 Hello everybody, it's Dr. Jill with Dr. Jill Live today. So excited to have a new guest today and a new friend. We haven't known each other that long, but I have great respect for what she's doing and so parallel to all of us in functional medicine with the gut. I hope you're real excited today because I know a ton of you struggle with gut issues. And today we're going to dive into some of the reasons why maybe if you've been diagnosed with IBS or SIBO that you haven't been able to overcome it and I know Bri will enlighten us with some of her expertise and I'm excited about our conversation. A little background if you haven't seen our other episodes we're all we're out into the 90s now and you can find them all on YouTube on my channel which is just under my name. If you need any resources I also have 10 plus years of weekly articles that are all available for free at JillCarnahan.com and products and services you can find at Dr. JillHealth.com. So I want to introduce my guest today. Super excited to have Bri Wiselman here. She's a licensed acupuncturist and medical director of Bri Wiselman Integrated Health. And it sounds like you have other practitioners which I'd love to ask you about when we get into like how your clinic has run. Over the past 14 years she and her team have empowered women with men and women with transformation of health. And she has been an expert in hormone balance and fertility which again I'd love to maybe delve into that just a little because it can have relation to the gut right. And she especially specializes with healing digestive problems such as IBS, ulcerative colitis, parasitic infections, candida and SIBO. And I love what she talks about in her bio getting rebuilding a bulletproof microbiome and that's where we're going to go today because again, a lot of the stuff on SIBO is great but often right breathe there's so many other things that can go wrong and if you just look at SIBO, there's deeper reasons and we'll dive into all that today. Prior to starting your clinic or founding your clinic she spent several years specializing in treatment of fertility and sub fertility at several IVF centers and in San Francisco Bay Area. And local clinic specializes in integrative treatment of hepatitis C. So that's awesome some of those chronic to viral things. She speaks and teaches all over she's a guest on frequent podcast she's done much education similar to me she did some work through the Kailish Institute in the Institute of Functional Medicine. And I am just absolutely delighted to have you here Brie thanks for joining me. Thanks for having me I'm thrilled to be here with you. So I always love to start on story as far as kind of how you got into functional integrated medicine your journey. Tell us just a little bit about how that looks and like even from. Yeah, did you always want to go into some healing profession or how did that look for you your journey. You know, I mean I think like many of us I had my own health challenges and then wound up finding myself seeking answers and putting together the pieces of the storyline so I think I always knew I wanted to be some kind of helping profession, but I don't think I landed on medicine until a bit later and the medicine piece actually happened. I mean partially influenced by my backstory I had severe asthma as a kid. I had some eating disorders as a teen I that translated later into kind of like my version of veganism which wasn't candidly very nutritionally complete there's a lot of great ways to do that if you want to but I wasn't doing it. You know I really just didn't have the education, and so I recognize that when I wound up with I diagnosed myself as having polycystical variant syndrome at the time that I was figuring that out it wasn't widely known about unless you had a textbook case. And so I figured out like, okay, why do I have all these irregular periods and act me that I didn't have as a teen but now I have as a young adult, a bunch of things like that and also this, you know, predisposition frankly when I was out of balance to run anxious or have panic attacks. So those were some of the things I dealt with insomnia to pretty bad insomnia that really drove me to seek answers because I was kind of falling apart. I was in my early 20s in med school, along with the best of us. And I would say that the medicine piece kind of ironically happened because in my teens, I grew really enamored of plant based psychedelics. I loved exploring with them. And, you know, their herbs their plants and so I recognize that there was this magic synthesis between plants and humans. And so my first venture into studying, you know, therapeutic medicine was studying western and European herbalism in Santa Cruz and so I started learning about plants and you know how they're available to everyone and then that segueed into, you know, that just kept me going. Yeah, I love that I love there's so many parallels I was a vegetarian vegan from 14 until 25 and I always say it almost killed me. And it's not it's not that I'm opposed to vegetarianism by any means I have a lot of patients support them and I'm actually primary plant based still. So, but, but the difference was like you I was not healthy in the way I looked at you know and I had it was carbitering basically. And process so a substitute. Yeah, right, right. So