inflammation where it does damage over time and you know, we're going to dive into the world of the brain pretty soon. But, you know, when we look at the models of depression in animals, they're routinely using lipopolysaccharide because it is a inflammatory thing, right? So they're injecting the animals with it. And it's important, as you noted, right? It gets into systemic circulation and it impacts the brain. So let's kind of dive into there about how changes in the gut microbiome impact the brain? So let's maybe first start with what does a good gut look like? What are maybe some of the good metabolites that should be produced? And then we can transition to when the gut microbiome gets distorted and then kind of go down that lipopolysaccharide a little bit more. Yeah. So what happens when things are going right or what it should look like is we eat all the right foods. So by that, I mean plenty of plant materials. I would say lean proteins are part of that, getting plenty of protein. But that goes into the gut and then it feeds the good gut bacteria that should be there. So that's what's floating around. I look at it in three layers. So you have what's happening in the center. So that's the water going through the hose. That's your food. And then amongst that, along the sidewalls would be the, our healthy bacteria that live there and there's healthy, healthy yeast as well. But when we're eating the right foods, those organisms, those, those healthy gut microbes are happy and healthy when they're eating and digesting and fermenting fibers from those, all those foods that we should be eating. And then that produces something called short chain fatty acids. There's polyphenols, there's other compounds. that keep the gut healthy, keep the gut walls healthy. And there's something called the mucosa layer that protects the gut wall. So the analogy I use for that, it's kind of like wearing a long sleeve shirt as you're walking through the woods, it's protecting your skin. So that mucosa layer is there, it protects the skin of the gut. And just like walking through the woods, if you brush up against some poison ivy and you're wearing that long sleeve, it doesn't interact with the skin, doesn't cause any irritation, it doesn't cause any of the reactions that we get when we get like a poison ivy infection. And then that starts to spread and get itchy and irritated. But if you have a breakdown of that mucosa layer because of a lot of the things we talked about before, whether it's stress, poor diets, medications, et cetera, well, now you get a breakdown of mucosal wall. So now as you walk through the woods, now that poison ivy is rubbing up against the skin. In this case, the skin and the gut is interacting with our foods and microbes, many not so desirable. So now you start to get a reaction there. And then ultimately, you start to get a widening of the gaps between the cells of the cell wall. So instead of being that nice new screen, letting fresh air and keeping the bugs out, now you start getting stuff that goes into the bloodstream and then causing systemic effects. Yeah. And so, you know, when we look at that with the brain, right, so we've talked about the good, we've talked about, you know, because we know with the good, digest everything like so the metabolites like butyrate helps the brain development develop and all that stuff but then on the bad side what are some of the conditions or symptoms people may have from a leaky gut that goes on for a period of time with their brain and we're not going to list them all because you could probably say everything but you know what maybe three big ones that people may not really think about I'd say just that, that description, that person that says like, I just feel like foggy all the time. I can't concentrate, I can't focus. And you try to do some work, you get sidetracked easily, you get distracted easily. You just can't think straight, you start forgetting things. And if you don't know any better, a lot of people just associate it as, oh, I'm just getting old, or maybe I'm just too stressed out. I got the kids, I got work, I got so much going on, I'm just overwhelmed. I mean, that might be part of it too, but especially with leaky gut and that low-grade brain inflammation, Things just aren't going to fire correctly and you're not going to function correctly. So it goes all the way from there on one end of the spectrum. It's kind of mild stuff. I would say it's a lot of those cases more than mild, but maybe a minor nuisance. You're still functional at that point all the way through to the more extreme cases where people will start to get symptoms of maybe like more severe memory loss. memory loss uh almost like the same um symptoms you get with uh traumatic brain injury or concussions and then oh yeah on top of that if you do have a traumatic brain injury or concussion and this is certainly your area of expertise um that that just ramps everything up and makes everything that much worse correct yep and you know and even beyond that we can go into basically any type of dementia and all that you know and you're seeing changes in the gut microbiome years or even decades sooner and we'd probably be a little remiss if we didn't take a second because the world of guts been evolving and everything's been about the gut brain axis and and everyone's like oh well the gut's like the second brain but you know I don't want to spend a ton of time on it but you know people may be disappointed if we don't so the vagus nerve you know, let's briefly talk about the vagus nerve from kind of its influence from brain down and then back up. Yeah. So we, so we know from research now, we