Amie: That is such a fascinating story. And certainly, when you have environmental provocative agents, you’ve got that chronic triggering of the innate immune system, an autoimmune condition is an inevitable outcome if you don’t get that sorted out. And, of course, once you develop an autoimmune condition, you’re 30% more likely to develop another one. And that’s likely because, you know, most interventions, allopathically at least, don’t reprogram the immune system. They certainly don’t look at the environment or underlying causative agents and antecedents. And so, unfortunately, many people are just resigned to the fact that that diagnosis and prognosis is what it is, when clinical experience tells us that certainly isn’t always the case. Well, certainly, in your clinical experience, I know you’ve been using the GI-MAP. You’ve done hundreds at this point, and so would be somewhat of an oracle, as far as connecting the dots around what you’re seeing versus what’s showing up clinically. And also, of course, how to apply that information for a patient’s healing. I’d love to know, given that you’ve been working in this space of, you know, chronic and autoimmune disease, and you’ve experienced it yourself too, have you noticed anything in particular with GI-MAPs and those types of clients, that consistently might indicate a connection there?

Vanessa: Absolutely. And I think the research is getting more broader. So, there’s some great systematic reviews, which I can give you a link to put in the show notes. And it’s really interesting. When I looked at these papers, I was like, oh my goodness, these are the trends that I’m actually seeing in many of my patients. So, you know, first and foremost, we see, with the gut, you can have dysbiosis. So, you can have opportunistic, which I call dysbiosis, where you’ve got that overgrowth of bacteria, maybe also certain pathogens, which, in the literature, we’ve seen that bacteria such as Klebsiella, the body, actually, it mimics HLA-B27. So, there’s a side note. If you’ve got patients who have autoimmune, and they haven’t tested if they have HLA-B27, that might be something you do want to test for them, or their medical profession tests for them. So, when I’m seeing a dysbiotic gut, with a lot of really opportunistic bacteria, particularly that Klebsiella, the Clostridia, the Prevotella, it links with the research. It’s saying, look, there is some links that they’re making at the moment with people, particularly around rheumatoid arthritis. Lupus, it’s quite strong. Even, what was it, multiple sclerosis, I was looking the other day. Juvenile arthritis. Kids get arthritis as well. So, we’ve got that dysbiotic picture, but then we’ve also gotta remember, as health practitioners, that we need to look to make sure that the person hasn’t got a deficient dysbiosis. And what the research shows is that a lot of people have low keystone species, and the one that has a bit of research behind it is the Faecalibacterium prausnitzii, which is a major butyrate producer, which has been shown to be depleted in people with autoimmune, particularly rheumatoid arthritis, and it has that anti-inflammatory effect.

So, first things first, when I get a GI-MAP, I’m doing a scan, before I see my client, and I’m looking, do they have a opportunistic dysbiosis? Do they have a deficient dysbiosis? And then what that leads me to look at is that last page of the GI-MAP, and the first thing I’m looking at in that section is zonulin, because, what the dysbiotic state of the gut can do is either worsen or create this environment, where there’s this dysregulation of zonulin. And so, we know zonulin… So, if we’ve got this trigger, of either not enough good bugs or too many bad bugs, if we just, say it in those simple terms, that dysbiosis can trigger this increase in zonulin. So can food, so can stress, so can many other things, you know, particularly gluten. And then when we’ve got this increase in zonulin, which is the protein that’s meant to keep the tight junctures of the gut, so the pathogens and antigens and all the stuff in the gut can’t get through into the bloodstream, what happens when we’ve got that high level of zonulin is the person is at risk. And then the person is at risk of this abnormal activation of their immune pathways. And then what we see, if we do measure cytokines, is sometimes that upregulation of inflammatory cytokines. You know, your typical interleukin 1 beta, interleukin 6, you know, interleukin 17, all of them.

So, that activation of the toll-like receptors on the dendritic cells and macrophages, it’s not a great thing. So, what I’m doing in the test is stepping back to say, right, firstly, like I said, is there a dysbiotic gut? Does that give me some clues? Then, importantly, before I drill too much into the specific bacteria, really looking to see what that zonulin number is. I’ve had clients, I don’t know about you, Amie, where it’s been over, I think my highest client, it was about 600, 700, which is a big number. We want it, you know, I typically want it as close to zero as possible. Less than 100 is good. Below 60, I don’t know what your views are, is great, because it’s the biological door to inflammation and autoimmunity. So, that loss of barrier function is absolutely critically important, because we’ve gotta stop that translocation of antigens. So, they’re the two really big things that I look at in the first instance.

