E189: Functional Medicine Nutrition with Megan Barnett

Episode 189 January 23, 2024 00:49:51
E189: Functional Medicine Nutrition with Megan Barnett
The POTScast
E189: Functional Medicine Nutrition with Megan Barnett

Jan 23 2024 | 00:49:51


Hosted By

Cathy Pederson Jill Brook

Show Notes

This is a conversation between Jill Brook and Megan Barnett discussing the relationship between nutrition, gut health, and complex health conditions like POTS and mast cell disorders. They delve into topics like food sensitivities, the importance of micronutrients, and the role of functional medicine in managing these conditions. 

Megan's website is: https://bioloungepdx.com

You can read the transcript for this episode here: http://tinyurl.com/potscast189

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Episode Transcript

E189: Functional Medicine Nutrition with Megan Barnett [00:00:00] Jill Brook: Hello fellow POTS patients and lovely people who care about POTS patients. I'm Jill Brook, your hyperadrenergic host, and today we are speaking with functional medicine nutritionist Megan Barnett about what is functional medicine nutrition and what might it have to offer complex patients like us. Megan is co owner of BioLounge, a cutting edge longevity and functional medicine clinic in Portland, Oregon, whose mission is to offer the latest scientific and medical advances to help patients extend lifespan, reverse disease, and prevent illness. Megan earned her Bachelor's of Science in Dietetics from Kansas State University, her Master's of Science in Nutrition and Functional Medicine from University of Western States. She is a certified nutrition specialist and also has a mindful eating certification from University of California. Megan travels extensively giving presentations on various nutrition topics, and I met her because we are both in a community of mast cell researchers and practitioners, and she generously shared some super helpful information that she had spent many hours pursuing, and it helped me personally a lot. And when I reached out to her to talk to her about it, she was so smart, so kind, so generous with her knowledge. So I'm thrilled to have her here today with us. Megan, thank you for joining us today. [00:01:24] Megan Barnett: Oh, thank you for having me Jill, I'm so excited to be here. [00:01:28] Jill Brook: So for starters, can you tell us what is functional medicine nutrition? Can you tell us about your clinic? What kind of issues do you help people with? Why did you pursue this instead of becoming a normal dietician and all that good stuff? [00:01:44] Megan Barnett: Sure, I can give you some background. So I guess the best way I could sum up what a functional medicine nutritionist is is somebody that has a background in functional medicine and uses nutrition as their primary tool to resolve underlying imbalances. And what that means to me in a clinical setting is instead of starting with nutrition, actually finish with nutrition. But what I'm looking at when a new patient walks in the door is What is their body trying to tell me through the symptoms? I think of symptoms as a language and you know, if you were to speak Japanese or something, I don't speak Japanese, I wouldn't understand what you're saying. I try to understand what the body's saying through symptoms. And then think about what underlying mechanisms may be affected or affecting those symptoms. So then I'm trying to think about biochemically or physiologically what's happening. And then look at, okay, well, Where are the potential nutritional factors that are affecting or being affected by this? And I will say that I think because of my specific graduate program that I did, we also spend a lot of time looking at factors that affect the gut barrier that are affecting the, the way our immune systems work. So we go beyond just the nutritional factors into infections, overgrowth, toxins, environmental factors, stress, et cetera. Anything that would be affecting the gut barrier and the immune system within that, the gut. I went into this field instead of into classical dietetics because I got sick, surprise, surprise, as with everybody else that tends to enter our field. So I was doing my undergrad, I actually was a general contractor for about 10 years and I was working in late 1800, early 1900 homes and I was young and naive and not using any proper protection in those situations, so that probably factored into my ultimate demise into chronic disease in my early 30s. But I had two little babies and I got sick and I went back to school and was being taught things that I was having a really hard time like don't worry if your patient gets sick of the vanilla carnation instant breakfast just add jello packets to it to change the flavor. And that was like the head of my department at Kansas State And I was thinking like, oh, I'm going to struggle with this, you know? So I ended up in chronic pain and I was seeing rheumatology and they were saying it's looking like scleroderma and, you know, at this point I'm in my graduate program and I'm pulling out my books and I'm like doc, this is saying terminal, is this what we're talking about? You're telling me I have a terminal disease you know, and this is a little TMI, but in the midst of all of this chronic pain, not being able to really move, I got a vaginal yeast infection, went to my OBGYN, she gave me a fluconazole, 24 hours later I had no pain anywhere. And I sat back and said, what does this mean? And so that personal experience, basically what came out of that is I did not have scleroderma. I did in fact have a systemic fungal infection that was then treated with the fluconazole. And went on to get very, very interested in the many things that might cause a symptom, not just one thing. And then also think about well, what does a diagnosis even mean? If, if a diagnosis is classifying my symptoms, is it telling me why it's happening? So that led me to really go, like, I need to be in functional medicine. I need to be the detective. That's what I like doing