Treating GI Conditions with Functional Medicine, with Dr. Ken Brown
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RHR: Treating GI Conditions with Functional Medicine, with Dr. Ken Brown

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In this episode of Revolution Health Radio, Dr. Ken Brown shares how he uses a Functional perspective to address GI conditions like SIBO and IBS.

Revolution Health Radio podcast, Chris Kresser

In this episode, we discuss:

  • Why Dr. Brown chose the Functional Medicine approach
  • What Dr. Brown’s clinical work shows about IBS and SIBO
  • The conventional approach to treating GI conditions
  • What postbiotics are
  • Atrantil as a treatment for SIBO and other GI conditions
  • Gut health, nutrient status, and stress
  • How to use Atrantil: dosage and duration

Show notes:

Hey, everybody, Chris Kresser here. Welcome to another episode of Revolution Health Radio. This week, I’m really excited to welcome Dr. Ken Brown as my guest. Dr. Brown received his medical degree from the University of Nebraska Medical School and completed his fellowship in gastroenterology in San Antonio, Texas. He’s a board-certified gastroenterologist and has been in practice for over 15 years with a clinical focus on inflammatory bowel disease and [IBS].

So I’m really excited to talk to Dr. Brown about his experience [in] treating GI conditions from a Functional perspective. He’s one of the few functionally oriented gastroenterologists that I’ve met and have interacted with over the years. And he’s developed a specific treatment for IBS, bloating, and SIBO that we’re going to be talking about in particular, because I found it to be very helpful in my practice, and I also often recommend it to people who aren’t able to access a Functional Medicine practitioner because it’s safe and it works so well.

So we’re going to dive into that in a little more detail and just talk about some of the research that he’s done and he is doing and how he looks at these kinds of conditions from a Functional perspective. So, without further delay, I bring you Dr. Ken Brown.

Chris Kresser:  Dr. Ken Brown, I’ve really been looking forward to this. Thanks for joining us on the show.

Ken Brown:  Oh, thank you so much, Chris. Love coming back on the show and congratulations to all the success that Revolution Health Radio has achieved since [the] last time I was on. Actually, you were pretty big then, also. So thank you for having me back.

Why Dr. Brown Chose the Functional Medicine Approach

Chris Kresser:  Yeah, it’s great to have you back. And for the people who missed that first episode, maybe we could just start with a little bit on your background. You’re conventionally trained as a gastroenterologist. But then at some point, you made the switch over to a more Functional Medicine perspective. So tell us a little bit about how that happened. What prompted that and what led you down that path?

Ken Brown:  So I consider myself a Functional gastroenterologist right now. And I know that a lot of Functional Medicine people that I’ve met have a really cool story about how they were overcoming a disease and then they learn through a different path. Mine’s a little bit different. I was doing pharmaceutical research and multiple studies, and that’s when I realized that wait a minute, they’re ignoring huge gaps in healthcare. And that’s where I started going down this whole path of how can we do things different[ly] than how this large pharmaceutical conglomerate is out there developing these drugs but not really looking at the other processes? So I came about it because I was doing clinical research on drugs and went, there has to be a better way.

Chris Kresser:  Great. That’s cool because it’s a totally different story, like you said, than you usually hear. You came at it from the other end of the spectrum, right?

Ken Brown:  Exactly.

Chris Kresser:  Kind of seeing under the hood of that drug research and then realizing, wait a second, these drugs are just dealing with the symptoms and the ultimate manifestations of these problems. They’re not really addressing the core problems.

Ken Brown:  One hundred percent. And then looking back [at] that time, I don’t know whose fault it is. It’s the whole industry. But the pharmaceutical companies put so much money into research and development, that by the time they go to a trial phase, they’ve got that thing pretty well dialed in, that they’re going to get whatever statistical analysis that they want.

Chris Kresser:  Right.

Ken Brown:  So they’re not going to spend $40 million to get to a study and then have a study blow up on them.

Chris Kresser:  That reminds me of the Upton Sinclair quote, which I often [use]. I’m sure my listeners have heard me say it a million times:

“It is difficult to get a man to understand something when his salary depends upon his not understanding it.”