The second one is the secretory IgA. So, what I find, Amie, is it’s either exceptionally depleted. So, it usually says below 200. So, I called the lab… Or, no. Not called them. I emailed them, in the U.S., because I do have some clients in the U.S. And so I contacted Diagnostic Solutions over there, and I said, “What does that mean? Does it mean it’s 199 or 1?” And they said, look, what we know in research is anything below, when it’s got that arrow saying, “I think it’s below 200,” is critically low. It doesn’t matter if it’s 1 or 199. We’ve gotta build up that beautiful mucin layer, because it’s protecting the GALT. It’s protecting that gut-associated lymphoid tissue.

The other, flip side that I see, not often, but I do see it sometimes, is where the secretory IgA goes bonkers, and it’s over 5000. I think if it’s, sometimes if it’s really extreme, it’ll say just over 6000, and won’t give you a number. If that’s high, if zonulin’s exceptionally high, and then also, if I’m seeing the…what’s the gluten marker? You remind me on there. I’ve got it here.

Amie: Oh, the [crosstalk 00:11:41].

Vanessa: Yeah.

Amie: Yeah.

Vanessa: If that’s high, all three of them, you know, you and I can’t diagnose celiac disease. It’s not in our scope of practice, but I have referred numerous clients in the past, and said, “This looks like the person may have celiac disease,” and 100% of them have come back having it, after they’ve had the biopsy. So, look, the GI-MAP gives such incredible clues.

Amie: Yes.

Vanessa: Phenomenal tool.

Amie: It is an incredible tool. I tell you what I found in practice, actually, finding the gliadin antibodies in the gut. I have caught celiac disease before it’s become celiac disease. And so, there’s no antibodies in the blood, but they’re starting to be produced in the mucosal tissue of the gut. And it’s such a powerful way to intervene before someone develops a full-blown autoimmune disease. And the difference is, it’s tricky with clients, I’ve found, because no one wants to give up gluten. I mean, you know, I’ve got a gluten-susceptible HLA, so I’m gluten-free, but gluten is also delicious, so I understand why people are reluctant to go gluten-free, but once you develop celiac disease, you know, a crumb can put you in hospital, and it severely curtails your quality of life as far as, you know, eating out goes, makes things feel very risky. And catching it at that point, I find, allows people to be glutened without consequence, if it’s happening intermittently. So, certainly, I think you have so many useful markers there. Secretory IgA is actually one that I look for, you know, without exception. As you said, highly elevated levels, usually response to infection, possibly inflammation, but of course, lots of things can cause it to be depleted. And I think one thing practitioners overlook is that low secretory IgA will cause leaky gut, because, with low secretory IgA, the communication across the toll-like receptors gets lost, and the dendritic cells start poking their dendrites through the wall, literally creating holes in the gut, as a result of low secretory IgA.

And I think, you know, some of the things you’ve mentioned so far are starting to hint, really, at the intersection of germ theory versus terrain theory. We’re looking at opportunistic pathogens, a loss of commensals, but also when you zoom out, an environment that has allowed things to disintegrate. And, for instance, low secretory IGA can be from chronic stress, amongst other things.

Vanessa: Absolutely.

Amie: You know, zinc and vitamin A deficiency. So many things. So, it’s really one that I think, you know… And without that, we also don’t have enough of that beautiful glycocalyx that provides a home for commensal bacteria. So of course, you’re going to have low commensal flora, because they’ve lost so much of their anchor points on the lining of the gut. And with that loss of secretory IgA, you get a loss of regulatory T cells, so of course, you’re gonna have, you know, allergies, autoimmunity, inflammatory conditions developing too.

Now, we are gonna talk, of course, about how this is all applied, but there’s a couple of other markers that I’d love to chat with you about specifically. And when we were speaking prior to hitting record, we were talking about the role of calprotectin, but also picking up occult blood in the stool, and how powerful that is too. What would you like to say about those two markers?

Vanessa: Look, calprotectin is absolutely one that if you are starting out, looking at the GI-MAP, you most certainly need to look there. And look, if…you want it as close to zero as possible. So, I think if it’s over 80, you really wanna be trying to understand what could be causing it, because what’s calprotectin? So, it’s basically where white blood cells are infiltrating into the lining of the gut. It’s released by neutrophils. So, I had a client, Amie, where their calprotectin was over 2000. A small child. So, when they went in and did the medical investigations, he had very severe Crohn’s disease. So, what have we been able to do? Well, we’ve been able to, I’ve also done other genetic testing, and exactly what you said, Vitamin A is absolutely critical. So is vitamin E and vitamin D. And we found that, given his genetic disposition, plus the environment of where he was living on a farm, and other things going on for him, like you said, a lot of people love gluten, it wasn’t helpful for him, he ended up in this exceptionally inflammatory state. I would hate to think how painful that was, because I know for clients who have a calprotectin of even 200 or 300, very painful.

