Episode 12: Dr. Mark Davis, ND on IBD & Fecal Microbiota Transplantation

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SPEAKERS: Dr. Andrew Wong, Dr. Mark Davis, ND

Welcome to the Capital Integrative Health podcast, a podcast dedicated to transforming the consciousness around what it means to be healthy and understanding the root causes of both disease and wellness. I am Dr. Andrew Wong, co-founder of Capital Integrative Health, an integrative practice committed to expanding access to holistic root cause medicine to the global community.

Today we are joined by Dr. Mark Davis. Mark is a naturopathic gastroenterologist here at Capital Integrative Health who specializes in inflammatory bowel disease and has clinical expertise in fecal microbiota transplantation and helminthic therapy. He is also a former faculty in the school of naturopathic medicine at the Maryland University of Integrative Health. Mark enjoys working with his patients to find solutions using an integrative evidence-informed approach.

Join us for a conversation about how naturopathic gastroenterology addresses gut health in conjunction with approaches like fecal microbiota transplant and home ethic therapy. If you suffer from gut dysfunction in general or conditions like inflammatory bowel disease specifically, don’t miss this conversation.

Dr. Wong

Welcome Mark to the podcast, thank you so much for being on today.

Dr. Davis

It’s great to be here.

Dr. Wong

Yes and you are obviously a part of Capital Integrative Health. You have your practice called IBD specialty clinic your practice and let’s talk about first your introduction to naturopathic medicine and what motivated you to pursue the ND route?

Dr. Davis

Oh great! Yeah, so I come from a long line of doctors and nurses. My great grandfather and my grandfather and grandmother all were educated in the University of Maryland system for the medical school and the nursing school and my mom’s a nurse and siblings or doctors and so growing up, I always knew that’s not what I want to do. Is what I thought I was like what they’re doing, what I see my family doing is prescribing drugs and doing surgical procedures and I was like if I want to help people I think I want to help people avoid that and not do that. So I thought no way I’m not going to do medicine. So I thought it would be the healing power of food that would help me be a healer and so I thought I was going to be a nutritionist and I worked at restaurants for many years. Whole foods restaurants, vegetarian, pescatarian, sustainable seafood all kinds of stuff and I loved that work. But then I discovered naturopathic medicine and when I realized there was something that could allow me to practice the art of diagnosis and assessing and treating the whole person and still help me with my goal of helping people avoid drugs and surgery I knew, I had found the profession for me so and it’s been a great fit for this past.

Dr. Wong

That’s awesome yeah and then I think we said this in the intro but you graduated from naturopathic from NUNM, the National University of Naturopathic Medicine in Portland, correct?

Dr. Davis

Yep, correct yep.

Dr. Wong

And I think what did you like most about Portland? And I mean this is a bit off-topic but we always go off-topic on this podcast. So portland versus Maryland. Let’s just talk about that a little bit.

Dr. Davis

I love both places. Portland was a great fit for me in terms of the culture of outdoorsiness and whole foodsiness and all my neighbors around me composted and rode bicycles and did other things that are good cultural fits for me and everybody knows what a naturopathic doctor is and these have been licensed there for a hundred years. In Maryland, naturopathic doctors have been licensed for I think five years and lots of people have never heard of what I do and there’s a great part of that too introducing people to something new but you know it’s a different cultural environment. I love the social diversity of where we live in Montgomery county way different than Portland and I love being close to family. I’ve got my parents and my sister and nieces and nephews and all kinds of people right around here. And I love working at Capital integrative Health.

Dr. Wong

Yes, we love having you here, yes. And I believe where you live in Maryland. I believe is also a little more woodsy. It’s a bit more, I know there’s a strong herbalist community, etc.

Dr. Davis

Yeah, yep. We’ve got some nice woods right in the backyard we like to hike in.

Dr. Wong

Nice. Do you ever pick mushrooms or have a go out looking for different?

Dr. Davis

I am not qualified to pick mushrooms. We pick some other things yeah, wood sorrel and nettle and other great things to go around here but yeah you really have to know what you’re doing.

Dr. Wong

Right, right. It’s good to get good some antihistamine tea there with the nettles.

Dr. Davis

Yeah, yes.

Dr. Wong

So I think you talked a little bit about this already but what do you enjoy most about what you do as a naturopathic gastroenterologist?

Dr. Davis

Well, I mean, I guess I love being good at what I do like that always gives everyone a good feeling and so focusing in on one organ system and especially like, I do on people with inflammatory bowel disease I feel like it allows me to get really good at assessing and treating one thing and so I get to feel good about that and I, in general, I just love puzzles. And every person is truly unique and they are their own puzzle and their health situation as a puzzle that changes over time and getting to work on that puzzle with them is just a joy.

Dr. Wong

Yeah. I think there’s this image in the universe of like you know a thousand different diamonds and or crystals you know you could say and it’s like a kaleidoscope and that’s how it’s amazing working with different individuals and how unique and beautiful each one is.

Dr. Davis

Agreed, yeah.

Dr. Wong

So as you were mentioning you are very good at what you do in fact a world-class expert in the conditions that you work with so let’s talk about that, to go into that broadly first. What conditions do you work with, especially as a naturopathic GI doctor? and then I do want to ask you a bit more generally about IBS and reflux too.