don't know all the connections or all the fine details of it, but we know it's almost like a two way street where their gut and the organs. So the vagus nerve is called the wanderer, the great wanderer, because it, it, it innervates and goes through and can affect functions of various organs, uh, in our body. It's, uh, that comes from the brain and, it can affect things that way. But then we're also finding out that if there's any problems in those areas, like a including what we're talking about today, the gut microbiome, it seems to feed signals back the other way to the brain. So it can work in both directions. And I know with brain injury, we often see things like slow gut motility. So it's common to see things like constipation, then that could lead to something called SIBO if there's a brain injury. And we also know that it's common for people with gut issues, gut inflammation and other gut infections that can cause brain issues. foggy brain fog and lack of focus and memory loss and things like that. And I'm sure you see that in your practice as well, where it's very common to have that really work both ways. Yep. Yeah, absolutely. does you know and there was research they've done where they basically resect the vagus nerve they sever it and rats I'm like oh wow they didn't get parkinson's they didn't get certain types of degeneration because as you said things can basically ascend the vagus nerve and then impact the brain and then on the other side right the brain fires down digestive enzymes stomach acid production intestinal lining permeability and that's where now you start seeing a lot of people in the natural health space are like oh let's do vagus nerve exercises been around forever but you know now more and more people are talking about it but that's kind of a basic level of going after it so we've talked a lot about dysbiosis leaky gut what happens when it's good what happens when it's bad now we're going to go into the testing arena and For those listening, and if you've already done stuff, this testing arena, it's tricky. It's frustrating. It's not perfect. And there's a lot out there. So, you know, what we're going to be talking about is really just our opinions, kind of maybe some of the stuff we've tried in the past, where we've evolved to, because I'm not using the same test now that I used a few years ago. I've shifted. So... Let's go into first stool testing from a gut health perspective. Yeah. So there's different types of stool testing, different companies, different laboratories running different types of tests. The functional medicine world, they're all kind of testing kind of the same stuff. But we should touch upon the conventional world first, because often I'll have people come to me and they'll say, oh, I had a stool test. Everything was fine. But in that context, they're usually testing for the, I call it the big battery stuff. So it's going to be things like food poisoning, foodborne illness, stomach flu type stuff. So it's the C. diffs, the E. coli's and things like that. It's usually a panel of maybe five to seven, eight tests, different organisms. whereas on a functional medicine test we expand that net quite a bit and we look for all of those same organisms plus uh an entirely different category of organisms so they're not pathogenic like that first group I mentioned mean disease causing so those cause obvious disease if you ever had food poisoning or stomach flu you know you got diarrhea that's crazy you got your chills sweats fever vomiting stomach cramps stomach pains but this other category is called opportunistic bacteria so these are bacteria and other organisms there's parasites and fungus and yeast that can move in they don't necessarily cause um uh obvious disease so you're not vomiting as soon as you get an overgrowth of these but they live there they fly underneath the radar of the immune system they don't want a major response because they want to live there and kind of chill out but because of the byproducts they release and because they're taking up space of other organisms that are supposed to do some good for us they're either neutral so they're not good or bad necessarily other than taking up space from the good ones or they can be slightly bad where they're releasing byproducts and compounds that can trigger autoimmunity for instance or just trigger general inflammation which then can affect this body wide so that's one of the things that a lot of functional medicine or most of functional medicine tests will test for we also look at the levels of major classes of beneficial bacteria so if we see really low levels of that we know okay we need to address that by either using probiotics or prebiotics or other compounds that help promote their growth in addition to the whole a variety of organisms, good and bad, that we can see in the gut. We also look for functional markers. So these are things like, are there any undigested fats in the stool? And if there are, then we look at, okay, are you eating too much? Are you eating too quickly and not chewing enough? Is your gallbladder not working and releasing enough bile? So we can make some adjustments there. Same thing with pancreatic elastase, which is an enzyme released by the pancreas that help us digest food. So it's just one little glimpse into how is that all working. And there again, if it's on the low side, and we need some help, we need some support, we can do that. Or we can use things like bitters that helps stimulate digestion, making sure the person is not driving down the road doing five thousand things at once, and then also shoving a sandwich in their face, and their body's not ready to digest