But what we’ve been able to do, he did go on biologics, which is immunosuppression, which is no choice when you’ve got numbers that big, but what we’ve been able to do is, he’s reduced the dose of that, and do some of these other things. So, really, you know, where we sit, as health practitioners using tests like the GI-MAP, is being able to communicate with a person’s general practitioner. Calprotectin is a very medically… What would the word be? Recognized measure. I’ve got a standard letter that I write to GPs, saying, “Hey, this is who I am. I’ve done this test.” I don’t talk often about all the other bacteria, because that’s often what they’re not interested. Calprotectin is the gold standard for measuring gut inflammation. So, if a person has calprotectin, you know, at a big number, over, you know, 100, definitely if it’s over 200, 250, I’m writing to their GP, and asking them to repeat the test and then consider other medical investigations.

The same with blood. So, if blood’s in the stool, obviously we need to be asking questions like, “Do you know if you have hemorrhoids?” or, you know, things like that. Because often, people will say, “Yes, I do.” But looking at the bigger picture, and again, if we feel like we need to, just create yourself a sample letter, have it there, so you’ve got it there in draft, and feel like you can communicate. There is nothing wrong with you calling a person’s general practitioner and asking for their email address, and sending it through. What’s the worst that’s gonna happen? They’ll ignore it. But the best is, and this has been the case with both you and I, is the person gets the most appropriate medical treatment for their case.

Amie: I think that’s a really good point, in the sense that more and more people are coming to holistic health practitioners, whether it’s a nutritionist, herbalist, naturopath, combination of any of those, and are really seeing those of us in this space as primary healthcare practitioners, for any number of reasons, which means, sometimes we are the first practitioner to identify something is seriously wrong here. And we’re lucky we’ve got so many tools, we’ve got so many tests that we can use, but also, there are limitations, including we can’t make a diagnosis. Even though we can say, “hey, this can often indicate that,” we need to refer them on for additional screening. And in this case, you know, I’ve, it’s very rare that I hear back from a doctor regarding a referral letter, although I don’t expect it, or either. They’re really busy. It’s just like, “Here’s an FYI,” and that’s, you kinda send it into the void, and then you’ve done your due diligence. But at the same time, you’ve actually provided that for the patient, to then take and start a conversation with their GP, and get, you know, appropriate referrals to specialists, further investigations. And as you said, calprotectin is one of those big red flags. Certainly, once it’s over 200, there needs to be further investigation, just for, you know, peace of, everybody’s peace of mind. And of course, blood is the same, to rule out anything that could be sinister.

And, but if we were to zoom out and really consider what all of that indicates, it’s inflammation, it’s breakdown of the integrity of the tissue. I’m thinking of one client I had, very similar to the one you described, who was a young boy, very high calprotectin, had a gluten-susceptible haplotype. Very difficult situation, because one parent was incredibly committed to removing it, and the other parent did not see the value in it, even though I tried to explain the slippery slope of continuing to give someone gluten who has a gut that looks like that, and a susceptible genetic makeup. But in his case, the inflammation was so bad, and impacted the integrity of the gut so much, that there was prolapse occurring. And it was so distressing, because one parent really wanted to take the natural route, but things had deteriorated so bad. In this case, I don’t think they used biologics initially, but there was steroids used, and gut-specific anti-inflammatories, which was necessary and appropriate, given the condition that the child’s gut was actually in. So, the sooner we do these things, the sooner we can identify a problem, and the quicker we can course-correct, or help our patients course-correct. Is there anything else that you see specific to autoimmune that would make you think, oh, gosh, there’s an autoimmune trajectory occurring here? Or would you say the ones that we’ve mentioned are really the main ones?

Vanessa: So, I think, just to everyone listening, you’ve gotta find your groove and your lane. People see me, Amie, when they’ve investigated everything. So, I’m not their primary person, like you were saying. I think it’s amazing you are, but that’s not where I fit. So, I fit where they’ve done lots of investigation, seen lots of people, and they’re really stuck in a corner, because they’re saying, “Look, the medication I’m on is not working,” or, “I’ve tried all these things and it’s not working.” So, what is really important? So, in functional medicine, what we’re trained in, and it’s the same as a naturopath, is taking the whole story. And what I find is, often, no one has ever sat with someone and listened to their whole story, and asked the big questions. Understanding the family history, asking the nuanced questions, because people don’t associate type 1 diabetes as autoimmune. They don’t think about, “Oh, grandma needed B12 injections. Perhaps she had pernicious anemia,” as autoimmune. So, as a health practitioner, what I’m always trying to do is to be really switched-on with my questioning, if there are signs that, yes, there’s that family history, there looks like there has been some environmental factors going on. And in the GI-MAP, we’re very lucky because they have kind of segregated those autoimmune-triggering and sustaining bacteria. So, if I’m seeing, you know, grandma had all these back problems, I’m not sure what it was, you know, and then I’m seeing Klebsiella, I’m thinking, okay, what’s going on here? Because exactly what you said, often, people have autoimmune or auto antibodies many years before any clinical or lab shows it.

