Remission of SIBO, Crohns, IBS and IBD in Just Weeks with Debbie Steinbock

Introduction and guest background 0:00

Hello and welcome to the Thyroid Pharmacists Healing Conversations podcast. I'm Dr. Isabella Wentz, your host, and this is a really, really special treat for me today because I get to have one of my dear friends on. This is Debbie Steinbach. We're going to tell you a little bit about how we met and I am going tell a you little about Debbie as well. We're going to be talking about the elemental diet today. This is a very powerful tool for healing SIBO, for helping with various types of health conditions such as ulcerative colitis, inflammatory bowel disease, irritable bowel syndrome, as well as Hashimoto's and hypothyroidism.

A little bit about Debbie. She is certified holistic health and nutrition counselor with a special interest in digestive disorders and autoimmune disease. Her 20 plus years in a clinical practice includes working with complex conditions that often involve gastrointestinal disease, thyroid imbalances, food allergies and sensitivities, nervous system dysregulation, and more. Debbie brings a uniquely personal perspective to her work with clients that was gained by navigating her own health challenges.

Debbie's deep personal understanding, combined with the passion for and commitment to continuing education and research, makes her a compassionate clinician with an insightful perspective. Debbie and her husband, Dr. Roy, are the co-creators of the Elemental Diet Success Plan, a step-by-step roadmap that teaches participants their proven tips and strategies to complete an elemental diet with clarity, direction, and confidence. Welcome, Debbie. It's so great to have you here. Thank you Isabella. It's so good to be here with you.

So in full disclosure, Debbie's one of my dear friends and we met when we were living in Boulder. She's actually one the first people that I called, maybe the person I first called when my husband was diagnosed with ulcerative colitis and she was able to give me a plan to get him into remission. Debbie, I'm just so grateful for your friendship and for you wisdom. When I can't figure something out with gut health, I just call Debbie. I'm like, ''I bet Debbie knows about this.'' It's so great to have this opportunity to pick your brain here.

So excited to be here and you can pick away. A lot of us, in functional medicine in this space, we have our own healing journeys that brought us to do the work that we're doing. Can you tell us a little bit more about how you got into the work that you do for everybody listening? Yeah, so like you just said, like many of us, I got in to the works that I do based on my own challenges with my health that started when I was a teenager. So when I was 13 years old, I kind of was given the label that I had irritable bowel syndrome, like most people in my immediate family do.

And that kind progress and got worse until I 18 years and the month before I go off to college, actually got diagnosed with Crohn's disease after I have my first colonoscopy. And those first couple of years, I did the traditional treatments that were out there for Crohn's disease. I took steroids.I took a bunch of different anti-inflammatory medications. Ultimately,I don't even know if I've ever told you this, enrolled myself in a medical trial for interleukin 11, where I would give myself a shot in my thigh like every week or something like that.

And I was really kind of at the end of my rope, like nothing was making me feel better. And a family that I was babysitting for at the time handed me the book, The Elaine Gottschall Breaking the Vicious Cycle Specific Carbohydrate Diet, the SCD diet. And I always say I got into nutrition as like my last ditch effort to heal my gut.

Debbie's healing journey with Crohn's disease 4:00

And while that diet didn't heal me 100%, it really turned off these like light bulbs in my head to be like, huh, maybe the things that I'm eating actually play a bigger role in by health than I had ever given them credit for. And not that I had like a terrible diet, but I have a traditional New York diet with a lot of pizza and Chinese food. So that was what got me interested in nutrition. And at the time I was studying psychology, planning to go to grad school for psychology and switch gears and decided that, I really wanted to take nutrition as my path and really help people like me who wanted heal their bodies.

That's incredible. And how long have you been in remission from Crohn's disease? Since I am about 20 years old, which is about 28 years this week. Incredible. That's just so incredible because this is a condition that a lot of times people say is incurable, right? That you can't do anything about it. And being a pharmacist, I just see more and more medications coming out for it with all the immune modulating medications. It's truly a life altering illness where your life is just centered around your bowel habits, and the discomforts that you have.

Yeah, absolutely. Absolutely. And I've seen the same thing that you're seeing. I tell people medication has changed so much in the time since I was 18 years old in those 30 years till now. There's a lot more available and there's good to that, but there are also a lots more harsher treatments available that they start with these days as well, which isn't always in alignment with what some people are wanting. Right. And I feel like, I mean, the opinion that if we can find something that works, why not do it?

And nutrition can work wonders for inflammatory bowel disease, for irritable bowel syndrome and Hashimoto's. Can you tell us a little bit more about some of the conditions that you specialize in? Yeah, so I started my career specializing in inflammatory bowel disease, irritable bowel syndrome, really just all digestive conditions. And then due to my own second health journey after my daughter was born with Hashimoto's and thyroid disease which is what connected me to you, I really kind of brought in my scope to really specialize more in autoimmune disease in general, thyroid diseases as well, and food allergies and sensitivities.

It's incredible. I know when we first met, my husband and I had just moved to Boulder. And I sent out an email to people on my email list and said, hey, I'd love to meet you guys and have some lunch at a local restaurant. Boulder has the best food scene for farm-to-table, gluten-free, and dairy- free food. That's when met. Actually, I responded to your email list when you sent out a newsletter saying that you were writing it from Boulder. I thought you we're living in Amsterdam because I had watched you on the thyroid sessions, Sean Proxton, and you are living an Amsterdam and I sent you an email saying, if you're visiting Boulder, come to my office and have tea.