and why I left kind of classical dietetics behind. So that was a really long answer to your question. [00:05:40] Jill Brook: No, no, that's a great answer and I think like you say, for many people who have something really complex going on, the old way of doing things kind of just doesn't cut it. And thank goodness you didn't stop at that diagnosis because sometimes it seems like a diagnosis means that everybody stops thinking and if that how it happens and you didn't get it quite right, oh goodness. [00:06:04] Megan Barnett: exactly, yeah, you want people to, to dig into the why behind your what and a diagnosis is nice because you can look at what the research says and say, okay, with this diagnosis, what do we know works or doesn't work, et cetera, et cetera, right? So it has a utility but it also doesn't need to be the end of the story, I think. [00:06:23] Jill Brook: yeah, okay, well, so speaking of complex things and doing some detective work and looking for answers, you recently changed my life with little old vitamin C, because I had been itching every single night for like two years, and it wasn't just an itch, it was like a stabbing itch. It felt like I had little imps all over my body holding pitchforks, .. stab it into my skin somewhere and then it would itch. And I knew that it was histamine related, but none of the normal mast cell supplements were helping. Antihistamines would help a little bit, but they made me too wired to sleep, so I couldn't do that at night. So I was losing my mind trying to figure out the trigger, which I never did identify, like every day of my life, you know, just reviewing every little thing. And I think a lot of our listeners are going to know that feeling. You're just ripping your hair out. And then you just happened to generously share some discoveries you made while doing a really deep dive into the literature like, all these experts, nobody had stumbled upon the information that you found, and it solved my itching problem in like under 20 minutes. And that's when I emailed you, and I said for the first time ever to a complete stranger that I could kiss you, because I was so out of my mind with relief. And you were so gracious about it but, you know, and you had more information to share. And I was just like, wow, here's somebody who cares. They're doing so much extra work. They're going above and beyond. But I'm just wondering, can you kind of like talk about your process on things like that? Just like as an example of how you work, because as I said, like nobody in traditional dietetics or in even the medical world is teaching about what you found. And so like, how'd you find that? What were you doing? [00:08:18] Megan Barnett: Well, you know, I think my process is probably maddening for most people because what it generally looks like is observation first. So I work in a clinical setting. Not only where I work with complex, chronic symptom presentation, right? So, providers send people to me and say, can you try and figure out what's going on with this person? And sometimes you don't have the research to tell you what is going on with them. You don't have a diagnosis, right? So I try to get very systematic and logical about what I'm looking for and then the interventions that I apply to then try and track the results. Now what happens is I'll see patterns, right? I'll do this, see people start to look the same in that, okay, that person has this presentation and so does that person and they have this going on and so does that person. Oh, and this intervention worked for all these people. I wonder why that's happening. Why would it be working? So one part of my research, and I would say it's a large part, is trying to find the reason why something's working. And justifying it with the research, right? And so I always get nervous because I say, Oh my gosh, am I just like always inherently biased with everything? Because I have a clinical result that then I'm trying to prove with research versus going in, you know, a double blind study where then, it's like, did it work? Did not work right? But I can't work that way because I'm in nutrition science. So it's virtually impossible. So I own this medical clinic with a nurse practitioner who is also a functional medicine provider and everybody we've hired that works with us is uber curious. And so you can toss out this idea and say, why do you think this is happening? Or, do you know anything that might work for whatever you're seeing? And everybody gets really geeky, and everybody shares ideas, and we send studies to each other on the weekends and say, did you see this, right? So there's this inherent curiosity that comes with not only my job based on the patients I see, but also our clinic. What happened with vitamin C is that I had COVID three times and I also had a reaction to my second vaccination where I developed histamine symptoms for the very first time in my life. And we were using vitamin C, we do high dose vitamin C IVs here, we're using it for a lot of people, but I wasn't seeing necessarily a histamine benefit. And I got COVID again and I said to one of the clinicians I work with, do you know anything that I could do? This is such a bummer. And we're going to go back down for weeks again because now my immune system's just tanked and he said listen Sometimes you need to do up to 80 grams of vitamin C a day But just do the titration just start low and then increase and increase until you have bowel intolerance. So I mean you should have seen a number of vitamin C bottles at my house, right? [00:11:17] Jill Brook: And for listeners, a normal amount of vitamin C would be more like one [00:11:20] Megan Barnett: one of those [00:11:21] Jill Brook: If you're talking like up to 80, yeah, [00:11:23] Megan Barnett: I'm up to 80 at this point with no bowel intolerance whatsoever, and I was feeling my immune system get better, but what actually was more marked about that is my histamine symptoms went away, that I'd been dealing with for, at that point, over two years. And I was at