that. And then we can have that conversation with the person. We can also look at levels of inflammation. There's something called calprotectin, which at high levels could indicate an autoimmune inflammatory bowel disease process or At lower levels, but still elevated from what we want to see can indicate just general intestinal inflammation. And then there are several others like the immune system of the gut. Secretary IGA is one. That's the troops that live in the gut and help us fight off infection at that level. And if they're really high, we know the guts and high alerts and trying to fight things off. or it's the other side where it's really low and it's at the point where it's probably been there a long time, the problem, and it's spent, it's wore out, the troops are gone so that we need to support that before we do anything else. So I really like the functional medicine test because it allows us to change things and focus on that individual and give them what they need most. And that's with any test, what you want it to do and the reason for doing it is will it change your treatment plan. And with the gut test, that's one of those where it's like, yes, it absolutely changes what I will do based on the findings and those different categories of tests that I just mentioned. Yep. And I really also like the breakdown of butyrate and the other short chain fatty acids to go in conjunction. Cause a lot of people have those low and based upon the beneficial bacteria, you kind of get to be a lot more strategic because you, And probiotics is just kind of this term that really means a whole lot of nothing because there's so many different strains. And I really like the test that we both do because you get a really good idea. You're like, oh, wow, I saw this. You have no butyrate, but you also have no acromantia. And acromantia is a big producer of butyrate. Or you've got these bifidobacterium or lactobacilli species are really low. And you can be a lot more targeted and you can kind of go and find the probiotic that's best going to support their findings versus saying, hey, let's give you a super broad-based probiotic because we don't really know what we're dealing with. So we really have to say where the prebiotic fire is to feed the problem bacteria, because like we mentioned earlier, even though there are many of these categories of bacteria are good, if you have way too much of some and not others, that can be a problem as well. correct yep so you know we've talked about right the things that shows um what are some of the weaknesses though with the stool testing because the stool testing by no means is perfect Yeah, so I guess one major thing we should address so we can talk about some of the functional medicine limitations as well, too, of those particular tests. But I see a lot of these direct to consumer microbiome tests. And the ones that I've seen, it doesn't include a lot of the stuff we just talked about, but it includes the broad categories of probiotic bacteria. And then there might be some genetic markers in there as well. And then they spit out a report that basically gives you, you should eat more of these foods and stay away from those foods. And I just never found them very useful. Yeah, they're a little bit cheaper than some of the tests we use. So you might be able to get a direct consumer test for like two fifty, three hundred dollars instead of four or five hundred dollars like the ones that we use. But they're really not that useful. And most of the time I see they say eat more fruits and vegetables, which we all should be eating anyway. And so I don't find them very useful in terms of the functional medicine testing. Even some of them can get a little bit into the weeds with some of those different assessments where they're looking at the microbiome from a really zoomed out level. You're looking at great broad categories of bacterial types. It just blends itself to trying to micromanage the microbiome, which it doesn't really work that way you can't really say like oh we need more bifidobacteria so I'm going to take this bifidobacteria probiotic because we know from research that once you stop taking that particular probiotic that strain is not that strength out of your gut probably within a month or so even some of the better probiotics that we use like explore based probiotics they might last a little bit longer but what makes the bigger change and the more persistent changes to promote the growth of the bacteria that we want there so um but yeah with some of those tests it seems like okay we're getting into that stuff and you take more of this more of that and and that's not really how the microbiome works yep yeah and some of the you know functional tests you know there have been some validity issues there have been some you know test free tests and then I'm always cautious on the ones that are partnering with certain supplement companies where they're basically trying to pre-tell you like, oh, here's what your results are. And then here's all the supplements you should then do for it. You know, it's while many providers like the protocols, personally, I'd always recommend avoiding those protocol providers. You know, people need to be able to really dissect it on their own. Yeah, you really need that clinical integration there. And I see this a lot. And I'll use some of these tests and not even stool testers, but there's blood tests out there. There's other like expanded panels for blood work. And you'll go through these companies and they'll give you recommendations of what to take. And yeah, they're okay. But like even take something like iron, for example, that's a kind of a clear example