Andrew: I wish I was there, where you are, down on the south coast of New South Wales. It’s a favorite place of mine in the world.

Dan: Yes. Yes. We’re very lucky down here in the south. It’s cold in the winter, but the sun’s been shining all week, so we can’t complain.

Andrew: Beautiful. Dan, can I start a little bit with your career? What’s your background? How did you arrive at an interest in naturopathy and herbalism?

Dan: Yeah, sure thing. I’ll give you the concise version, Andrew, otherwise we’d probably be here all day. But we’re sort of going back, I guess, about 20 years ago now, and I’ll sort of do my best to paint the picture, but it was the good old, sort of, Epstein-Barr virus, into, you know, scenario for me. So, not uncommon, as you know, in our industry. But yeah, just definitely, that path of illness to, kind of, discovery, and then eventually recovery. So, high school certificate year, year 12, lots of pressure, HSC and all the things. And I come down with a pretty heavy case of glandular fever at the time. And two weeks later, that sort of, you know, eventuated, and two weeks later, I was back doing my HSC. So, it was all quite fast, and happened very quickly. But, point being, I sort of didn’t recover well after that. And for the next two years, I was sort of doctor-shopping, if you like, and just kept getting told the same old thing, that “You just need to rest your body. You’re still getting over Epstein-Barr.”

And yeah, as I say, it got to about the two year later mark, by the time I was about 19. And I could just definitely tell that something else was not quite right. Just wasn’t thriving. Lots and lots of upper respiratory tract infections, fatigue, brain fog, you name it. But certainly wasn’t presenting in a typical way that you would to suspect that there was an underlying gut, sort of, auto-inflammatory process happening. So, I was eventually diagnosed celiac, when we changed gears a little bit and saw an integrative doctor. She ran a barrage of tests, and found those celiac antibodies quite raised. And so, from there, it was a big aha moment, and a lot of relief, and going down the path of the GI specialists and the, okay, you need to be on a gluten-free diet for life, and this is how we manage the condition. But you’ll do that, and life will return to normal, and we’ll never hear from you again, basically. Everything will go back to normal within a matter of weeks to months.

For me, that was not the case. And I guess, over the course of the next few years, kind of worked that out, and went on a bit of a journey because it was, recovering from all the damage that I had taken throughout that period of misdiagnosis, with subsequent antibiotics, just one after the other, boom, boom, boom. So, lots of antibiotic cocktails. And by that time, in my early 20s, I was quite beat-up. So, the gluten-free diet definitely helped initially, but I quickly worked out that it was kind of the end of the road with the modern medicine approach, as far as celiac recovery and management went. This is where I started learning about gut dysbiosis and the microbiome, and more sort of integrative approaches. So, that sort of evolved into a really keen interest. And I worked out, by probably the age of 23, 24, that yeah, just that I had a really keen interest in the science side of it, and learning about the autoimmune and gut connection and so forth, and eventually started studying it in my mid-20s. Took up the naturopathic degree through Endeavour, and did that over the course of the next five or six years on and off, and was still working at the time. So, started practice at the age of 30. I’m 37 now, so this is my seventh year in practice. And we moved down from Sydney, down to the South Coast when I started. So, what’s that? Yeah, seven years ago. And fast-forward to 2024, and here we are.

Andrew: Can I go back to the diagnosis? What was it that twigged in your doctor’s mind to test? Because you’ve got that age bracket, the sort of late, or mid to late teens. The high school certificate is the classic. The hormones around that era, and the stress. So, that perfect storm is when EBV just knocks people. But how many get tested, and how many don’t?

Dan: Yeah, exactly right.

Andrew: So, what was it that where your doctor said, “Listen, we need to test. We need to find out?”

Dan: I can remember going in… I was still under the care of my folks at the time, and I can remember going in to this particular integrative doctor, who I maintained a great relationship with for years after, and doing the old palpation on the gut. It was probably the first time that my mother was saying, “He’s not thriving.” There was that word. And I was like, “What does that even mean,” you know? “Daniel’s not thriving.” And it made sense. It was, like, in all aspects. It just was like I hit a sort of roadblock. And prior to that, mind you, there were no signs or symptoms to alert us to anything celiac-related. So, I didn’t have the classic picture with gut symptoms. And that’s probably why it was misdiagnosed for so long. For me, it was more fatigue, brain fog. Extreme, extreme brain fog. So, it was a very cerebral picture. Recurrent tonsilitis, which was why probably EBV kept getting blamed for the illness. And whilst that might have been partially true, the celiac was kind of there, bubbling away in the background. So, malabsorption then ensued. So, it was eventually, I had to get really, really low for it to be recognized. So, we’re talking about getting to the level of weight loss, greying of the skin, not leaving the bedroom. Yeah, very, very recluse. And so, that, I think, tipped the doctor off to the fact that there could be an absorption issue. And that was the first time those antibodies were run. And sure enough, they were sky high. Yeah.