the point of getting ready to do the, like, remediate all the mold out of my house in Portland, Oregon, in the middle of a rainforest, where you were never going to remediate mold in a 1920s craftsman, right? But I was ready. I had already had them in. They were like, yes, you have mold. I'm like, of course I have mold. Okay, so we're going to do this. And I took a step back and I said, okay, this is my internal body. So that's why I'm reacting to all these things. So what's going on? Well, then I was able to start utilizing that with patients that were dealing with mast cell activation syndrome chronic itching, which sometimes comes along with that, but doesn't necessarily always fit that whole profile of like mast cell, right? And they weren't needing nearly the dose that I was taking. But what was even more fascinating is that what we did not see the benefit in IV vitamin C. So that was the original irritant to my brain where I thought, well, I I have to go look in the literature because why would it be benefiting people orally but not benefiting people intravenously in the way that I was expecting it to with histamine? So the rabbit hole that I went down was really around the interaction between vitamin C and the mast cells within the intestinal barrier. And then the degradation of histamine and so what I was finding in the literature is that yes, when you take vitamin C, and this is just even two grams of vitamin C, it degrades histamine, but it also increases DAO, which is also degrading histamine, right? So countless studies later, I became a believer in utilizing vitamin C for people that were experiencing Any type of histamine reactions. And then I was speaking with a couple of our fellow mast cell physicians here in town. And I said, are you seeing low vitamin C in people? Like, are you, are you seeing that when you test them? I test people. So I look at intracellular levels, the levels within their white and red blood cells for micronutrients. But they were not doing that. And then after we were talking about this, it started coming up in conversation, like, oh crap, we're seeing people at even like as low as what would be considered scurvy level. So, you know, long answer, but I'm like, now I'm in that research. Like, what are all of these, you know, significant deficiencies where we may just be right on the edge of that presentation of scurvy or presentation of briquettes or presentation of all the things we know about as nutritionists. In the most extreme deficiency, but we don't necessarily think of in maybe subclinical deficiencies, right? [00:14:19] Jill Brook: right? So I mean, that's kind of two different rabbit holes to go down with vitamin C. One is just so it's clear for our listeners that yes, everybody recommends vitamin C and mast cell activation syndrome, but they're recommending like one gram a day. And what you found and what you shared with me was that at way higher doses. Obviously talk to your practitioners before just doing this. There's nuances, but that like for me, higher doses work like Benadryl for me, which is amazing. And I have no idea what my vitamin C levels would have been, but the second rabbit hole is that people who ought not have extremely low vitamin C. You are finding them at scurvy levels, you say. These are not people who are out to sea for months on end without any vegetables or fruits. And so what on earth would be causing that is the next question. [00:15:10] Megan Barnett: Right, and that's what I think about, you know, I think about these things all the time. Why are we where we are right now, and I'm going to say a bunch of anecdotal things because I don't actually have any research to back this up. There might be research, I haven't found it. But my understanding is that when you endure a a viral infection or a trauma or even just chronic stress, there's a larger demand on the stores of vitamin C and of most of the B vitamins and zinc kind of to show up to the party for adrenal function and cortisol production and a litany of things that our bodies need to function under higher pressure. Our food sources in general, we know have less nutrients than they had before for many reasons, even if you're eating a whole food diet. And then we're asking more of the savings accounts of these nutrients in our bodies to show up every single day. And I say that kind of because I, I have this other part of my business that is totally bizarre, but I do work with a small percentage of pro athletes and I run these tests on them too. So think about how a pro athlete uses their body and it's like hours of training every single day, right? And I see largely the same presentation in their micronutrient levels as I do in somebody that's chronically ill. , and I used to say to moms all the time that were like working moms with three kids and going to soccer practice every single day, you know, and they had no time to themselves. I would say, well, we have to treat you like an Olympic athlete because that's what you're asking of your body. But I think that's really what we're talking about with a lot of humans today for a lot of reasons is there's just a lot of pressure on the organism. [00:16:57] Jill Brook: Yeah, that makes a lot of sense. And I think you're saying like, not just the physical demands and the mental demands, but the environmental stresses and everything. So, okay, so that brings me, like, when you have a new patient in front of you who has something complex like POTS and maybe some of the common comorbidities like autoimmunity or MCAS or whatnot, what is your approach? What do you start thinking about or doing? [00:17:23] Megan Barnett: Okay so I guess as a clinician, there's like this clinical screening that starts. So we have a pretty hefty initial intake form for people, but really what happens is that's sort of basics. And then when I see somebody for the first time, we go through pretty much every system in the body. And then I think maybe even more importantly We go through a timeline, which is, this is sort of a