The Oral-Systemic Connection & Nutrition Interventions

Kalea Wattles, ND

The oral and gut microbiomes have a complex relationship influenced by several factors, including the micronutrients, macronutrients, and phytochemicals we consume. Research suggests that the intestinal microbiome can be influenced by diet and that these dietary interventions may improve outcomes in a broad spectrum of diseases, including obesity, diabetes, non-alcoholic fatty liver disease, colorectal cancer, and cardiovascular disease. Today, we're talking with functional medicine nutritionist Megan Barnett about the oral systemic connection and the role of personalized nutrition in the microbiome. We'll be discussing how the oral microbiome influences inflammatory pathways via the gut and how personalized nutrition may help bring the body back into balance. Welcome to the show, Megan.

Megan Barnett

Thank you for having me.

Kalea Wattles

I have been so excited recently to see that the oral/systemic connection is having a moment. We're all catching onto the fact that what's healthy for the mouth is probably healthy for the rest of the body, and vice versa. How did this topic become an area of special interest for you?

Megan Barnett 

Well, it was not something that I learned about in school, but in my undergraduate degree, I was tasked with a 30-page report on some, any scientific topic of my choosing. And don't ask me why, but I went down the pathway of Dr. Weston Price. So I had dental hygiene and oral health on the brain, and I had a patient come in my first year of practice that had elevated cholesterol, but that was new for her, and I'd worked with her for a bit. And we saw this spike that had happened over a matter of a couple of months. And I said, "Well, we know that inflammation and the desire for your body to make more white blood cells can impact cholesterol. Do you have any inflammation anywhere that you know of?" And she said, "No, I feel great." And I said, "Okay, well, I'm going to have to think. Call me if you think of anything." 

And 15 minutes later, she called me from the car and said, "Hey, I forgot to tell you, my dentist just told me that I have five apical lesions. Those are infections under old root canals. Do you think that could be a factor?" And I said, "I have no idea, but can I call your dentist?" So that was the beginning for me. And this dentist is a biological dentist in Portland, Oregon, Dr. Kelly Blodgett. And it's been so fun to work with him now for almost five years. But she was such a good sport. She let me draw blood before her oral procedure and get her lipid levels. And then we took her blood again about two to three weeks after she had all five of these teeth removed. And her cholesterol levels dropped—total cholesterol by over 40 points. So that was the beginning for me. And then I didn't understand why it happened, so I had to spend a lot of time in research figuring out what we already knew about these microbes and how they may be impacting our entire health.

Kalea Wattles:

That is a really powerful example. Pretty powerful; the numbers speak for themselves. I've had similar experiences measuring high-sensitivity C-reactive protein before and after dental procedures and found that especially when we reduce gingival inflammation that systemic inflammation really goes down. And it's so amazing to watch. So luckily you have this functional medicine background. You're already trained to look at humans in this very holistic body systems approach. And we see these shared inflammatory pathways as a major route of connection, and the spread of oral bacteria through the bloodstream can contribute to systemic inflammation. Will you talk to us a little bit about how that translocation of oral microbiome, oral microbes through the intestinal barrier, can increase our risk of systemic inflammation? And we're thinking like about our cardiovascular system. How is it all connected?

Megan Barnett: 

Yeah, it's such a great question. And it has nuance to it that I've just, I continue to learn about. So when I think about microbes in the bloodstream, one of the things we test for pretty regularly is antibodies against lipopolysaccharides. And so of course you think about the intestinal barrier, but what we now know is any microbes within the mouth can move into the intestinal tract. Some of them are more susceptible to the stomach acid, so some don't make it through the stomach acid effectively, while others do. And so then we're thinking, okay, well if these microbes have moved into the small intestine or even the large intestine, but let's talk about the small intestine and if there's any intestinal permeability, then those microbes can of course move into the bloodstream. But that's one part that I think in functional medicine we're thinking about a lot. We think about the gut barrier a lot in functional medicine. 

The other factor that I think we need to be thinking more about is that translocation within the mouth into the bloodstream. And that's happening under the surface. You may have totally asymptomatic people, but they have had crowns, they've had root canals, even wisdom teeth that have been taken out. And those cavitations are harboring infections and microbes that have, that are asymptomatic but are brewing for years or decades. And because there is interaction with the capillaries, those microbes can move into circulation without moving into the intestines, just via the endodontic tissue in that circulatory system.

