Teresa: Well, firstly, I’d like to say that when it comes to cancer, I’m very much about prevention. So I like to talk to people about that before they get the disease, if at all possible. Because what we do know and particularly about bowel cancer is that diet is one of the modifiable risk factors that we can address.

So I support patients all the way through the cancer journey. So whether that be through pre-cancer, you know, hoping to avoid it, or going through the steps of nurturing people when they actually have the disease, when they’re going through chemotherapy, when they’re going through radiotherapy. And one of my specific areas of interest is for patients who have an external stoma, which is where the small intestine or the large intestine is pulled out, literally, through the skin on the stomach and a bag out, and that can be very traumatic for people.

And it can happen to people who have Crohn’s disease, or ulcerative colitis as well. So, and in my 30 years in practice, not only do I focus on gut, but obviously, you know, I’m in general practice with several NPs and an acupuncturist and a dietitian, and psychologists, so lots of different, let’s say, chronic cases come across my path.

Andrew: Can I ask just about that point on prevention? You and I are well versed in the sort of medical model of primary prevention, which doesn’t mean prevention, it means early intervention. Do we have anything in our toolbox where we can actually look at preventing a problem before it presents or rears its ugly head, like for instance, looking at let’s say tracking over a period of time, markers like calprotectin, or maybe looking at combining that with, you know, the CVSA stool tests and looking for fibres or other inflammatory markers in there. Is there any clues that we can have to say, this is going to be a problem?

Teresa: It’s interesting, because calprotectin wasn’t actually a feature in my own personal journey. So I didn’t have any issues with that. Despite the fact I did get bowel cancer. So, you know, it’s an interesting one. I think GI mapping is incredibly important, because there are certain bacteria that we know are an issue and can cause, let’s say, the increase in inflammatory cytokines and interleukin 17 as an example, in Ulcerative Colitis and Crohn’s disease.

And there are definitely biomarkers of specific bacteria that are found in the bowel that have been identified as being present. Not necessarily causing, because we don’t know that yet, but being present around the polyps. So that plus, looking at the genetic snips. Of course, the MTF HR is one of those snips that we should be looking at because of its effect on methylation, in particular.

Andrew: Gotcha. And so can I just ask about these bugs? Are there any that…I don’t like the sort of all bad or all good, I’m not into that sort of, you know, smiley face and demonic face, there sort of seems to be…you give it the terrain to grow, and it will grow sort of thing. So we’ve got to focus on terrain a lot. But are there any, let’s say, culprits that we’ve got to be aware of, the putrefactive bacteria, the Proteobacteria.

Teresa: I’m gonna say there’s a whole host of them, and I can’t pronounce half of them. So I think the thing to do is when you have a GI map, they do fall under the Firmicutes. So they fall under that category. So if you’ve got an imbalance, then you certainly should be looking at that. That is something that you want to get under control.

Andrew: I remember I was extremely interested in this. It was a rat study, a mice study, but it was so elegantly done, where they did a beautiful car wash out and crossover between some rats that had these genes with a preponderance for, I think it was bowel cancer, and rats that didn’t. And it was this PDL one. And it was just really interesting how I think it was Bifidobacterium breve [SP]. But there were others. But Bifidobacterium breve a came up as I like, this is one that we should be really focusing on now. That’s with rats, I get it. But it was just a beautiful study that was elegantly done. And I’m wondering where probiotics…

Teresa: And I love those studies, I love looking at those studies. And I know that Bifidobacterium are extremely important. I’ve never really seen an overgrowth of Bifidobacterium it’s usually an undergrowth. So that will give you a clue. But I’d like to just remind everybody that genes are only 16% of the possibility of us getting a disease.

So again, it’s back to that epigenetic factor, look after yourself, you know, make sure that you’re eating well, sleeping well, et cetera, and low-stress levels. I should take a leaf out of my own book. And you know, all of those sorts of factors.

Andrew: So we talk about these general nutritional considerations, what are the general ones that we need to look at? Foods to eat, foods to avoid frequency, fasting?

Teresa: So yes, okay. So obviously, we need fibre. So if we’re talking about preventing bowel cancer, then we’re talking about higher fibre diets. And from the most recent research, they’re saying, not 30 grams, 50-70 grams of fibre per day, it’s pretty hard to reach. So that’s an important factor. And resistance, starches, antioxidants, seven servings of vegetables per day, you know, providing their the good type of vegetables and providing there haven’t been sprayed, or pesticides, etc.