Dr. Davis

Yeah great. So first I want to talk about the word gastroenterologist and what it means. So in conventional medicine, when we say a gastroenterologist at its core it just means a doctor who focuses on helping people with gastrointestinal disease but in practice in conventional medicine, that means a doctor who’s graduated medical school and then done a three-year internal medicine residency and then a three-year gastroenterology fellowship. So that’s what it means in conventional medicine and in naturopathic medicine. We are a much smaller profession without as much infrastructure so we’re still building out a lot of that residency and fellowship type structure. So the core meaning of naturopathic gastroenterologists is the same. A naturopathic doctor who helps people with GI disease but in terms of the fellowship, well I’m excited to and now I don’t know if you know this Dr. Wong but I helped found the gastroenterology association of naturopathic physicians about seven or eight years ago and I haven’t been on the board of directors for a couple of years but just this year our fellowship project reached fruition. So in 2022 for the first time, people can, people who have been practicing or done a residency for long enough, seeing gastro patients who have cases reviewed by peers and elders in the profession can sit for a naturopathic gastroenterology board exam so we can be board-certified fellows of the American board of naturopathic gastroenterologists.

Dr. Wong

Yes, that’s so exciting. Well, congrats on finally getting that up and I know it’s probably been like you said a couple of years in the works I know there are naturopathic oncologists. We have Dr. Keats here at CIH are there any other fellows, or fellowships?

Dr. Davis

Yep. There’s a so the oncology fellowship is the first, there’s an endocrinology fellowship there’s a pediatric fellowship those are the only ones that can think, and now we have the gastro one.

Dr. Wong

And maybe one it’s really great to have the credentialing and the infrastructure there to support the evolution of naturopathic GI. And the other thing about gastroenterology, in general, is it’s such a broad term like when you think about cardiology you think about the heart or the vessels you think about neurology as the brain but you know there’s like I don’t know how many organs are there in the GI tract there’s tons of right.

Dr. Davis

There’s a lot. I mean my mouth and esophagus and stomach and small intestine the large intestine the liver and the pancreas and there’s a lot.

Dr. Wong

And of course the naturopathic and functional medicine, integrative medicines well you know we always think about how the gut is the root of health and can also cause a lot of diseases that’s what Hippocrates said many many years ago right so yeah so that’s really you know one of the most if not the most important organ here as I’m sure you would talk about, every organ is important but certainly, the gut is up there.

Dr. Davis

Yeah, absolutely yeah. So I have colleagues in the naturopathic gastroenterology community well there’s just a lot of diversity in what we treat and even when we’re working on like we that we had our conference a couple of weekends ago and one of the main lectures were gastroenterology and mental health and how those two interacts and another one was gastroenterology and autoimmune disease and how those interact. So really the gut health does interact with every organ system in the body.

Dr. Wong

There’s so much to talk about we’re definitely gonna have to talk on another podcast even though we’re talking today mostly about some of your specialties I do want to talk about irritable bowel syndrome for a second, you know this affects and statistically, it says you know up to 12 percent of the population it’s probably much more than that. But what is irritable bowel syndrome? why is important? and then you know we think of it of course and the type of medicine we do in general as a label as a more of a diagnostic label rather as a root cause.

Dr. Davis

Yeah, so I often call IBS or irritable bowel syndrome a hundred things with one name, and what it means is essential that you have changes in bowel frequency or consistency with certain types of abdominal discomfort that lasts for at least a certain amount of time and you talk about all the organs that go into the digestive process and IBS can be about what’s happening in your small intestine it can be about what’s happening in your large intestine it can be about what’s happening in your stomach it can be about what’s happening in your central nervous system or even with the immune system so that type of discomfort like you said twelve percent I, I’ve seen twenty percent. One out of five people is a common number that can be caused by many many different types of things and therefore, there are many many different approaches to helping somebody with that type of discomfort between dietary testing and other types of assessment and dietary interventions and herbal interventions and probiotics. There are just a million ways to help people with IBS.

Dr. Wong

As you alluded to with the nervous system as well you know the brain connection right so in a way we could call irritable bowel syndrome also potentially irritable brain syndrome right? There’s sometimes.

Dr. Davis

Oh sometimes, it can cause absolutely sometimes the best way to help somebody with IBS is to work on supporting their nervous system.

Dr. Wong

Yes because we know the nervous system kind of downstream affects the gut too.

Dr. Davis

Absolutely yeah. There’s a real back and forth.

Dr. Wong

Back and forth bi-directional correct, yes exactly. So you are an expert in a few things, many things but we’ll list some of them here and then just kind of go through them so we’ll

start with inflammatory bowel disease now. Irritable bowel syndrome, like you said is a diagnostic label with a hundred causes and one of those causes could be inflammatory bowel disease which is a bit more you know there’s some pathology involved there’s some inflammation involved a little more serious you know I would say, what is IBD? and then what are some of the root causes of IBD that you have found?

Dr. Davis

So IBD stands for inflammatory bowel disease and it’s much less common only about one out of 200 people in this country has one of the two major types of IBD and those are ulcerative colitis and Crohn’s disease and what they have in common is there is detectable inflammation and usually ulceration in the digestive tract. For ulcerative colitis that’s just in the colon and for Crohn’s disease that can be anywhere in the digestive tract from the mouth or even around the mouth all the way through the esophagus the stomach the small bowel the large bowel to the anus or just around the anus of perianal disease and there’s usually a fair amount of pain involved there’s often bowel frequency diarrhea although occasionally there can be constipation and there’s often a fair amount of blood loss like I have a seven-year-old with Crohn’s disease that I’m working with right now who’s going in today for a blood transfusion because she’s lost so much blood through you know rectally that she just needs some additional blood in her system. So that’s what IBD is and there are a couple of other more unusual types but we rarely see those, so ulcerative colitis and Crohn’s are the major kinds and there are some genetic links that people with certain families and certain genes I have but genes are necessary but not sufficient. So certain types of ways that we get inflamed and our immune system can act and that, our mucous layers in our gut can be built because of our genes can predispose us to IBD but then we also need environmental triggers and lifestyle factors to kick us into that hyper-inflammation and then to keep us there so when we’re working on treating we can we can’t change somebody’s genes but we can change what’s going on in the microbiome and in their environment and lifestyle and how their immune system.

