In this episode of Functional Medicine – Back to Basics Dr. Rutherford begins to delve into the nuances of how he goes about treating patients who are suffering with chronic conditions. Today he will be discussing the large intestines and why they are one of the first things that may be tackled.
Note: The following is the output of a transcription from the video above. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors.
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So I’m, doing the treatment part, and so so we’ve talked about basics, we’ve talked about about exams, we’ve talked about histories, we’ve talked about priorities. We’ve talked about really the foundational stuff that needs to be set up for your treatments, even to really be effective in in the functional medicine world.
A lot of times we’ve talked about how, when you do those back to basics, then when you do those basics that that a lot of times a lot of times, a lot of the problems will clear up, doing blood sugar, doing stress hormones.
Doing doing low blood pressure and getting those things under control, you can look back at the at the segment on priorities to see what I’m talking about. If that’s, something that sounded like that was interesting to you.
So once you start getting the physiology and under control there’s, there’s, a there’s. I think the important thing in functional medicine is there’s, a hierarchy of care, and fact I was just at a seminar this past weekend with my mentor dr.
KRAS Ian, and he was talking about gut function and he was. He was talking about a north, the South approach, meaning you should look at the gut from north, meaning your mouth to south, meaning the other end of the other end, and and you should – and you should look at it in a specific order.
Well, that expands across the board to to every case that comes in here. If you have a person where people come here with neurological cases, dizziness vertigo balance migraine people come here with gut cases, people come here, fibromyalgia, chronic fatigue, thought Hashimoto’s, autoimmune.
Those types of things that expands a gut as part of that, but but but you have to evaluate that case and then you have to figure out for that particular case. What should a specific hierarchy be for that case now that doctor I just mentioned doctor Razi and actually developed something called a metabolic assessment for him.
I live and die by this form. You can’t get it unless you go to his classes. Okay and he’s got a copyrighted, and so I can’t. Send it to you, because he – because I’m talking about it on here, and he would sue me so he probably wouldn’t.
He’s, a really nice guy, but I can’t, send it to you so anyway, so so it’s kind of in an order. It’s, kind of in an order of the way that you would treat so the first parts like what’s called dysbiosis, which largely happens in your that you went in your large intestines and then the next part is leaky gut And the next part is chemical sensitivities now, technically, this is an order in which, in theory, the physiology breaks down, but everybody doesn’t break down the same way.
So this gives you the opportunity to gather an awful lot of data from the patient and then be able to having studied functional medicine know the hierarchy in which you should in which you should proceed.
But I’m, going to kind of go. I’m gonna spend the next several weeks, probably more than several weeks going over the the specifics of this metabolic assessment form, because the this metabolic assessment form directs you to treatment, and if you, if we go back to diagnosis, it also directs Us to what what tests we should be doing and and within framework of each of these categories, category one in general is large, intestines and dysbiosis, but within each of these categories there are also specific questions that lead you to start to understand.
What’s going on with the patient, so the first category is a category relative to the gut bacteria, so you’ve heard about the microbiome, the infamous microbiome. Sometimes we start out with the gut. Sometimes we started out with the liver.
Sometimes we start out so pay. Let’s. Let’s. Just use fibromyalgia! Okay, because that we’ve, seen a zillion fibromyalgia cases and then, for some reason, everything that seems to be a big interest.
In my in my audience, fibromyalgia, chronic fatigue and and thyroid seemed to be very popular, very popular among my patient population, and so let’s just say you have Hashimoto’s. Let’s, say I’m. Sorry, let’s.
Just say you have fibromyalgia, so we wouldn’t. We would gather all of the data relative to what we’ve said and then we would and then we would. We would look and see what you have here on your metabolic sessemann form if you are in chronic stress response, that is a hierarchy for us and we will talk about the brain after we talk about the rest of the system, but but we will usually find Out what we think is wrong in the in the in the in the general immune digestive, endocrine system, okay, and and treat that at the same time, we would treat the chronic stress responses which are all over our website.
So if you want to know about that, you can go to power, he’ll talk, comm and look about stress and chronic disease and fight flight syndrome and those types of things so the gut, so the gut frequently is, is the first place.