Ken Brown:  I’ve never heard the quote, but that makes total sense.

Chris Kresser:  It’s one of the great truisms in life, right? Upton Sinclair was good at distilling those. So one of the things I’ve always appreciated about your work is your research focus, which, of course, comes from your background in clinical research. And that goes, of course, right along with the product that you created, Atrantil, [which] I use a lot in my practice, and we’re going to be talking a lot more about later on in the interview. But maybe we can set the stage by telling folks a little bit more about your research that you’ve done, and what you’re working on now, because that’s, I think, a really important piece of what you do and what you bring to the table.

Ken Brown:  Yeah. So for anybody that doesn’t know, I’m a board-certified gastroenterologist in internal medicine and gastroenterology. And I took a big interest in my field in my specialty with irritable bowel syndrome and inflammatory bowel disease and [the] autoimmune process. And that’s when I started getting into research, pharmaceutical research, and stumbled onto this concept that we ended up developing Atrantil over was the fact that [IBS] could actually have a cause. And ultimately, that became small intestinal bacterial overgrowth, and so on. And so that was the beginning of realizing, okay, there could be this whole new world. And we’d launched Atrantil about five years ago, and have learned so much since then.

And so you asked what kind of new research we’ve headed. Once we had published our studies in Atrantil, I had to focus on trying to get the word out and trying to get more people on this thing. And so, throughout this whole process, I’m being contacted by scientists all over the world. We’ve got PhDs discussing different aspects [of] how these molecules in Atrantil called polyphenols can benefit people, and that’s where the science is headed right now. It’s like, wow, okay, if I can get back to where we can start doing some clinical analysis, because I’m a clinician, so I want to know how this work[s] in the real world ultimately.

Chris Kresser:  Yeah.

Ken Brown:  And there [are] some great ideas out there. And we’re working on a few new products. So it’s really cool.

Chris Kresser:  Yeah, this is definitely an exciting time. There [are] lots, I think we’re just scratching the surface of understanding the microbiome and how things should work in the gut and the different pathological states when things veer off from how they should work. And, for example, you probably heard this, I recently read a paper where Dr. Pimentel and others are now proposing a separate category for what we used to call methane-predominant SIBO. We’ve talked about SIBO on several different episodes, so I think a lot of the listeners will be familiar with it. We’ll back up and do a little primer in a moment.

But [there’s] a fully separate condition now called IMO, or intestinal methanogen overgrowth, to distinguish that from SIBO, which usually involves bacteria that produce hydrogen, whereas IMO would be archaea that produce methane, and they result in distinct clinical presentations with different signs and symptoms. And so we’re now really looking at these as maybe related but distinct conditions that might require separate treatment. And this could be a good segue for talking a little bit more specifically about what you do in your clinic because this is your area of expertise and what you focused on SIBO and now, IMO, and IBS-C, which is IBS [with] constipation, IBS-M, which is IBS that has mixed constipation and diarrhea. And this is interesting, because you and I both know, Ken, when you look in the literature, a lot more of the studies talk about IBS-D with diarrhea. It’s more common, [and] there are more treatments available for it. And you’ve specifically chosen to focus on IBS-C, [IBS-]M, and SIBO. So talk a little bit about that, how you ended up with that focus, and then what you’re working with in the clinic there.

Check out this episode of RHR for a discussion on the Functional Medicine approach to treating SIBO, IBS, and other GI conditions with Dr. Ken Brown. Dr. Brown also shares information on his polyphenol-based supplement, Atrantil. #functionalmedicine #chriskresser

What Dr. Brown’s Clinical Work Shows about IBS and SIBO

Ken Brown:  Absolutely. So how I end[ed] up working on this focus involves the person you were just talking about, Mark Pimentel. I was actually part of the studies for the original Xifaxan studies. And Mark was sharing his animal data way before it even was general to the public because it was so fascinating to me. He’s the one that said we’ll never be able to treat the methane-predominant bacterial overgrowth because archaebacter[ia] are not bacteria. So I think it’s funny. That was like 10 years ago. Then this year, he’s saying it’s IMO. I’m like, you could’ve said IMO back then.