I’ve had clients come to me with a ANA, anti-nuclear antibody titer of 1 to 1520 or something. And what have they been told? “It’s all fine. There’s nothing to see here.” And I’m saying to them, “What’s your family history? What’s going on?” We’ve gotta get that number down. Now, the thing is, autoimmune in children is not the same as adults. So, with children, we’ve got the thymus. That’s obviously in the middle of our chest. And it involutes. And so we’ve got this period up until about 12 or 15 in children, where their body is training their immune system. And so, that’s sometimes why, Amie, in children, we are trying to get them into remission, whether it be medical or unmedicated remission, quickly, to try and signal to the body, “Nothing to see here. Go away. Quieten down,” to really reduce that polyautoimmunity, and also that multiple autoimmune. Because it is, it’s definitely, for some children, a balancing act. And what I’ve found, and this is anecdotal, I couldn’t find any research, but as you know, before seatbelts were invented, they didn’t save lives. But what I’m finding, particularly in the children, is they had significant intestinal permeability, so, that significant level of zonulin. They did have some of those nasty bacteria at high levels. Later in life, their gut is perfect. They’re in great gut health. However, there’s other things going on, particularly around food sensitivities, IgG, food intolerances.

And so what I’ve been doing is, you know, scratching my head and going down a lot of rabbit holes. And what I think is happening is, because of the age that they had this positive ANA, plus this gut intersection, which is, obviously, we think fueled by what’s going on in there, now, down the line, they’re having issues with food intolerances. So, the question mark I’ve got is, does it go away, or do we have to keep doing things, because the thymus needs certain nutrients too. And it’s similar ones to what you said around the gut, you know, vitamin E and vitamin A, and all of these things. So, yeah, I think we can’t underestimate taking a person’s story. For me, it’s 90 minutes. If someone comes to me because I offer a discovery call, which is very helpful, almost everyone books an appointment after that. So, if you don’t offer discovery calls, it can be a great touch point for people to get to know you, and answer your questions before they invest. And, you know, if a person I think, “Wow, they’ve got numerous autoimmune, they’ve got numerous things going on,” I’ll pencil a little bit of extra time. So, sometimes it may take two hours, but we’ve gotta be delving into what has been, you know, “when did you last feel well?” is the magic question. And delving into things like stress, infections, bacteria, viruses, you know, all the things, because they can obviously be a straw that breaks that camel’s back, when we’re thinking about, like you referred to earlier, the secretory IgA, and some of the real fundamental aspects of the gut.

Amie: I think that’s really wise guidance. Even if someone’s not working, sort of, you’re almost at the bottom of the mountain, aren’t you? People have fallen off and tried everything, and you’re kind of the last resort. And also, in order to really provide a good roadmap for someone’s healing, going through their history, from birth, you know, in utero, how were they born, were they breastfed, you know, all of that, all the way up to that age, can be really telling. And I love that question, “when did you last feel well?” because that also pinpoints when, you know, things started to shift with them, which could, you know, you can explore that time period a little more. So, from that point, though, what I’ll say is, clearly, as a practitioner who’s dealing with people as a last resort, you’re seeing these last-resort humans who’ve tried a lot of different things, either DIY, or maybe seen practitioners who have less training in environmental background, or maybe, like, zooming out and looking at that whole functional picture. I’m curious to know how you broach functional testing with patients. And I ask that question because it’s one of those things that, as practitioners, we’re always weighing up the benefit of the investment versus, you know, is this really going to inform or alter our way forward?

And functional testing, it’s expensive. It’s expensive if you did all of the things. I mean, you could arguably spend $10,000 or more on all of the fancy pathology that we have available, and really, prioritizing and triaging what should and shouldn’t be done is something that every practitioner has to overcome, as a challenge, clinically speaking. And of course, sometimes that’s informed by patient’s budget, you know, whether or not it’s gonna change things. So, I imagine, for you, you maybe do it more often than the average practitioner, because they’ve come to the end of line, and you just need more data to actually figure out what’s going on. But do you have a kind of, not a checklist per se, but, in your own mind, patients that you’re like, “mm, probably don’t need to do this, at least not at this stage,” versus, “okay, these are the red flags,” they’re like, we actually have to do this now in order to be able to move forward. Like, where is the line for you? Or what do you do to help with that decision-making?