is it might suggest that you're low in iron. But why are you low in iron? Is it because you're not eating enough, not absorbing enough? Maybe you're a female and you're losing too much iron on a monthly basis. Maybe you have a stomach ulcer or tumor and it's bleeding all of the time. So Those automatic algorithm-based test results and plans don't account for all of the different factors that affect people. So same thing, the microbiome tests, the stool tests aren't immune to that. And yeah, it might give the practitioner a start, but you don't want to go based on that alone. And certainly when it's direct to consumer, that's a lot of what you're missing. They're spitting out a bunch of information data based on algorithms, but there's You don't know if you don't know. Yeah. All right. Anything else you want to cover on the stool testing before we move to the next one? I think that's it. I was going to say they're not the they're not the most fun test to do because you do them on your own. People ask all the time, I'm going to come in your office and like, how do I give a stool sample? But now put your fears at rest. Part of them, some of them, you get a take home kit, you go home. And you provide the sample in the privacy of your own bathroom, but then part of that is you have to sample and get it and put it into a test tube. So not the most fun test, but it's one of those probably more than, I mean, blood labs are probably the most common tests that we use, but stool testing is probably the second most useful and the second most common test that we order because it does provide someone's information for our cases. All right, let's go into blood testing now from gut health, you know, whether it's looking at intestinal barrier to even the whole food sensitivity arena. yeah yeah so I love the food sensitivity food allergy food intolerance food inflammation however you want to say that different tests will use different terminology uh some will include more than one of the above so um that's something I don't know how you feel about this to be quite honest but in our practice it's not one of our initial tests unless someone has already gone through the ringer with another practitioner perhaps but It's not one of the first tests we order because if you have a lot of intestinal dysbiosis, leaky gut syndrome, inflammation, more stuff is going to get through the gut wall. So we talked about that before. So if you do a blood test, which checks for antibodies and other types of reactions to various food and food ingredients. So I think the one we use, it's like two hundred and eighty seven food and food ingredients. So if you have a situation where more stuff is getting into the bloodstream, then obviously you're going to be reactive to more stuff. And then what we find is that if someone goes and has that test on their own or with another practitioner right at the beginning of their care and the beginning of their journey and trying to heal themselves. They'll light up the whole test. Now they're afraid to eat anything and they're anxious. They don't know what to eat. They get frustrated because they can only eat like five different foods. So in the beginning, we usually try to stay away from that. We work on the gut first through the usual stool testing microbiome gut function. test. We clean up their diets and then work on lifestyle and do that for a few months first. And then if they continue to have problems. So most people, if they do that first part, I would say seventy percent or more never need to go on and do a food allergy test or food intolerance test. But for those who continue to have issues and we're not quite sure we can identify it through diet elimination alone. All right. Let's get the food allergy, food inflammation, food intolerance test and see what foods are continuing to light up their their their results and then avoid those which will help things continue to calm down and heal up better uh so that's where I stand on the food allergy inflammation testing I don't know how you feel about it or because I know there's an argument to be made you can do it right from the beginning too because you'll be able to see which ones uh irritate the person the most to help them heal a little bit faster yeah I used to run them more frequently years ago but over the past couple of years, honestly, I don't run a whole lot. You know, I'm more of like, Hey, go gluten free, dairy free. Let's see where you're at. Then let's rebuild your gut. And if we need to, then let's do it. But up front, like you said, right, you get, you get someone and you run one of these specialized tests and they light it up. Twenty five, fifty percent of everything. And it's like, They're like, I don't even eat half those foods. How's that positive? And it's like, well, there's what's called cross reactivity. So ultimately I tell people, this is like, you know, you're at a place and you're like, I think that looks like so-and-so. And then when you get closer, you're like, nope, definitely not them. Well, the immune system does the same thing. It can attack things that it shouldn't be attacking because it's confused. And if you get the test and it lights up, it really just means your immune system is confused. It doesn't mean you actually have issues with all of those foods. So I've actually stopped doing it for the most part for a couple of different reasons. Because in general, I don't really find... it's a big needle mover for most of the people. And we've got to be careful when we're running these labs. Cause unfortunately a lot of the tests that we are talking about, these are all self pay, you know? And so we've got to be, when we make