Kalea Wattles:

So now we're seeing multiple routes of exposure, either by translocating through the intestinal barrier or into the capillary system in the gums themselves, right?

Megan Barnett: 

Right.

Kalea Wattles:

And then if we have, I'm just imagining that if we have some gingival inflammation, that that barrier probably becomes more leaky.

Megan Barnett: 

It does. The more inflammation, the worse, obviously, within the entire digestive tract. And I think we have to remember the mouth is the beginning of that digestive tract. It is not separate. I know we have dentists for the mouth and doctors for the rest of it, but it is one system. But I think now we're seeing more and more research that is also forcing us to look at not just the microbes but the biofilms that are built within the mouth and their interactions of different species such as bacteria and fungus. So when that happens, we do see then an elevated level of inflammation and damage to tissue.

Kalea Wattles:

And you mentioned you're working with a great dentist in your area, but for those of us who maybe are in primary care or in solo practice, how are you screening for this in your clients? Are you asking them about their dental health? Or what's your assessment piece like that you would even start to think about an oral connection?

Megan Barnett: 

That's a great question, and it is part of our initial intake for all of our providers. So we ask about any history of root canal, crowns, cavities, bleeding gums, sensitive gums, and, like I said, even wisdom teeth because you can have a perfectly healthy mouth, you may never have had a cavity in your life, but you may have had your wisdom teeth taken out. And you can have cavitations where there are infections. So we ask about all of it. And then when we're thinking about it in the context of the rest of the body, then the question is for me, is there inflammation that's not necessarily explained by something else? Is there a symptom or symptom profile that doesn't make sense with the other things I know about this person's health history? And then I'll typically go down the dental oral route.

Kalea Wattles:

Anyone who's listening who has taken IFM's Immune Module before probably remembers, like, we are inflammologists in functional medicine, so when we see that elevated inflammatory burden, we go looking for the root cause. And now we're really appreciating the fact that sometimes that root cause is coming from the mouth. So I think that's very well said.

Megan Barnett: 

Yeah.

Kalea Wattles:

Will you tell us a little bit about how our dietary macronutrients, our micronutrients, the phytochemicals we're consuming, how is that interacting with our oral and then our gut microbiome?

Megan Barnett: 

There's a few things I think about in the context of our macros, microbes or micros, and all the other amazing molecules we get in our food. There are aspects to our diet that will feed our unhealthy microbes or our more pathogenic microbes. So when we're thinking about carbohydrates, we're thinking about refined sugars preferentially feed and grow the microbes that we may have problems with. And those simple sugars can also cause inflammation to the lining of the intestines, right? So more opportunity for microbes to move and translocate. The more complex carbohydrates, though, and the fiber-rich carbohydrates in opposition, and resistant starches, are feeding our healthy microbes. So of course we want to be moving our diet towards that complex carbohydrate source of fuel versus the refined carbohydrate. 

Protein has shown to be pretty neutral at this point. Now, that's what the current research says. So we're not looking at protein, we look at protein as functional medicine providers for inflammatory pathways for other reasons, growth hormones, et cetera, et cetera, pros and cons, but not as much for the microbiome. We need protein to keep a healthy intestinal barrier, of course. 

And then fats, we have a lot of mixed information around right now. So logically, we're thinking about the anti-inflammatory fats, the unsaturated and the omega-3s for supporting our healthy tissues, the inflammatory fats, the trans fats, et cetera, we think about for damaging our tissues, so we're going to always be thinking about barrier function. Saturated fat is all sorts of mixed up in the research right now for the specific context. And so we have a lot of research showing that it's damaging to the microbiome and damaging to the gut barrier. But almost all of that research, at least that I've seen, is also in the context of feeding the, animal typically, high sugar diet at the same time. So then it's very, then we cannot really separate that data out. So I think we'll continue to learn more about that. 