Dr. Wong

So just to recap what you just said Dr. Davis, you can have genetics that might set someone up for inflammatory bowel disease IBD either Crohn’s or ulcerative colitis but those genes don’t necessarily have to be expressed based on the environment and lifestyle either choices or experiences that person might have.

Dr. Davis

That’s absolutely right, yeah. People can have the genes and in fact, everyone has who has it has the genes since they were born some people like my seven-year-old patient start getting symptoms when they’re 11 months old like she did or even younger. I had a patient who first started getting symptoms in her 70s and she never had IBD symptoms before that so it can come out at any age although it’s most common to start getting symptoms in your 20s and 30s.

Dr. Wong

So is it true that when someone gets treated with IBD let’s say in a naturopathic way potentially there’s some epigenetics involved that the genes start to turn off and then the inflammatory genes and that’s how people get better? Is there another mechanism there?

Dr. Davis

We think that is part of the mechanism yeah. There are a lot of mechanisms through which we help people with tissue healing, tissue rebuilding microbiome, and changing immune system calming but epigenetics seems like it’s one of those ways.

Dr. Wong

Great. So what are some of the approaches that you take when working with patients with IBD?

Dr. Davis

Well, I always tell my patients there’s five phases of treatment. Phase number one is to make sure you are safe in an outpatient setting. There are times when I talk with a patient and I’m like well it’s time for us to stop talking so you can call an ambulance because you’re not safe in an outpatient setting and that’s the most important thing. So that is always phase one. Phase two is clinical remission, no symptoms anymore it’s easier to say than to do and it’s often a long process but getting people to clinical remission that’s phase two and unfortunately, a lot of clinicians would stop there “oh my goodness my patients have no symptoms, I’m happy we’re done here” but for me, that’s phase two. Phase three is what we call serologic remission meaning when we test biomarkers blood tests like ESR and CRP stool tests like fecal calprotectin and other things when we look at those biomarkers they’re all normal because you can be symptom-free with elevated biomarkers and that is evidence that you may be at increased risk of getting colon cancer down the line if you have Crohn’s you might get narrowing strictures or obstructions you can get what are called fistulae where inflammation makes a tunnel from your intestines to the bladder or the vagina.

Dr. Wong

Even or not symptomatic you’re saying this is the serologic positivity of the inflammation so great fecal calprotectin also for the things like ASCA and those types of things too.

Dr. Davis

Well, that’s a good question. I don’t use ASCA and pANCA although those levels can get larger and smaller. I don’t use those as biomarkers to track inflammatory levels because they’re good great indications of the flavor of inflammation someone is having but not great indicators of how severe that inflammation is yeah like calprotectin is so phase three is serologic remission. Phase four is histologic remission which means when your gastroenterologist goes in with a colonoscope or an upper endoscope or both and takes biopsies and the pathologist looks at the tissues they say there is no inflammation in those tissues maybe there’s some evidence of past inflammation but no current inflammation we call that deep remission or histological remission and it is a great prognosis for the future that you’re much much more likely to stay in remission durably if you get that deep remission. So I love it when we get there, yeah that’s phase four and then phase five is just maintenance where we run some of those biomarker tests every three to six months to be able to predict a flare coming before you get symptoms and make sure we’re doing whatever we need to do.

Dr. Wong

Got it. So I want to go back to that. That’s really great, I mean that does offer hope for some people with IBD let’s say or they have IBS they’re not sure if they have IBD inflammatory bowel disease so back to the phase one just so the listeners kind of know if someone has red flags you know so to speak red flags it’s like okay you need to go to the ER you need to this can’t be an outpatient kind of thing, what are some of those kinds of “red flags” that you know?

Dr. Davis

So they actually, interestingly enough vary per individual but some examples might be more than 10 bowel movements a day. Now, I’ll pause there because I’ve had patients having 20 or 30 bowel movements a day who say no. This has happened to me a lot in the past. I’m not going to go to the hospital even though I’m losing enough fluids that you know I hear you telling me this could be dangerous it isn’t always dangerous but if you’re having more than ten bowel movements a day you need to check in with me if I’m your doctor or whoever your doctor is to say, “Am I still safe to be outpatient?”. Dizziness can be a sign that you’ve lost so much fluids that you’re getting hypotensive and that could be dangerous to your heart and other organ systems so you need to go get some IV fluids or something else if your hemoglobin gets low enough and again it’s more about the rate of drop of hemoglobin than an absolute number but below seven is a, you know a great example being low enough that we might, can be concerned. “I want to give you a blood transfusion or just if your pain is a constant eight, nine, or ten out of ten most of the day”. These are all reasons that you might need to go to the emergency room and not.

Dr. Wong

So uncontrolled inflammation, dehydration, and blood loss to the point of significant anemia might affect the heart, the vascular system things like that, okay. And then in phase four which is histologic remission, I’m curious if there are statistics in the literature on, or in your own practice experience of you know how many people with IBD get to that point of either I guess serologic or histologic remission.

Dr. Davis

That is a great question and I actually don’t know the statistics from the literature or my own practice. I would say it is uncommon enough that it is a big celebration for me and my patients in my practice when we get there.

Dr. Wong

What I found, it seems like just you know as a primary care doctor with people with IBD, people like kind of go into remission a bit, and then they might flare up again depending on what’s happening maybe the diet changes stress things like that.

Dr. Davis

Absolutely true this is a relapsing-remitting disease it comes in waves where symptoms get worse, and symptoms get better even aside from stress or diet or other things that can trigger us. It just waxes and wanes and so and but that’s clinical remission that’s what we’re talking about symptoms. Histological remission once you get there that tends to be more durable I’m sorry a serologic remission tends to be more durable and then histologic remission when we get there and sometimes we do that is the most durable of all.