And then on top of that, we have to make sure that we have diversity. So that’s something that is largely lost. When we look at our predecessors and they opened a jar that was seven, I think it was 7000 years old, and they examined the bacteria in this jar that was making a cheese of some kind. And they were billions of different types of bacteria. What we’re finding now is that that’s becoming less and less diverse, and I think that’s where we run into trouble.

Andrew: Right. Gotcha. And so we do need to cover supplements, you know, what supplements do you find are of merit, particularly when you’re talking about fibre and helping good guys to grow in the bowel?

Teresa: What well, you know, look, I’m a bit of a designs for health person. I do use a lot of their products in clinic, so I might be a little bit biased here. But one of the reasons why I absolutely love that paleo fibre is because it actually has types of fibre that can be used in a low FODMAP diet. And this is really important for me because when I have patients that I am nurturing back to good health, I want to have something that is low FODMAP, something that is largely a soluble fibre that I can use in a very small amount to start off with then incrementally increase so that there’s not a reaction in that person.

Because as a practitioner, if you put too much of a certain type of fibre in to start off with, and your patient gets a reaction, you lose that patient, they don’t want to come back because bowel problems are quite embarrassing, they can be anyway. So and I love the bamboo fibre. I think that’s something that is innovative and has been well received.

Andrew: Now, now, this is something that interests me. I remember speaking to a chap, he was from North Queensland, and he was using sugar cane, but the fibre, not the sugar. And the only problem I came across is that it was extremely hydroscopic. It was like plaster of Paris floating on water was very hard to mix. So it’s kind of like… do you know PectaSol-C? Have you ever used that?

Teresa: Yes. Yes, yeah.

Andrew: So can you give us any hints on how you might use these, some of these fibres that are like extremely hydroscopic? How do you tend to get them into patients?

Teresa: Well, yogurt is the best thing. So you know, if you mix it in with yogurt, and then pop it in with whatever cereal a person is wanting or doing a Bircher muesli as an example, or you know, a porridge, then that’s the best way to do it.

I find that it does actually go quite well in milk if you…and I’m not talking about cow’s milk, but whether you use coconut milk or almond milk or oat milk, that seems to work quite well. And it goes very well in any of the syrups, like the coconut syrups and maple syrup. So it can be mixed in with that and then added to food.

And, you know, you can actually put it in food and cook it. So that’s another way that you can do it.

Andrew: Okay, great. And so, you know, when we’re talking about bowel cancer, and we’re talking about during therapy, prior to therapy, after therapy, and the progression of conditions that accompany some of the especially chemotherapeutic regimens. What do you find useful with, you know, let’s say mucositis? And if I was going to pitch get pick a stage, let’s go it’s already gone, you know, you’ve had a runaway effect, somebody hasn’t come in to see you until late so you’ve got a stage three. Is there anything that is worthwhile for you to rescue that mucositis?

Teresa: Are you talking about during chemotherapy or post chemotherapy?

Andrew: Okay, during.

Teresa: So during chemotherapy, glutamine, post-chemotherapy in cancer patients, no glutamine. Okay, so if you read the research, you can actually use it during chemotherapy, especially at randomized or, you know, put it in some food, if it’s tolerated, but after chemotherapy in bowel cancer, no. I’m not really sure why, but the research tends to say could be proliferative.

So during chemotherapy, definitely.

Andrew: Right, and what about things like…

Teresa: There’s a but there, sorry. So, you know, if we’ve got a remission, that’s great, because we do need to repair the gut. So you’re going to need that at some stage, but it might be six months down the track.

If we’re talking about inflammatory bowel conditions, then certainly, we would definitely use it in an inflammatory bowel condition like ulcerative colitis or Crohn’s. But the decision, the clinical decision for me is, is it more of a SIBO presentation and inflammatory bowel condition? Or is it more a lower bowel condition? If it’s a lower bowel condition, then I’m going to use the product that’s got the big glycerides licorice in it.

If it’s more a SIBO presentation, then I’m going to use something like GI Revive, but I wouldn’t do that before I’d done a GI map. That’s something we definitely want to do.