functional medicine approach, that you start at birth, at childbirth, and you maybe even talk about the parent's health prior to birth, and you go through every decade, everything that occurred in their body or with their health or with their you know, psychological health or stress or whatever, and the combination of looking at all the systems, not just, why are you coming here to see me today? That's one part, you know, what are your symptoms today? But really looking at everything going on with their liver, or their sleep, or their stress, or their exercise, or hydration, whatever, and the timeline. What we're looking for is that a picture starts to sort of emerge from that around what may be pushing the body towards the symptom presentation. Because again, I don't really like to look at the symptoms as the end all be all or the diagnosis as the end all be all, I like to think of that as the body trying to tell me something that I'm then trying to figure out under the surface. So, for instance, when I'm having that initial conversation, I am thinking about nutrient deficiencies, I'm thinking about inflammatory foods, I'm thinking about environmental allergies, I'm thinking about environmental toxins, I'm thinking about stress and then like the ability to rest and repair, viruses, exposures to viruses over time and then more recent viruses. I'm trying to figure out what it is in each unique person, right, that might be reducing the body's ability to thrive. Then I just have to have some sort of a hypothesis going on, right? And the conversation with the patient typically goes like, okay, here's my hypothesis. We have two options. We can test my hypothesis by doing labs. and maybe we are looking for infection for for different peptide responses by the immune system to food or we can utilitize the hypothes tois Take you off of certain foods. We can do this, you know, antimicrobial approach and see what happens. Most of the people that come to see me want to test. They're kind of over it. They're done being sick and they want data. As I'm sure you can imagine, it's a long road for most people to figuring out what's going on with them. So then we'll normally test. We'll figure out a panel of tests that will help prove or disprove the hypothesis. So I think, you know, the pressure I feel as a clinician is I better have a darn good hypothesis because I don't want to go spending people's money or wasting their time with a test that isn't actually relevant. [00:20:20] Jill Brook: So, so, fantastic. So can you talk more about what are some tests that come up pretty often in this population? [00:20:28] Megan Barnett: Yeah, when I go into this type of work with people, I think the body is the body is the body. Right? Like a human body has ways that it thrives and it has ways that it doesn't thrive. So regardless of what the presentation is, we need to think about the foundations of what throws a body out of balance and what keeps a body in balance. So that's how I frame testing. So let me give you some ideas of the most common tests that I use and why I would use them. Once upon a time, when I didn't work with really complex people and I was just, really I was working more with like autoimmunity, which I shouldn't say isn't complex, it's totally complex, but it's kind of not the wild card that MCAS is, I did a lot of food sensitivity testing, but I did it with a specific lab that tests the immune system's reaction to the peptides within the total protein of foods that we were concerned about was a little more of a sensitive test because of that. And, you know, I always say, I'm not going to ask people to spend a lot of money on a test if I don't get really incredible results from the test time and time and time again, right? This is a test that ended up yielding results for a really large percentage of the people I worked with. So, what I see when we apply that information, when we take the foods out that the person is making antibodies against, and I'm talking about IgG and IgA antibodies, okay, not IgE, which is what we're normally thinking about, right, in MCAS, but IgA and IgG. I was seeing reductions in histamine, so one example of that would be a kid with eczema and hives. That was allergic to, you know, milk and the cat or whatever. Right. And then we would take the IgG and IgA foods out. And all of a sudden the eczema clears up, the hives go away, and he's not nearly as itchy around the cat. Well, that's a head scratcher for me. Right. I'm like, why is that happening? I'm sure there's all sorts of reasons. I just didn't totally understand them. So that test has held its power, I would say now in all the years that I've been using it. And we've continued to see it be part of the picture. I am challenged by physicians on a regular basis as to why I do this test. Like, there's no evidence, there's no efficacy for IgG testing, and there sure isn't with IgE. And I'm like, listen, I don't know what to tell you. It just, it works, right? But now, as I spend more time in the mast cell research, I start to wonder if because there's an IgG receptor on the mast cell, If the potential for increasing IgG when the immune system comes in contact with certain foods, that there may be the mast cell getting this receptor filled, right? And then it actually looks like it doesn't release histamine, it releases cytokines. But we also know that IgG is stabilizing for IgE. So then it makes my brain wonder, okay, well, are we having like a very acute IgE response but it's just teeny teeny tiny to certain foods, not even high enough to register on a food allergy test or skin prick test because the IgG is swooping in and stabilizing the mast cell? I don't know the answers to any of these things, Jill. I'm just telling you these are the [00:23:45] Jill Brook: Yeah, you [00:23:46] Megan Barnett: right? [00:23:46] Jill Brook: is, this is completely, completely fascinating, and I guess just for our listeners, we have in the past talked about molecular mimicry, whereby if your body makes an antibody to something