Dr. Wong

Super. So what are the favorite approaches in general if you could outline for us, that you think we’re working with either Crohn’s or UC, and do you treat them a little differently just kind of curious about that?

Dr. Davis

They are a little different, yeah. What they have in common is their inflammation of the digestive tract with ulceration often bleeding pain etc. What they have differences between them is ulcerative colitis is always just in a colon and it’s always contiguous meaning the inflammation starts in the rectum and it moves without any skips up the colon. Crohn’s disease is sometimes in the colon sometimes not sometimes part in the colon part somewhere else and it has what we call skip lesions so it’s not contiguous it can be in various places disease tissue with healthy tissue in between they respond differently to certain things, for example, tobacco, nicotine, very very bad for people with Crohn’s disease but actually helps keep people with ulcerative colitis in remission which I never recommend someone start smoking but I have recommended they delay quitting until they get into better control.

Dr. Wong

We’re not, we’re not advocating keeping smoking for those of you out there who are smoking but

Dr. Davis

Yeah, here’s a note. I ran into a patient who had inflammatory bowel disease and an associated autoimmune lung condition and it was getting so bad she was having to stop some of her physical activity and her gastroenterologist said: “look this is ulcerative colitis related, I’m going to recommend you start smoking tobacco”. I’ve never heard of that recommendation before but because it was a lung thing get that nicotine in there but she flared so bad with smoking, that they change the diagnosis to Crohn’s.

Dr. Wong

So interesting, yeah. So it could be used as a diagnostic tool, I suppose.

Dr. Davis

Possibly.

Dr. Wong

We probably don’t want to do that, but

Dr. Davis

Yeah, but I don’t use smoking as an intervention. But things I do use as interventions diet is a huge one there are all kinds of interventional diets including fermented foods in some cases, probiotics, and prebiotics lifestyle medicine, your habits your exercise, your sleep, herbal medicine is something. I use a lot of wormwood and mastic and green tea extracts and many many other herbs nutritional therapies, vitamin D, and butyrate which actually butyrate directly crosses through the cell membrane and affects our epigenetics it goes right to the cell nucleus.

Dr. Wong

Do you like butyrate in supplement form or through, indirectly through foods and stuff?

Dr. Davis

Both. But I use it a fair amount supplementarily giving it orally in increasing doses of up to four grams a day with my IBD patients and sometimes with IBS patients which is another evidence-informed protocol.

Dr. Wong

Yes back to the diet for a second because we know that nutrition is really important here with IBD but in general do you feel like that sort of plan is also maybe applicable to other people with gut issues too like more of an anti-inflammatory diet?

Dr. Davis

Yes. I love like, I like, I told you before nutrition was my first love that worked in restaurants. I worked towards becoming a nutritionist initially before I found naturopathic medicine so I love food as medicine and it is so individualized what diet will help one person. There are specialty diets like the specific carbohydrate diet, semi-vegetarian diet, autoimmune paleo diet, and low to no sulfur diet and we can guide diets by IgG or IgG4 testing. So there are so many different diets and we can make our best guesses as to what diet will help one person but I always tell people we’re starting off on a diet blueprint and we’re going to individualize that for you based on exactly what’s going on for you than how you respond to a therapist.

Dr. Wong

Right, that one’s a bit unique and also maybe depends on the state of their gut, right? Isn’t it true that based on the state of their gut inflammation might be able to tolerate more or less foods?

Dr. Davis

Oh, absolutely! you know, generally, I tell people we want to have a whole foods diet. That’s minimally processed in order to feed our healthy gut microbiome and have general health but there are times when my patients with inflammatory bowel disease are so inflamed I tell them the opposite. “I want you to have a low fiber diet of highly processed foods, you’re going to have white rice, it can only be white rice. I want you to have a, you know very very processed things in order to decrease your microbiome diversity and let your immune system calm down”. So it really depends on where a person is.

Dr. Wong

Some people would actually benefit from a little bit more refined starches at times it sounds like.

Dr. Davis

Yeah, that’s a therapeutic diet. I mean, I generally tell people you want whole foods but there are times when I tell my IBD patients to avoid whole things.

Dr. Wong

Like if they’re in a flare or something like that.

Dr. Davis

Get a flare, yeah.

Dr. Wong

Got it. Where are you on curcumin and fish oil or omega-3s? How does that play a role in the therapeutics?

Dr. Davis

Okay great. So yep, big fan of curcumin which is the primary anti-inflammatory extract of turmeric. I love the whole turmeric too and I love the safety and efficacy profile of turmeric and curcumin for patients with IBD and other things too including autoinflammatory joint disease and other things.

Dr. Wong

Turmeric will stain your kitchen counter orange or yellow so just be aware of that.

Dr. Davis

Very true. I have experienced that myself.

Dr. Wong

Yes, yeah. And what about, of do you like more like eating fish or fish oil or algae oil or were you on that?

Dr. Davis

Yep. I definitely have used all those interventions with people. I will say there are different amounts of fish oil that can help different individuals and people with different conditions and in my experience in my read of the literature for IBD patients it is very very high doses like 10 grams in a day or more so that is a substantial commitment to fish oil. Now fish oil has other good side benefits that sometimes we enjoy including benefits for the heart and decreases in total cardiovascular mortality although you probably know there’s emerging literature showing that for people with atrial fibrillation large amounts of fish oils may actually aggravate atrial fibrillation. But in general, for cardiovascular disease, fish oil is a big benefit. So if someone can commit to those big doses which is you know a two tablespoon dose three or four times a day depending on the concentration of the fish oil you get, so, that’s a lot of efficiency.