And then you send me back an e-mail saying actually I moved to Boulder and was like, what? We should be friends. and then we've been friends ever since. Here we are what is that 10 years almost? Yeah I miss our Wednesday nights when we would get together and have like tea and just have women's wellness nights it was a lot of fun. Totally I got a picture that a reminder picture of that the other day and I was nostalgic about it too. Yeah. So Debbie was like, when my husband Michael was diagnosed with ulcerative colitis, I was able to help him get into remission within just a few weeks as well.

And that was largely because of your recommendations and all of the things that you told me. I had gone to IFM, the Institute of Functional Medicine, amazing, brilliant people. And they gave me protocols for inflammatory bowel disease and had talked to some other people, we had followed some of those protocols. At one point, I remember Michael had a flare up and I got back on the phone with you and you're like, actually, it's this, so there's a lot of things that I feel like you know some of the information out there even in functional medicine isn't as well I guess informed or dialed in but you've really helped people dial dial this in with like very um a very great way of of like soothing like I love your approach where you focus on how do you soothe the gut absolutely I think that the truth is is that There's a lot of protocols out there specifically for inflammatory bowel disease, but not everybody really understands like the true sensitivity that's happening in the gut when somebody has inflammatory bowel disease.

And oftentimes these protocols, even though they have natural supplements in them, they had too many for somebody to tolerate when they're in that state of their intestinal tract. This is kind of my motto in life, but I really try to keep things as simple as possible because I've gotten really good results that way. And I think that more is not necessarily better. So when I was researching the root causes of Hashimoto's, I came across the gut and thyroid connection and learned that as many as 50% of people with hypothyroidism actually have SIBO.

And this is another kind of condition that you specialize in. Can you share with me some of the symptoms of SIbo and how somebody might know that they have it? Yeah, so the symptoms of SIBO really like overlap with what we would think of as the classic symptoms, of irritable bowel syndrome or IBS. So what that can mean is that it can be gas, that could mean bloating, pain, distension, and generally that goes along with altered bowel habits that mean diarrhea, constipation, or alternating between the two.

Sometimes people will have symptoms like nausea or GERD or reflux as a result of SIBO as well. It's interesting. I feel like it's the chicken or the egg thing because I personally had IBS maybe 10 years before my Hashimoto's diagnosis. And when I went through Institute of functional medicine training, they talked about how irritable bowel syndrome oftentimes precedes an autoimmune condition, right? Have you seen that in your clients as well? Well, I mean, if you think about it, like the gut is really the seed of our health, right?

So it makes sense that if things in the go awry, that we kind of like open the door for autoimmunity to arise. Yeah, that makes so much sense because when we think about Dr. Alessio Fasano's work, the three-legged stool of autoimmune, you need to have the genetic predisposition. You need have some kind of a trigger and then that intestinal permeability. And we know like SIBO is like a powerful inducer of intestino permeabilty. When we had talked about the inflammatory bowel disease approach, some of the things that we were utilizing for my husband were like very amazing natural medicine protocols, but they made inflammatory bowl disease symptoms worse for him.

So it was berberine and oil of oregano and very high dose probiotics.

SIBO symptoms, testing, and treatment options 12:00

I won't name the brand, for inflammatory bowel disease and IBS and the same thing with SIBO. There's a lot of different healing protocols out there and then there's also for like gut health, but some of them can actually make SIBo worse, right? Yeah, yeah, I think, well, with SIBO, you also wanna figure out, but there's several things to say. With SIBo in particular, we can do breath testing to determine like which gas is predominant. And if we're gonna use an herbal protocol, there are certain herbs or combination of herbs that work better for certain gases that are present versus other types of gases, meaning like methane versus hydrogen versus Hydrogen Sulfide gas.

The second thing is that there's, I would say, a lot of people that have SIBO are also dealing with a large bowel dysbiosis. And sometimes when we use some of these protocols, what happens is we're killing bacteria in the small bowel and the large bow. If we do that too quickly, we can have a lotta die-off symptoms. as a result. And anytime those bacteria die off, they have their bacterial cell walls, the lipopolysaccharides, and those activate our immune system and can make us feel pretty terrible and really overwhelm us if it's done too quickly.

And there's also controversy about using probiotics and SIBO and like fermented foods. Can you speak to that? Because sometimes I know in, I guess, the natural medicine integrative world, it's like, oh, you've got digestive symptoms, take probiotic, right? Yeah, many cases where they activate SIBO, or SIbo specifically, what I would say is that there's just some people that don't do well with probiotics. I sometimes say that the people that do the poorest with probiotics are often the ones that need them the most, but we really have to like baby step them into their diet, sometimes starting with just like the B.

infantis strain, like, the one that you would give to, an infant, a newborn, and then work our way on to other strains. But I would say, that I see it more broadly where probiotic might not work for an individual, at least at that specific point in time. I've seen a few cases where people tell me that they feel like it makes their SIBO symptoms worse, but again, whether it's truly aggravating SIBo or just like some sort of irritability in the bowel by stirring things up. I don't have the data to say.

Well, it would make sense because when you have, let's say, one of your main symptoms of SIBO is having a lot of gas, right? And when shifting your microbiome with probiotics or kind of remedies, if you haven't increase of gases, then it's like, oh, all of my symptoms are just feeling so much worse. Exactly. I steal our friend Steve Wright's term. He calls it gut remodeling. And after going through many remodels in my home, it's like stuff gets stirred up and looks worse before it settles down and it looks pretty.

So that to me is a great analogy. I love that analogy. I wanted to, so we talked about SIBO present in about 50% of people with hypothyroidism. We talked some of the symptoms, we talk about the testing for it. There could be three different types of SIBo. So each type of CIBO might require different protocols. Could you speak to some protocols that are maybe, you know, maybe that used out there and Perhaps some of the pros and cons of different protocols from meds to herbs to diets for SIBO? Absolutely.