like a food that you're eating, then maybe That antibody will will also attack some healthy body tissue that looks similar So that's a mechanism by which they think that autoimmunity could be [00:24:10] Megan Barnett: Yep. Yep. [00:24:12] Jill Brook: and now you're saying But there's also a way that a mast cell Could go either way. Maybe IgG is setting it off or maybe it's stabilizing and it's funny that you mentioned that IgG can be stabilizing to mast cells because I just finished my IV IgG for the month which helps my mast cells and so the funny thing is since I knew we were going to be speaking about IgG and IgA antibodies and the classical normal allergic response, which is IgE. I went up and I just kind of did a quick remind myself. What's the latest greatest thinking on this? And sure enough, even like the top allergists will say this is a mystery. We see that people are reacting to foods, and we're not sure why. We now acknowledge that there's something going on with IgG and IgA, but we don't really understand it. The IgE is the old traditional Allergy, you know eat a peanut, go into anaphylaxis, but these other ones are still kind of a mystery and so so it sounds like what you're saying is who knows what's happening but clinically you believe that these tests are helpful for you. [00:25:20] Megan Barnett: Yeah, yeah, and I mean, I would say at this point in my career, if I were to guess, I've probably run somewhere in the neighborhood of 1500 of these food sensitivity tests. So, I have a large panel of patients that have had really significant benefit, everything from chronic pain to chronic fatigue to mast cell to POTS. Now, POTS is really interesting and I was looking at some research recently because I'm like, why are they improving when I take food sensitivities out for POTS? Come on, there's got to be a reason here, right? There's definitely no conclusion on this in the research, but there is this question around the potential autoimmunity theory with renin because, you know, they're seeing angiotensins the same, POTS, no POTS, but renin isn't. And so I don't have an answer for you there, but is there a possibility that when we downregulate the production of antibodies, let's just say that to be more general. That we have less activity against whatever tissue. And that's when I think about it, for instance, when we're dealing with Hashimoto's for thyroid autoimmunity or any autoimmune disease, the way I describe this to patients is if you just think about taking your hand to the little knob on the stereo and turning the volume down, all we're trying to do is turn down the volume on the production of antibodies. If your antibodies are attacking something in your body, one reason or another, If we turn the volume down, we have less tissue damage, right? So, I think that's what's happening, and I don't totally know why, right? Now, micronutrient testing, that's very logical. We look at what's in your white and red blood cells. If you're deficient in your white and red blood cells, which live for three months, we make the assessment that you have probably been chronically low in that nutrient. We bring your nutrient status back up to optimal levels. That's going to affect everything from the mitochondria to your ability to break down histamine, you know, et cetera, et cetera. So that's a little more cut and dry. I feel like when we do those types of tests. [00:27:28] Jill Brook: so when it comes to that micronutrient testing, do you think that people in this population are deficient typically because they're unable to eat normally or properly? Or do you also see it in people who have pretty normal diets and they must just not be absorbing or processing it ? [00:27:46] Megan Barnett: yes To all of those things, and I think that it depends on the status of the body when they developed POTS, like what was going on before that. And then, and I say that because In any conversation I'm having with somebody around nutrients, I'm thinking about what are you taking in from your food? So what are you actually putting in your mouth, right? What are you actually able to digest and absorb? Because then we have to really think about how the digestive system is working in that person. Is it working optimally? Can they actually even break the food down? Then we have to think about the health of the intestinal lining because that's where absorption happens, right? Then we have to think about the ability to actually utilize the nutrient within the system, which is partially genetic even. We have a lot of genetics that will affect that. And then we think about, but how much do you actually need? How much of each of these nutrients is your body demanding to complete all the processes it has to complete? And that's where I say I have a lot of questions because if you are under stress or in duress, your body needs more than somebody that is laying on the beach in Fiji every day of their lives, right? Living their best life. That's stress. So if we just call it stress, it doesn't matter why, right? You have to show up to the party with a lot more resources if your body's under stress. And so I often wonder, like, can we even get all of that from food? If the body is under stress. And that is why we do supplementation, we do IV therapy, we do whatever we really need to do to get the nutrient in the right form into the person's body to resolve that foundational issue. [00:29:38] Jill Brook: Yeah, I used to be such a hardcore believer that if you just tried hard enough, you could get everything you needed from food. And I even did some pretty out there experiments like, you know, eating three bell peppers as a snack, just thinking, I'm going to get my vitamin C this way. But, but I'm now a believer that that's not actually possible. And I have a big Wisconsin appetite. And I feel like if I couldn't do it, nobody can. [00:30:05] Megan Barnett: Yeah. Yeah, I, I do joke with people because, you know, you might imagine that I'm pretty focused on my nutrition, right? I live in Portland, Oregon, where