Vanessa: I think, in a lot of my training, we were taught to really, you know, “what’s brought you here today?” And often I’ll say, “Oh, I really wanna know what’s going on in my gut.” So I make sure I make that note, because I type notes as I go. Then we go through all the symptoms, all the history, like you said, right back to pregnancy, what birth order were you, you know. Did mum have any miscarriages? Was she vegetarian? You know, all the, really long list of questions. And then, at the end, in my training, I’m taught to retell the story. So, I’m, like, saying, “Look, I hear that you came in here today because you really wanna understand your gut. You’ve seen a gastroenterologist, you’ve seen a rheumatologist, you’ve seen an ophthalmologist, and you’re at your wit’s end.” And so I tell them their story, and I think 100% of people, is my guess, 99%, have not been heard. And they’ve gone, “Wow. Look at that.” You know, that, “I can see now how some of the pictures, how the pieces of the puzzle align.” You know, whilst autoimmune’s not in your family, you did have this stressful event, you think you’re exposed to mold, X, Y, Z. Here are the options. And so, what I think is, if you’re new to this, creating blogs or videos, sharing content widely and freely, is great. So, if people research, go on your website, read what your point of view is, to see that you are evidence-based, to see what the options are, when they come to you, they already have it in their head. They say to me, “I want this, and then can we do this?” And then, they know the prices, they know what to expect. It’s much easier if you don’t have to convince them. Sometimes people have not done that work. In my discovery notes, I always have a link, as well, to videos or blogs that they can read, so in between the discovery call and the appointment, they can come up to speed. And then I’m doing less education in my initial consultation.

Amie: Yeah.

Vanessa: So, for a client who isn’t aware of the options, I’ve got a printout. So, I’ve got this mammoth folder, I don’t have it right here, with all sample reports. Cost me a fortune, because it’s all color printed and, you know, it’s a dollar a page. But it looks beautiful. And what I can do is then flip through, and say, “Look, based on what I’ve heard from you, from your story and your frustration, this is what this could tell us.” And so, yeah, often, having the visual as well. Now, being online, Amie, having just a folder, where you’ve got them all in there, you can just quickly open it up. For a lot of people, at the end of my consultation, I say, “Tell me your reflections from today.” And at the beginning, that felt really weird, and I was like, why am I doing this? But it’s amazing what they say. And a lot of the time, is hope. “I’m really excited to do this test,” is what people often say. And also that they’d never had anyone put pieces of the puzzle together.

So, I think, really stepping back to go, look, what are the bits of the story? Where are their most significant pain points? I had a gentleman recently who had several accidents, and significant surgeries. Since then, he has had crippling anxiety. So, not autoimmune, but, you know, still inflammatory, neurologically. You know what I learnt? And we were talking about this earlier, Amie, no one knows everything. So I delved into the world, when I got his GI-MAP back, very low secretory IgA has been linked to anxiety. And so, for him, he was like, “This is fantastic.” He’s like, “[inaudible 00:35:27] that test, I can now do things.” And so then it was able to equip him to take action. We knew exactly what we had to do. I could tell him, look, I think it’s gonna be a multi-month project, and he could go away and do that. And I was able to explain that I thought it was because of, you know, all the medication he’d been on, and antibiotics, and the stress.

So, the more you do it…you just gotta start. You know, it feels nerve-wracking. Don’t bring your financial or money bias into it. As a person who didn’t know all my options, it was very frustrating. So, you know, down the line, I know I could have tested all these different things, and guess what? I would have spent whatever it cost, because I wanted data. And I have clients like that, who come in and say, “tell me all the options,” and they’ve spent a lot of money. Others come in and they just do one test maybe every couple of months, and they still get good results. But I think sometimes we have a block, where we go, “Oh, this is so expensive. I don’t want to tell them about it.” Whereas people are coming to you because they want to know the options. They’re coming to you because you’re different. They’re coming to you because you think different. They’re coming to you because you’re looking at this through a different lens. And we need to honor that within ourself. That’s been one of the biggest lessons for me.

Amie: Yes. I think that’s such a great point, because you’ve painted a picture that’s really clear around connecting the dots for people. And also, I love the fact that you have this folder where you can actually show them the kind of information that you can get. And if you work online, you can always screen share, you know, a sample report and do the same, and really help them see the value in that. And I think people are willing to invest where they actually see there could be a good return. This could really make the difference. And I think many people, including myself, are very data-driven. Also, it really helps with compliance, actually, to be able to see why they’re being recommended, what you’re recommending, and what difference that’s meant to make. But I think, fundamentally, what underpins that is removing pre-judgments, misjudgments, limiting beliefs around resources and finances, and just presenting what’s so, and allowing people to choose what to prioritize. And rather than taking the option off the table for them prematurely, when you have, A, no idea of their position, I mean, I personally, obviously, think it’s really lovely, as practitioners, we’re so mindful of where we recommend our patients invest. And I certainly take an approach where I would prefer people to invest in treatment or correcting the environment, rather than multiple data. If it’s not gonna change what we’re doing, at least initially, then I’ll be like, we can circle back to that, depending on how far we get with these other changes, but we’ve got obvious steps to take already. But oftentimes, especially when you have someone who’s come to you as a last resort and tried many things, and already spent a lot of money on things that didn’t work, having a clarifying pathology test done, to really refine recommendations, can ultimately save them a lot of money in the long run, and a lot of stress, a lot of confusion. And as you said, restoring hope. I think hope is powerful, powerful medicine, really. And that really helps to drive, I think, patient belief and motivation for what you’re recommending as well. So I think that’s really, really insightful. Thank you.