like now I look back like oh my gosh and I had cancer 25 and I look at that diet and I think part of that was leading and I didn't know I'd see liac so I was eating a lot of gluten so again we can we don't need to talk about my story because people have heard it but it's so and that our choices really do affect our mood in our way dinner and even like feeling bloated or overweight I wasn't really ever overweight but I didn't feel well in my own body because I was eating the wrong foods right and my gut was horribly dysbiotic. So it's interesting to have those experiences as our, you know ourselves and and really understand it on a different level and sounds like you have that journey to. Oh yeah, yeah no I mean what you just said could have been going to come out of my mouth. And then like what you're saying is your main of the main big big thing for you was immune dysfunction right and so for me it was hormones. And, but the thing is that ultimately what we all come to is it ties back to that health. Right. Absolutely. Yeah so let's dive in because Sebo is kind of our topic but I think what you and I both want to do is say well what else is potentially going on with Sebo and then how do we really get because you mentioned even in our emails back and forth and I know patients can attest to this it often you're diagnosed and then six months later you're diagnosed again it's recurrent and people go in this cycle and they're like do I can I ever get rid of Sebo. So first of all let's talk a little bit about what is Sebo and what is the connection to IBS because often this label of IBS is really kind of a wastebasket term it describes the symptoms that it doesn't tell the why as far as why you're having the symptoms. So do you want to start with literally right so small intestinal bacterial overgrowth and we shorten that to Sebo and many people have heard a lot about this but essentially it's just the idea that we should have a large amount of bacteria in our colon or large intestine, but our small intestine should be not sterile but relatively so and so if everything's working appropriately we have the right motility we have the right digestive power and secretions. And so on and so forth and what happens is we kind of maintain that situation that there's a whole bunch of things that can break or go off that wind up allowing colonization of bacteria where they shouldn't be you know bacteria gone wild. And so that's basically Sebo and what that leads to is a lot of the symptoms now known as IBS and we know that most cases of IBS have at least a Sebo component from the research and that you know basically if you have bacteria living where they shouldn't be, they are going to ferment anything they can get their hands on that you didn't manage to digest completely. And then that will create gas and bloating and a lot of times pain from the distention inflammation leaky gut and so on and so forth and all of the symptoms that can go along with IBS constipation diarrhea, and so on. Yeah, the tricky thing is is that oh, go ahead. Okay, keep going. Well the tricky thing is just that. You know now we know that basically Sebo equals IBS but the thing is that there's all these other digestive pathogens or dysbiotic arrangements that can basically yield the same symptoms. And so when I was in Chinese medicine school there was like a proverb and I'm probably butchering it, because I don't, you know speak Mandarin but basically it was something like you're entitled to have more than one problem at the same time. And that is so I just want to pause there because Western medicine is the opposite. It's like everything should be this unifying one size fits all diagnosis and a lot of times that causes docs to really not look outside that well it can't be anything else because it's this, or if they if they don't have an answer or ICD-9 or 10 code for that they say well it's all in your head right these things that they're not true and I get so frustrated and patients get so discouraged because I love that you share that. And I mean no discredit at all to any of our medical professionals but it's so true and it's really a symptom I see as this victim to the system, right, like if that's how our patients think even as patients that's how we're conditioned to think from the time we're kids, you know we're going to look for the one answer and so even people who are well versed in functional medicine I'm sure you hear this all the time but you come in you're working with someone and they're like, Okay, so is when you finally find a new piece of information. Yeah, this the thing that's going to be better and of course like my heart breaks. Oh, of course you wanted to say yes that's simple but like those of us who got into the functional medicine field and surrounding fields are medical truth seekers because we tend to not be afraid of the mystery and the unknown and admitting that for every one thing we learn there's like 10 things we have questions about, and we understand that there's going to be multiple overlying causes, you know. Oh, this is so good because if you're out there suffering and wondering like why am I going to go into that so hang tight, but the other thing that's so important here is. There is no one size fits all and often it's very very complex and there's