So there's three ways to eradicate SIBo. Let's start with antibiotics. Antibiotics are the way that the medical community addresses SIbo. And antibiotics for SEBO can be very effective for some people. So for hydrogen or hydrogen sulfide SIBO, we use one antibiotic called rifaximin or xifaxin. For methane SIBo, they add a second antibiotic, neomycin or metronidazole, on top of the rifximin and xifexin, and that, depending on which studies you read, can have like a 60 to 80 percent success rate, but it often requires more than one course of medication for some people.

Cifaxin in particular, if it's not covered by your insurance, is incredibly costly. Incredibly costly, yeah. That can really be a barrier to care for people, But like I said, antibiotics work, they can be very effective for For some of my clientele in particular, they're not looking to take antibiotics. Some of them, in fact, come to me saying, well, I feel like all the antibiotics I took for my sinus infection or my urinary tract infection, that's kind of what got me here in the first place. I want to choose a different way to treat SIBO.

So then the second option we have is doing herbal antimicrobial treatments. And as I said already, depending on the type of SIBo that somebody has, the types of gas or gases that are present, because it's not just one, sometimes you can have multiple gases present. We would use an herbal protocol that's a single herb or a combination of different herbs. And then thirdly, as you mentioned, is about diet is the third way to treat SIBO. And this is really where there's a lot of misconceptions that I see.

So the only diet that eradicates SIBo is that elemental diet. But diet can be a really great tool for symptom reduction, such as a low FODMAP diet or a paleo diet. When we take out highly fermentable foods or common allergens, people feel symptom relief, which is amazing. But those diets are not curative in the sense that once you put those foods back in, peoples' symptoms will often return until they've eradicated. SIBO. And so that's where the elemental diet comes in. There's a lot I can say about that.

So if you want, you can ask me more specific questions. But for SIBo, it's been studied to be 80 to 85% effective for a two to three week elemental diets. I have clinically seen this across all three types of gases that are present. Incredible. And just for everybody listening, I feel like the FODMAP diet is like, the most popular diet out there for SIBO and for IBS. But I've personally seen so many people on it for months, years at a time. It doesn't really change the microbiome for the better.

worse and less diverse from the research that I've seen? Have you seen that as well in the clients that you're serving? I have. And what I had seen, like my premise is really that if a diet's working for someone, great. you know stick with it but what I see is that people are needlessly avoiding a lot of foods because they're on a list that says these are low FODMAP but when they actually test them out they generally don't get symptoms from them so with a low fodmap diet specifically what i always tell people is, that you want to find which foods are your triggers I'll use myself as an example.

I don't do great with large quantities of broccoli, cauliflower, beans, garlic, onions, but a lot of the other foods that are considered to be higher FODMET, being cherries, peaches, dandelion, chicory root, I do not have any problems with those foods. Again, based on our unique gut bacteria where we're at in our healing journey, how stressed we are at the time, how many of those foods we stack on top of each other. But like I said, what breaks my heart is when somebody's been on a super restrictive diet for weeks, months, or years, and they're not even seeing symptom improvement.

Oh, yeah, for sure. And like, I'm a big proponent of like the gluten-free diet and the dairy- free diet or just eating cleaner and healthier overall. But the low FODMAP diet, can you go through and give us a quick overview of all of the foods that it restricts? I won't go through all of them because there is a big whole list. Basically, you break it down. I forget what every FODMAP, exactly what they all stand for, but they're basically foods that are higher in fermentable fibers like inulin, sorbitol, lactose, I'm forgetting some of the other ones.

But what I do with my clients is I have them take a look at that list and they might do a two to three week elimination of highest FODMAP foods and then bring them back in one category at a time and test them out with very specific amounts and see if they have reactions to those foods. And then if you don't, they can continue to put those food back into their diet. Yeah, and I think that's kind of the correct way to do it. I know I've had some people that haven't had the benefit of working with a nutritionist and they just end up restricting like a ton of different foods.

So just things like fructose that is found in honey and in a lot of fruits, so they're just hardly eating any kind fruit. They're avoiding dairy products. They're avoiding different types of vegetables. They are avoiding various sweeteners. And they're having a hard time with like beans and artichokes, asparagus, all of these like really good prebiotic foods, onions, garlic, apples, cherries, pears, and peaches. It's a lot and it's kind of hard to keep track of. when you're on a low FODMAP diet, it's also trickier to eat out.

I think a lot of places know gluten free and dairy free, but then you are like, I have to be onion and garlic free. And I can't have like cherry sauce. So I'm a big proponent of using nutrition and food as medicine, and especially when it can help somebody feel better. But to your point, like you said, some people are on this overly restrictive diet for way too long without actually getting symptom improvement. Now, the elemental diet. This is really your zone of genius. And I will say, when you recommended that for my husband, we hadn't even considered that as a potential thing that might help his ulcerative colitis.

That brought down the inflammation and his symptoms down so incredibly quickly that I'm just like, more people need to know about this. there's a few different ways to use it. And so we'll get into that because you can use a different way for different conditions. But first, can you tell us what exactly is an elemental diet? Yeah, yeah. So an Elemental Diet is a medical food that consists of powdered nutrients, and I'll go through and explain what's in the elemental shakes. that you combine with water and you make into a liquid beverage that can be like a sole source of nutrition that somebody can subsist on for weeks on end as complete nutrition.