Andrew: Gotcha. Yeah. So, what’s really interesting to me is, fatigue in a teenager, obviously, we think about iron first, but if there’s chronically low iron, then you’d go, “Ah. Absorption. Celiac.” Was there any hint of low iron throughout your earlier years, or any hint of, like, breathlessness or, you know, underperforming when you did sports day, or anything like that?

Dan: The latter, exactly. So, where I really knew something was wrong was I was trying, you know, with my limited knowledge at the time, to “get well.” So, that meant, for me, lifting weights and trying to, you know, build my body, and just build back. But when I’d do that, I would go catabolic. I would actually break down. And sometimes for weeks. And then I’d come kind of good again, so I’d do it again. And that pattern kept happening. So, once again, that’s where, you know, I eventually had to just keep pleading with the oldies, “Something is wrong, I’m telling you. And it’s not just glandular fever,” you know?

Andrew: Gotcha.

Dan: Yeah. So, like I said, I did have to get quite low for the practitioners to think outside the box. And I’ve always carried that with me, even as a naturopath now, to never… I mean, obviously, I’m biased, being a celiac, but to never disregard the importance of running that celiac serology when you’re seeing that sort of not-thriving picture, and the amount of times we’ve seen, you know, even low-level active antibodies, and you wouldn’t otherwise suspect it. Then you get your classic cases, where it’s very, very, you know, true to classic sort of hallmark celiac symptoms.

Andrew: Yeah. Can I ask you, something you just mentioned before? And you said it as if it was inconsequential, but it’s got to do with labels. You said, “I’m a celiac.” Versus, “someone who has celiac disease.” Yeah? Do you know that, you know, where the disease becomes the person, if you like? Does that bother you?

Dan: It did for a long time. It doesn’t now, I think, because it’s been so long. So, it’s been over half my life. And the awareness now is very, very, you know, different to what it was 20 years ago. So, it definitely did for a long time. And it’s interesting you bring it up, because sometimes I do say that unknowingly. And it’s something that I don’t think about anymore, but I often catch patients saying it. You know, I’ll talk to them about that, sort of, that mindset, and changing their terminology. So, yeah, it’s a quite important thing to raise to people that feel that they’ve, I guess, been dealt a bad card, or, you know, that sort of victim mindset.

Andrew: Yeah. So, I guess where I’m going there is, because you’re proficient in what you do, you have a level of comfort, it doesn’t define you. You’re quite fine with it. But for somebody who’s investigating this along their journey, they might be a little bit touchy on the subject. Is that how you felt, and what you see in your patients?

Dan: It was, yeah. Yeah, like I say, for a long time. And I think it’s more in the social settings that it becomes quite apparent. You know, at home, it doesn’t bother you. Quite often, the whole household will just be gluten-free, and it’s not something that you tend to think much about. But it’s sort of those social settings where the rubber meets the road, where, you know, you’ll be, you know, a classic one is you’re sitting at a big, you know, dining table at a restaurant, you’re doing the order, and it gets to you, and all the attention’s on you. And, you know, you say, “Can I please have the item on the menu that’s marked GF? Oh, and by the way, I’m celiac. Can you let the chef know?” You know, so that’s where you get reminded. Yeah.

Andrew: Yeah. But do you find there is a greater awareness, now that it’s, I mean, we should have had this for at least 10 years minimum. But do you find that there’s an, not awareness, acceptance, indeed care, by eating establishments, food establishments, that know now about what a celiac is? No, you can’t sneak that in. No, it can’t have a little bit. It’s gotta be zero. Of gluten.

Dan: It’s definitely improving. And I always tell people, despite that and the awareness, you gotta remember that, you know, the waiter takes your order. It then goes to the kitchen, which is, you know, a separate area. And that’s, you know, something that you need to be very confident in. So, pick your restaurants wisely. Stick to the same, you know, routine. And yeah, you’ll avoid trouble. And fortunately, for me, it’s been, oh, gosh, probably over a decade since I’ve been gluten poisoned. Touch wood.

Andrew: Gotcha. Let’s go into our topic today, because it’s quite broad. When we’re talking about seeing a patient first for any sort of gut issue, where do you start? Where does the patient journey begin with you? Do you begin with testing? Do you begin with, you know, family history, patient history? Do you start on, like, a few supplements first before your test? How does it look?