Dr. Wong

And then we do know we have some cardiovascular patients on aspirin or Plavix or something like that they have to be as you know, to be careful with the interaction with meds or even other elements that have blood-thinning effects.

Dr. Davis

Yeah. So I find myself using fish oils not as much because of the high doses and sometimes interactions but for some patients, it’s a great intervention.

Dr. Wong

Great, great. And certainly, we know that there’s most of us have a the omega-six to three ratios is too high like this whole idea the inflammatory you know aspect of the fatty acid ratios. Great, well we can also segue into, I do want to talk a little bit about gluten and I think you have, I know you have this case that you may want to share but you know, where are you on gluten? and you know, we know that this is a big topic of course in the last certainly last 10 years. Should everyone with IBD or even IBS for that matter and that’s opening up a can of worms no pun intended for the next part of our talk today but you know in terms of gluten where are you on gluten and should people be eliminating or should people be eating a pizza every day?

Dr. Davis

Yeah, so that is also very individualized and I think when we look at our ancestry and different cultures throughout the world there are cultures who have included gluten grains in traditional and whole foods oriented diets for centuries and managed to live healthfully like that. So I don’t think everybody needs to exclude gluten grains from their diet other people have ancestral groups and they may have gotten a genetic roll of the dice that makes them inherently intolerant to gluten and in fact if we look at the genetics HLA-DQ2 and HLA-DQ8 maybe about 40 of us are positive for one of those. So I think, about at least 40 of us have the potential to have very strong immune reactions to gluten. Does that mean we all do? No. So I think gluten-containing grains can be good food and part of a helpful diet but for some people very very important to avoid, it can make huge differences in health through avoiding gluten. I have a dear friend and colleague Dr. Lisa Shaver, she’s a naturopathic doctor who specializes in celiac and gluten intolerance of many kinds and she has lectured in the past on the ethics and importance of not giving a gluten-avoidant diet without first ruling out celiac disease. Because if somebody doesn’t eat gluten you can’t reliably test them for celiac disease so, and then you don’t know if you need to encourage their family to get tested if they have additional risk for other autoimmune diseases all these other things. So I test a lot of people for celiac sometimes even if they’ve been tested in the past. I say, “you know what I’m just going to test you again and make sure we’re giving you the right tests”. Everyone at CIH orders the right tests but in the past older sets of tests were ordered at other clinics so I don’t think gluten is a bad food but it is definitely bad for some people and we try and figure out who that is.

Dr. Wong

Now, are you ordering the celiac comprehensive panel plus the genetics like I think you do Prometheus maybe but or is it just the celiac should be enough for most people?

Dr. Davis

Well, it depends on where the person is and if they’re like really trying to give up gluten and so if we order the genetics and they’re negative for the genetics they can’t have celiac so it’s not worth ordering, the antibodies yes. So, but if they’re positive for the genetics well then I definitely will order the antibodies.

Dr. Wong

Okay got it, got it. And let’s talk about a little more about another of your specialties, and you’re a world-class expert in something called FMT or Fecal Microbiota Transplant. So let’s talk about that just to find that I don’t know if everyone’s heard of that, so what is that yeah and what conditions?

Dr. Davis

Okay, this is a passion of mine, I’ve been working with this for over a decade and obsessed with it. Right when I graduated with my naturopathic medical degree I bought the website fecalmicrobiotatransplantation.com because I knew I wanted to be involved in

this.

Dr. Wong

Did you know like four years before like you know first-year ND student did you know like oh this is what or when did it?

Dr. Davis

Oh no, no. I remember the moment I discovered it I was, I was working on a shift trying to help out an IBD patient and trying to think what we could do to help this severely ill person and I was scouring the literature on PubMed in the hallway at my school and I came across these papers from I think it was 2003 by Dr. Thomas Barody an Australian gastroenterologist and he wrote about using this therapy that I’ll describe fecal microbiota transplantation on some dozens of patients with inflammatory bowel disease and putting a large number of them into clinical remission and the reason behind it made so much sense to me it blew me away. I right away knew I want to be involved with this I want to do this.

Dr. Wong

That’s incredible, that’s great.

Dr. Davis

Yes so the process is well here’s the story is that we all have trillions of microbes in our gut, trillions of the tea that’s so many and for some people, the lack of certain good microbes or the overabundance of certain bad ones or just an imbalance between the two can make people sick or sometimes so sick they could die. So your gut microbiome has a lot to do with your health and for some of those people giving you an influx of new healthy colon bacteria can make your gut ecosystem correct again and remove some all of the symptoms that were making you sick or sometimes very severely ill previously and the most effective way to do that is to collect stool from a healthy screened donor and stool is two-thirds bacteria by dry weight so we process the stool in order to concentrate the bacterial portion and then we administer that stool extract full of healthy colon bacteria to the sick patient either as an enema or through a colonoscope or through capsules or there’s some other way.

Dr. Wong

These are live bacteria, yes.

Dr. Davis

Live bacteria and trillions of them and the difference it can have on people’s health can be profound. There’s an infection called C. diff. colitis that I know you’re familiar with that kills tens of thousands of Americans every year, every year. And giving antibiotics can often help the people who get this and we give antibiotics for this, and maybe two-thirds of the time when you give antibiotics for it people get well and they stay well but that leaves a third of people who end up getting sicker and sicker and in tens of thousands of people’s cases dying from it and giving fecal transplant durably cures it at least 90 percent of the time, yeah at least 90 percent.

Dr. Wong

Just a little bit, imagine on the C. diff. do you ever find that the high-dose probiotics like sac boulardii is an alternative to antibiotics?