Andrew: Okay, so this is good. So you’re using basically the bacterial or actually it’s more than bacteria, isn’t it, the using the microbiome genetic signals to govern how you wind your way through different therapies, through the patient picture, is that correct?

Teresa: That is correct. Yeah, that is correct.

But another clinical pearl here is that you can use Curcumin with either. So whether it’s actually post chemotherapy, some oncologists are okay you using it alongside chemotherapy in bowel cancer, but it depends on the chemotherapy, and you have to research each chemotherapeutic agent with curcumin to find out whether or not you can or you can’t use it. But for inflammatory bowel conditions, definitely using curcumin, and the reason for that is that it does address both gram positive, gram negative type bacteria.

It balances the GI microbes, which is fascinating because I never even thought about the fact that it could do that. And it’s also immune modulatory. So yeah, definitely use that. And I’ve had great success with that.

Andrew: Gotcha. I’ll send you a thing that I did on ginger as well. It was really interesting. To me, it’s just really interesting that we think the foods feed us. And it’s really interesting that the foods are feeding the genes of the bugs, and the bugs genes are telling our genes to say settle down. It’s just this really interesting thing. We’d like to think that we own the bugs.

Teresa: No, we don’t. And, you know, I’m not a big advocate of going in hard with antimicrobials. So I do a very gentle antimicrobial formulation, or treatment I should say. So I would definitely use for parasites and worms of course I’m going to use you know, Burberry and black walnut and sweet wormwood etc. For about a two-week period, but then at the same time, I’m using those prebiotic powders, I should say, and a digestive enzyme.

Because when you’ve got a system that is underpowered, something like the digestive enzymes will actually help a person to recuperate more effectively because they’re getting the nutrients from the food.

When it comes to more of that, sort of SIBO presentation that definitely be oregano oil, and what better way to do it and have it in a capsule. I mean, it’s just fantastic. It works amazingly. And I’ve done GI mapping before and after. And, you know, we brought all those nasty bugs right back down to where they should be.

Andrew: Right. Can I ask about, when we speak about curcumin and it sort of, to me it tends to get pigeonholed to either arthritis or cancer? But we forget often about its use in many inflammatory conditions, including other bowel inflammatory conditions, but we mustn’t forget about the other beautiful herbs that we’ve got about at our disposal. Albeit somewhat hard to procure supplies at some stage, like things like Boswellia. Do you use a lot of Boswellia in like inflammatory bowel disease at all?

Teresa: I do and I tend to use Boswellia when there’s an inflammatory bowel condition and an arthritic condition. But one of my go to herbs is Hemidesmus in Crohn’s and Ulcerative Colitis, yeah.

Because it is autoimmune in nature. And if you’re not a herbalist, yeah, if you’re not a herbalist, then what can you do? Because obviously, I’m teaching in the nutrition faculty, and we’re not allowed to, well the students are not allowed to have herbs at their disposal. So vitamin D zinc, crocetin, and a good vitamin C. Did I say that? Vitamin D, crocetin, vitamin C.

Andrew: C. Yeah. Right. And so then we get on to antioxidants as a general thing, and when we’re talking about cancer and inflammatory bowel disease and how patients can handle certain foods or not. How do you find they handle things like foods high in bioflavonoids, these isoflavones, things like that, bioflavonoids, like berries, for instance?

Teresa: So in an acute presentation of inflammatory bowel disease, and post-surgically, the most important factor is a low-fibre diet. Okay, so that’s a diet that’s under 10 grams. And it seems counterintuitive, but you can’t put an itchy scratchy insoluble fibre into a bowel that’s been traumatized with a para advised ileus after trauma. Hence, you can’t put an itchy scratchy fibre into a highly inflamed bowel in an acute presentation.

So when you’re putting antioxidants into antioxidant foods into an inflamed bowel, you have to be careful to find out whether or not they’ve got high fibre. So berries don’t, surprisingly, and even strawberries, don’t, you think they would because all their little pits, but they don’t. So you know, putting those types of foods into the diet, it’s incredibly important.

But you have to distinguish with the spinaches between baby spinach, which is a low fibre, and English spinach, which is a high fibre. So you can use peas for high fibre, but you can use snow peas for low fibre. So it’s really important that we look at that distinction. And then as soon as that acute episode is over, or you know, your post-surgery bowel is starting to work more effectively, we can then slowly increment fibre again.