Dan: I’d say it’s probably different for each patient, Andrew, but I make a very strong point in my intake form to be very thorough, so that by the time I’m jumping on the call with them, I’ve got a very well-rounded understanding of where they’re at, their family history, their current symptoms. My intake form, you know, probably takes a good 10 to 15 minutes to fill in. So, as I say, by the time we jump on the call, I’ve usually got a whole lot of pathology, not always, but most often, as well, to go with it. So that helps me, after the initial, you know, 45 minutes of questioning to sort of work out, do we jump straight into testing, or has this person already been to three or four practitioners, and they’ve got a plethora of decent testing, but they’re just after a different opinion? In that case, we usually just jump into treatment. But generally speaking, I do like to start with testing. I feel like it’s a good investment. Five years ago, maybe I would have said something different, but with what we can see of the microbiota and the ecosystem now, I feel like that money is quite well spent. And I always say to the patient, if we don’t have the funds to test, that’s okay. It’s not a prerequisite. But, you know, if we can test, I can be very, very specific with the application of different nutraceuticals or prebiotics or probiotics, without the guesswork. So it’s that whole thing of test and don’t guess, I suppose. Mind you, you know, after seven years, and my own personal history, and just being in the health and wellness space for a while, a lot of practitioners would agree, you get a pretty good sort of understanding of what tools are very likely to be useful versus others.

Andrew: Gotcha. So, what tests…

Dan: Even without testing. Yeah.

Andrew: Yeah, yeah. So, what tests do you tend to favour? What do you employ?

Dan: If we’re looking at the… Yeah, if we’re looking at sort of understanding… Well, first, we’ve gotta understand, is the patient’s digestive symptoms in the small bowel or large bowel, or both? So in an ideal scenario, if the feasibility isn’t an issue, we’ll do testing for small intestinal bacterial overgrowth, via a series of breath tests, and followed by then the stool test, to give us a really good, well-rounded understanding of the ecosystem, where we’re not just kind of fixated on looking at pathogens, but we’re looking at the balance of the whole ecosystem. And I’m quite in the camp of, yes, we wanna understand what critters are in there that are causing dysbiosis and inflammation and so forth, but equally, if not more important, we need to look at the balance of the other guys, which, let’s face it, even 10 years ago, we couldn’t even see half of what these guys were doing, or didn’t know what roles they had. And we can talk about different species that sort of make up that commensal ecosystem as we go.

So, to answer the question, yeah, if we can do both, we’ll get an understanding of where the problems are. Sometimes, it’s very classic that it is all small bowel, and we’ll get a positive breath reading for SIBO. And you’ll usually understand that from the interview with the patient, you know, “Oh, I eat, and it’s only half an hour to 45 minutes later that I’ll get a lot of symptoms.” Versus the person that says, “A lot of my symptoms happen in the PM hours of the day, the back end of the day. I kind of wake up, I go to the bathroom, I do my business, the first half of the day’s okay. Later on in the day is when I start getting quite a lot of signs and symptoms.” Yeah. So, we can tell, by questioning, we can get a pretty good idea, but ultimately, the testing helps us elucidate the specifics.

Andrew: Gotcha. And so, we’re talking about microbial testing. What about other, sort of, inflammatory markers, for instance? Calprotectin, you know, we can go and go. But what do you tend to rely on most, or what do you find is most useful?

Dan: The testing I’m currently using, I really love the fact that we understand the species down to a really, really definitive level. So, what pathobionts and what commensals are in the gut, but we also have an array of digestive markers and inflammatory markers, like you mentioned, which is very handy.. And with that, we are also looking at fecal occult blood, human DNA presence, fecal calprotectin, secretory IgA, branched chain amino acids, ammonia, and a lot of the metabolites that the biome produces. And that’s where that information is really helpful for me with patients. So, yes, I love to know what species are present in someone’s gut. Equally important, as I said earlier, is what the metabolites are, and what’s being produced and what’s predominating. So, for example, are we seeing lots of hydrogen sulfide gas production? Are we seeing lots of ammonia production? If so, what are the species that are responsible for that, and what can we do about it? And it’s really interesting, Andrew. When you interview different patients that are on different types of diets, you can usually tell by their biome reports how they’re eating, and by what sort of species are overrepresented or underrepresented. And we can get into the specifics of that. But, you know, 2024, it’s very popular for people to be on these extreme ends of the diet spectrum. So, we can, as I say, we can see a lot from the biome, the impact of that, whether someone’s having issues with breaking down all the protein and the fat that come from a more sort of paleo-esque type of carnivore type of approach, versus someone who’s on more of a plant-based diet. Yeah.

