Tracy Konoske, MS RD
Tracy Konoske is a Registered Dietitian (some may call her a Nutritionist) who specializes in Natural, Integrative, and Functional Medicine. You probably have a sense of what Natural medicine is – herbs, supplements, stress reduction. Integrative comes into play because most sick people are on one or more conventional drugs so we “integrate” care. We also “integrate” your body, mind, and spirit when addressing your health conditions.
1:30 Functional Medicine Journey: After her training, Tracy had a face-to-face practice. Five years ago she closed that practice to create a thriving 100% virtual practice, while she lives on her 35 acre farm in rural Montana.
5:14 Gardening: Everyone can do something. Almost anyone in any location can grow salad greens for an entire summer, using a raised bed and creating your own soil. Even in cities, many people can have a few chickens. You can use the manure as fertilizer for your raised bed. We could all take more charge of our food supply.
6:49 What is SIBO? It is an overgrowth of bacteria in the lower part of the small intestine, which should be almost sterile. It is where we do our digestion and absorption. The microbiome we speak of is mainly in the large intestine. There are two types of SIBO. People with SIBO Hydrogen tend to have a fast transit time and loose stools. SIBO Methane has a slow transit time and infrequent bowel movements with hard compacted small stools. Each has its own treatment.
9:31 Top Causes of SIBO: The causes are many. Food borne illness (food poisoning) causes 25% of SIBO. Head injuries, even those from years ago, can impair the brain’s ability to regulate digestion. Poor diet or low hydrochloric acid, often from antacids, can be the cause. GMOs and pesticides could play a role as well.
11:54 Gut/Brain Axis: Dr. Datis Kharrazian, a leader in the area of Gut/Brain Axis, assesses bowel tones and pallet arch shifts; which can reveal vagus nerve issues that impact digestion. The vagus nerve begins in the head, runs behind the ears, behind the throat and encapsulates with a web, the heart and nearly the entire digestive system. The vagus nerve has a critical role in gut/brain axis. The vagus nerve can be stimulated with gagging, gargling, and coffee enemas. Discussed at this year’s SIBO symposium was acetyl-L-carnitine ,because the vagus nerve is an acetylcholine based nerve. Also discussed was Lion’s Mane; a mushroom with nerve regenerative properties. Most people with SIBO have cognitive dysfunction and acetyl-L-carnitine is good for the brain, so it provides two benefits by helping the brain fire and the vagus nerve fire. Tracy uses these treatments with her SIBO patients.
14:05 Chronic SIBO: We need to be looking at what caused it and how to address those causes rather than only prescribing herbs or antibiotics.
15:28 Stress Reduction and SIBO: Repairing the vagus nerve is critically important. Imparting this to patients is a big challenge. Heart Math and deep breathing are effective, but compliance is an issue. Through stress reduction, nerves can be replasticized; where modifications can be made to the nerve so it can again fire and receive signals. It takes 3 weeks for the vagal nerve to replasticize.
17:47 Fight or Flight Impacts: If your body is fleeing the figurative bear, it is not digesting food. Digestion is a low priority in stress response; the food sits there and ferments. Our stressful lives may be a large contributor to the current SIBO epidemic. Bile is antimicrobial and it is suppressed during times of stress. Having your gall bladder removed can be a risk factor for SIBO because it reduces bile flow.
21:20 Food and SIBO: To fix SIBO, Tracy puts her patients on a low FODMAP diet or the hybrid FODMAP/Specific Carbohydrate Diet created by Dr. Allison Siebecker (http://www.siboinfo.com/uploads/5/4/8/4/5484269/sibo_specific_diet_food_guide_sept_2014.pdf ) We are trying to reduce the fuel. Many people have lost the ability to digest disaccharides, so a combination of FODMAP/SCD, though restrictive, is effective.
21:53 Prebiotics/Probiotics and SIBO: Tracy does not believe that we should be using prebiotics or probiotics on SIBO until we know if their migrating motor complex works. The migrating motor complex sweeps the garbage from the small intestine. Gut motility, the ability to have regular bowel movements, is not an indicator of a poorly operating migrating motor complex. So if the garbage is not being cleared from the small intestine, prebiotics and probiotics are feeding that garbage.