layers and I'm like you I'm sitting for the patient listening like okay well after this in my mind and what do this first and then this and then this. We're not going to talk a lot about today because we could spend a whole other hour but mold and Lyme disease and so these really complex, which is now the, you know, a huge force in my practice. There is so many layers and I always say you know six to 18 months is minimum for start so if this is a long haul. I love that you're talking about the complexity well speaking of complexity CBO okay so granted. We've kind of described this bacterial over good you did a fantastic job of kind of describing what it is. And I think, according to some of the experts research is about 80% of IBS at the high end is actually CBO. But what else can mimic CBO or go alongside do you want to go into some of the other things that you see as far as treatment and that we need to think about that could also be there. It could be to them either can you know consistent recurrence of symptoms. Yeah, absolutely so I mean this is basically how you were just saying I stack my, my list of like okay we have to do this and then this and then this and this sequential order. There's also an order to the diagnostics so it's a really common that you know someone comes to see me and they've I'm not their first time at the rodeo right they've seen a 235 really great practitioners but they've maybe even done treatments for CBO they know they have CBO. They don't tell me all about it, but a lot of times they'll like first stop is they never tested stool panels, like just be thick and sometimes they have but maybe they haven't, they only run one or they haven't run one that really was optimized to look for pathogens versus general bacteria diaspora. So, I always have people run to stool panels side by side that's just kind of a hallmark of how I practice after years of seeing even the best panels like the state of the art panels in the field miss something and another one catches it. And there can be a lot of discussion about that like over diagnosis and stuff but basically if we have. So, for example, you can have there's tons of parasites that mimic or trigger and inflammatory bowel disorder or IBS so Giardia, Lamia and to me the histolitica cyclospora cryptospridium even blastocystis hominus which is a proto that can be commensal like in some people. And again this is one of those, I think about my Chinese medicine training, it's the pathogen and there's the train, right so it's like, how well do we tolerate the things that we have is as important as the name of the bad guy. So blasto that's why it's confusing you can have blasto show up and not be sick from it. And you can also have you know what blastocystis is found in 67% of patients with IBS and can in and of itself create symptoms. So the other organisms I look for a cryptospridium defragilists. So a lot of those so definitely your your protozoa and pathogenic parasites are biggies. And if somebody shows up as having those on stool testing I absolutely will clear them. And there's an order to operations of how I approach these things so I tend to work from the top down and also from the relatively macro to the relatively micro meaning. It's something that tends to reside predominantly in the upper GI like each Pylori. Each Pylori is a bacteria that again falls into that category of could be commensal could be problematic, depending on the criteria and in who and when. And so if we have a huge over colonization of each Pylori in the usually it's found in the stomach and the proximal part of the small intestine. And we radically impede our ability to have optimal hydrochloric acid levels. And so because and I want to talk about that later. Yeah, that is such a key criteria for reestablishing gut health and for having you know anti pathogenic activity mechanisms. I'll treat that first, and then go into the larger protozone parasites, and then clear things that fall into the realm of this biotic bacteria like SIBO, or just dysbiosis. And usually things like fungal overgrowth which I didn't mention that to fungal dysbiosis I'll kind of usually handle that last, although there are a couple caveats, for example. I was a SIBO of the methane dominant type. Around five years ago I started switching it up and treating the fungi first. If there was also a CFO or fungal Candida dysbiosis. And I found that that worked better clinically later on down the line I heard ideas around why that was having to do with fungi being able to create a low oxygen environment. And so I don't know if that's true or not I just know that this is that typically when I treat them in that order it works better. So those are some of them I would say you know fungal, the fungal microbiome, again is a huge consideration because, you know, gosh, testing for for fungi and Candida is like, it's kind of the wild west it's tough and the reason is that, you know, they're hard to find they are smart. They'll the gold standard obviously is, you know, aspirate, which is invasive, you know, going in getting a sample of the fluid and looking if they're there but that's not practical in clinic so we don't none of us do that outside of studies. Still testing, obviously you can look for markers of Candida and other dysbiotic fungi there, but it can