Andrew: Do you ever use a particular food or group of foods as, like, a challenge, to see if a particular, forgive me, the type of bacteria might be sitting there quiescently? And, like you said, you know, the patient tends to get symptoms later in the day. You might be seeing them in the morning. But do you ever say, “Listen, why don’t we challenge with this sort of food that you ordinarily have at lunchtime, for instance, that you don’t have at breakfast?” to see if you can elicit a response with your testing when you do the test? Or actually, no, that doesn’t make sense, does it? Because the test is done by the patient at home.

Dan: It’s interesting. It’s a great question. What I often do, Andrew, is I say to them, I paint a bit of a hypothetical scenario, and I say, “All right. I want you to envision yourself eating a bowl of chickpeas for lunch today.” And you can usually tell by the expression on their face. The folks that might have, you know, the presence of SIBO, they usually say, “Oh, no.” Straight away, they start shaking their head, “No, that’s gonna be disastrous.” “Oh, no. Very, very soon if I tried to do that, the last time I happened to do that at X, Y, and Z was quite disastrous.” On the flip side to that, when we’re done a lot of, you know, a lot of treatment, and we’ve put them through various protocols to balance out the ecosystem, one of the foods that I do use as a bit of a proxy are black beans. And I explain to them, these are, you know, probably the most gentle out of the legume kingdom, great prebiotic content. And I say, “Start with a small handful. Cook them really, really well. Soak them if you can. And see how you react. Give yourself a few days between, and then try again.” And we just try and build up the tolerance. I’ve had patients come in that, you know, they’ve been through all sorts of antibiotic cocktails, and told they’ve had parasites and just, it’s just kill, kill, kill for years and years, to the point to where they’re on literally four or five foods. And bringing those patients back can be quite challenging. But those usually are the patients where it’s just a mess with those metabolites. So, we’re seeing elevated levels of branched chain amino acids, hydrogen sulfide, ammonia, histamine. And, you know, a lot of the critters that sort of secrete these metabolites are quite abundant, and it’s a slow and steady process with those guys to get them back to normal.

Andrew: Gotcha. Can we go through some of these testing, these metabolites in greater detail? Ammonia, for instance? Calprotectin? But there’s others as well.

Dan: Yeah, definitely. Yep. So, secretory IgA, I always explain to folks, is an interesting marker. That’s made in the mucin. It’s kind of like the police task force. And we’re looking at levels between sort of 500 to 2000 micrograms per gram as being sort of the normal range. If we see it quite low and underneath, and underrepresented, it’s kind of that immune depletion picture. And you do see that. It’s probably rarer that you see that. Quite often, what I’m seeing more commonly is the elevated presence of secretory IgA. And when we see that, we’re usually, you know, correlating that with a dysbiotic picture, or an auto-inflammatory picture. So, the task force are just on high alert, essentially. That’s how I explain it to people.

In line with that, fecal calprotectin’s a great marker. That’s the one that mainstream GI specialists will often use to look at IBD patients, and, you know, measure different interventions, and pharmaceuticals and whatnot, to see if it’s active or in remission. But as naturopaths, again, that’s kind of a great marker that we can utilize to look at whether people are kind of in the clear for very full-on inflammation, or they’re in that borderline kind of area, which is, I think, around 50 to 100. So, when there’s that borderline result, you know, sometimes it is useful to send them off to a GI specialist for an opinion. Certainly when it’s over 100, we’re doing that regardless of what we’re doing as naturopaths, to explore the underlying cause there. Typically, that’s usually down to a sort of auto-inflammatory IBD kind of case, where there is very overt inflammation. But even then, you know, as naturopaths, I like to think that there’s a lot of nutraceutical tools that we can use to intervene, or add as, you know, adjunctive therapies there, to help drive that down. And I’ve seen that quite commonly, even with just good old curcumin, at the right dose.

Andrew: And, Dan, what about ammonia, for instance?

Dan: Yeah. Ammonia is an interesting one. It’s an emerging metabolite. And I always sort of make a point when I get a patient through that is on a more, I mean, yeah, athletic diet, carnivorous diet, paleo sort of diet, however you want to refer to it, but a diet essentially where there’s not much of that fermentable carbohydrates coming in, and it is quite protein and fat-heavy, which can be great short-term for metabolic reasons, but long-term, for the microbiome, can start to tip the balance. And this is where branched chain amino acids, ammonia, and hydrogen sulfide, and histamine, come to think of it, the four of those, can be quite elevated. And it’s an interesting one because the patient doesn’t necessarily have a whole heap of gut symptoms always in that case. And it can be quite different. And what I mean by that is, for some people, high ammonia can just mean brain fog. For another person, it can be chronic fatigue. For another person, it can be achy joints. And so, that sort of highlights the importance about looking at these metabolites, and understanding that the microbiota isn’t just simply the composition of what species make it. It’s how your diet is interacting with those species, and then what compounds they’re producing.