We start not always, but the gut is frequently the first place. We start. I went to that seminar last weekend. Dr. Crosby made two statements that I thought were very very prescient. He says it’s. You can ‘
T supplement your way out of most of these cases. They’re, a part of it, but that’s, not how you do it, that’s. What people are trying to do online and – and he said – and he’s – getting really upset because functional medicine is becoming all about the gut in the diet.
He says: function, medicine. Now you got a doctor, you got a function, medicine doctor. They put you on like the for our program to get get your gut under control and they give you and they put you on the automated Paleo diet and and they and they that’s.
Functional medicine. It’s, not, but it’s a part. It’s, a big it can be a big part of it. We start out with the larger size. A lot of people don ‘ T realize that the dysbiosis that all these things that they’re hearing about a lot of them are are in the, and I made a mistake when I said microbiome that’s more your it’s more than the Small intestines, but but your large intestines, so we’re, so large intestines, so here’s, the symptoms.
Okay, if you’re, let’s, say a fibromyalgia. Let let’s say we’ve, already discovered that with you have fibromyalgia, you have an autoimmune problem because you usually do, and so we’re gonna be looking to dampen your autoimmune.
Prop your your autoimmune responses and one of the first places we’re gonna look, mister your large and small intestines large intestines. The symptoms would be feeling that bowels do not empty completely so and within the framework of this entire category, there are specific, so lower abdominal pain, relief by passing stool or gas passing store.
Gas means we have a bacterial problem. Gas is a bacterial problem. Okay, it’s, it’s, it’s, it’s, the breakdown of bad bacteria. You can get a couple of different types of gases, but if you get, if you get a methane gas, that’s, SIBO and small, that’s, a small intestinal bacterial overgrowth that can be gas.
That can be bloating. That can be passing large amounts of foul-smelling air, so you’re, passing large amounts of foul-smelling gas and you get distension after you eat there’s, a good chance that you might have something called small intestinal back to your overgrowth, that Alternating constipation diarrhea now just now understand we’re, treating a case.
We’re, looking at the gut and we’re, like ok, 75 % of the immune system is in the gut this person that’s. How she Moto’s whatever it is. If you have an autoimmune problem, which most of my patients do, 75 % of the immune system is in the gut.
Most of you have mystery diseases. You’re struggling. You can’t figure out what’s, going on yeah and and everything’s normal and your doctor’s, telling you to say that mostly you do have an autoimmune component to your condition.
Okay, so so another symptom, alternating constipation and diarrhea. This is called irritable, bowel syndrome. Okay, irritable bowel syndrome is art alerts us to the fact that person is probably in a chronic stress response.
They’re now calling irritable, bowel syndrome, irritable brain syndrome. Again, you could look at our irritable, bowel syndrome, presentations on power, Aalto, calm, but but this area directs us to directs us to a number of things, because irritable bowel syndrome is gonna tell you you had work, you got to work, you have to work with The brain you, however, that particular practitioner works as a brain.
They may actually I practice functional neurology, also, okay, so we do brain rehab exercises. We have a lot of tools here that we use to calm down the stress responses in the brain and give that person the tools we have herbs.
We have botanicals, we have brain, we have exercises, we have different types of techniques here that we can help to have the patient, take home and and and so so so from looking at the we’re. Looking at the bowel aspect of this metabolic assessment form and it’s telling us it’s, brain okay and other symptoms of your large bowel Riya alone.
If you just have diarrhea alone, I hate diarrhea, because it can be so many different things. It can be segmented, filamentous bacteria that’s. Some of the other bacteria that can break down the number one causes of diarrhea here is usually people, aren’t drinking enough water or they have a bacterial infection in their gut, but there’s a there.
You know if you’ve been up in the mountains. Of course. We you know it ‘ S like you have a you, have a parasite, but but constipation is, is a little bit easier. Constipation number one cause is usually stressed.
The set number two causes usually is usually thyroid problems. Constipation can be again, it can be not your persons not drinking enough water, hard drive, small stools same thing as constipation a little bit different.
That also will indicate to us that the persons either got a thyroid or or a stress response, coded tongue or fuzzy debris. Most of you out there probably know we would use the term dysbiosis. A lot of you would say that’s, probably candida and – and it can be, can certainly be Candida.