From a micronutrient perspective, there are very specific micronutrients that we have great research around for barrier function, like the fat-soluble vitamins, all of them, A, D, E, K. Vitamin C is essential and critical for the intestinal barrier. We're missing that a lot. I think we are really underestimating how many people are vitamin C deficient. And there seems to be a different interaction when you take it orally than when you give it by IV. We do want those intestinal cells to have interaction with the vitamin C and B vitamins. And interestingly, we think about this with our barrier function, but we have to think about it as well with the risk around periodontal disease, the risk around that inflammatory process even progressing, right? Prevention is the best medicine. So that's how I think about this. 

And I did have a patient who came to me. She was sent to me by the biological dentist, and she was a young woman. From the outside, the picture of health, and she was doing everything right, but she had been diagnosed with leukopenia in her teen years. I think she was in her very early 30s when we started working together. And she had an oncologist with very poor bedside manner. He said...or a hematologist. He said, you're going to get cancer. You don't have the white blood cells to fight it. It's a matter of time. In tandem with this, she was watching her gums and teeth degrade, and she's like, "I don't know how this is possible. I'm doing all the right things. There's got to be an answer." And she also continued to miscarry over and over and over. So we were scratching our heads, and I was thinking, "Well, this is going to be really complex. I don't know what we're going to find, but we're going to try and find it," right? And I ran a basic panel. So she had been under the care of providers for almost 15 years at this point in time. She had never had her vitamin D tested, period.

Kalea Wattles:

Wow.

Megan Barnett: 

We ran her vitamin D, it was 11. It's the only intervention we used. We got her vitamin D up to 50. All of her white blood cells regulated, all of her oral health concerns were alleviated. Her periodontal disease was no longer. And she carried a baby to term. And I tell that story because we all know as providers that it's never that simple. It's like never that simple, right? But it is amazing when we think about micronutrients, how essential they are, if we are largely deficient, to this entire systemic response and to our mouth and to our entire digestive tract.

Kalea Wattles:

I mean, just my observation as you're talking about all of these factors that can impact our oral health is that the same interventions that you're using to support that permeability and to support the healthy microbial composition are very similar to things that we would think about for supporting metabolic health and healthy glucose levels, supporting our mitochondria, supporting our detox abilities. And so when we look at oral health as a doorway to supporting our systemic health and reducing the risk of chronic disease, I think that's a really powerful notion. And I know you're speaking at IFM's Annual International Conference on this topic of reducing risk for chronic disease by taking care of our mouth. And it's all starting to make more and more sense to me as I listen.

Megan Barnett: 

Yeah, it's exciting, isn't it?

Kalea Wattles:

It's so exciting, especially because the mouth is something that anyone, like you said, you can ask the screening questions, you can do it in a basic assessment, you can work with a dentist. And there are these very approachable dietary and lifestyle factors that you've mentioned. And I want to go back to the dietary fiber piece because we know that most people aren't getting enough of that, of the whole grains or the complex grains and that great fiber source. And that those sources of dietary fiber can help to promote the growth of bifidobacteria and lactobacilli, which we want to be the predominant species in our mouth, in our gut, in the vaginal canal. Will you talk to us a little bit about the physiology of digestion of fiber, particularly, and why that's helpful for our microbial composition?

Megan Barnett: 

I would love to, and I think this is such a large topic, because we think about fiber right now for in many ways being the fix all for a lot of conditions that would affect systemic inflammation, tissue health, and microbiome health. But I like to drill down into the nuance of fiber because different fibers do different things in our body in this way, right? So we have insoluble fibers. I always explain this to patients as this is what makes your food crunchy, right? When you crunch down on that carrot, that's insoluble fiber, it gives you the structure. Soluble fiber, on the other hand, is gooey. Think about that if you see chia seeds get wet or you pour out the liquid from a can of beans, right? It's gooey. And while insoluble fiber is essential for our health, it bulks up our stool, it kind of agitates the lining of the intestines, so it supports motility, and we feel full when we eat it, so we want all that insoluble fiber. 