And I always explain to patients, those compounds that they’re producing can either be anti-inflammatory, and driving your health, or pro-inflammatory, and degrading your health. And of course, there’s always going to be a balance. It’s an ecosystem after all, with hundreds and hundreds of species. But looking at that data is quite valuable. I’ve said it already on the podcast today, but even five years ago, we weren’t able to see much of that in terms of the metabolites produced. And therefore it was more just focusing on what species were present, and whether we had enough “good guys” and “bad guys,” and a balance. But I do use that data when I follow up and do another repeat test, which I usually recommend either 6 to 12 months later if the budget’s there. And it’s really interesting to see what interventions work to balance that out.

Andrew: Great. Anything else that we need to be aware of with regards to the metabolites? Because these are really, these are interesting to me. Really interesting.

Dan: The other one is hexa-LPS, so lipopolysaccharide. And it’s the Citrobacters and the E. colis, and Klebsiellas and these types of pathobionts that, when they get too high, make this thing called endotoxin, or lipopolysaccharide. And it’s not something where the bugs are trying to harm us. It’s just how our immune system surveys them, and in response to them, if they’re too high, will produce more inflammatory compounds as a result. But elevations of these pathobionts is typically what we see drive the sort of Western dysbiotic gut. And then from there, you can then argue, you know, we’re seeing offshoots to various disease risk conditions, such as obesity, type 2 diabetes, Parkinson’s, you know, and a plethora of other conditions that wouldn’t ever been linked to the gut microbiome 10, 15 years ago, even. So it’s quite exciting to see that sort of space evolve.

Andrew: Can I ask you, with people who are neurodivergent, for instance, they tend to have an overabundance of the clostridiaceae. Are there any things that we need to be aware of, apart from identifying that overabundance? For instance, metabolites, particular metabolites they may throw out. Is there anything that we need to be aware of with regards to, A, these people who have these conditions, and their gut scenario, if you like, but also how we intercede with them? That’s a bit of a broadsword, that question, isn’t it? What can we see if we did testing on neurodivergent people? Do we… Is it plain as day, or is it nuanced?

Dan: When you ask that, I think straightaway back to a case I saw about a year ago, which was an autism case, and I don’t treat that presentation, you know, clinically often. It has, you know, obviously cropped up over the years a couple of times, but it’s certainly not my area of specialty, but I do recall when we did shotgun metagenomics testing on this particular case. I think it was the Prevotella species or the E. coli was making, on its own, I think, almost half of the microbiome. So, the abundance of that species, or that genus, was that represented, which was the highest I’ve ever seen. I’ve not, I’m not aware of, you know, whether that’s a classic finding for that sort of, you know, neuroarchetype, but I just remember thinking that that is very significant, and it’s quite likely that that is adding, you know, a large degree of, you know, what would you call it, influence, on how that sort of condition plays out.

Andrew: Gotcha. Any other metabolites that we need to be aware of?

Dan: The only other one I think about is mucin degradation.

Andrew: Oh, of course.

Dan: And that’s, again, a newer sort of kid on the block, but the gut, obviously, as we know, makes mucus, it sows and reaps mucus, and there needs to be a good turnover and balance of that, for protective reasons. But when there is a lack of that fermentable fibre, the critters in the biome will go to that as a fuel source and thin the gut wall, and then, therefore, make the walls of the gut in the large intestine more thin and leaky, you know. And as we know, leaky gut is kind of, and permeability is a precursor to a lot of these, you know, Western, you know, type of conditions that we’re seeing, you know, massive amounts of. So, I think that does come back to the conversation about fibre, but then, it’s, from there, it’s like, fibre isn’t just the one thing. It comes in all different shapes and sizes, as one of my mentors, Jason Hawrelak, likes to quote all the time. And it’s so true. I use that often in consults even today, get people thinking about, you know, away from thinking that fibre is just this thing that comes in cereal, which we all grew up in the ’80s and ’90s thinking of, you know, the Kellogg’s fibre, and that it, you know, thinking about polyphenols and, you know, blacks and purples and blues, and the colors of the different skins on various fruit and veg, as microbiome feeders. So, you know, that’s getting back to the 40 plants a week, 50 plants a week type of conversation. And I always make a point to say, you know, I’m so not a practitioner who is more plant-geared. I believe in the power of animal protein as well, but there just needs to be a good balance of both at the end of the day.