Dr. Davis

So I’ve treated a lot of patients with C. diff. and I have found some patients with mildly active C. diff. colitis who high doses of probiotics along with berberine and a clean diet can get rid of their C. diff. I’ve never seen that work with moderate to severely

Dr. Wong

After symptomatic sometimes we’ll see on you know we know these do the DNA based stool testing the C. diff. is positive so there’s some microbiome imbalances and often it allows that’s treated to overgrow for the asymptomatic patients would you say, that probiotics would be sort of the first line there? I typically tend to not treat asymptomatic patients with antibiotics.

Dr. Davis

Yes, same, same. C. diff. is an interesting microbe. There’s a Canadian microbiologist a friend and a colleague of mine who says that C. diff. ‘s kind of like teenagers at the subway stop that if it’s crowded at the subway stop and there’s a lot of people they’re going to mind their manners and they’re not going to do anything but if everybody gets on the subway and leaves which is what happens when you give some antibiotics that deplete the gut microbiome all the adults leave the teenagers go crazy and they’re knocking over trash cans and they’re spray painting and whatever and causing trouble.

Dr. Wong

So all teenagers have behavior problems is that what your saying? Just kidding.

Dr. Davis

No, no!

Dr. Wong

There are some well-behaved teenagers out there.

Dr. Davis

So, yeah. So C. diff. in tiny amounts in the right gut ecosystem can actually be not problematic. They do secrete small amounts of toxin but your body processes it gut cells heal very well and it actually is not a problem and I don’t treat it. Sometimes I will try to look at it as a sign of you know maybe there’s a little imbalance starting and use probiotics or sometimes Berberine all depends on the patient and what’s going on, yeah.

Dr. Wong

Great! So, so getting back to FMT. So, you know there’s a passion of yours, you’re a world-class expert in this you’ve been doing it for over 10 years now. What conditions is it helpful for and maybe if you want to share a patient sort of a case study success story too?

Dr. Davis

Yeah, great. So well we know it works very very well for proceeded better than anything else that we have as a tool as clinicians it also works very very well for my practice focus on inflammatory bowel disease people with ulcerative colitis, Crohn’s colitis, and even Crohn’s in other parts of the body can, could have dramatic dramatic responses and I’ve used this hundred of times with inflammatory bowel disease patients with many many cases of good benefit fascinatingly there’s also emerging evidence that it can help people with certain types of neurodegenerative conditions including multiple sclerosis and maybe Parkinson’s and maybe autism spectrum disorders. And there’s really, really interesting literature there and I’ve seen all of those in my own practice there are other hyperinflammatory conditions like graft versus host disease and it can help hepatic encephalopathy and other things, and then interestingly enough it can help many people with IBS like we said before IBS is a hundred things with one name so it certainly isn’t appropriate for everyone with IBS but there are cases that I’ve seen get really really great responses.

Dr. Wong

A big target. I have so many sub-questions based on your amazing answer there. So number one is let’s kind of go through some logistics of let’s say a patient has IBD so maybe let’s say Crohn’s and maybe they don’t want to go on biologics. I do want to talk about that in a minute but you know if someone has IBD, or Crohn’s and they want to try FMT, what’s logistically the process for them doing that so they want to see you and talk about it?

Dr. Davis

Yup, great question. So for the past eight years, FDA has had guidelines limiting clinicians like us to only treating, to only using c diff to treat patients I’m sorry to only use FMT to treat patients who have c-diff not responding to standard therapies so you or I could only prepare or administer or prescribe c diff or prescribed FMT for patients who have c diff so that’s a limitation. So many patients with IBD do end up getting c diff but for those who don’t, they can’t have clinicians prepare, administer or prescribe it for them. So it could still be very very helpful for them and in that case they have two options. Option number one is to go to another country where it is allowed. I’ve had patients travel to the United Kingdom, to the Bahamas, to Argentina, to Australia. There was a clinic in Canada for a while so there are places that allow FMT to be used for more.

Dr. Wong

Are there any advocacy or legislative work that’s in the works for the US to expand the scope you know of FMT, or?

Dr. Davis

There is, I was on the board of directors of the fecal transplant foundation and we did some work around that and I would say it looks like it is unlikely that FDA is gonna reverse their opinion. So despite some good advocacy work by us and other foundations, they’re moving in another direction and they’re trying to get a lab-grown microbiome product to replace FMT which is good in many ways. I’m excited to have more options and lab-grown products for my patients but it’s also frustrating in some ways because those products will have 5, 10, 20, or 30 micro species of microbes in there whereas the human gut.

Dr. Wong

Less diverse, yeah.

Dr. Davis

Yeah, 150 or more species in a given dose. So what will it actually be able to help and how much in the same ways, we’ll discover that over the next five-ten years so it looks like the FDA is not going to reverse their opinion and make it more

Dr. Wong

What’s the timeline of the lab-based kind of stool?

Dr. Davis

I’m gonna say my best guess is a year from today, we will have an FDA-approved product.

Dr. Wong

Interesting, interesting. Yeah. I got it and I thought it was interesting what you said about the neurodegenerative disease because that’s definitely an interest and focus of mine in terms of the practice and brain health. So you said MS, Parkinson’s, and autism, definitely really interesting. Do you know in the case studies or literature on that is it like a certain point in the disease process that it’s more effective or have they gotten a deep dive into that kind of?

Dr. Davis

So the literature is too sparse. There have been two trials published on autism and only case studies published about MS and Parkinson’s and so I would say we don’t, we don’t know yet, and looking at the literature on autism and microbiome in general I would say no I’m not an expert in autism but my guess is the earlier the better the earlier it happens the more profound effect you could potentially have, yeah.

Dr. Wong

Make sense, yes.

Dr. Davis

And with MS and Parkinson’s I’m not sure, I will say the literature is pretty clear that changes in the microbiome happen in Parkinson’s up to a decade before the first symptoms start so that is really a microbiome-driven disease in many ways.