But when we're talking about the microbiome, we're thinking a lot more about soluble fibers. And different soluble fibers will do different things. But from an anatomical perspective or physiological perspective, I think about it like, eat a can of beans, when it gets to your stomach, it's going to expand, fiber expands, it helps you feel full, but it slows digestion. And what this does for us is it reduces the glucose spike, so that means less inflammation. It also starts to trap toxins in the small intestine. And this is important for the health of the entire digestive tract but really the whole body, right? So as our liver is trying to get rid of toxins, and I think about endotoxins like estrogens and I think about exotoxins from our environment, but the liver's tasked with that. It is binding it to bile, largely, and then shuttling it back into the small intestine by way of the gallbladder. And soluble fibers have this stickiness to them. They have a binding capacity. So this bile is a garbage truck, it’s in part vehicle to get rid of all of these toxins. And the soluble fiber, when it binds to it, is able to prevent that from being reabsorbed into the bloodstream. 

So we're reducing toxic load, reducing inflammation, optimizing health. And as we slow this digestive process, we're absorbing more of the micronutrients at the same time. Eventually, this soluble fiber gets into the colon, and then now, hopefully, it's attached to bile and toxins and all the stuff, all the garbage that we're going to send to our toilet. But when that soluble fiber gets in the colon, it becomes a food source for our microbiome. We can't digest it and absorb it, but they can. And different fibers feed different microbes within those families of microbes that we want to keep healthy and alive, right? And so I harp on this with the people that I work with. Soluble, soluble, soluble. I mean, we really want about 20 grams a day. That's where we see the biggest bang for our buck in the research for the health benefits. And we see robust changes in the microbiome. Now, it doesn't change your diversity, right? You don't get to have new microbes when you eat soluble fiber, but it preferentially feeds the microbes that you want to thrive. And when that happens, of course we're producing more short chain fatty acids, we're building up the colon walls, we're helping with the integrity of that gut barrier. So it's just a win, win, win, win, win, win, win. It's one of the most impactful things I think we can do from a nutritional perspective.

Kalea Wattles:

So you mentioned in terms of sources of soluble fiber what your favorites are, chia seeds, you mentioned beans. Are there some others that are on your radar that we should think about incorporating with some regularity?

Megan Barnett: 

Absolutely. So the top winners for me are beans, lentils, really any legume. Whole grains, as long as you tolerate them from a glucose perspective, right? So that's why so many people have gone off grains. We know that, we see that a ton in our field. People aren't eating grains for glucose, they're not eating grains for inflammation, et cetera. Well, if you tolerate whole grains, they're a phenomenal source of soluble fiber. I also share with my patients avocado, which most people love, is a great source of soluble fiber, sweet potatoes. And I do want to say it's a little caveat, but resistant starches are incredibly important for our microbiome as well. Fiber is different, right? So we don't get away with everything just by eating soluble fiber. But yes, flax and chia, et cetera. And then we do often ask our patients to supplement with a soluble fiber supplement for one reason. It is because it can get you up to that 20 grams. And it also has a higher affinity for binding. So when we're trying to reduce cholesterol or we're trying to clear estrogen, we're looking at supplements to be a little more sticky in the gastrointestinal tract.

Kalea Wattles:

I have to return to this resistant starch piece.

Megan Barnett: 

Yeah.

Kalea Wattles:

Because you said sweet potato, and then you're like…

Megan Barnett: 

And then I was like, oh yeah.

Kalea Wattles:

So one of my favorite tricks is to cook and then cool. Like root vegetables, like sweet potatoes. Will you talk to us a little bit about resistant starch and just do a little side adventure about why resistant starch is helpful or beneficial?

Megan Barnett: 

Yeah, I mean, they just preferentially, again, feed the microbes that we're really trying to support. And so we see people go onto restrictive diets such as a very, very strict keto diet or a very strict paleolithic diet where they're not getting enough diversity in their vegetables or they're not eating grains. And you can see a reduction in the health of the microbiome because they're not getting these resistant starches. And so there's certain ways that we can get them in our diet. Like you said, cooking and cooling. There are things like the popular green banana fiber or green banana flour has become something that a lot of people like to use in their baking, plantains. You have to look again at, as we know, everybody's individual. So we're hyperfocused on making sure people get enough soluble fiber and resistant starch. We're also paying really close attention to that being beneficial without causing any harm. So we are looking at glucose levels, et cetera, et cetera, to make sure people are able to tolerate what we're giving them.