Andrew: So, that was gonna be my next question. It’s sort of, you know, we always talk about, when we’re talking about good bacteria, feeding good bacteria, it is always and only plant food. But there is a balance. We are omnivores. Sorry, vegans. I’m gonna get lambasted, I know. But if we’re talking that, then surely, a balance, there’s obviously that critical balance, but surely bacteria that are fed by meat proteins and fats are not in and of themselves bad. It’s just this abundance. Correct?

Dan: Exactly right. Exactly right. And, I mean, the reality is that in non-civilized, non-Western nations, hunter-gatherer societies, when they looked at the biomes of these people, who, by the way, when they make a kill, are going to gorge on animal protein, and preference it. Yes. That said, they’re not gonna make kills every day, and have meat for breakfast, lunch and dinner. So, that comes back to the conversation about, well, there’s these fallback foods, which are the plant foods and the tubers and the berries and the nuts and seeds, and that sort of thing. So, if we try and reflect that, which, I look at everything through an evolutionary lens when it comes to health, that makes sense that the diet, ideally, is somewhere between, you know, perhaps 60% to 70% plant fibres, versus that 30% of animal proteins.

Andrew: Yeah. Yeah. I often describe to people who are wanting to investigate the paleo diet, and they think it’s all protein. And I say, “Hang on. Cavemen didn’t eat mammoths along the way to killing the mammoth. The mammoth was the prize at the end of it.” But along the way, they had to eat tubers and berries and nuts, and things like that, that sustained them.

Dan: Sometimes for days on end.

Andrew: Loren Cordain, in fact, when he presented at a symposium… Who was it? Pete Evans. Pete Evans begged to provide, to do the menu for that symposium. And when you go out there to lunch, it was largely plant food, absolutely spectacular plant food, with some, you know, obviously generous amounts of meat. But I wonder if part of the issue these days is not so much what we’re eating, but how much.

Dan: How much we’re eating, how changed it is from its natural state when it’s harvested, how it’s stored, where it’s travelled from, what’s added to it. Yeah, all of those things, for sure.

Andrew: Great.

Dan: And the abundance, yeah. The intake.

Andrew: Yeah. Yep. Which is my, obviously my demise. But anyway. Dan, can we go into a little bit more depth about what you use with most merit? You’ve spoken about curcumin previously. If we’re talking about a gut inflammation, you know, you’ve got classic things like fish oil, for instance. But even things like food, like, I’ve been keenly interested in these, for years. And forgive me for rabbiting on about them, but they’re called PDENS now. So, plant-derived exosome, exosomal-like nanoparticles. Right, PDENS. And the original one that I investigated was ginger. So, back then, it was ginger exosome-like nanoparticles or GELNS. What’s happened, what, basically, the message is that the ginger plant, when we eat it, they butt off this little vesicles, packages, that contains RNA. That RNA talks to the bacteria, the genes in the bacteria. The genes in the bacteria then talk to the genes of the human, to say, “Settle the hell down.” It was really interesting, although it was a mouse study. They’re now investigating these plant-derived exosome-like nanoparticles, PDENS, for drug delivery. And what they’ve found was that they dampened inflammation. They made an anti-inflammatory medication safer and more efficacious. I’m keenly interested in this. So, you mentioned before about Jason Hawrelak talking to you that fibre isn’t just the cereal fibre, that it’s in a heck of a lot of other foods. Do you find that you select certain foods to elicit certain responses at all? Like, you mentioned endotoxins? You know, LPS?

Dan: Yeah. Yeah. So, look, I’m one of those practitioners where I like to use a combination of, obviously, diet and the medicines. But I always try and place more emphasis on what they can do in the diet, because everyone, not everyone I should say, but most people are very much geared towards the, what’s the latest and greatest? You know, what’s the silver bullet? But I always say to people, when it comes to microbiome resolution or balance, there’s so much that you can achieve with just dietary changes. And it’s actually the doing part where people fall down. So, the education can be there till the cows come home. You know, I’ve got all these charts of here’s your black foods, here’s your red foods, here’s your purple foods. When you’re doing your shopping, just simply try and add more, you know, and just work your way up slowly.