Chris Kresser:  Yeah. So for people who are not familiar with SIBO, who are listening, which I don’t think at this point, are very many, maybe you could just give an overview of SIBO and IMO, and then IBS-C, and IBS-[M] and how they’re different from IBS-D, which is the more typical presentation.

Ken Brown:  So irritable bowel syndrome, as a gastroenterologist, and you’ve had several gastroenterologists on your show, it really is the most common condition that all of us treat. And what’s really weird is that the symptoms that the society has agreed upon are really vague and kind of trash can.

  • Do you have abdominal pain?
  • Do you have a change in your bowel habits?
  • Is the pain relieved with using the restroom for at least once a week, times three months?

Very weird diagnosis. So [for] the [cases of] irritable bowel syndrome, we now believe many of them could be a result of bacterial overgrowth. So studies showed that many people that had an intestinal infection would later develop irritable bowel syndrome. And that’s the whole concept that Dr. Pimentel figured out with animals first and then moved it into human[s] and has definitely been pushing the boundaries every single time, and I love it.

When you have some sort of event, you change the motility and I’m going to say this a couple [of] times, Chris, because I think that that is the future of where we’re going to have to head with treating a lot of these diseases.

Chris Kresser:  I agree.

Ken Brown:  It comes down to the motility. And it’s really exciting because the people that have been watching this, the people that are just now learning about SIBO, meaning my colleagues, are going to be a little bit behind. But when we’re looking at this, it comes into motility. So when something affects the motility, your intestines that normally move continually from mouth to anus, they stop for a moment. And if that were to happen, then it is possible that bacteria can grow. If bacteria start to grow, then whenever you eat, specifically something like a carbohydrate because bacteria love those, they can digest it before you can. And this is how I explained it to my patients when it’s a very classic SIBO presentation.

And then when you mentioned that is there increasing, you’re talking about irritable bowel with diarrhea, definitely, the studies would suggest that there’s more IBS-D. And off [into] a quick rabbit hole, I’m not sure that that’s true, because many times IBS-C presents as functional constipation. That’s the diagnostic code, which is how they do the research versus IBS-C with methane production. So that’s just there. So what we do believe is, if you happen to have been normal, you had antibiotics, got an infection, and then you have trouble eating, then it is possible that you have this thing called SIBO. And if you have diarrhea after you eat, it is possible that you are producing hydrogen sulfide. And if you’re very constipated, it’s possible you’re producing methane. And since you’re bringing up the recent articles with IMO and all that, as you know, it’s a finally moving target for the academic centers.

Chris Kresser:  Yeah.

Ken Brown:  And I say finally, because the Functional Medicine community has been talking about this for quite a while, and now we’ve got Mayo doing research on it.

Chris Kresser:  Right.

Ken Brown:  We’ve got other people.

The Conventional Approach to Treating GI Conditions

Chris Kresser:  It’s definitely more on the radar in the conventional world, which is good, because we get more research and more insight and data on all this stuff.

So let’s talk a little bit about the conventional approach to these conditions. Specifically, how it’s lacking. Because, as you pointed out, these are not rare conditions. These are conditions that affect a shocking number of not only Americans but people worldwide. And I think the prevalence is even understated because a lot of people are not comfortable talking about digestive issues. And I know from doing intakes on patients for well over a decade, often, and this is more common in males than females.

But I’ll get a male patient who comes to see me for high cholesterol and maybe declining exercise tolerance and performance or cognitive issues, and GI problems won’t even be on their top five complaints. It won’t even be listed anywhere in where they could actually fill out their complaints. But when you get to the section that asks them about the function of their body systems, they’ve got nearly constant gas and bloating or diarrhea every day, or whatever and they’ve just learned to live with those problems and don’t really see them as problems. And so those people are not even reporting those issues to any doctor or any other kind of research authority. So I’m curious what you think. But I think these problems are even more widespread than the statistics let on, and the statistics are already pretty significant.