these decisions, or at least I hope that providers do when they make these decisions. Cause I know we do is we try to say like, look, we're going to ask you to spend money on a test. You need something that's actionable. That really is going to move the needle and the, highest leverage way possible. And then if we want to then go to the next level with testing, right? And I do want to briefly let you explain the difference because there's a lot of terms being used interchangeably. You know, let's, we'll, we'll group food allergy by itself, and then we'll group food sensitivity and food intolerance in their own group. So briefly explain the difference between the two. Cause a lot of patients, I know they come in probably to you and they're just using it completely as if they all mean the same thing. What does it actually mean? Yeah, so food allergy, and there might even be like levels of this. So true food allergy or an immediate onset allergy, an IgE, you might see that allergy response, an anaphylactic type of response. So that's like the peanut allergy where you get exposed to even peanut dust, your tongue's blowing up, your airways are closing, and you need the EpiPens. to straighten that out all the way through to people that just break out in hives immediately after getting exposed to something. So when you're talking to especially conventional allergists or a conventional medical doctor and you say food allergy, that's what they're going to think. And that's why when I talk to some people, I'll say, oh, we can test you ultimately if we are still struggling after a few months. And I mentioned the fact that we can test for food intolerances, food allergies. They'll say, I already had that test done. I went to the allergist and they pricked my back with this grid and they see what I reacted to. Well, that's that one type of allergic response, that allergy response. And then we have some delayed onset allergies. response. This is when you eat something tonight for dinner, you might not notice it until the middle of the next day. You can never associate the two together because it's not an immediate response. And then to the other side where it's just a pure intolerance, perhaps. So you probably heard of things like dairy intolerance. or lactose intolerance. So that's just where your body can't break down that lactose and it gets down to the lower bowels and draws water and it gives us diarrhea and cramping and all the associated side effects. We get lactose intolerance. So that's not an immune cell immune system the body and a problem on the body. So that's, that's the main difference between those. And then there's just a general inflammatory response where if you're eating foods, like maybe fried foods using certain like oils, or you're eating too much sugar or processed grains that can just trigger a general inflammatory response and irritate the gut there. It's just a general irritation. It's not an allergic response. So that's the range of different reactions that we often see. Okay. And then are you wanting to talk at all about some of the other blood tests? You know, cause there are blood tests for like lipopolysaccharides and some of those other markers of, you know, not only systemic inflammation with LPS, but intestinal barrier breakdown. I don't personally run those tests a lot. I know some other clinics, you know, they kind of live and die with that test as kind of one of their starting points. It'd be neat to see. I mean, I'd probably run a lot more tests if money was no object or if it was free, but it's kind of like one of those things where you said before, pick your battles and we have to be judicious with our patients' cash reserves. So, yeah, order the tests that are going to give us the most impact and actually could potentially change how we address their case. With that said, there's some that are found on everyday ordinary blood work, even from the conventional family doctor, conventional doctors. That might be something like C-reactive protein, for instance, or ESR, which is sedimentation rates. There's even one called eosinophils, which could indicate some intestinal inflammation. So there are clues in other tests. And there again, that's where the clinical integration comes into play where you have those sort of tests and you kind of suspect some things. And then if you go on and get like a microbiome function test, you have test results there. And it gets to the point where, all right, enough data. We know what we're working on. We know what we need to do. Let's go to work versus do all these battery of tests. And I've seen people come in. They've had testing done, all sorts of inflammatory markers, all sorts of, I mean, white blood cell, different types of markers there. I mean, maybe the cases that are really chronically severe, Lyme cases, chronic inflammatory syndrome, stuff like that. Maybe you want to get some of those tests, but for the average person, it just, it becomes this just be a lot of noise and then it becomes overwhelming for the patient and the clinician alike. So yeah, the test that we run, we If we stick with those, that gives us enough information and we move on from there. And if something happens where we're not getting results or we need to dive a little bit deeper, we can always go deeper. That's certainly available. Yep. Yeah. I'm kind of in the same boat, you know, because the stool testing is a lot more actionable for basically similar pricing. You know, there's a lot more you can do with it. And like you said, it's clinical integration and taking some of the labs because, you know, sometimes your active protein, you need to go deeper because there's