But being conscious of that on a day-to-day basis, and then being consistent with that, is the challenging part. But for the folks that do it, we can see massive changes in diversity, for example, in the gut microbiota. But to answer your question specifically, one of my favourites, and again, I have to thank Jason Hawrelak, the Big Mac Hawrelak, as I like to call him, for this one. But it’s the pomegranate peel. So, the peels of the pomegranate. And there was even a time where I actually, you know, broke them down, and got a big delivery of these beautiful biodynamic pomegranates, saved all the peels, cut them up, you know, put them in the blender, dehydrated them. And I went through two huge tubs. It took me about two years to get through them, mind you. But not everyone has to go to that length, but you can purchase that online, you know, quite easily. So, that’s one example.

The black beans, which we already mentioned. And I think it comes down as well to saying, “Hey, you know that sweet potato you eat, yeah? Try and get the purple version.” “Hey, you know that rice that you have three or four times a week? Try and get the black and red version as well.” And you just get them thinking like that, just to diversify the color palette coming in. And the effects are quite good. Another one is the EGCG from green tea. Such a basic thing that, you know, just getting people sold on, if you just have a very strong cup or two, daily, of green tea, that goes a long way, not even just with the biome, but outside of the biome. So, those are my favorites from the sort of culinary dietary perspective. In terms of the nutraceuticals, I’m very jazzed and excited about the non-dairy serum-derived immunoglobulins.

Andrew: Oh, yeah.

Dan: The people that come through that are dairy sensitive. Their faces light up when you talk to them about a dairy-free colostrum alternative. And it works wonders. I’ve seen great results before and after with leaky gut testing, using the lactulose mannitol test. And just in those patients like we’re talking about earlier, like myself a long time ago, that are just not thriving, that just have a really beat-up gut, and you’re pretty sold on, you know, the gut permeability as a core factor there, such a great, you know, gentle additional tool. In addition to that, again, something I’m playing around with more and more these days is the human milk oligosaccharides, 2′-FL, or 2′-Fucosyllactose, which is naturally-occurring in mother’s milk. Using more and more of that. In the prebiotic kingdom, which I do more and more of, once again.. And I’m, it’s not that I don’t use probiotics still, but I kind of have a limited range of single-strain probiotics that I kind of stick to. I could probably count them on one hand, but outside of that, it’s more about the prebiotics.

Inulin is one of the favourites for the folks that can tolerate it. And coming back to those markers we were talking about earlier, Andrew, great for, you know, attenuating that calprotectin, even when that’s borderline, or raised. Does a great job. Secretory IgA, when that’s elevated, there’s good research with galacto-oligosaccharides, or GOS. Partially hydrolyzed guar gum is another favourite. And that’s the one that I usually go in with prior to knowing what the biome looks like. Irrespective of that, we say, you know, get your sample sent off, and regardless of what comes in, let’s just get you started on this guar gum stuff, and we’ll just start you off nice and slow and gentle.

Andrew: Can I ask about tolerability? So patient compliance, I guess, we’re talking about here. But when we’re talking about some of these fibres, like, for instance, banana fibre… There’s a sugar cane fiber. Really hard to mix. They’re hydroscopic. They float on top, and as soon as you put the spoon in, they go poof. So, with regards to patient compliance, do you ever talk to them about, listen, you know, this is how you take this sort of fibre, why they’re mixing it in with food? Or, indeed, well, mixing it in with a food on their plate, or mixing it in with a, like, a condiment, like, for instance, apple sauce, or something like that?

Dan: Yeah.

Andrew: Do you ever employ these tactics?

Dan: Yeah, I do. Absolutely. The first one that comes to mind, and I happen to have it right here in front of me, for those folks watching, is the inulin. And the sell that I say is it tastes like fairy floss, and it actually does. And that’s what I say to the mums and the dads, for the kids that I see. You know, you can literally get them to spoon it straight into their mouth, and it doesn’t necessarily require that water, although it can go in water. But the compliance has been great with that. And you can just get it straight into the mouth, and it’s got that really nice, naturally-occurring sweetness. So, inulin is great for that. With the guar gum, I usually say that’s quite seamless, so it’ll go into everything. To your point, the resistant starch, that’s a harder one, a trickier one. So, smoothies are great, you know. If we can get the patients doing three or four smoothies a week, and get a generous dose of the RS in there, which is a prebiotic that you can go quite high with, or you get quite better outcomes, I find, when you go, like, more around the sort of 10 to 15 gram mark, even for some folks.