you can pretty much get whatever you want. And I eat organically, and I eat a very plant heavy diet, but I don't exclude any food groups. Like, I eat really optimally for a human being in this species. And I've done now three micronutrient tests on myself. It was abysmal last year after my multiple rounds of COVID. [00:30:38] Jill Brook: Oh, that's kind of encouraging. [00:30:41] Megan Barnett: Oh yeah, I couldn't believe it. I'm actually waiting for my most recent results to come back and genetically too there are certain things like that we don't understand, right? Like I'm double homozygous for the MTHFR and I have no issues with homocysteine whatsoever. Well, that's a little bit baffling if you think of it only classically, right? But my MCV is off the charts, so I have to inject B12. So I think, you know, I give that example because we don't know enough to say, well, we know this one thing about you genetically, so we know what to do with you nutritionally. We really have to apply the intervention nutritionally. And so, when I think about nutrition for the subset of the population that's struggling with whatever they're struggling with health wise, I think about, well, let's pull the pressure off, let's take the things out of the diet that are causing pressure, which may be a food sensitivity, may just be sugar, right? I work really hard on blood sugar balance with my patient population and we use continuous glucose monitors and things like that as well. So we're looking at, okay, what are any of the things that are causing pressure on the system that can also be not enough nutrients? That's pressure on the system, right? But then I think, what are all the things we need to do to provide enough resources for the body so it doesn't have to negotiate? And the way that I, I really try to articulate this to my patient population is just like if you had a thousand bucks in your savings account and you had to pay rent and you had to buy groceries and you had to take your car into the shop. And all of that was going to be 1, 500. What would you not do? You probably wouldn't take the car into the shop, right? So our symptoms sometimes to me are a reflection of that negotiation. The body's making, it's probably going to keep your heart beating. It's going to work hard to maybe, I don't know, keep your temperature up. And, but there's going to be things that you don't have enough resources to complete. And I think that's where, when we think about nutritional science versus general medicine, it's really important to remember that every biochemical process in the body requires micronutrients to complete the biochemical process, and if there are not enough of those micronutrients, or macro for that instance, you can't complete the process. It's not woo woo. It's not like, ooh, nutrition is some crazy thing. It's, it's just literally what we're actually made of as human beings. So you have to have enough of all the stuff and not too much of the bad stuff. [00:33:09] Jill Brook: Can I ask you for a little more detail about your IgG and IgA testing? Because probably some people are listening and saying, Well, I did, for example, the autoimmune paleo elimination diet, so that means I took out eggs and nuts and wheat and blah, blah, blah, and so does this test measure kind of just those most allergenic foods or is it able to tell me things that I wouldn't know if I kind of already did some of those basic elimination diets? [00:33:47] Megan Barnett: Yeah, that's a great question. So we built a custom panel through Vibrant Labs and the way that we built it was we take the common foods like wheat, dairy, egg, soy, nuts, any foods that have lectins or aquaporins in them, corn. I think that's it. And we do peptide testing on those foods because those are are the most common food sensitivities, right? So those are the foods where we're looking at maybe 40 or 50 peptides within each one of the proteins of those foods. Okay, but we know that that's limited because those are just the common food sensitivities. So we tack on to that a food sensitivity panel of another 200 foods. And those other 200 foods are much more peripheral, right? We're looking at avocado and quinoa and sweet potato and those sorts of things. Seafoods and whatever, all sorts of, of other foods that we're not going to be thinking about when we're thinking about a classical elimination diet. And we don't test the peptides within each one of those foods because that would be a 10, 000 test, but we do test the whole peptide shape or the whole protein shape. And so we've found really good luck with that test yielding results that give us a little broader understanding. For instance just last week I was reviewing labs with somebody and they had a couple of the classic things, you know, dairy, eggs, but also cherry. And they were eating cherry all the time, right? And this is the other question that comes up all the time. If I'm eating it, am I going to be sensitive to it? Okay. Well, it's a good point. It's really hard to be sensitive to something you've never eaten because your immune system's never seen it. It's like a vaccination. You have to be primed a little bit, but No, because everything you're eating doesn't come up on a food sensitivity test, right? It is for whatever reason something that does increase the production of IgG and IgA in your body for whatever reason. [00:35:45] Jill Brook: So that's great to know. So somebody who has already tried really hard at elimination diets but feels like they're still reacting to something, this test might be a way to figure out what weird, random, unlucky thing just happens to be getting you. [00:36:00] Megan Barnett: Potentially, but I, when you said that, it made me think of something else that comes up a lot in this patient population, so. And I'm gonna say another thing that people are gonna roll their eyes at. So just prepare yourself because I know the image that this has in medicine and with just patients in general. But what we see very regularly in this patient