Kalea Wattles:

We're talking about supporting the microbiome in the gut with all these dietary interventions. And I imagine someone might be listening and thinking, okay, I understand now that the bacteria from my mouth can travel and kind of affect the health of my gut. Is this a bidirectional communication? I mean, when we start to repair the gut microbiome, do we see changes to our oral health?

Megan Barnett: 

Yes, we do. Because anytime we reduce inflammation anywhere in the body, we reduce inflammation everywhere in the body, right? That is the great thing about our organism. I do think it's really important for providers to be thinking, though, about looking systemically at this and really taking into consideration the microbial effects when these little critters have moved into the bloodstream. And a couple things I wanted to make sure I touched on when I'm talking about this bidirectional relationship is that there is mounting research that when those microbes or the endotoxins from the microbes translocate into the bloodstream, there is a higher risk of pancreatic cancer. There's a higher risk of endometriosis. There's fascinating research coming out of Japan right now where they're culturing endometriosis and they're finding oral microbiomes, oral microbes in that tissue, right? So we're thinking about how the microbes are affecting the abdominal organs, the systemic organs. When we can identify and treat properly, then we see inflammation in the mouth reduce in tandem with seeing it reduce everywhere else. But like I was saying about the biofilms, sometimes you have to directly treat the mouth and you have to directly treat the gut. And we have physicians we work with that are swabbing all the different bits and pieces of a person's body because we can't just treat one in one place and expect it to affect everything else. And that's because they do set up these nice little homes for themselves.

Kalea Wattles:

You mentioned earlier your case study about your patient who had trouble conceiving and had all of this dental inflammation. And I have a fertility practice, so I see this fairly often. And I was so fascinated with the research, looking at a placental infection and how they found microbes that actually were not present in the vagina. Which you would think just intuitively that there was some vaginal migration, but they really were present in gingival plaques of the mother. And that was mind blowing to me.

Megan Barnett: 

It is, it's fascinating. And we’re finding that microbes that are located within the gut are translocating and migrating to the mouth. So these microbes are tiny. They get to move where they want to if they're given an opportunity. And I think that really speaks to the critical importance of our barrier systems, right? We need to keep those walls strong so they stay where they're supposed to be.

Kalea Wattles:

So many barriers that…

Megan Barnett: 

So many barriers.

Kalea Wattles:

So you're obviously, from a functional medicine perspective, you are individualizing treatment plans, you're tailoring it to a patient's needs. And as you're thinking about approaching someone who, maybe they have, maybe it's a gut health situation, or maybe you can clearly see that there's inflammation in their dental cavity, in their oral cavity, how do you go about tailoring these treatment plans? What steps do you take to really zone in on the personalized needs of each of your clients?

Megan Barnett: 

We like to address the low hanging fruit first. And if there is an ability to support a person without having to send them for a great big dental surgery, then that's what I want to do of course, right? But what we're going to look at initially is do we have a strong foundation nutritionally, and then what gets better? So I always like to take this step by step because if we resolve nutritional issues and we resolve deficiencies and the person's health fully resolves, then do we really need to send them for tens of thousands of dollars of procedures? Not necessarily, right? But then we're taking the next step and we're saying, okay, if nutrition didn't get the job fully done, then we probably need to do some testing. 

And so there are tests that I use to, like I said, culture, I'm culturing the mouth. There's sometimes the sinuses, sometimes we're doing stool testing, we're looking for the specifics, obviously. Sometimes we're doing blood testing and we're looking for these microbes in the blood. And this is where then I coordinate care because I'm a functional nutritionist, so I'm not prescribing things, but I like to do a lot of the investigation because then I can triage, and I can advocate for their care. From that point, we may be treating directly those microbes before we even get to the dental intervention, okay? Because again, that is a really big ask, and I like to make sure every other foundation is set. So we may be working on the gut microbiome and the barriers. We may be treating oral infection, we may be compounding things for that or treating the sinuses. 

And then at that point, we're normally asking our patients, if we're concerned that there is something going on in their mouth that is leading to this symptom presentation, to go and have a cone beam scan. It's a large sort of x-ray of the mouth where we can see the layers of the endodontic tissue. And at that point we have an idea, okay, we've done all the other things. We've really set the strong foundation, and they're still symptomatic. And now it may be time to move to that next level based on what we see in that cone beam scan and advocate for the care with their dentist. Or sometimes they're flying to see a biological dentist to have the work done to remove the dead tissue and infection because for whatever reason, that is a really tough place for our immune system to address, and so these infections can just kind of fester in little encapsulations, and it does take a surgical intervention at times.