What we see more, a more broader bacterial infections passing passing large amounts of gas that smell. We talked about to how that might be small intestinal bacterial overgrowth. So these are this. This is like the category of bowel symptoms.
Now, why why would you go to the bow first? Why would you not go to the small intestines first, you kind of do. I’m going over, but I’m going over the bowel right now. The bowels of the small intestine certainly work together, but they are very differentiated and in in the way they are treated.
So so so, if you’re having like a chronic problem, the first place is you’re gonna go to? Is you’re gonna? Go to your your? If you, the people who come in here, this may not be you, but the people come in here all or it’s, some sort of a chronic fight flight response.
So so you’ll notice that a couple of times I said that’s. What’s, causing the bowel problem? So the person has that bowel prof that has that problem they can take all they want to do. They can take, they can take, they can think Metamucil.
They can take magnesium, they can. They can do all the things that they want to do and they’re in and there and they’re there. Constipation is not going away unless you fix that stress response. The what I’m.
What I’m going over here is everybody, wants the magic bullet. Okay, everybody wants the magic bullet. What do you? What do I do for this? But, as you can see, these bowel symptoms have different causes.
Some of them have bacterial causes. Some have different types of bacterial causes. Some of them have a brain cause. Okay, some of them have a specific, like maybe Candida, type of things. Some of them are small intestinal bacterial overgrowth, so those are all different.
Now, as I talk – and I’m talking a little fast here today but like as I talk, if you have the, if you have the passing a large amounts of foul-smelling gas, you’re gonna want it like you’re gonna want to look up, see Bo you’ll want to look it up: small intestinal bacterial overgrowth, and you’re, going to want to look up treatments for that, and we’re and we’re gonna talk about that.
Okay, but but basically see Bo. You’re gonna have to kill the bacteria you’re gonna have to starve the bacteria, so that’s, a special diet. If you’re looking at the fuzzy tongue there, that’s, a special diet, okay, and that that may be different, then or it may be the same as the SIBO diet.
But most of the time that’s, a different diet and then you can use herbs and botanicals and things of that nature. Most of you in the alternative, feel know to starve the back the candida bacteria from by not giving it sugar.
You know to you, may not know that you should kill it, but you may also not know that later on, we’re, going to talk about hydrochloric acid, and if you do all of this stuff and you don’t, take your Bragg’s, apple, cider, vinegar or hydrochloric acid tabs that once you have once you’ve, taken the things that you should take to get this under control.
It’s, going to come back because the hydrochloric acid, that’s, not there in your stomach, should be there to kill these bacteria when they try to come back. So constipation is a huge one. It’s, one of the biggest reasons we start with, with with this aspect of the physiology.
The two reasons that we start with the gut is autoimmunity and the other reason we the three reasons it’s, autoimmunity leaky gut and food sensitivities and constipation. Constipation is because why, if you’re, not if you’re constipated and you’re, not pooping, you’re, not detoxing.
All that heavy load that your that is being done in your and your liver and your gallbladder, your intestines, to detox you if it’s not getting into the I was not getting in the toilet. It’s getting into you now your itchy.
Now you may be getting skin that different types of skin things so so constipation is, is very, is very important and – and so that is so – that’s, something that if you do have constipation, if you do, if you can take magnesium, if you Do have a number of of these alternative medicines that that they gave that can get your unconsummated that’s, a good thing to do most of the time.
If you, you have to get the stress response under control, you have to get the physiology under control, then you have to get the thyroid under control and then your constipation will go away. Sometimes it can be sluggish gall bladder.
Sometimes it can be a sluggish liver, gall, bladder or maybe even pancreas, and you’re, not getting the enzymes there. So sometimes enzymes will go, but the trick is get the liver, gallbladder or pancreas under control, and so to do and – and so I mean there are lots of different things that you can use, but you have to figure out what it is.
So I’m, so I’m. Not I’m kind of going through this to show you that, like a lot of things, why a lot of things you’ve done is failed and why sometimes you need to figure out like find something or somebody who can put Put all this thing together for you and say which one which one he thinks should you do? You might go on a baseline diet where you get on the autoimmune, Paleo diet and you take out all of the allergens and all of the antigens, all the foods that will flare up autoimmunity and this all might go away.
It might all go away because it may be that those things were the things that were flaring everything up. Okay, if they don’t go away, then you should stay on that diet, because that sets a baseline. It takes all this inflammation away and then you look at it.