And I always say what elemental means is that the components in the shake are broken down into the simplest components possible. So there's no protein, for example, in elemental shakes. It's in the form of free-form aminos. There's no complex carbohydrates. It is simple sugars like glucose, fructose, dextrose, maltodextrin, glucose polymer. And there's fats in elemental shakes. Then there are nutrients in vitamins, minerals, and electrolytes. So like I said, this is something that you can subsist on.

And the benefit of the elemental shake is that they get absorbed in the upper part of this small intestine. We'll talk about why that's good for SIBO, why it's for inflammatory bowel disease, but they got absorbed into the lower part very rapidly. And what that does is it allows time for most of the bowel to be at rest. So you're really feeding the person while resting the valve and starving any potentially overgrown bacteria. And one more thing that I wanna say is that elemental diets have gotten a lot of press really since, in my opinion, I saw like the big jump in them in 2012, 2013, sometime around there, but they were developed in the 1950s.

So this is not a new treatment. NASA actually is one of the first people that used elemental shakes because when you go up to space, you don't have a lot of space in there. For a lots of people, it decreases fecal matter. NASA was using these shakes in the 1950s. Then in this 70s, they started to be used in inflammatory bowel disease. This is a treatment that has many decades of research and clinical experience. And more than that, in some countries, elemental shakes are actually the first line therapy.

In America right now, you get diagnosed with inflammatory bowel disease. Biologics are our first-line of therapy, and in countries like Japan, I believe the UK, Canada, the elemental diets are some of the very first treatments that are used when someone is diagnosed. Wow. I didn't realize that was the case than other countries. It's incredible. I had somebody reach out to me and send me some information about a family member of theirs that were diagnosed with Irritable Bowel Syndrome in Poland. The recommendations they got were so solid compared to the recommendations we get.

Yeah, that's actually some really great recommendations. You know, of course, being a pharmacist, I was very surprised to learn that the US and New Zealand are the only two countries that allow direct to consumer drug advertising, right? Here in the US, we're allowed to get commercials on our TVs that talk about these different drugs. So most people have seen these commercials for biologics, and the pharmaceutical companies have a huge marketing budget. And I feel like having worked in pharmaceutical sales, I do know that marketing does work.

A lot of times, these marketing efforts do influence practice guidelines. in the United States, the way that when there isn't that marketing being put in Europe and other Asian countries, perhaps they actually look at more of

What an elemental diet is and how it works 28:00

the clinical evidence. I believe I saw something about how elemental diets were first designed after people, after clinicians noticed that a lot of patients with inflammatory bowel disease would go into remission with total parental nutrition, which is basically like IV nutrition. But then that had some downfalls as well. When the bowel is at rest, healing happens. Can you explain that a little bit more and why that's like so relevant and so important with, you know, perhaps irritable bowel syndrome and any kind of inflammation that somebody might feel in their gut?

Yeah. So I always say that elemental diets do primarily three things. They're hypoallergenic, they're anti-inflammatory, and they are antibacterial. Hypoalergenics essentially means that they don't have any of the common allergens in them. Everything, as I said already, is broken down into the smallest component, amino acids. As you know, Isabella, generally when people have a reaction, a sensitivity to something, their reacting to the protein portion, of that particular food. There is none of which is what makes them hypoallergenic.

That's what leads to them being anti-inflammatory as well. When we can calm gut reactions, we calm the immune system reaction, and we decrease inflammation that way. And then thirdly, why they benefit conditions such as SIBO, IBS, IBD, is we know that there's some degree of like bacterial overgrowth, whether as I said, that SIBo or dysbiosis going on. And when we, the shakes, because as said are absorbed so high up in our 30 feet of intestine and small intestine, whatever, large intestine is below that.

that essentially leaves the microbes that are in those areas without any food source. With enough days without a food-source, those overgrown microbes end up dying in the most natural way. We're not killing them. They basically die of starvation, essentially. You feed the human, but you starve out the bad microbes. Feed the humans, starve the bacteria. What kind of conditions can an elemental diet help with? So like I said, it really kind of hit the mat medically with inflammatory bowel disease, then has really expanded into SIBO and IBS.

And then the other conditions I've seen it be used for are things like eosinophilic esophagitis. rheumatoid arthritis, cystic fibrosis. I've even used it with clients going through chemo and cancer treatments and for the same reasons it can be used for people that have HIV or AIDS to just again give really easily absorbable nutrients. I love that. And there's like a few different ways to follow an elemental diet. So you can go like fully elemental or partial elemental. You taught me about the partial-elemental part.

Can you share a little bit more about that? Yeah. A full elemental means that 100% of your calories, all of the nutrients are coming solely from the shakes. And how long somebody would use that is really based on the condition that they're using to treat. But most typically I start out with people aiming for about two to three weeks of that. Once they are prepared for their body to do so, you don't just like wake up tomorrow and start that, there's really like a preparatory period that goes into your body doing that but I would say, generally two three to weeks, I've seen people extend that longer, especially in inflammatory bowel disease because sometimes they feeling so good.

A full elemental diet can also be used at the onset of somebody coming into a flare-up. They feel a flair above their IBS or their IBD, and they could do a full-elemental diet. I have clients do it for sometimes like a weekend, a long weekend. Sometimes as short as a day to just calm that immune reaction that's happening in their body. Then as you spoke to, there's the partial elemental diets. And that essentially means that a portion of your calories are coming from the elemental shakes and a Portion of them are from well tolerated easy to digest whole foods And the premise here is that the shakes, let's say you do your morning and afternoon filled with shakes.