population is dysbiosis in their gut, right? So an imbalance within all the microbes within the microbiome not withstanding fungus and parasites. So where I rub up against this conversation is Candida can overgrow, right? It's like weeds in a garden. You can have some, you just can't have too many and yet if you talk to the general medical they're going to say that's not a thing. So here's my argument. If you have thrush in your mouth, that's an overgrowth of candida and candida is allowed to be in your mouth. You just can't have too much of it. If you have a vaginal yeast infection, your OBGYN is never going to roll their eyes at you. They're going to say, okay, let's treat it, right? Well, the gastrointestinal tract by and large is hard to see, right? However, candida can absolutely overgrow in the GI tract. Doesn't mean you need to eradicate it. You don't need to get rid of it completely, but if it does get out of control, this is what the literature supports. And this is what we see clinically. It increases the release of histamine from mast cells because it increases the production of IgE. It causes sugar cravings. It causes itchiness and skin manifestations and all sorts of things that we link to histamine because it increases IgE and histamine. But the other thing it does that's probably less known about it is when yeast metabolize... In the body anywhere, but let's go to the GI tract. Their byproduct is a toxin called acetyl aldehyde. Acetyl aldehyde is the breakdown product from alcohol that causes you to have a hangover. So imagine if you've got these little acetyl aldehyde factories in your gut that are constantly producing this cellular toxin that cause you to feel just not awesome at all. Okay. And it increases the release of acetylcholine in the brain. This happens because it increases histamine in the brain. So people come in and they have this whole plethora of symptoms that are maybe histamine related, maybe mast cell. And they're saying, and I can't focus and I have like this insomnia and I feel like I have attention deficit and we treat them for yeast and that goes away. [00:38:47] Jill Brook: Wow! [00:38:48] Megan Barnett: Which is crazy, right? It's just cuckoo. We do this with kids all the time. My kid has attention deficit and eczema. Your kid has a yeast infection and we treat the yeast infection with nystatin. I mean, I don't, I'm not a prescriber, but our clinicians do. Basic nystatin. And so we see that in tandem with parasitic infections too. So when we're doing labs, like I do conventional medical labs all the time, we may see the eosinophils are a little elevated and then we'll do a secondary test for parasites in our yeast. Because of that relationship to histamine. So that's another, you know rabbit hole I go down because we see it so commonly. [00:39:27] Jill Brook: Right. Well, and I can see where, you know, today's lifestyles are certainly encouraging this. I mean, everybody's got too much sugar and things that contribute to dysbiosis and, oh man... [00:39:41] Megan Barnett: yeah, it's a conversation we actually have with our moms and people that are trying to have kids, because the reality is, if you look at the last hundred years at how we've used antibiotics between our, just our food sources, you know, putting antibiotics into our cows and chickens and everything else, right? And then we look at how we've used them medically, we have really broken down the healthy bacteria that would keep candida and other infections at bay within the intestines. And then we've made food very convenient, which means highly processing it and taking the fiber out. And so it's another conversation that comes up with the people that I work with, which is we have to rebuild that balance in the gastrointestinal tract in order to support the immune cells. Within the gut which is not just mast cells, but you know, it is including mast cells. We have to rebuild the microbiome, but we have to rebuild the intestinal barrier. That barrier is critical to keeping the things in the intestines that need to stay in there and keeping those things out of the bloodstream where they cause a secondary inflammatory reaction. Yeah. Absolutely! I hope what people take from this is when they year oh, yeah, people should eat less sugar and less processed food. And oh yeah, people [00:41:21] Jill Brook: should try to not eat antibiotics No. These things have very big cumulative effects that are kind of starting to affect everybody. And so we, I have this assumption that today's young people need to eat a lot healthier than Young people did 50 or 100 years ago, you know, what our grandparents could get away with eating. It doesn't surprise me that we cannot get away with eating that because they didn't have these additional assaults. [00:41:39] Megan Barnett: Yeah, yeah, it's exactly right. And I think it's a challenging conversation to have with kids and to have with parents because they have access to more junk today than they did a hundred years ago. It's hard to say no to that stuff. You know, I have two teenage kids. My kids are 15 and 17. They've grown up in a household with a relatively obsessed mother, like I'm, you know, we're going to eat green stuff and everything's organic, right? They make horrible choices. It's like they're twisting a knife in my heart every single day. But... They have some level of tolerance because of their age. And, you can't say that for all kids. You know, some kids come out of the womb really struggling, right? And they are vulnerable to a lot of these conditions a lot earlier in their life than we all were in our lives, right? I think it's getting younger and younger, but there's no way you can't get away with this for your whole life. You can't eat poorly and abuse your body and not be ill. And, I was speaking at a dental conference last weekend, actually about the microbes in the mouth and in the gut. And I said to them, as a dentist, do you see anybody that has an unhealthy mouth that has a healthy body? And they said, no. And I