be hard to catch and that's sometimes by virtual location right so what you're seeing on a still panel is often mostly reflective of what's in the colon. But the thing about Candida, in particular is that it can really colonize anywhere along the GI track. Yeah, you're not always seeing the same rate of shed. It also, you know, is sneaky and transitions between fungi and yeast form so just like other micro molds it can go intracellular and can hide you know or not shed, not shed and then shed and so there's various ways that you can detect that organic acid antibodies to the to Candida and still testing being some of the main ones. What I find is that a lot of times the most common symptoms of fungal overgrowth especially small intestine kind are exactly the same as CBO right belching loading indigestion nausea diarrhea gas constipation. And there are actually studies in 2015 done that 25% of patients with unexplained GI symptoms did have CFO or small and small fungal overgrowth. You know, then I'll see that a clue for me is if it worsened after someone was treated with refaction in the omicin right and kind of fuel on the fungal fire so those are some of the biggies and I think you know just the overarching take home is not to settle on one pathogen problem there and to make sure that we're complete in our investigation like what else might be contributing and a lot of those organisms like to party together. I basically like you'll see, you know, the three best friends that anyone could have like, you know, Giardia blasto or Giardia blasto and Candida and I'll throw each by Lori in there but those guys really are mutually supportive and commensal, you'll often see C diff and as co infection so there's you can go on and on there's all kinds of partnerships there. But when I see one I'll often suspect and look a little bit deeper to make sure that we're getting all those especially when someone doesn't respond to treatment meaning they keep getting ongoing infections. I love that overview so many pearls of wisdom there first of all the fact that you do to still test, I often do but since I'll do one and then a few minutes later do another but I love the idea of actually doing them. And most people probably that see you and definitely that see me as well are have been other places and they're kind of like we've won an answer so I love that pearl. And because we have no sponsorship or association, can I ask what tests you like to you. Yeah, yeah, and I will say it's changed over the years. It's like 2000 something, you know, early ups and so. Yeah, so right now what I do is I run the GI map, and then there's a panel called para wellness. Yeah, that's actually old school technology. Yeah, it's like, and he triple stains it there's very thorough and it's awesome so between those two. And what I'd say is those are the panels I run when I'm looking for pathogens. There's a whole bunch of awesome panels when you're looking to optimize microbiome like biome effects. Those are similar. Yeah, love those. Okay I love that very parallel completely. Yeah, and I love that you mentioned exactly what I was thinking with Candida organic acid serum antibodies stool, and even then sometimes you'll miss it so. And I will tell you like the old GI effects which I still occasionally use or some of those I give it's not PCR for the Candida it'll just give a level, if it's one plus if it's there at all. It's there. So just because it's one play you know so I love this because I think we think in practice. One last one to throw in there I don't often run it anymore but the doctors data, they actually culture it out which, you know, oxygen rich environment all that but once in a while you'll find it there when you can't, you know, so you and I know this but what works for those of you listening each each stool test has different technology so us as practitioners really have to know, are we looking for PCR DNA are we looking for culture because some of those one might detect it and the other might not. And that's what's tricky and I love that you mentioned pair wellness because of parasites no matter what tests you use are the most difficult to detect so if you've been suffering from gut issues forever. And you either haven't had a good stool test or whatever that would be the thing that's probably missing because it's very hard to detect, would you agree. I would absolutely agree. Yeah. Yeah. And I've even gone to sometimes where I'm highly suspicious I have a history or whatever analogous prophylaxis will be a treat I have a couple protocols. Yeah. So a couple of the questions, each pillow rates like blasto I think both of those can be commensals. So, what would be a decision making thing that you would do for blasto or each pillow and whether or not to treat like would you most of time treat if they have symptoms or is there any kind of criteria you decide which ones to treat and which not to treat. Yeah, great question. So blasto, I mean, it's kind of simple point and she would it's like if you're by the time someone's coming to me there usually is a medic. Yeah. So then I usually would treat it. I'm going to say, you know, someone's coming to me like there's some thing that's strictly in the realm of women's health and hormones and I have blasto, and they really have no GI complaints