And with some of those patients, it’s important to note, too, that sometimes with prebiotics, the needle doesn’t move until you get up to those sort of levels. And that’s something that, over time, I’ve had to get really comfortable with, and sort of go out on a bit of a limb. So, three or four years ago, it might have been, let’s just start you on, you know, five grams, or a teaspoon, and just kind of leave you there for weeks to months, and see what changes. As patients come back and say that they’re tolerating it, though, I’m each time now getting them to up it, and push the envelope to that level, to just below where there might be a bit of discomfort. And for some patients, it’s almost like they just turn a corner at that 10-gram mark, with inulin or partially hydrolyzed guar gum. It’s quite interesting.

Andrew: Right. I know this is gonna be a multi-pronged question, forgive me, but with regards to other things that you might employ, if we’re talking about healing an inflamed gut, you’ve got things like zinc, obviously. You’ve got the zinc carnosine, for instance, which has its own action with healing lesions, let’s say. We’ve got to think about even, you know, liver herbs, for instance, helping with digestion, with bile flow. And then the second… Sorry about this double-prong thing, is, if we think about the effect of stress on the gut, and we think about how it can be deleterious to healing the gut, how much do you employ, let’s say, anti-stress herbs, or the, you know, the nervines, the adaptogens, in helping somebody to cope with the stressors of life while they’re healing their gut?

Dan: I’m glad you asked.

Andrew: Oh, okay. Great.

Dan: It’s huge [crosstalk 00:42:33]

Andrew: I think you’re gonna hate me.

Dan: Not at all. Not at all. Because it’s one of those things that, it’s very easy to overlook. You know, mindfulness, nervous system balance, parasympathetic versus sympathetic. You know, the role of the vagus nerve between the brain and the gut, which, you know, over the years, I always think of your conversations with Mark Donohoe, that you guys have, you know, talked about that ad nauseam. And it’s so true, you know, that the power of the vagus nerve, and what the nervous system can influence in these cases. That was very, very, like, specific to my healing too, Andrew. So, you know, there were periods when I think back to my journey where I’d come good, and then I’d, you know, get poorly again, and then come good. And if I had have known about the nervous system back then, I think I could have done a lot more. Very easy to say now in hindsight. But, yeah, just the power of, you know, various healing modalities, even just, you know, walking in nature 20 minutes a day, something so simple. The breathwork. And I’m sure we’re preaching to the choir when we go on about this, but I concur 100%, you know, the amount that we can achieve just by, you know, the mindfulness, and these sorts of, you know, parasympathetic practices, equally important as just the medicines that we’re recommending too.

Andrew: Sure. You mentioned retesting earlier. Can you just give us a little thing about the benefits of managing somebody’s symptomatology, tracking their progress of therapy, versus the cost of therapy? How do you sit?

Dan: Yeah. So, it’s something that I don’t entertain… Like, if someone says, “Oh, Dan, I wanna jump back in there and have a look at what we’re doing, and see if it’s changed,” I say, “Listen, we can do that. It’s probably not worth doing that in terms of the invest, the financial outlay, until about the six-month mark, you know, realistically.” And that might differ from patient to patient, slightly. But how I sort of approach that conversation, I suppose, as I say, although it is quite a big investment, doing that retesting at the six-month mark or the nine-month mark, that might allow us to cut down your supplement intake by half. So, then it’s like, you work out what you’re paying in supplements, you know, where they’re the six or seven things that we started with, we might only need two of them, you know. But ultimately, using your presentation, along with the results, will ultimately guide us there. And I will usually preface that when we do the first round of testing, via planning that seed, and say, “Now, this is good data. We’ve got a benchmark now. Let’s earmark it for six months that we do another test.”

Andrew: Dan, I have to ask, where can we learn more? Do you have any e-courses or anything like that that you provide to practitioners, or even patients at all, to learn from?

Dan: It’s funny you ask. I’m actually in the process of putting slowly together an online autoimmune masterclass.

Andrew: Okay. Great.

Dan: And that’s something that’s been on the mind for years. So, it’s taken me a while to get into action. But yeah, I plan, later this year, early next year, to put that out. So, my main sort of online presence is through Instagram. That’s where you can find me and reach out. And yeah, practising still Monday to Friday. I do my four patients a day, with gaps in between, and just keep it at that. And that’s how we tend to manage it. But, yeah. So, look out for that to come out online, and also the website, thefunctionalnaturopath.com.

Andrew: Love it. Dan, we could learn so much more from you. Thank you so much for taking us through gut inflammation markers and management today. I really appreciate it.

Dan: My pleasure. Good to chat to you, Andrew.

Andrew: And thank you, everyone, for joining us today. Remember, you can catch up on the show notes for this podcast, and they will be lots, plus all the other podcasts, on the Designs for Health website. I’m Andrew Whitfield-Cook. This is “Wellness by Designs.”