They're essentially extending that bowel rest that you've had of like fasting through the night into the day, you know, through afternoon by not requiring digestion of your body. And then maybe, you know, somebody has like a late afternoon and a dinner meal of like, well tolerated food. And that can be used both to transition someone onto an elemental diet or off of an element diet in some cases. I remember you told us about the mushy and squishy diet. Yeah. And so these are like soups and stews, and really well cooked foods.

So we're not eating like, I don't know, potato chips or crackers. It's incredible because my husband did the partial elemental diet. We put him on a whole host of nutrients. I could link to those in the show notes that you had recommended. Then he went through this process. He was able to get into remission very, very quickly within just a few months. Now he can eat whatever. Like he just can't eat, whatever he wants. he has been in remision for many, many years now, at least six years, because this happened right after our son was born.

that he was diagnosed with ulcerative colitis. The prognosis for that, when we got from the doctor that diagnosed him, it was basically like, you need to be on these medications pretty much forever and this is what your life is going to look like. It was a pretty bad progosis and he's got no inflammatory markers. He doesn't have to avoid any foods. I will tell you, he is a little bit grumpy. at first about like having to do like a bit of a liquid elemental diet and then having To eat like the mushy foods.

But when he started to feel better, he was like, Okay, yeah, this is so so worth it. The only times he's had a flare up was when He was eating something with erythroel, which is common sweetener that's in keto foods and of course I remember calling you and you're like okay get him back on that elemental plan and so we always keep elemental diet like on hand. I Remember when I was first learning about elemental diets people were like making their own and then there's like commercial products available.

Do you have a preference or thoughts about sourcing or considerations or making your own? Yeah, so the fact that there's so many different options on the market these days, in my opinion, speaks to that elemental diets work and more people are becoming knowledgeable about them. So, you know, of course, just like any clinician, I have the ones that I use again and again that i see really great success with. Absorb Plus is really like Ginny Patel Thompson, who's my friend and colleague of 25 plus years.

Without her, I would not have known about elemental diets. She really put them on the map for me 25 years ago. And she has a product, Absorbed Plus, that was whey based, still is whay based. Has a brown rice one, which we haven't talked about this yet as the Bella, but there's also what are called semi-elemental. Okay, so just really quickly, semi-elemental might have whey, they might rice protein, and they also have amino acids. But they have small, short peptides, dipeptides and tripe peptide, the brown rice and the whye protein.

So amino acid, dipeptides versus like a polypeptide, I believe like collagen is a polipeptides, okay? That's not elemental. Aminos, dipeeptides and tripe peptides can pass through the small intestine lining without requiring digestion. So that's why those are what are in the elemental and those semi-elemental formulas versus a collagen or a protein shake, which is very different. Okay, I got totally off track. Okay. So there's Absorb Plus Amino, there is Physicians Elemental, Dextrose Free, that's another one I use.

There's Allison Seebecker, who's really the queen of SIBO and just a wonderful person and friend. She has a homemade formula that she put together many years ago that is wonderful for people that live in countries where they don't have access to the elemental shake formulas that are on the market commercially like we get here. And I choose the type of shake really based upon the condition that somebody's coming to me with. So for example, if someone doesn't do well with fat, that's really sensitive.

We don't want a product that has a fat put right into the shake because they can't tweak that to their needs. So we'd want to choose one where they could add their own fats, the type and the amount that they do well with. You know, so examples like that as more hit the market, I really study the ingredients. Some shakes have really great like methylated vitamins, others have poorer forms of nutrients in them. So I'm kind of like looking at all that when I am choosing shake formula for my clients or in my course I give like you know the pros and cons as I see it of all the different shake formulas on the markets.

Is there one that's like less tasty or more tasty in your opinion? I am such a dork. We have talked about this before. I have had friends over for elemental shake tasting parties because the companies will send me different samples to try. And what I had realized is taste buds vary so widely. Like I always use this example when chocolate formulas started to come out, I was like, oh my God, this tastes like vomit coated in cocoa powder. and Roy's like this is delicious, you know? What? People will tell me that, like, they love the shakes and they continue drinking them.

Other people will never want to touch them again once they complete their elemental diet. So it varies so widely. I remember, I think we did Michael drink a pina colada flavor, and I, think it was fine. It didn't taste like a Pina Colada, but... That's the physician's and elemental deck spree. And other people say it tastes like vanilla cake. I think it tastes like a pina colada and I swear there is no pineapple or coconut in it. So go figure. Yeah, as far as elemental diets, one of the things they're super, super effective, they can be incredibly helpful.

They can provide some of these amino acids that when we have digestive issues, when have hypothyroidism, we're not breaking down our proteins properly. And that can cause us a lot of inflammation. That means we are also not extracting those amino acid. amino acids are already done for you within the elemental diet. These are some of the pros that you're getting super nourished and that your eliminating the inflammation in your digestive tract and you can rebalance your microbiome naturally. What are the cons or potential side effects that may occur, especially if somebody perhaps isn't using it correctly without being guided?

Exactly. I sometimes sound like a broken record, but I always say that people who plan for an elemental diet are really planning for their success. Because what I often see is people get so excited, they just go for it. They don't really know what they're doing, what their body's going to go through. And your body can have side effects from an Elemental Diet. i call them par for the course side-effects of the Elemential Diet, things that if we know to expect and we what to do with, we can easily overcome them.

But if they catch you off guard, oftentimes people will throw in the towel on it. So so briefly, these side effects can come in. The form of well, let's take the obvious hunger. You're not eating solid foods, and that can be either cause people to be more hungry if their not doing their calories correctly or just psychologically be really challenging for people. especially if they're feeding a family, have children, are having business lunches, et cetera, so hunger. People can have energy swings and blood sugar fluctuations.