and there's other stuff going on. I might not, you know, why disrupt the microbiome, even in a relatively safe way. Now with each pillory I have kind of like this. Yeah, hierarchy of how I think about it. So one is it overgrown, like actually overgrown. Yeah. And then two are their virulence factors. If there's a virulence factor I'm at least going to treat to try and clear the virulence factor at the bare minimum. And then three is the person symptomatic right so those are kind of the three criteria. If someone has over overgrowth plus a virulence factor, even if they're not super symptomatic I might recommend let's use some like probiotics and inhibitors and some some things that disrupt and adherence like sulforaphane or anything or something just to kind of you know dial it back. But if someone symptomatic and has either of those factors then for sure we're going to try and change it. I love that and one of the things I think methane sebums the other thing I had questions about because I know our listeners who've had sebo that might be the one that goes back and like I find that to be the most common recurrence. It's hard right. It's a hard one. Yeah, yeah. And just when you listening basically there's hydrogen sebo there's methane sebo and there's hydrogen sulfide sebo which we can now test. What do you typically do do do the breath tests as well for those and do you have any particular favorites. I do. I'm a real stickler about the breath test, like, I mean I get that there's a lot of ways we can find suggestions. For sure, you can look at stool panels and other markers and find suggestions of it you can suspect it based on history and symptoms. I do like the breath test. Again I've danced around over the years with the different testing I currently am using primarily the trio smart which is the, it has the three gases. Yeah, love that we can finally. Yes, hydrogen sulfide. I'm redoing something that I used to do is for a long time I was using before bio health labs closed they offered a test that had used three substrates for testing. I'm going back to adding in the fructose based on the data that's showing that that's just how much higher I think actually there was just a recent talk with Jason Harlach about this. Yeah, there's just same things, the very recent article about how big of deal the fructose is yes. Yeah, and you just did this genius quantification of the data to actually and I was like, oh, so I thought it was like yeah now we know it's like that so thanks Jason. But yeah, I mean so we're going back to instituting for post testing parallel to the lack of those at every, every time we bothered to test for it. I'm not sure if that same kid or a different. Can you do that with it? I don't, we're doing it right now with a different kit, but I'm actually kind of trying to figure out what the best way of doing it is so yeah, yeah. I'm the same exact thing I like how do we do it. Absolutely. Yeah, I love that though so far so. So we talked about it. So let's talk just a little bit about we talked about diagnosis, people have a pretty good idea of the other things. I want to in just a minute go to what you mentioned the hydrochloric acid and some of the upstream and downstream things. But before we do. Let's talk just briefly about say blasto there's herbal and there's medication treatments what are some of the common things you would use for the protozoa. And then let's talk about HPILORY and then let's talk about SIBO briefly treatments. Yeah, great. Okay, so, um, yeah, blasto, you know what I, I have not had much of a hard time clearing that early. And it's usually like one of two directions. It's kind of a cocktail of your, you know, there's a whole bunch of different anti parasitic formulas from various companies. One of the things that I find non heavily is GM acrobats from Designs for Health, but there's a bunch, you know, old school tricycline by or that you know there's all the different ones so sometimes it's a matter of like which particular cocktail in what ratios of herbs, but I'll use a product like that and one of the key things that I see is that I think that a lot of times practitioners are a little bit shy based on the dosages they're on a bottle. Yes. So when you're, when someone's being observed by you, which they are, yeah, for health, I'll dial up those dosages, sometimes pretty high. So I'll start, you know, baseline using, you know, two caps three times a day if a product but I'll go up from there. Sometimes, and I'll usually use multiple things so I have reinstituted using more oregano oils. I had kind of laid off for a while but then recently I've read research that shows that there's actually prebiotic components of oregano that do promote some of the beneficials. So judiciously, I'm using it. And then someone who has, you know, completely wiped out beneficial microbiome and might be a little bit more cautious. I use a lot of the products in the line, you know, Biosidon. Yeah. And I'll also add include even if there's Artemisia in a formula, one of the key things I do when there's either a resistant parasite or just something like blasto which is known to kind of be a little tougher is I'll use Artemisia. And I think of that kind of like how I would and again I can't prescribe DiFlucaon but like what I mean is you monitor it