Kalea Wattles:

You just opened my mind to the fact that our sinuses, obviously, let's say someone has postnasal drip.

Megan Barnett: 

Yes.

Kalea Wattles:

That that would likely affect the microbiome, both in their mouth and in their gut. And I just had a light bulb moment when you were talking about that, maybe I'm thinking of all my patients that have things like chronic sinusitis.

Megan Barnett: 

Yes.

Kalea Wattles:

And how there's this level of inflammation and probably some bacteria there. Wow, that was really interesting. Okay, so you're working with a collaborative care team, and I think that that's always to the patient's benefit when you're collaborating care and everybody's bringing in their expertise. Will you talk to us about how you're using your skills in the nutrition-oriented physical exam? Like we teach in the functional medicine curriculum to help you identify early warning signs of systemic disease?

Megan Barnett: 

Absolutely, so of course we have the initial intake. I'm looking at their entire health history as we do in functional medicine. It starts from their birth. We're asking about their parents' health. I'm very specifically paying attention to the mother's health and what their microbiome may have been like when they were conceiving and giving birth, right? As we know, we pass this to our children in many ways. After a thorough health history and looking at how the systems are interacting with each other, I'm hoping to pick up some clues, right? I'm trying to put some puzzle pieces together for a hypothesis. 

And then there is, not a traditional physical examination, but I am looking at what's happening with their skin, what's happening with their hair, what can I see when they open their mouth? What's going on with their tongue or the color of their gums? What about the color of their eyes? Their eye whites, not their, not the color of their eyes, right? But the whites of their eyes, the tissue around their eyes. When I start to see inflammatory things going on in the epithelial cells that I can see, then I start thinking about what's happening in the areas I can't see. When I speak to dentists, I say, you have the best view, you guys. You get to look at the window into the digestive tract, and so I'm trying to do that as much as I possibly can. And as we know, then you form a hypothesis, then you start to think about what might be going on. And with the permission of your patient, you're going to test to confirm your hypothesis. So my initial investigation is typically largely based on history, current symptoms, and then what I can see when I look at the patient.

Kalea Wattles:

And you mentioned before that when we see those signs of systemic inflammation, there can be multiple sources of inflammation happening simultaneously. But one of the most common we see, or something we think a lot about in the functional medicine world, is dysbiosis, which isn't a traditional infection, but it is an imbalance in our gut microbiome. Will you talk to us a little bit about some of your favorite tried-and-true techniques for gut dysbiosis? Or at least how you begin to approach a client who has a dysbiotic pattern?

Megan Barnett: 

Absolutely, it depends on what their symptoms are because that will tell me a little bit about what I think the primary dysbiotic microbe is. And I'll say in our practice, the large majority of our patients have a pretty significant yeast overgrowth. And I think this is something that we…is so logical in what we do. We are a hundred years into antibiotics, not only for humans, but in our food sources, right? We're probably close to a hundred years of processed, refined foods that preferentially feed microbes that we don't want to proliferate. Yeast is one of those. It likes to live on refined carbohydrates and sugar. 

And so when I'm thinking about what this patient is experiencing, when they say things to me like, I have itchy skin, or they have eczema, or they have psoriasis, or they crave sweets or refined carbohydrates like chips, and they tell me, you know, they would claw somebody's eyeballs out to get to it, which is not uncommon. I say, "Okay, we might be dealing with yeast," right? Constipation is another sign. And then bacteria has a different profile. It doesn't always look the same. It can… typically, you're going to see some sort of digestive symptoms like what we refer to as SIBO, maybe upper gastric bloating, which can also happen with yeast quite a bit, right? We see lower gastric bloating, we see issues with digesting fibers. Every time I eat vegetables, I bloat. Diarrhea, constipation, depending on what their symptoms are telling me, then we're going to generally test and we're going to do a combination of trying to reduce the microbes we feel are overgrown. And we may do that with herbals. Sometimes I pull my care team in and we're doing it with prescriptions if we find something really nasty. And we're rebuilding and we're doing that foundationally with food, so giving them a nice high-fiber, whole food diet. 