Again, this can be minimized greatly by choosing the best formula for you and spacing it out, doing the right calories, but But I see that a lot where people are just feel like they're on an energy or blood sugar roller coaster, because these are rapidly absorbed nutrients.

Full vs partial elemental diets and practical use 42:00

And then oral issues, that is the one that was the biggest surprise for me personally when I did an elemental diet. I knew to expect it, but I didn't know how uncomfortable that could be. And I came up with a lot of protocols. In my program, I have what I call a detox support kit, and that lists for people all the challenges and what tools they could use to overcome them. So oral issues generally come from a lack of chewing, which creates lack a saliva production. This wouldn't happen, Isabella, on a partial elemental, only on full.

because you are eating food and chewing. I think, quite frankly, the aminos and the shakes create a coating on the tongue for some people as well. Then the biggie is change in digestion. That really can vary widely how people react to an elemental diet. Some people will experience breast or bottle-fed baby diapers, hopefully not wearing a diaper, but poops. on an elemental diet where other people will have very, very little stool volume and what comes out will look quite solid. So it can really vary very widely for people.

But to be prepared for that and know how to treat their bowel if they go several days without a bowel movement or if on the flip side they're having several liquid bowel movements in a day because both are within the realm of normal. Interesting. And I think also I remember when we were first talking about elemental diets, you had brought up a weight concern. You can lose too much weight, is that right? Yeah, well, especially if they're not doing it correctly. So in general, I would say that amongst my clientele that I've worked with one-on-one, and I have not seen that be an issue.

In fact, utilize it as a tool for people who are looking to put on weight or at least maintain their weight while on an elemental diet. But I have had people come to me who have done elemental diets incorrectly, have lost a ton of weight. That can be a concern for some people for sure. Then while we're talking about concerns, given the blood sugar piece, someone who's diabetic would want to be under supervision if they needed to do an element diet, Yeah, I've had a few clients that have done it on their own and I think it was like they didn't calculate how much they should be having based on like their weight and have really crashed their adrenals and had blood sugar swings.

You know, anything from lost too much weight to just really felt awful on it just because it wasn't done correctly. And for a while, I kind of had this idea in my head that like just the elemental diet, like it's just not something that is, you know, can be done, but you've really You've worked with so many clients, and then you've really simplified it to a science where you talk about exactly what a person needs to do to be successful with an elemental diet, to figuring out exactly how much you need based on your current weight and goal weight, what your health goals are, how to utilize that throughout the day.

It's a bit of an art and a Absolutely. I say that all the time that people think an elemental diet is easy because it's simple. But as we know, simple isn't always easy, because its simple in the sense that we just drink shakes all day long. How we do it, how we feel, what our body needs as a result of that process, that's where the science, the art comes in. I think, can we talk about how a person might feel on the elemental diet? Are they going to go into ketosis? Will their brain feel better?

Well, they have mood issues. Are there concerns with eating disorders? What are your thoughts on, I guess, the brain component of that and how do you deal with that? Yeah, so like we said, people who are underweight need to have special concern. People who have diabetes need medical supervision but take special precautions. And people with a history of eating disorders, I have done it with some who really recovered from eating disorder as long as they're in a place where feeling like they are restricting in this way doesn't feel like it's re-triggering something.

And then a lot of the things you spoke to, I don't think an elemental diet that should not put somebody in ketosis. I mean, they're simple sugars. So there's one company that has like a keto elemental. But all the other things you spoke to like the energy, mood, brain issues, I think those are really minimized if you do an elemental diet prepared and correctly for your body and the health condition you're going in to treat. Thank you so much for that insight. My personal experiences, I used the elemental diet when I was earlier on my healing journey, and I thought it made me feel pretty good.

The weird thing about it was like I wasn't preparing food, And I think this was kind of a mental hurdle for me to get over. I don't know if anybody that you've worked with feels like that, because I had spent so much time preparing food, thinking about food. It was very interesting for me. Yeah, I see that go-to ways. For some people, they're just like, ''I don' know what to eat. Everything makes me feel bad. Oh, great. I just get to drink this for two weeks, three weeks,'' whatever it is, and that feels a vacation for them mentally and physically.

And then I have the clients, as I say, that call me and need like an SOS check-in because they're in their bedroom having a breakdown while their family's sitting at the table. And just, it is so emotionally hard for them to deal with. Sometimes you don't know which one you're going to be until you are in there. So that's why you want to kind of like know what to expect and prepare in ways. What I mean by that is like when I did the elemental diet, I prepared and did a lot of cooking in advance for our kids.

because you can't just have your kids not eat for that time. It was like half of our dishwasher would just be filled. The top was just like mason jars of just shake. And then the bottom would be like plates from what I warmed up for the kids. it was the least amount of dishes I had ever done in a two-week period because I did things to prepare so that the kid could eat. But I didn't have to be at the grocery store slaving over the stove meal after meal when I wasn't eating. Yeah, I think that's such an important consideration.

I want to say my husband was on a business trip to the point where it was just me and these jars and I was okay with not having to prep food. And it worked out pretty well. But I remember I only did it for a few days. It was one of the things that I that I utilized, and I feel like it helped even just those few days, but for people with SIBO and more serious digestive disorders, they really do need to do it for the long haul, is that right? Yeah, yeah. Generally, yes, because you want to have enough time to affect the immune system, inflammation, bacteria, all the things that we've talked about.