so if I have any suspicion there's going to be an issue. Artemisia is an herb that can be toxic to the liver if taken too long or in too high of doses so I'll run liver enzymes before or after starting it just or if anyone has any symptoms that could be related to strain on the liver pain or anything. I'll have them stop it right away and retouch to make sure they're okay. I love it again so parallel and I love that you talked about those because you really that's exactly the thing I found two tricks that you may not know from your doctor or you may have had is number one the dose matters and I'm like you I actually push it pretty hard. Number two is sometimes say someone has persistent Candida or SIBA or these and even in my history 20 years with Crohn's disease one reason my guts in great shape is I have stayed on some low level herbs to keep that suppressed for years for years. So some of you are like oh can I be done in eight weeks well yeah but it'll probably come back. Yeah that I think for some people now not everybody I have a weaker immune system I have a history of Crohn's so for me it's definitely I need that suppressive dose but I'll leave caprylic acid if you think. Long term. Yeah, no 100% and especially that's one of the reasons I particularly love Biosidon, because also I just love Chinese that's my training and I know you know the formula I know the company. But basically, so many of those herbs are prebiotic. So you can be having this antimicrobial activity going on, not to the exclusion of going out the good guys right and so I mean I agree I'll sometimes keep someone on one product or something small low key while we go on to next pieces, absolutely. Okay, love that let's switch to H Pylori that's another tricky one. What are some tricks as herbs and things that are powerful against H Pylori. So I'll use a lot of mastica and again I'll do set up pretty high. Some of the zinc carna scenes or the more recent iterations of zinc and pepsin some stuff that are affinity to zinc matters like the delivery form right. Yes, you would think is different if you're trying to raise someone's intracellular level versus fight off the cold versus right so I'll use them that targets the mucosal membranes and then I like a lot of the newer formulations of the licorice, you know. So, DGL and such but there's newer ones that like gut guard that really really are shown in studies to block adherence of H Pylori to the membrane so a lot of each Pylori is about killing, you know, disrupting its ability to adhere and lowering its numbers so of course things there's like, I'll use L plantarum which is shown to inhibit it I'll use so for thing in different forms and AC those all block ability to adhere, but also that's, you know, in particular with each Pylori like if we don't have the right acidity and the gut it's not going to clear. There's so many times people say I've had each Pylori three, four times and then I'm looking at like the dysbiotics, you know the ones in the mouth. Yeah, show up in the stool panel that huge levels of staff and strap and like enterica okay well that's because. Yeah, you don't have an stomach acid to kill you know to clear this basically so then we'll really focus in on things like bitters and using BTN HCL and and then looking at beyond that like. So okay so it's a little chicken the egg right because certain bacteria like each Pylori basically decondigate or break down our stomach acid as a way of ensuring their survival brilliant like that. But then also we need to restore the acid to and clear the bacteria to optimize the HCL so both both are true. So often do some replacement but then I want to make sure that it's actually coming back on its own if possible, you know, barring some other cause. And that's kind of where we're going with these root causes that's one of those things that causes recurrence evil these upstream things, what are some other upstream. Right, literal upstream. So, so I love that you said that so this is kind of like it's funny it's one of those things that was like probably the first thing you know when you started learning that health it was like four hours and right all that okay so. The simplest things are often the most powerful and then most time tested so basically I think upstream so literally I start with the mouth. So, what's going on in the dental microbiome. And if we're not like, basically if anyone's practicing gut medicine and not thinking about that like please start paying attention, you know, most people are aware that at this point in time but there's so many of those ground negative bacteria that colonize the and also huge levels of fungi so I've read studies where one of my favorite ones is there was, they were testing stool panels for Candida. And just by having people brush their teeth three times a day we're able to significantly lower the level of Candida in the stool test without any diet change or any treatment. So really all these things colonize our oral microbiome our sinus, and then what happens is they, you know, are swallowed with our food so we have to take care of the mouth and so we have any, you know, if we have any 94% of Americans have some form of diabetes so basically if I have anyone with GI issues we're going to treat the mouth but if you have any kind of dental issues, I'll