Dr. Wong

This idea that the alpha nucleon that starts out in the gut retrogradely goes up to the brain and causes the depletion I think of dopamine and other chemicals maybe that that’s the idea that a lot of these neurogenetic diseases actually start in the gut. I think that literally started a basic science study that they released the results of and that a lot of the beta amyloid protein that is found in the brain as you know pathologic they had amyloid plaques it actually starts in the liver you know. This idea that retrogradely everything’s kind of going up the entire nervous system. So I think that’s really fascinating but also a little scary is a lot of these things start decades before so you know looking at the gut you know this is back to the prevention. The best cure is prevention right in a way the best treatment is prevention and so looking at the gut microbiome you know optimizing you know reducing inflammation balancing the immune system this may pay really big dividends down the road for even organs like the brain.

Dr. Davis

Absolutely!

Dr. Wong

Amazing. And then were you on if someone coming in with IBD and they’re on a biologic? Let’s say like can that person be given an FMT you know if they’re sure on a biologic.

Dr. Davis

Oh sure yeah, I’ve done that dozens of times.

Dr. Wong

Done it, awesome okay great.

Dr. Davis

Very safe, yeah. There was a literature review of I think about 150 patients with various kinds of immunocompromise biologics, hydrosteroids, HIV AIDS solid organ transplant and other things and FMT is found to have an excellent safety profile including zero serious adverse events in anybody on biological.

Dr. Wong

I mean it’s essentially a very you know it’s not, it’s the therapy does that does not work against the body it works with the body because the body’s used to these microbes and really just balancing it more. It sounds like, so that’s great. What’s kind of been your most dramatic success story I would say in the I guess for IBD or you could just say whatever you like I guess.

Dr. Davis

Yeah. There have been a lot. Yeah, one time one that comes to mind is that I just like his quote. It was a, I think 55 year old male with about a 20 year history of ulcerative colitis. Had been on prednisone for most of 20 years he was what’s called prednisone dependent for a long time and had other side effects from that we did FMT and for the first time, the first time in two decades he went into a medication-free clinical remission and he called me and said, “I can’t believe it took me 20 years to find this, you know thinking that I could have maybe done this 20 years ago”. So that was a quote that stuck in my head and made me want to be even more of an advocate for FMT.

Dr. Wong

Yeah. When you get, when you get those type of results and the patient’s lives really changing you know that so amazing. I guess we can talk about helminthic therapy. I know I’ve been talking a lot about FMT but that’s another of your interests. So helmenthic therapy. What is helminthic therapy? for some reason my mind always goes to helmets and Vikings and stuff like that so.

Dr. Davis

Yeah. You’re not the only one, yeah. It’s Helmenthic (h-e-l-m-i-n-t-h-i-c) helminthic. And what a helminth is a tiny worm-like organism that lives in the guts of vertebrates so every kind of vertebrate in the world has different types of these worm-like microorganisms. They’re usually microscopic that live in the guts and I think of them as just another kind of probiotic another part of the gut ecosystem. Now just like bacteria and viruses, there are kinds that can hurt you and there are kinds that are just commensal they don’t, they don’t hurt you they hang out or maybe they’re even mutualistic they actually benefit you.

Dr. Wong

So not everyone littering in the subway is bad.

Dr. Davis

That’s absolutely right, yes. Yeah, so of course we can think of harmful bacteria but there are beneficial bacteria we call this probiotics. We can think of harmful viruses but there are actually beneficial viruses in our gut ecosystem and there are harmful helminths like elephantiasis the elephant man that’s caused by a helminth there’s something called river blindness that makes hundreds of thousands of people get vision impairment every year that’s a helminth and the ones that hurt your liver and your kidneys um but those are the bad ones and even the bad ones if they evade detection by your immune system by upregulating tolerance and the good ones don’t cause any substantial harm and I can talk about that more specifically while still up regulating tolerance in your body. And so the majority of patients that I see are suffering because their own immune system is wreaking havoc on them they are not being tolerant enough of their own self and so when you up regulate tolerance you down regulate hyperinflammation and so if you look at populations of wild vertebrates of any kind fish and birds and primates and every kind of mammal and even wild humans the hunter gathered humans in bolivia and in south africa, all those wild type populations about two-thirds of any given population is going to have helminths in their gut at any given point in time. They’re a natural part of the vertebrate experience and what you want is the helpful ones and not the harmful ones. And so, if you have a hyperinflammatory condition and you bring helminths back into your gut ecosystem which I’ve done for myself multiple times for family members for many many patients even for a colleague on stage at a talk once if you bring those helminths back into your gut ecosystem then you can experience sometimes dramatic down regulation of hyperinflammation.

Dr. Wong

Yeah there’s so many, so many great just lego sub topics we could talk about here but you know I think the really important thing that I want to just highlight to everyone listening that you just said really beautifully is that when the immune system is hyper vigilant, if there’s loss of immune tolerance and there’s hyperinflammation you can get things like autoimmune disease you can get we’re living right now at the time it’s recording the COVID19 pandemic, so basically there’s morbidity and mortality from COVID you know. Hyperinflammation of the lungs and then long COVID and you know all these type of things. So a lot of these are caused by inflammatory cytokines and then like il-6 and things like that interleukin-6 but also loss of immune tolerance I think is what’s happening a lot of cases. So a lot of chronic disease I would say, gut but also other diseases are caused by this loss of immune tolerance to have some therapy like helminthic therapy that can restore some of that immune tolerance is huge and so I’m also kind of wanted to get back to the whole idea of playing with dirt right this whole idea that we should probably be gardening and like putting our hands like not washing our hands all the time although we recommend that before you eat you know you wash your hands we don’t want anyone to get food poisoning or anything but there is this idea that I believe if you correct me if I’m wrong Mark but if you know societies and individuals and societies and communities that have, are living in a more ancestral type of climate or you know upbringing maybe they have more exposure to the dirt and to the different helminths they colonize the gut they cause immune system tolerance they have less autoimmunity they have less sort of chronic atypical allergy, is that correct?