There are different probiotics for different conditions that we may be using to support, resistant starches. Sometimes we're using colostrum or IgG if we really find that the immune system is taking a hit from the microbial overgrowth. And we are often using things like activated charcoal to help pull things out. And of course, we're making sure people are moving things through their digestive tract every single day. I have a saying that I use almost every day, which is, just because it's common doesn't mean it's normal. It's not normal to poop every third day. So there's a lot of reeducation for our patients with their understanding around what their digestive tract should feel like and what other symptoms are connected to what they're experiencing in their gut.

Kalea Wattles:

And when you mentioned that you are doing testing, is this a comprehensive stool analysis, is it a breath test, is it both? What are you turning to the most?

Megan Barnett: 

Generally, we utilize a comprehensive stool analysis. And then we have a secondary company I'd say we use very regularly that is just looking under the microscope for parasites and yeast. And that's because we have a very high level of parasites in the region where I live. And so we see that, we see Giardia extremely commonly, and it likes to live next to yeast. They're neighbors and best friends. And so we see that very commonly. We have to treat those medicinally with pharmaceuticals. And then our team, you know, we have a functional nutritionist working with a medical provider, and in tandem, we're treating and then rebuilding the gut together when we have that situation.

Kalea Wattles:

Very helpful. And when you have the patients who have candidiasis, are you finding you can see it in the mouth, kind of the classic thrush symptoms, or not always?

Megan Barnett: 

Not always. Sometimes we do. I would say outside of the peripheral symptoms, skin issues and the things we'll see outside of the GI tract, probably the most common symptom that we see now is acid reflux or GERD.

Kalea Wattles:

Interesting.

Megan Barnett: 

Yeah.

Kalea Wattles:

Okay. So many clinical pearls being revealed here today. And we know that you're speaking as part of the personalized nutrition focus area at IFM's Annual International Conference in 2024. Will you give us a little sneak peek, let us know what you're talking about and what advanced clinical strategies that the clinicians will get when they attend that discussion? I'm sure it's full of pearls like we've found today.

Megan Barnett: 

Well, I'm really excited to be diving more deeply into oral health and the oral microbiome. I have a personal goal of reconnecting the head to the rest of the body. I want all functional providers to be thinking about what's going on above the neck and below the neck and how they're related. So I'm going to dive into the diseases we may see when there are problems with the oral microbiome’s symptoms, how to take a thorough intake, how to create a relationship with a provider that's going to support you in this way, right? Having a dentist by your side is really important. We're going to see this come up a lot. And then I'm going to offer the nutritional strategies that I use, supplements that I tend to use for rebuilding these barriers within the mouth and the gastrointestinal tract. And then share some case studies, because as we know, everybody's different. So my experiences are not going to look like everybody else's. So we have to be very curious with our patients and make sure we're crossing or checking all the boxes with oral health when we're looking at the rest of the body.

Kalea Wattles:

I've long been saying that your dentist is part of your primary care team. A dentist is a primary care provider, so I'm so aligned with this mission that you're on. As we come to the close of the episode, what important takeaways do you want our listeners to leave this episode knowing and thinking about and bringing into their clinical practice?

Megan Barnett: 

I would just say start getting curious about the mouth. And when we do have dentists on our team and people are taking great care of their mouth, it doesn't necessarily mean that their dentist is looking at it through the lens you're going to look at it. So don't think just because they've got all their people and maybe their mouth is healthy that there isn't something there that's going to give you some information that's going to help you support your patient. It's part of the whole system. And you'll find some really fascinating things when we start asking about the mouth.

Kalea Wattles:

We're excited. We'll stay tuned, we'll remain curious. Megan, thank you so much for being with us. We can't wait to see you this summer at IFM's Annual International Conference. Thank you for sharing your insights today.

Megan Barnett: 

Thank you so much for having me. I really enjoyed it.

Kalea Wattles:

To learn more about this topic, join us for IFM's Annual International Conference, May 29 through June 1, 2024, at the Bellagio in Las Vegas. For more information, visit aic.ifm.org.