And now I would love to talk about some, a case or two, if we have time, because this is where the rubber meets the road, and really kind of identifies what’s going on for somebody. I know, for you, I mean, you’ve got so many, and we could pluck from the pool of cases that you have, with rheumatoid or celiac disease, irritable bowel disease, ulcerative colitis. But do you have a favorite child? I hate to ask you that, to pick your favorite, because I’m sure there’s many that you’re incredibly proud of. But I’d love to hear from you, you know, that sort of start to finish, where you ran a GI-MAP, found these things, recommended some changes, patient implemented the changes, and there was a really positive change. Can you think of anything you’d like to share with me today?

Vanessa: Yeah, I’ve got a few. So, we must always remember that we can provide such beautiful, nurturing, empathetic support for people, that potentially has been missed. So, I had a client come to me, she was on her last immunosuppression drug before they resected her bowel. She had very severe ulcerative colitis, which is IBD. And she had a business where she travelled a lot overseas. She’d seen a previous health practitioner. She’d done a different test. I said, “Look, send it through, show me, and we’ll have a look.” She didn’t follow through on any of the recommendations from the previous person. So, what I think we’ve always gotta ask and wonder is what’s this person’s appetite for change? So, I say to people, “Do you wanna go mild, medium or hot?” So, she was definitely not a hot, but the practitioner she’d seen before wanted her to go hot. So, the notes, I got a copy of it all, and it was all very sensible. Like, what the person had said was spot-on. But, it didn’t meet this lady’s needs. She just was like, “Nope. All too hard. Not doing any of it.” So, then fast forward, what, 12 months, and she’s in dire straits because they’re like, “We’re gonna cut out your bowel if this next IV drug doesn’t work.” And we repeated the GI-MAP. And of course, you know, it was not the greatest. And the biggest thing I felt, because I said, “How many things do you wanna do?” And she said, “One, maybe two.” And I said, “Right, okay. Let’s go. What’s the biggest thing that I think will make a difference to you?” And because I also knew some of her genetics, I said, “Look, we’ve gotta get gluten out.” And she was eating it numerous times a day, three, if not four times a day. “No. No. No. It’s my lifestyle. I like it.” Or, also drinking alcohol. “No. No. No.” And I said, “All right. What’s the benefit of consuming it?” And I sat there. I sat there in silence. And, you know, don’t feel awkward about silence, because they’re thinking. And she goes, “All right, then. I’ll do it.” And I was like, “But what’s the benefit of consuming it?” And she’s like, “Well, there is none, obviously, is there? I’m gonna have my bowel cut out, and then I’ll have to travel with my work overseas with a bag, colostomy bag, forever.” So, I think the power of motivational interviewing, questioning. She is really good. So, she will probably be on these medications for a long time, because they’re very helpful for her. But what it’s meant is she’s able to get her gut into a better state, where her body is able to manage with the drug she’s on. So, she’s not gonna have that resection, which is great.

I had another lady who had, or has, was diagnosed with Wells’ disease. It’s a very rare disease. There’s only a few hundred in the world. And that’s the other thing I’d say is, when people come in, don’t get nervous. If they say, “I have this autoimmune” big name, you’ve never heard of it, don’t get lost in your head, because, at the end of the day, they all have their nuance, but what it is, is it’s chronic activation of an inflammatory condition. So, for this lady, it’s very painful skin. And she came to see me because she was getting all the things done, and still crying in the night. She was waking up her husband, she was sleeping, but she was in so much pain, she was crying. And her husband said, “Enough’s enough.”

For her, just working out, changing a few foods, the pain went away, which blew my head up. Like, that was extraordinary. So, working on the gut, saying, look, what are the foods that we’ve just gotta take out, to alleviate some of the pressure? The skin, on the inside, her gastrointestinal, you know, gut healed, but the skin on the outside of her donut, as I call it, because we’re like a donut, aren’t we, healed.

Amie: Of course it did.