Dr. Davis

That’s absolutely true. Yep! The more exposure you have to a broad diversity of microbes including microbes associated with other animals, domesticated animals, wild animals, soil, and wild plants, all that exposure, decreases autoimmune and allergic diseases. There’s a great book for anyone interested in going deep on this topic called an epidemic of absence a new way of understanding autoimmune and allergic disease by Moises Velasquez Manoff, excellent book that goes into depth and they talk about FMT a bit they talk about helminthic therapy, but mostly they talk about why it is that there’s so much autoimmune allergic disease in countries with greater economic resources today.

Dr. Wong

That’s awesome well, I want to get back to helminthic therapy and take a deeper dive maybe on another podcast because we’re covering a lot of broad topics here. So love to have you back for a second podcast here. I want to talk about the kind of some lifestyle recommendations you might have for people at home to support their gut health in general. It’s sort of a general idea, it’s like someone has some gut issues maybe some bloating, some reflux obviously there’s different precision medicine that we can do but what are some of the basic things that people need to consider in terms of lifestyle practices to support their gut health?

Dr. Davis

I like what Michael Pollan had to say about food which is, to eat food not too much, mostly plants. He wrote a whole book about food and nutrition and he was like that’s the conclusion that I think we can come to and by “eat food”, he meant real food, he meant whole food and not macaroni and cheese. Okay, so the more processed your macaroni is the more processed your cheese I mean those are very highly processed products and yeah and so he means whole foods and so I think you know I have four kids and the one thing if you ask them, “what does your dad think about nutrition? and what is the best thing for people?” they’d say the less processed the better in general. That doesn’t mean our family doesn’t eat any processed.

Dr. Wong

It can be hard especially with kids, absolutely.

Dr. Davis

It’s not just hard. It’s like food is so many things. Food is health but food is emotions and food is socializing and food is you know convenience and so there’s a million factors to take into place and to me health is freedom and to the degree to which someone can have you know pizza and a beer and still feel good. I celebrate that you know and I have patients who are like I never want to have pizza and a beer and I’m like great I celebrate that too but if you want to I want to encourage your ability to achieve that freedom.

Dr. Wong

And it goes back to I think that ability to tolerate pizza and beer it goes back to in theory you know the health of the gut but also mindset too like what are you eating. The food for I know we’re going to have different podcasts down the line on that and sort of intuitive eating and looking at that too but yeah that’s great, yeah if you, if you’d like to it’d be great to talk about helminthic therapy a little bit deeper. I would love your time. It’s awesome. We can also get into saffron and different things, different favorite herbs that you like. But let’s kind of close with some questions we asked all of our guests here on the podcast. Thank you so much Mark for being on here today. Do you have a morning routine and you know is that affected with the four kids or you know just kind of curious about that?

Dr. Davis

Oh yeah, yeah. My morning routine really changes with the season. So in the summer, I am staying up later and I’m sleeping later and I’m eating more raw foods and I have more outdoor exercise as opposed to indoor exercise you know running in the woods near our house etc. But right now it’s getting colder the school year just started so a lot of our morning routines are about re-establishing that rhythm of you know getting up and having all the kids have their breakfast and be ready for school and getting out the door and getting myself ready for work so, yeah. More, more cooked foods and warm foods and indoor exercise so yeah the morning routine definitely changes throughout the day.

Dr. Wong

And I feel like our microbiomes are also seasonal they probably change with their lifestyle and the temperature and the humidity and the foods we eat and all that stuff too.

Dr. Davis

That’s absolutely true!

Dr. Wong

Great! What book or podcast you’re enjoying the most right now and what is it about and why do you like it?

Dr. Davis

Great question! I just finished reading Oliver Sack’s book, Hallucinations. For, if any of your listeners don’t know about Oliver Sacks he’s America’s favorite neurologist author. He died about five years ago but a brilliant writer, and brilliant doctor. In the movie Awakenings, Robin Williams is playing him in that movie and he, Dr. Sacks describes the wide gamut of hallucinations that he knows about and encountered as a practice neurologic practicing neurologist. Everything from Charles Bonnet Syndrome to Parkinson’s associated hallucinations and drug-induced hallucinations and other things and he’s just such a good writer and describes the human condition in medicine and in life just so well that I love him as a writer.

Dr. Wong

Great! To check that out. And then the final and most important question what do you do every day to cultivate joy?

Dr. Davis

Oh great question! Well, I have four kids and three dogs so there’s a lot of organic joy.

Dr. Wong

That joy is right there.

Dr. Davis

Yeah! Bundles, bundles and parenting can be frustrating and it’s so much work but so much joy with that and I guess I would say. Just taking the time to listen to my own needs and wants is probably my biggest habit that keeps me joyful.

Dr. Wong

That’s huge, yeah. I also find that that to be really really helpful connecting back to the center you know back to the back to your own center and then that’s great thank you so much. And then how can listeners learn more about you and work with you Dr. Davis?

Dr. Davis

Well, I’m right here at Capital Integrative Health. So calling or emailing the clinic to get an appointment or you can read things that I’ve written or watch interviews with me at markdavisnd.net that’s “m a r k d a v i s n d like nancy david.net” and there’s a section on writing and some interviews there’s a TEDx talk that I did and other things so you can find out more there.

Dr. Wong

Thank you so much, Mark for coming on today, and love to see you again on the next one. Great to see you!