not obvious things. It's a nonspecific marker versus you're like, hey, you're insulin resistant and you're, you know, you're diabetic. Like that's probably where we need to start because that alone is going to shred your gut, change imbalances in your gut microbiome. Yeah, absolutely. Next, I don't personally do a lot of this testing, but I know lots of people come in having it done. So people are doing urinary testing for metabolites that, you know, they're basically correlating saying like, oh, well, this is going to be bacterial or this is going to be yeast. Are you doing anything on that? And, you know, this more of the organic acid testing that happens. Some people are just kind of in love with, you know, they're going to have every single patient they see is going to do it. Whereas I'm kind of on the other end of the spectrum. If you come in, I'm never going to do it on you. And I'm probably not overly going to look at those results because it's, it just doesn't rank up there really high for me. Yeah. When I first started functional medicine, I looked at that test. I'm like, man, this is so awesome. It has so much information. And then you start looking at cases and getting the results back. And you're looking like through the interpretation manuals, you're looking up the different individual organic acids and it just becomes so overwhelming and At the end of the day, like you said, it really doesn't add a whole lot to the picture. Now, I can make an argument for some of the microbiome-related metabolites. So some of them that can indicate that you have a bacterial overgrowth or a yeast overgrowth. Sometimes the stool testing, honestly, misses some of that stuff. Um, but usually you pick that up when you're doing the patient history and going through their symptoms. It kind of gives you an idea that they're dealing with that anyway, and there's enough clues elsewhere. And a lot of times what we're doing anyway, when we treat someone, it's going to address those things, whether we confirm they're there, absolutely yes or not. Um, so yeah, the urine testing, the organic acids, uh, again, really cool to have, but is it worth four hundred and five hundred dollars uh no nowhere close to it if I could do it for fifty bucks maybe um and I'm sure it's again now the caveat is some severe cases where you can't figure it out where you're not getting anywhere from the basic stuff then I could see myself and I've done that in the past where it's like all right oh I don't know what to do with this patient I'm honest with the patient say hey I don't know where to go with this there's this test that could possibly provide us some more information and here's the cost we make that decision together but by no means is it a routine test I can't remember the last time I ordered one. I'll put it that way. Correct. It's been years for me. And, you know, just maybe I'm not smart enough, you know, but it just was not something that I prioritized really high. And people would come in, often bring in multiple. I'm just like, well, you're still not feeling any better. Like it's, you know, and that's important to realize is in the natural health space, we do have to acknowledge that. are those in the natural health space who are absolutely guilty of over testing people and you know the companies push it and people come in with way too many tests I don't really have a lot of clinical utility and and that is frustrating because then patients you know they kind of feel because they've spent the money on it that we should then be able to do something with it when it's like I'm sorry but I don't actually put that up there in the hierarchy of things that I use in making my decisions so know we've talked about testing let's start going a little bit into treatment considerations that people should do so let's kind of almost start with what's just kind of the basic level the foundational things that people should be doing to help leaky guts because we're really kind of even the healthiest of people are still going in and out of leaky gut transiently due to changes in sleep or stress and other things like that. So what are just like, boom, these are the foundational things pretty much anyone should be doing for their gut health. Yeah. And the answers will be, it's something that I share quite often with my patients. And what I like about what we do is what helps one thing will help all the things. So everything I mentioned is going to help with leaky gut, but it's also going to help with diabetes potentially or poor metabolism. It's going to help you lose weight. It's going to help your brain function better. It's going to help you sleep better, have less pain. and so on and so forth because what makes one type of area or one area of the body healthier is probably going to make the other other areas of the body healthier as well so it's it's the basic foundational thing that's getting enough sleep at night so getting poor sleep being chronically sleep derived is going to cause a whole host of problems in the body one affecting ultimately affecting the gut and the microbiome eating the right foods so that could mean different things for different people depending on your sensitivities and intolerances But in general, for the most part, that means eating plenty of vegetables of all types, more variety, the better. I tend to stick the lean but for the most part, you should probably stick to your lean proteins. And same thing, variety. So chicken, lots of fish is pretty good. Red meat on occasion, whatever you like there is going to be good. Or if you're a vegetarian and you don't eat a whole lot of meat, there's certainly vegetarian sources of