Yeah. And I want to say the research that I saw was like two weeks minimum, but sometimes even three weeks for... Are you talking about for SIBO? Yeah, is that right? Two weeks has an 80% success rate and three week's 85% of normalizing legolactylose breath test. Yeah and that would be follow-up testing to make sure that your SIBo is actually gone, right, because One of the challenges I see in people who treat their SIBO, and I kind of joke that they just like trimmed their CIBO that, they didn't eradicate it because you might have a SIBo test that's very, very high of a very degree of bacterial overgrowth in the small.

And then they'll use medications or herbal protocols or something, right? That's not an elemental diet. And they will go from like high SIBO to moderate SIBo versus like, or the SIbo will like start kind of creeping back up. And so they oftentimes need to repeat those protocols versus the elemental diet. It's just it can take, I think, in your experience, it could take severe SIBO to like eradicated SIBo versus just like shaving it a little bit, right? Yeah, yeah, I'm forgetting the exact numbers, but I'll do the best I can from memory that a two-week elemental diet can have like an 80 point parts per million reduction in gas levels.

And I've certainly seen that. I have seen 80, 90 points reduction and two weeks in some individuals. Whereas I want to say antibiotics and herbs are either 20 to 30 point reduction, for two weeks for medication, a four week protocol for herbs. So an elemental diet really can kind of fast track the process for some people with SIBO. if your bacterial overgrowth responds to whichever treatment you pick. I always use the analogy that if you were to have a UTI, you would pee in something, they would be able to tell you not only that you had a urinary tract infection, but what bacteria was present.

With SIBA, we don't know what bacterias present, We only know the class of bacteria. This is a bacteria that produces hydrogen, methane, hydrogen sulfide, And so we kind of do the best we can to choose the herbs or the medication that works for that. Why an elemental diet, I believe, is more effective is because we're not treating, we are just starving. In theory, all bacteria respond to starvation. I think that really simplifies the treatment protocols, especially if somebody has severe SIBO because you just know the elemental diets just going to take it down by 80 plus points.

Obviously, the higher the points of the parts per million on your breath test, then more severe the SIBo. I've looked at all of different types of bacteria and from a pharmacology standpoint, it's like this drug works for this one, but maybe not for the one. people might end up taking multiple courses of antibiotics and they can have resistance or just not the response they were hoping for. So this is really, really awesome. Can you tell us a little bit about your elemental diet course? I'll back up a little.

As I said already, I got into using elemental diets in my practice back in the year 2000. What is that? 25 years ago now, right when I started my practise. Really, at that point, When it started to come out, how effective they were for sebum, I started getting this influence because there were so few practitioners that knew about and used elemental diets in their practice at that point.

Side effects, safety, and success strategies 54:00

I was in this really unique position to now have this whole other group of people that I using elemental diets for after using them for inflammatory bowel disease for so long. And after doing that for several years, what I did alongside my husband is we put together this course that we called the Elemental Diet Success Plan. That really takes people from the beginning to the end of doing an elemental diet. How to get their body prepared, which shakes are the best to purchase given their unique conditions.

Just so you know, we don't make the shakes. I just educate people on how to do the diet, and then how do troubleshoot problems as it comes up along the way. different protocols you would want to use if you have hydrogen versus methane, SIBO versus are doing this for inflammatory bowel disease, tips for detox, if that should arise for you during the process, and then most importantly, how to transition back onto food after the elemental diet. with SIBO, things that might prevent relapse that you want to put in place immediately after so that that doesn't happen, etc.

It's really like taking hundreds of people through this course with my virtual handholding, essentially. I love that. You've helped so many people over the years, including me and my family and we're so grateful for all of your knowledge and expertise and the way that you guide people is just such a caring and gentle way. and yet so effective. I really, really appreciate you. And I've learned so much from you and so excited that you've created this course to help other people go through their healing journeys.

Can practitioners get this courses as well? Yeah, so I had a few practitioners take the course. What I always say is that the courses guided to guide somebody through or geared to guides someone through the elemental diet. So they would be taking the coarse kind of like learning how they would be guiding their client or patient through the elemental diet. It's not a practitioner course, it's a course for the individual to take themselves through. But those are all the steps they need to learn to guide their own clients through elemental diets.

So it's not like overly scientific where some of the I know practitioner courses are oftentimes very scientific and we like that, but this one is very practical and hands on. So I feel like both practitioners could benefit from the practical information and definitely anybody with SIBO could take it into their own hands and be able to care for themselves. Yeah, and in the end of the course, we include this whole like resources and references. And I keep adding to that. I just did my 2025 updates this January, but with new studies that have come out because if anybody wants to, they can click through, I have them categorized by condition.

If you want to look at the studies out there on Crohn's disease or inflammatory, irritable bowel syndrome and SIBO or cystic fibrosis, rheumatoid arthritis, you can and read those studies as well. As many of them as I could find not being a researcher. And I know some people really love those and then there are people that are like just want to skip past them, but they're there for you guys. if you wanted to get that information. There's just so much research supporting the elemental diet for SIBO and for so many of these inflammatory conditions.

And we know that SIBo is so common in people with thyroid issues. I know I've had a few people like restless leg syndrome and iron deficiency where SIbo was really driving that and driving a lot of their quote unquote thyroid symptoms, they've had a lot of success with the elemental diet with with getting those into remission. Are there other maybe weird or random things that you've seen that have improved? Yeah, so what I always tell people is there's some conditions that are comorbid with SIBO that we just can't snap our fingers and get rid of the condition.

So I've had a couple clients that have Ehlers-Danlos syndrome and that can be one that they have a higher likelihood of getting SIBo and sometimes they need to do protocols every few months or however often, and I've used that with some clients that have Ehlers-Danlos. There was one more, oh, clients have adhesions. We can do some things manually, but I have some client that had adhesion from scar tissue from inflammatory bowel disease or just from pregnancy that are at higher risk of SIBO because motility is just disturbed.