Vanessa: Phenomenal. And then I had another lady who had stage 4 cancer, she’s the most inspirational woman I’ve ever met, in remission. Had to take a particular medication, which then, as soon as she started taking this other medication, she became exceptionally distended. And I remember her looking at me, and I’ve never seen fear like it, in her eyes, because she was afraid, obviously, the cancer would come back. We did the gut test, and like you said, there were some clues there, so we started working on gut. She was then later diagnosed with scleroderma, but it’s now…and scleroderma’s where there’s tightening, of the skin, tightening of the organs. It’s a very dangerous autoimmune condition. It’s, they call it resolving, with scleroderma, not remission. So, it’s resolving. It’s going away. And this lady has spent, you know, a lot of time and effort in working out her gut. And really, that distension, which, honestly, she looked nine months pregnant, now she’s just back to normal, standing up straight, feeling fantastic. So, there are a couple of stories, and I’ve shared a few earlier as well, Amie.

Amie: They’re incredible stories. And in those stories, first of all, incredible stories of hope, and that, really, anything can be transformed, with the right information, and, of course, taking the right action. But I think one of the things you said in there that was really clinical gold is screening your patients for their level of motivation. I use a scale of, like, 0 to 10, of how motivated you are, how willing you are to change your lifestyle, diet, exercise routine. But I like the mild, medium, and hot scale, actually. And I think this is really helpful too, because as clinicians, we have the most incredible myriad of tools in our toolkit. And we could write someone the most comprehensive program that would answer everything, right? But change is actually hard. This is one of the most frustrating things I find as a practitioner, personally, and that is what we’re really in the business of is changing people’s habits. The irony is people pay us to tell them what to do, but nobody likes being told what to do. Most people kinda know what they should be doing, but still won’t do it, and knowledge just isn’t enough sometimes. So, motivational interviewing, really powerful. It’s the same reason why I trained as a life coach, because I’m like, yeah, there’s something else. There’s something missing here in helping people actually effect change, but also, checking in with someone about their capacity. You know, I’ll have some clients who’ll say, “I get overwhelmed really easily. I just wanna do, like, little things over a period of time.” That’s great, but most people aren’t really, haven’t even really thought about it, or maybe aren’t saying that part out loud. And then you’ve got other personalities that are, like, want the most efficient way there, and wanna do, happy to do all of the things, all at once. I do think there’s a limit to how much change the body can handle in one go. So, you know, the extra spicy clients, you might need to dampen them a little bit, of course, but knowing, like, the kind of human you have in front of you, and their capacity for making shifts, can also be really helpful for you to actually stage out things. And I love the fact that you said, to one particular client, “This is a multi-month project.” I mean, they all kind of are, I suppose. And one of the things I like to say is, “You wouldn’t have one session with a personal trainer and then wonder where your abs are.” Like, it’s something that, you know, [crosstalk 00:48:55]

Vanessa: That’s a good one.

Amie: …yeah, consistently showing up and making changes. And it’s something that happens over time, and often, a few months is gonna be required, especially in order to give them support, redirect. Like, going gluten-free, that’s a whole palaver in itself, and helping people identify just how much stuff gluten’s in, and then finding gluten-free alternatives that don’t taste very ordinary, below ordinary, and finding what works for them. That takes time, that takes support, that takes encouragement, that takes helping people, you know, recommitting and remembering their why. And certainly, it’s a shame as humans, most of us have to really be under the threat of something quite significant before we will make changes, but that is also human nature, and reminding them of that also, I think, is really, really, really, really powerful.

So, I think, ultimately, in our chat today, you have done the most exceptional job, in sharing with practitioners, just how powerful using the GI-MAP can be, and what some of those markers can really indicate. And I can see that you’re obviously very passionate about this. And knowing what a difference it makes to patients’ lives, you know, that is completely understandable. I have a few last things I wanna say in closing, but is there anything else that you can think of that you would love to share with practitioners, in terms of encouragement or education, or any last clinical pearls?

Vanessa: Yeah, I would, one thing that’s come up a lot is stress. And I think that link, you know, Amie, that link with vagus nerve dysfunction and stress in the gut. So, most certainly, make sure you are screening them for resilience, what are their stresses, and what’s their stress reduction techniques that they’re doing? And a lot of people will say “nothing.” Doing nothing. And so, again, trying to work through, slowly, as, through your therapeutic relationship with them, how can you gently introduce them to something to help? Because, yeah, I think vagus nerve dysfunction is at the root of a lot of this, for many people. We would love autoimmune to go away, but the facts are, in our role, what we’re trying to do is to help a person, firstly, meet what their goals are. So, get really clear as to what their goals are. And then, I’m always thinking, look, if we can reduce the number of autoimmune conditions a person gets, keep them as symptom-free, flare-free for as long as possible, for some people, that remission state looks like years, decades. Others, you know, I had a little boy with juvenile arthritis. He was in remission, doing so well, went to the movies, had a frozen coke. Couldn’t walk the next day. Poor kid. For him, great lesson, though. So, his flare was short. His flare was only a few days. And he was able to come out of it. So, that’s what we also want, is for our clients to have, when they have big symptoms, that they go away quickly. And if we’ve got, and we’re building that resilience in their mental and physical and spiritual health, then they’ll be more in a state to be able to facilitate that.