use again the like dental side and or bio side and nor some kind of silver preparation and just, you know, treat the mouth, at least while we're treating the gut, and then also, you know, chewing. So how we eat, and really this kind of is a bigger topic than just chewing it's about. So chewing, you know, it does help actually allow time for signaling signaling to happen to prime the gut and it allows all the saliva to do the first stage of digestion, make the our carbohydrates and certain parts of the proteins more available to be digested. But the signaling allows for HCL and pancreatic digestive enzyme secretion. But the other thing that happens is in order to chew our food that much we kind of have to be, we have to slow down. Yes, we can't be in a rush. And so, this is a really hard one in this day and age because everybody is, you know, technology hasn't made our lives any simpler. We're all so busy and so what I see is like such a huge driver, and I do want to get back to the actual digestive secretions but what I see is such a huge driver of all chronic GI issues is really that sympathetic dominance. Not enough balance between the gas and the breaks of our nervous system and that doesn't allow for Vegas nerve signaling, which is everything for digestion we get, you know, if we don't have that proper signaling, our mortality shuts down, and everything just sits there and ferments. Yeah. And that beautiful coral bloom of bacteria after we get done with a meal happens, you know, where it shouldn't be in the small intestine. We don't make, you know, when our body thinks we're in an emergency stator and go mode it says hey you can eat later, you know, obviously there's something going on where it's not a good time, you'll be vulnerable if you can't digest your food. So we don't make those all those secretions and so I think a lot about things like addressing traumas, if they haven't been and not me but helping someone resource to find a good match for getting support with that. I think about all the neuroplasticity gut brain access stuff, you know, I love group to program I love feedback I like frequency specific microcurrent or at least bagel nerve stem at home with a you know little eastern acupuncture Qi long EMDR somatic like, you know, there's a million reasons. So just getting us to drop into that parasympathetic state is everything and at the very least just like stopping and taking a breath before the meal it sounds so simple but it's so profound and eating outside, if possible and weather permits and like wherever you live, like actually taking your meal outside and breathing fresh air and feeling hopefully the sun on your face. Yeah, we're just. That's just huge I can't I can't really you know, or emphasize it. I love that you went there because it's so critical especially now people are more stressed than ever there's just so much going on and the isolation and the pandemic at everything. So it is really critical because this is one of those missing pieces. I remember years ago I'm in Boulder and starting to treat some athletes and they especially their training or whatever. And that couldn't heal their gut right because they're doing triathlons and training, and they get this divergence of this blank big flow blood flow that should go to the gut for healing it's all in their periphery doing their, you know, training, right. So, so I always would be like okay well decide when you want to be either in between seasons or we can't really focus on this if you're training I just, it won't work right so same, same idea because they're using all the blood flow to the periphery so if you are really training and you want to heal your gut you might want to take a break or decide timing wise but that's a, because you're again in your sympathetic system and and not really able to rest and relax and restore. But I love that you mentioned that. Oh my gosh we covered so much let me think about what else is talked about treatment protocols we talked about methane we didn't talk a lot about methane I feel like that's a tricky one. So, you know, medical medication routes that always require a couple medications but what about herbs because I feel like herbs can be a little tricky. I find a few, I have a few things that I like but what do you like to use for methane Sebo. I mean my basis is always garlic, right the Allison, that's always like a given and then I wrote in the other thing so I'll use a lot of the like ADP oregano that is kind of just for everyone out there it's like a form that releases a little bit more slowly without having like a time release. Basically, and can give a little more access so I'll use that. I'll definitely use a lot of probiotics all you, but specific ones. I'll use. I'll tend to incorporate some biofilm disruptors with that one like sometimes something like biofield film phase two that has, you know, a little bit more potent of an activity because of the business, at least some of the enzymes enzyme based biofilm disruptors. I'll also so oregano sometimes, sometimes more berberine but definitely the garlic is like the background but I agree with you it's more challenging and sometimes it takes a little bit more I don't want to say guess and check but yeah, you do a little bit of one you based on the other information at hand you