23:21 Smart Pill: With cutting edge capsule technology, there is no need for barium studies. You go to the doctor for this test which requires you to consume a food bar to help carry the capsule through the digestive tract. You swallow the capsule. Over the next few days the capsule travels through your digestive tract and data is captured on a small device you wear. It monitors your PH, which will reveal whether you have sufficient hydrochloric acid. It monitors pressure, showing how effective the valve is between the small and large intestine. It measures transit time in its entirety and segment to segment. It is predictive. If you have high PH, slow transit time and not enough pressure in the valve between the large/small intestines, you may be at risk for SIBO or these markers can help determine the cause of chronic SIBO. It determines future treatment. This test is now being covered by some insurance companies and Medicare.
28:51 Herbs for SIBO Treatment: Tracy follows the experts: Dr. Steven Sandberg-Lewis and Dr. Allison Siebecker. Patients differ as do their tolerances. Tracy often uses berberine, neem, or high doses of ADP oregano from Biotics. If her patients have high levels of methane, they need to take garlic. Tracy says that Biocidin liquid antimicrobial, Designs for Life Silvercillin liquid, and essential oils are on her radar as treatments. Essential oils lack data, but she is suggesting its use in conjunction with other treatments, often as a last resort.
30:51 Elemental Diet: This was just introduced at the recent SIBO Symposium. There is little data, but Tracy is intrigued. A lactulose breath test was administered. For two weeks, patients followed the elemental diet; no food, just amino acids with a fats and carbohydrates in a bad tasting shake three to five times per day. There was no fuel for the fire and it produced remarkable follow up tests. It was as effective as antibiotics. It is expensive. Dr. Siebecker discovered that you can source your own ingredients and make your own for a fraction of the price.
32:57 Effective Pharmaceuticals: Antibiotics can create SIBO, but antibiotics can also fix it. Xifaxan is now FDA approved for IBS. It is effective for Hydrogen (diarrhea) SIBO. Xifaxan stays in the small intestine, so it will not cause a yeast infection or UTI. It predominantly leaves the microbiome intact. It only works in the small intestine, because it needs bile to activate it. Once in the large intestine, it crystalizes and dissipates. This is not your typical antibiotic. Xifaxan also helps the body to prevent resistance to antibiotics with which it is paired; so they retain their potency. For methane or hydrogen/methane SIBO, patients would take xifaxan along with either neomycin or flagyl (metronidazole). Tracy, however, works with a functional medicine doctor who finds that either tinidazole or compounded tindamax has fewer side effects than flagyl. Standard protocol is that these be taken for 14 days.
36:19 Retest: Patients can remain symptomatic. When retesting shows that SIBO is gone, but the symptoms remain, then one looks elsewhere for the cause. It could be celiac, food sensitivities, gastroparesis, Lyme disease or other causes. If the small bowel is now fine, perhaps it is the large bowel. Tracy is treating such a patient now with fermented foods, short chain fatty acids, saccharomyces boulardii, and building microbiome diversity through a diverse and fibrous diet.
39:28 Adhesions: According to a presentation at the SIBO Symposium, when patients fail SIBO treatments quickly, you should consider that the cause may be adhesions. Adhesions can come from surgery, trauma, inflammation or infections. An inflamed gut could possibly create adhesions. We are just beginning to explore the causes, assessment and treatment of adhesions.
45:18 Morning Routine: Ideally, Tracy would like to sleep until she wants to wake up, do her Heart Math, pick greens from her garden, make her smoothie, and exercise. However, the chickens, and maybe the cows, need to be fed and watered. She realizes that a morning routine is important and she has a checklist in her head, but struggles to bring it to reality.
47:05 Just One Supplement, Nutrient or Whole Food: Tracy’s top pick is her daily green juice. It contains no fruit; just “green stuff”. She feels that she is at her best when she drinks it.
48:31 One Health Tip for America: Tracy believes strongly that genetically modified foods should be removed from the American diet, or at the very least, appropriately labeled. She would also like to see more Functional Medicine training for physicians.