And same thing, an elemental diet, If somebody knows they're going to need multiple rounds of treatment, an elemental diet can be very effective and more sparing for the microbiome. Thank you for that insight. It's interesting because some people do have recurring SIBO2 and there could be other things driving it like H. pylori infection or something that really suppresses your stomach acid. Then you also need to consider why you keep having these regrowth. I feel like when you are that kind of a person, I don't think you want to keep taking the antibiotics time and time again.

mindful of what's driving it and then perhaps using a more gently and effective approach. I have the link for the Elemental Diet Success Plan. It's going to be in the show notes, and you're also offering $50 off with the code THIROID50. Thank you so much for that. You also have a free download for people. Can you tell us more about that? You can put that link in there too. I think it's mindfulfamilymedicine.edtips. Five tips for elemental diet success. That's just a freedownload that we have available that to me is the most important five things you can do to plan successfully for your elemental diets.

I'd love to ask you a couple of rapid fire questions if you have a minute. What do you wish more people knew about healing IVF? The one thing that we did not talk about that I think is behind a lot of what we've talked about is the gut-brain access, the nervous system. Particularly when There are cases where say inflammatory bowel disease goes away, but the gut is still more irritable. I see that a lot. IBD is gone, inflammatory markers gone. But there's still this irritability. And I think You know, that's something that I have needed and continue to work on for myself.

In some ways, it is so easy to tweak your diet and to take some supplements. It's really hard to change your patterning, your history, or your thoughts, the way your nervous system reacts to triggers. And I can tell you as someone who has sat in a clinical chair for 25 years, It is really a missing piece for so many people with IBS. Yeah, yeah, I think the brain-body connection, it really doesn't get enough appreciation, right? And how stress really contributes to everything. Not that I know anything about stress.

No, nor do I. Ladies, the leisure. Yes, yes, one day, in the meantime, we're going to educate people on how to take charge of their own health. I You and I, you've been my advisor as I've Been working on a IBS book. And I know that you and i have gone back and forth a lot about like stress.

Course details, relapse prevention, and closing reflections 1:02:00

There's a chapter in there definitely just about that because it's an important trigger. Another rapid fire question, what do you wish you could have told yourself when you were first diagnosed? A couple things. First is if I knew at 18 that here at 48 this week, I would have a 25 plus year career working on the gut. I may have had a better, not that I wouldn't have been glad that it happened, but it really was a make lemonade out of lemons kind of situation for myself. But really when I think back over the last 30 years of my 25 year The microbiome has gotten so much attention, and we know so more than when we did back then.

I always tell people the story, like when I first got diagnosed, there was no internet. Borders books or Barnes and Noble whichever one was there and there was literally two books on the shelf under inflammatory bowel disease and now there's like volumes So just the interest the different ways to approach this both from a body a brain a nervous system perspective Like it's just become like a super exciting field It's so incredible and one last question the gut and thyroid connection Yeah, so I was thinking about this, knowing I'd be talking to you.

And I think the thing for people to understand is why SIBO is so linked with Hashimoto's is because thyroid disease creates that altered gut motility. When we have an altered got motility, we open the door for bacteria to overgrow. So I that's the think for to people understand about where that connection lies. And then why, just to come full circle, an elemental diet, I think, is effective for people who have Hashimoto's is because many people, who has Hashimoto's, are in that place of having multiple food allergies or sensitivities.

So a diet that is so hypoallergenic benefits that. And, then secondly, People who have Hashimoto's often have a lot of nutrient deficiencies that go along with their thyroid disease. Elemental diets give you a product that delivers them in the most absorbable form. In my brain, that's where this puzzle comes together for thyroid diseases. I love that. And I know that you've worked with a lot of clients with thyroid disease as well, walking them through the diet. Yes, thanks to everything I have learned from you.

Oh, it's so wonderful that we get to learn from each other. Totally. I didn't share that part if I had two minutes. When you know for me treating my Crohn's was I found that best route for was not medication. But I have told Isabella that you when I first got diagnosed with Hashimoto's I tried medication I was over medicated and hypothyroid. and was just like, see, medications do not work for me. And I spent the next two years like a zombie trying to take care of my daughter. It was when I found Isabella and read your book that I gave myself permission to say like okay, I am doing all these other things.

They were already part of But what if I do need some thyroid hormone? And really, your integrative approach that balanced both things was really what helped me get back to my health. So thank you, my friend. It's my pleasure. And I feel like an integritive approach is the kindest thing you can do for yourself. Sometimes it's medication, sometimes it is nutrition, but just doing what's right for you and your body at the right time. we all need to get past some of like the biases or some other things that we might not be open to and just keep an open mind because there are so many wonderful healing modalities out there.

I know I've opened up your eyes to thyroid hormones. You've open up my eyes for the elemental diet. So it's been incredible and I'm so grateful for elemental diets. It really gave my husband his health back and gave me my has been back. for everything that you do for people. That's why you're my soul sister, all of our common lifestyle and interests. I would love to, if you could share your website and where people can learn more about you and your work. Yeah, so my website is mindfulfamilymedicine.com and you can about me there and my nutrition practice.

My husband is an integrative pediatrician and that's our shared website. Wonderful. And Dr. Roy Steinbach was also on the show as well. So tune into his episode. Thank you so much, Debbie, for joining us today. It's such a pleasure to have you here and everybody joining today, I hope this conversation is going to be part of your healing journey. If you know of anybody that could benefit from this, please share.