You go wow, you know I have. I have this coded fuzzy tongue and, and it’s still there and I’m on the diet, so that didn’t go away. So now what you would do is you would actually do a test that we would do something called a GI stool test.
We would look to see it. What’s in your stool? We let’s, see do you have other bacteria there’s, a lot of things. Are you making pancreatic enzymes? Are you making gallbladder enzyme or is the gallbladder making ejecting it’s? It’s, it’s, bile and creating anti inflammatory enzymes and and breaking down your fats and so on and so forth.
So again, just the the the internet thing is like okay for some things, but really the internet thing is like selling supplements it’s, selling herbs and selling botanicals, and, and it’s and it’s. It’s, really it’s, really not for the chronic condition patient it’s.
It it’s. It’s, something that you need to to get involved in a little bit understand a little bit more. What’s going on so you can attack and then understand you can take the you can take you. You know you can take herbs and botanicals for the fuzzy tongue, but you get it.
But you have to understand if, if those herbs and botanicals are killing the bacteria and if the diets killing the bacteria and you’re feeling better. But it comes back later. You have to look at the rest of the hierarchy of what’s going on and find out it didn’t come back because I don’t have enough hydrochloric acid in my stomach, and these are these are.
This is like um there’s, not a lot of other things that what I’m talking about. So let me just be clear when I say I’m, giving you I am giving you some some clinical pearls here. So, in other words, is it is it that there’s, a lack of hydrochloric, you’ve done your candida cleanse.
Is it that there’s, a lack of hydrochloric acid? Do you need to start and start saying, Bragg’s, apple, cider, vinegar or hydrochloric acid enzymes, or something like that and enzymes? Or is it that there’s? A stress response is causing the hydrochloric acid problem and that’s, that’s, the main flow for the gut, no matter what you have in the gut, if you’re, if you’re, if you’re if you’ve done it.
If you’ve gone through a small intestinal bacterial overgrowth protocol and it worked. If you’ve gone through a cleansing at work, you’ve gone through a fast, and we’re gonna always comes back the big, the two big things to look that to the three things to look through is, Is your thyroid working because your thyroid slows your gut down? So if that slows, your gut down, you’re, not making enough hydrochloric acid or you are you’re stressed.
If you’re stressed that’s, going to cause you to not make enough hydrochloric acid in your stomach. Hydrochloric acid decrease is what happens before long before you get all sorts, or do you just not make enough hydrochloric acid there’s, something called parietal cell antibodies in your test.
Ins, parietal cells and the pride of cells make hydrochloric acids. Sometimes people can’t. Those cells, don’t work. Sometimes there’s. There’s, an immune attack against those cells. So do you even make hydrochloric acid people have Hashimoto’s.
Have this parietal cell antibody thing a lot, maybe 40 50 60 percent of the time, so that person’s. Gon na have to take hydrochloric acid for the rest of their life, the other two people. Maybe they get their thyroid better and they get their brain better and all of a sudden, all sudden they start making hydrochloric acid.
Now they do their Candida thing. Now they do their SIBO thing and they’re better, and if you do that, as we’ll talk about future, maybe a lot of these other things get better. Maybe the leaky guts gets better.
Maybe the hydrochloric acid is now good. As we’ll talk about later, maybe that’ll help your gall bladder your pancreas to start working, that’s, functional medicine. Okay, this is functional medicine.
It’s, not throwing something. You know you know, throwing darts or throwing spitballs at different things, and and and just hoping that one of them takes there’s, a hierarchy to care, and we’re gonna go through that hierarchy, so that so the starting hierarchy Is usually look to the brain? Okay, so it’s.
Gon na be look to the brain. Maybe you meditate. Maybe maybe you exercise, maybe you maybe you knew do tapping exercises. Maybe you do self guided meditations? Maybe you take herbs or botanicals whatever? It is you if you treat this gut without treating the brain there’s, a good chance.
You’re gonna fail, and so so the hierarchy is. First, we’ll, get brain and in general the intestines is a pretty good place to start for people who have chronic conditions that won’t get better. It’s, not the it’s, not the it’s, not the mother lode.
You know for most people, but it is a good place to start because then it can clean up a lot of other things. You