And most people don’t sort of look at the fibre content, or they might go on Google and search for it and that’s not adequate. So where you need to go is Nut Tab, Food Standards Australia New Zealand website and go into the nutritional database and you simply type in fibre under nutrients.

And it will come up with a list of fibre foods. So you just, I’ve got my own list. Of course, I do. But you pick out the low-fibre parts and the high-fibre parts. And you can also look up antioxidants. So as an example, if you wanted to look up beta carotene, you could look up beta carotene in the nutrients and then go through those foods and say, well, which of these have got that highest amount of beta carotene, and then offer those to your patient as a low fibre option, and then look at the foods that have the higher fibre options.

Andrew: So what about cooked versus fresh when you want a more soothing effect on an inflamed bowel? Do you favour sort of more soups and cooked things rather than fresh?

Teresa: Yeah, definitely my soups and stews, but just to remember that fibre is fibre. So if you blend it, it’s still there.

Andrew: Yeah, that’s right. And also, once it’s cooled.

Teresa: Yes, so resistant starch. So let’s say you’ve got somebody who’s in an acute stage of ulcerative colitis or Crohn’s, where they’ve just come out of surgery. They’re panicking because they’ve got diabetes. And we need to regulate their blood glucose levels at the same time. Or if it’s a cancer patient, you want to be regulating blood glucose levels.

So you go for the cooked and cooled rice, the cooked and cooled potato, and the banana flour starches. So you might not want to do lentils at that early stage. But certainly later. So just looking at that as an aspect to you know, put some fibre into the diet, or starch into the diet, but not to impact the glycemic index.

Andrew: Gotcha. There are so many tricks that we’re learning here, Teresa, and there’s so much more to learn, obviously, I mean, 30 years plus of practice, and I don’t mean that with offence. I mean this with admiration. There’s a lot that we can learn. So where can we learn from good evidence-based resources about fibre and foods, so that we can help our patients and guide them with evidence?

Teresa: Look, I love Google Scholar. I mean, obviously, I have access to all sorts of databases. But you don’t need that. You can go on to Google Scholar and simply type in something like high antioxidant foods. And you will find a review of high-antioxidant foods. And you can look at that.

You can go to Nut Tab, if you’re not quite sure about the names of some of the antioxidant foods, you can certainly do that. There are some good books out there, of course, you know, am I allowed to mention some of the books?

Andrew: Please do, and I was going to hope that at least one of them would be yours.

Teresa: Yes. Well, I’ve written chapters in it, yes. It’s actually the book by Leah Hechtman, which is a combination of many practitioners. And it’s the Advanced Clinical Naturopathy. So, yeah, that’s like a Bible. It’s a great big time. The recent edition is fully referenced. So it’s great. If you’re doing some study, there are lots of references in there that you can put into your essays, etc.

Andrew: If you talk about a tome, it is one of my most valued texts that, it sits pride to position there on the bookcase behind me. It’s even been signed by Leah. It needs your signature as well Teresa.

Teresa, I could talk with you for hours, there is so much that I can glean that I could suck from your mind. But we have so little time, I would love to get you back on the show at another stage. And maybe we can talk about another subject, would you be amenable to that?

Teresa: Lovely. Can I just mention one last thing?

Andrew: Please do.

Teresa: Never underestimate the value of using something that dampens the stress response in these diseases.

Andrew: So when we’re talking about the stress response, like what?

Teresa: We’re saying here, but more specifically, try Ganda. Because it’s just the pinnacle of that supplement.

Andrew: Wonderful news. Teresa Mitchell Paterson, thank you so much. You obviously have not just a wealth of knowledge, but it’s this care. And I know personally that it’s care because you’ve cared for a friend of mine during your professional career. So thank you for that. But I just thank you so much for what you’ve brought to us today, but also to the many hundreds of students who have passed through your lectures and gone out into practice. Thank you for your work.

Teresa: You’re very welcome. Hope to see you again soon.

Andrew: And thank you for joining us today. Remember, you can catch up on the show notes to this podcast and of course the other podcasts on the Designs for Health website. I’m Andrew Whitfield-Cook. This is Wellness by Designs.