protein as well. Some fruits, I tend to stick to the berries. So blueberries, strawberries, blackberries, raspberries, they tend to have the The least amount of effect on blood sugar spikes and falls. And they contain lots of antioxidants, polyphenols, which are good for the gut and gut microbiome. And then we have nuts and seeds. As long as you can tolerate them well, they have plenty of good fibers, plenty of essential fatty acids and oils that are good for our body. And so eating the right types of foods, keeping the healthy gut microbes happy because they do a lot of good stuff for us, getting nice, clean, fresh water, avoiding toxins, getting physical activity. I think there's some research behind people that are sedentary versus people that are getting an appropriate amount of physical activity in terms of gut health. And here again, it's what helps one thing is going to help all the things. Yep. No, that's absolutely true. You know, I tell people like foundations of health are the foundations. It doesn't matter if you have cardiovascular disease, if you want a better gut, if you want a better brain, like, you know, everything interacts. And the worst thing we've done in medicine is it's really dissecting the body into little pieces and ignoring the fact that everything is interacting. Um, Let's go a little bit into some targeted interventions that you may implement. Now, this is one of those questions that I personally hate being asked, but I'm asking you because I'm a nuanced person. I'm like, well, why? But what do we know? You know, because what we don't want you doing if you're listening to this is to take what's going to be said here in this next part. I'm like, oh, that automatically is going to apply to everyone. And that's why a lot of people are chronically sick is they go to Google. They talk to a friend who had an issue. It's like, yeah, but your friend is not you. Like, you know, even if you have the exact same symptoms, the mechanism behind that's going to be different. So kind of walk us through. more of a thought process person so kind of a thought process that you would do with someone right they've come in look my diet's immaculate I'm exercising I'm sleeping I'm not overweight I don't drink alcohol I don't smoke like what's kind of the thought process to help an individual who's coming in with what we've talked about you know the fatigue the brain fog maybe they've got some joint pain and and some bloating Yeah. So from a, from a gut perspective, so let's assume that we've, we have some testing and there's some stuff going on with their guts and maybe they have some, even some symptoms of gut issues going on in addition to some of these other health issues that we often see in our patients. So, With the gut alone, we'll stick with that to keep it easy. Because sometimes we'll start them with obviously healthy diet and dialing that in. And we've done some lab work. So if their vitamin D is rock bottom, we want to help them boost that through getting out in the sun more and using supplementation. We might see some B vitamin deficiencies or low magnesium. So usually the first month or so, we want to get them some basic nutrition and build that part of the foundation. usually by month one or into month two, that's when they'll have time to get the gut testing done and we'll get those results back. So then we start to get to work on that. And the thought process there is what does their overall gut health look like? Are they super inflamed? Like is their calprotectin high? Is their secretory IgA maybe really low? So their immune defense system in their guts on the low stuff on their own. Um, perhaps they have, uh, they do have high zonulin where the leaky gut's a problem and then their microbiome, their healthy microbiome, their healthy microbes are all on the low side. So in that person, and maybe they have parasites, maybe they have a yeast overgrowth, maybe they have a couple of different, and it's usually more than one type of bacteria that's a high overgrowth. Um, The old, but maybe the initial me when I first started learning functional medicine was like, oh, there's bad stuff there. There's bad bacteria. There's parasites. We need to kill them. Let's give them antimicrobials or antibiotics if you're a prescriber. But I learned the hard way is you give a person in that situation that I described an antimicrobial. And now what happens is a one, you might get a quick die off because of those bacteria are being weakened by that. So whether it's berberine or oregano or anything like that. but they have leaky gut, right? So all that junk that's being released from these bacteria dying are now going in the bloodstream. So I'm thinking of one person specifically gave them all that stuff to kill off the bad stuff. And they're basically in bed with like flu-like symptoms for three days. And so not good. And ultimately won't be as effective because, yeah, we can kill them off, we can knock them down. But if they bounce back at all, either they stop taking the antimicrobials or you have a certain segment of that bacterial population that's resistant to that particular formulation. Now they bounce back and then the person gets a recurrence of problems. So now in the beginning you need to spend a month or sometimes even two or three building up their system. So helping their immune system, their gut working on stress, uh, providing things like, uh, there's different formulas out there, but whether it's medicinal mushrooms or zinc or vitamin a or vitamin D, um, using healthy or probiotics or good gut microbes that help support the immune system and calm down the inflammation in the guts. We might even