You know, we, like I said, we would love it to go away for good. For some people, it does. You know, they go in remission, for a long time. For others, they may never go in remission. And that’s where for us, as health practitioners, it’s really important you get familiar with interaction checkers. So, if you’re not using those, and you are attracting clients who are on medication, you must always check their medication before you prescribe anything. Because if they’re on immunosuppression medications, and you’re giving something that’s going to counter-interact that, you need to be aware of that, because we don’t want to be making them worse. And sadly, Amie, I have had people come to me taking a bunch of stuff, which they should not have been taking. So, that’s the other little pearl I’d leave you with, if you don’t already do that. Get really familiar. Get really practiced at it. Just, and always, at the beginning of your consultation, ask, “Is there any change to your medications?”

Amie: Yes. That’s a really good point. You’ve made so many good points there, that I wanna just reflect back. So, in terms of intake forms, I think every single practitioner will either get that prior to the appointment, or be asking about that. And that’s all well and good, but sometimes changes are made between sessions, by the doctor or the specialist, and the updates aren’t necessarily passed on to you. So I think that’s an incredible question to ask upfront, actually, just to protect the patient, and of course, yourself. And I love that you identified the green flags, that someone is heading in the right direction. And yes, as practitioners, you know, our ultimate goal and ultimate win is to put someone into remission permanently, when it comes to autoimmune things, but having larger gaps between flare-ups, you know, less extreme symptoms when they flare, and a faster recovery, are also signs that things are physiologically so much better than they were. So, keeping that in mind is really helpful, and that’s where quantitatively defining someone’s experience prior to seeing you, and reflecting back on that’s important, because I think it’s easy for us as humans to forget how bad we felt, too. And I’m sure every single practitioner listening to this has had a client saying, “Oh, I’m not getting any better.” But then when you reflect on the frequency of headaches, just as a random example, or the frequency of diarrhea or the frequency of nausea, it’s dropped by 30% or 50%, and then it’s a moment to go, “Oh, okay. Actually, I am heading in the right direction.”

But probably my favorite point you made was looking at the vagus nerve and the nervous system, because, you know, it really only, autonomic nervous system things only function optimally when we are in a parasympathetic nervous system state. The digestive system is one of those systems that is a sacrificial lamb, when somebody is stressed, and, you know, spoiler alert, low secretory IgA is a big red flag for that. But what we know from animal studies is acute stress, or sympathetic nervous system activation, actually redirects up to 70% of the blood flow from the gut to other, more survival-critical organs, like the heart, the lungs, and the brain, and skeletal muscle. And in the moment of, say, being attacked by a tiger, that’s great, because there’s no need to digest your steak sandwich if you’re about to become someone else’s lunch. But in today’s modern lifestyle, where we are chronically, we’re operating under the influence of adrenaline all the time, from other, non-lethal threats, but our body doesn’t know are non-lethal. We’re just chronically depriving our gut of the circulation it needs in order to be able to function properly, and I personally see this a lot with SIBO, but other gut stuff too, is chronic recurrence of those types of conditions are due to that.

Vanessa: Absolutely.

Amie: Absolutely. And so much so, even just checking simple things, like is your patient eating their meals sitting down, in a relaxed space, or are they watching, standing up, watching the news, or a horror movie, or whatever it might be, or in their car? Which, I have to say, I was guilty of once upon a time, eating breakfast in the car. But these things are not helpful, across the board, but particularly problematic if there’s digestive or autoimmune things, so…

Well, Vanessa, thank you so much for taking us through this. That was an incredible exploration of the GI-MAP, and I know we only scratched the surface, really, because it’s so rich in the amount of data it can provide, and what we can do to apply that. But for anyone who would like to connect with Vanessa, she is found at thehealthygutnutritionist.com. She also has a podcast called “Thrive Forward,” and also, @thehealthygutnutritionist on YouTube. Now, if anyone is also interested in mentoring with Vanessa, we’ll make sure we put a link to indicate your interest in the show notes as well. But in the meantime, I also wanna thank you for listening, all of our beautiful listeners out there, for joining us today. And remember, you can find all of the show notes and our other podcasts on the Australian Designs for Health website. I’m Amie Skilton, and this is “Wellness By Designs.”