see what it does and if not you switch directions I definitely do some of that with it. And I think that a lot of the times the inclusion of something anti fungal even without a strict fungal diagnosis and without it being a full fledged anti fungal program has been helpful that's another thing that I'll do so whether that's just like some acid type or some, you know, yeah, caprylic acid type yeah some Laura Seiden or those have sometimes I've seen been big boosters and then also. Oh, so what I didn't really complete talking about was optimizing digestive secretions. Yes, what I just wanted to mention because I mean there's a lot of information about this out there but I rarely if I've retreat anyone without at least the inclusion of something to promote acid either bitters or HCL, but also I use a heavily lean on pancreatic digestive enzymes like a lot of pancreatin and the key there is that and why okay so those digest carbs and and break down you know sugar fats and starches to some extent. We can see if someone's actually low based on their last case level on a stool panel but I have a different marker for what I call low than what the lab will help you. So I want them to be pretty decently high, and that will help prevent unbroken down food from being fermented, but the key is that we need enough, we need the right pH for them to work. Yeah, so like if you just give enzymes in someone who doesn't have the right acidity, they're probably not going to do much. So those are always kind of a combo thing and I play with the different levels. separately. And then each of those what happens is that in turn. We need that pH change to happen in order for bile to be released and so bile is like this huge piece so that was what I really wanted to say is that for methane what I found is that bile bile bile there's almost always a bile problem. So, by release, what happens is basically that we need, so we need enough acid to stimulate bile release and then we need enough of the, we need hydration to make enough bile and so many people with GI issues already hydrated because it doesn't feel good to drink a lot of water, or to have insufficient water. So, you know, there we go. You know there's not enough water. And then they're also deficient in fat soluble nutrients because they haven't been able to absorb and digest their fats know what happens is so one of bile's job is obviously digesting fat but the other job is that it absorbs toxins to be presented to the liver and where it's doing that primarily is in the gut. So, we have, you know, if you have a whole bunch of gram negative bacteria to have LPS entering, maybe you also have Candida spilling a bunch of you know ethanol and its metabolites parasites with their toxins the bile gets saturated carries that to the liver. And then if it's doing that over and over and over again time, you know day in and day out all these other stressors on the system, eventually we kind of can easily get depleted and it's going to last as we should have. So I see that as problematic for the rhythm and timing of motility there's a role that vial has to play with that. And also of course with being bactericidal like vial and probial and anti fungal. So that's another thing that I see is for methane really emphasizing any clues that someone might have not enough vial. We have done such a great job in our last like 40 minutes or so we we've been everywhere I mean we've really covered a lot and you are so nice. I love what really was amazing. I think people are going to really really really and they're going to want to rewind and listen to this again and all those little tips and tricks. I will say because we mentioned special herbs and very specific things. Please consult your medical professional to help you with us. Granted I mean you can try things but we're not giving medical advice and this can be complicated and there's lots of good practitioners like Bre out there that can help you. Speaking of which Bre if you want to know more about you where can they find you tell us more about your space and where they can find you. Absolutely well so there's always my website which is Bre wiselman.com my last name's a little tricky to spell but don't worry if you try for it on Google you'll get there. I also put the link below and I hang out a lot on Instagram actually. So if you want to just, you know, chat with me there through my profile, I'm available and underneath my posts. And then I'm available for consultation I also have a team of three practitioners and a health coach working with me and an amazing back office team to make it all work. Awesome. And you're in Portland did you say right do you do virtual consults to. I am I'm in Portland I actually at this point only do virtual consults here four and a half months ago I've been in Santa Cruz for 25 years or 23 years prior. And for the last about like five to seven years I primarily been virtual. So we work with people all over the US and have worked a lot internationally as well. Yeah, so I will be shown everywhere you can hear this podcast wherever you find it I will link up to Bre and Bre it has been a pleasure we're going to do part two. This was so full of good information thank you so much for your time today. Oh my gosh you're welcome thank you so much for having me. You're welcome.