use some prebiotic fibers to help build that up. Some amino acids that can feed the layers of the gut that help seal that leaky gut. So you need to do that first. And then we'll come in on the other side. And now we can start going to war with these bacteria and killing them off. And we'll go through a couple of different, sometimes we'll alternate like two weeks, two weeks. Sometimes we'll do four weeks of antimicrobials. And then on the other side of things, well, now we just waged war. We killed everything off. We got these The battlefields kind of tore up and smoking and a mess. Well, now we need to rebuild. Otherwise, there's bad stuff's going to move back in again. And it could be the same stuff, could be other stuff. But then the third step of all that. So first step is build up and support. Step two is go to war against these these bad microbes that shouldn't be there. And then phase three is kind of the rebuilding phase so that it's less likely to come back later on. So that's kind of my overall approach to gut issues. And like you said in the beginning, if for one person it might hurt help one person might hurt the other so what uh if we're using things like prebiotic fibers good fiber that's good for most people but if you have an overgrowth of bacteria um you're just going to feed those even more and make the symptoms a whole lot worse so it really needs to be tailored to that person Yep. And that's where, you know, using testing is so important because it's what I tell people when they're like, Oh, you know, what's the testing going to do? I'm like, honestly, it helps me be a ninja. It helps me be a sniper versus just saying, Hey, your guts off. And it's like, now you're just being more generic, you know? And it really is though. It's, it's having that balance of what are things going to be the biggest leverage points versus not. And And I think we've all had people that have had that Herxheimer, the die-off reaction. And that's where if you're fragile and you've got a ton of symptoms, it's usually always a horrible idea to kill stuff first. It usually just goes horribly wrong. And just like you, I spend a lot of time controlling the immune response of So that way, when we finally stir the pot, right, we step on that ant pile, we're ready for what's going to happen. Because once again, you know, it does impact people. And depending on how severe a patient is, days or even, you know, a week or so that it can really knock them down. Whereas others, if they're in a good spot, hey, they can do it just from the beginning. And that's where it's working with someone is so important. And that's especially true with C. diff. I'll just highlight that particular organism because, and we see this a lot in conventional medicine, when you get treated with an antibiotic, next thing you know, the person has a major C. diff infection. And in a lot of cases, I think personally that C. diff is probably there just kind of living under the surface. And then when you try to hit it with an antibiotic that's not specific for that, it gets a little ticked off and starts to send out endotoxins in its defense. And we can have this happen with functional medicine as well. oftentimes we will see C diff that's in there. And usually C diff infections are pretty serious. I mean, they kill people in nursing homes due to dehydration and not being able to treat it. So we associate it with like, oh, you're gonna have major, major diarrhea, but we do see it in there just living underneath the radar. And if we just like, let's say we didn't do testing, and we just started throwing random antimicrobial blends at the person, and they do have a C. diff infection or a C. diff population living in there, now they start to release their endotoxins. It can make the person quite sick. Whereas if we know it's there, then we can start with a little bit of Saccharomyces boulardii or something like that that's a little more gentle that won't evoke that same response and then save that person from having that major side effect, that reaction. Yep. All right. Anything else you would like to share with the listeners? I think we covered a little bit of everything today. So yeah, no, I love the gut and I love working with, with people and it's yeah, we got to probably talk about this all day long. Yep. Yeah. This, this has been great. If people want to learn more about you, where should they go? So follow me on social media. It's easy. I like to say I'm the only buddy touchinsky that I know and I think is probably exist out there in the world. So if you find me on the social media, that's probably me. But for our clinic. So we see people in Pennsylvania, Florida and Mississippi. And you can go to go peak med dot com. And on there, you'll find our website. You can find more information about us. We have a group practice here. And then on that specific page, gopeakmed.com. You can schedule a free discovery call. We can talk about what you have going on. And we can figure out if it's a good fit for what we do here in the practice, whether it's gut issues. We do a lot of work with people with mycotoxin illness, chronic fatigue syndrome, long COVID. So kind of that you just can't your doctors can't figure out what's going on. You've been to every specialist and they all say you look great. Testing's fine. No problems. We work with a lot of people who find themselves in that situation and we biome function test, advanced labs, et cetera. Okay. All right. Well, thanks for being on the show. It was great having you. Thanks a lot. And, uh, like, like always a pleasure talking to you and, um, and especially, uh, all these sorts of topics. So thanks for having me.