said, right, because the organism is failing, right? And we're trying to figure out what is it in each unique body that's pushing the button hard. It's pushing it the hardest. And then how do we take that pressure off the system? And I think that that is, in essence, you know, always my goal when I'm working with somebody is to figure out regardless of your diagnosis, what is that thing and how much of it can be resolved with just your precision nutrition, right? It's not, doesn't look like anybody else's because it has to be based on what your body's actually in need of to thrive. [00:43:23] Jill Brook: Well, this is all so fascinating, and I know we don't have much more of your time left, but is there any other area of research that you are most excited about these days for this particular community? [00:43:36] Megan Barnett: ,I have been thinking about that a lot lately because everything with regards to the microbiome and nutritional research is what I'm most excited about and it's also the hardest. It's so hard because the essence of nutritional research is we are all an N of 1, every single one of us. And, like I was telling you, I was talking about another doctor with another doctor in my community when she was saying, Oh my gosh, she's testing all of her POTS patients and they all have vitamin C levels at scurvy level, all of them, right? And when she said that, I thought, Now, that is something that would be really fascinating if we could do that type of research with people presenting with the similar presentations, right? Whether it's an MCAS presentation, it's a POTS presentation, whatever. If we were looking at what are those actual common deficiencies, because I know I was just pulling up a paper on EDS and there were like six nutritional deficiencies that are across the board in that population that have to do with the ability to make connective tissue. Well, it's logical, right? [00:44:46] Jill Brook: Whoa! [00:44:47] Megan Barnett: Connective tissue. We have to make that. And that's what is kind of problematic in that community. Right? So what we see in the patient population generally is deficiencies around vitamin D, CoQ10, vitamin C, potentially zinc, iron, and B12. I would say those are the top that we see. I would love to even just have a small clinical trial where we looked at intracellular micronutrient levels in this population to see if there's something going on there. And I think it would be really fascinating to put specifically people that have been diagnosed with POTS on their unique anti inflammatory diet. Once we know what their triggers are, right, to see if there is response that would align with it being potentially autoimmune in nature. You know, again, I have to work backwards in everything I do from clinical patterns. So that's how I think about structuring research as well. [00:45:43] Jill Brook: Yeah! Yeah! And I absolutely agree that everything's an N of 1, and even if we did manage to have some research that proved something, each person would then have to go to test it on themselves, but I will put a plug out there that Standing Up to POTS has has research grants and usually February is when the deadline is for proposals. And so that does sound pretty intriguing to me to see if there are some consistent micronutrient deficiencies or something that we don't know about. I know that you had sent me a case study about it was a patient who had orthostatic hypotension and a scurvy like presentation. And I had not seen that. That was something. And so, yeah, there's a lot here to, to wonder about. [00:46:30] Megan Barnett: there is. [00:46:31] Jill Brook: Yeah. Is there anything else that you think people in this community should be thinking about or know about? [00:46:37] Megan Barnett: You know, I think when I go back to time and time again, is that, we have to cast a wide net when we're trying to figure out what is behind these symptoms, right? We do, we need to look at all the bits and pieces, but we can't forget the basics of how the human body thrives. When we're thinking about how to support people, we need to think about nutrition. Obviously, that's what I'm thinking about at that. Height of my interest, but we need to think about how we're sleeping, the air we're breathing, the water we're drinking, and I was gonna tell you a lot of the times we see the, that we put dust mite covers on people's beds and all of a sudden their itching stops at night, right? So we're thinking about what are all the things that are causing, you know, potentially these little insults, but we can't always say, don't prescribe a drug to somebody until you've got their nutrition in check because the nutrition might actually fix the problem and you don't need the drug, right? We just need to make sure that we've got those foundational bricks laid and then go from there because the body will tell us a different story when the foundations are in place. And then we're doing something very different than what we were doing when there was a lot of noise because the body wasn't well supported by the basics. [00:47:56] Jill Brook: That's a great point, and I love how you think about this stuff. Where can people find you online if they want to follow you? [00:48:03] Megan Barnett: The easiest place to find me is my website, because I'm pretty old school, I have social media, but I don't use it, so is my website, which is bioloungepdx. com. [00:48:15] Jill Brook: We'll put that in the show notes so people can find it easily. Megan, thank you so much for your time and your information today. It's just a delight to speak with you, and we're so glad to have your brainpower and your compassion and your dedication helping our community. [00:48:30] Megan Barnett: No, thank you for having me, Jill. I really enjoyed it. I appreciate it. [00:48:33] Jill Brook: Okay listeners, that's all for now. We'll catch you next week, but in the meantime, thank you for listening, remember you're not alone, and please join us again soon.

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