Ken Brown:  Every time I look at this, and when you start realizing that bloating is not even a symptom that’s included in the IBS criteria, the [Diagnostic and Statistical Manual of Mental Disorders], or the IBS, whatever four criteria that [they are] now, that that’s one of the problems. We don’t really discuss what the true symptoms are. And you’re exactly right. When you see somebody, much like I would do. If I see somebody and they’re saying, “Oh, I’ve got a little bit of rectal bleeding, so I’m here to schedule my colonoscopy.” Okay, then you look at their med list. You’re like, “It looks like you have Hashimoto’s. Wait a minute, you’ve got rheumatoid arthritis, also?” The second I start asking about gut health, they all have issues. And the reality is the state of our digestive health will determine how we feel physically and mentally. The GI tract plays such a central role in everything, including brain health, immune health, all the really important stuff.

Chris Kresser:  Right. There [are] two ways to get energy, right? Breathing air and [eating] food. So if one of those is not working well, we’re going to suffer. So yeah, so getting back to the treatments. Like again, my listeners have heard me go on about this ad nauseam. And I wrote a book about it, where one of the fundamental issues with conventional medicine is that the approach is primarily based on suppressing symptoms with drugs and not addressing the root cause. And I think digestive conditions are really the ultimate example of this.

If you look at the drugs that are available for these conditions, it would almost be comical if it wasn’t so sad. So If someone has diarrhea, you’ve basically got Imodium and other drugs that slow down the motility. If you’ve got constipation, you have laxatives. If you have acid reflux, you’ve got proton pump inhibitors that suppress stomach acid production, almost to zero, which has lots of risks both outlined. And then if you’ve got IBS, you’ve got antispasmodics or other drugs that can reduce that symptom. You’ve got [selective serotonin reuptake inhibitors] (SSRIs) that are often prescribed.

But in really no case that I can think of is there a drug that is actually addressing the root cause with the exception of antibiotics for SIBO, but I don’t know if we can really. Treatment of SIBO has definitely gone a little bit more mainstream now and certainly, some conventional gastroenterologists are using that. And, of course, Mark Pimentel would consider himself a conventional gastroenterologist and I don’t know that he identifies … We’ve talked about this on the podcast, he doesn’t necessarily identify as a Functional Medicine guy. But it’s still not widespread. There’s many, I have many patients who’ve gone into their conventional GI doc looking for SIBO treatment only to be turned away.

Ken Brown:  Yeah. So your initial question was, well, like what are you seeing in the conventional? And unfortunately, Chris, this is the whole SIBO thing, it’s still on a really slow uptake with most conventional gastroenterologists. Therefore, if you see somebody and they have normal labs, and a normal colonoscopy and endoscopy, then it’s pat you on the head, good news, you just have IBS. And more often than not, it’s the SSRI that actually gets prescribed first, which is scary.

Chris Kresser:  It is scary. Yeah. And it’s, this is a situation that’s been going on for a long time, too. And so, I’m happy to see that more gastroenterologists are learning about SIBO and testing for it and treating it appropriately. But we, I think we can both agree, we still have a ways to go there.

Ken Brown:  Yeah, and one other thing that is coming to me in just big clumps, where now it’s like, oh, my gosh, we got to decide something here. We’ve got to figure it out. Chris, I don’t know if you’ve seen this, but I’m seeing so many people that have had symptoms that clearly were some sort of infection that led to some sort of IBS/SIBO.

Chris Kresser:  Yeah.

Ken Brown:  And then the one autoimmune disease. Okay, I’ll take it. But then we get into this dysautonomia [postural orthostatic tachycardia syndrome] (POTS), Ehlers-Danlos [syndrome], which is a whole separate thing. But I’m gathering patients and very smart, intelligent engineers, accountants. They’re like, “Look, I was normal. And then six years ago, all this stuff started happening. Now I’ve got weird heart rhythms and things like that.” Have you seen any of that in your practice?

Chris Kresser:  Oh, yeah, definitely. I’ve been, over the last couple [of] years, talking so much about the gut, the enteric nervous system, and the connection between the nervous system and the immune system and every other system, of course, and I think that’s one of the most underappreciated aspects of gut health. And to your point, I think moving forward understanding the gut as a nervous system organ and motility as one component of that nervous system function of the gut is going to be the new next frontier in terms of treating some of these issues. Because I now look at SIBO and IMO as symptoms of a deeper underlying problem, which is usually disrupted gut motility. And I think that’s where the treatments, even the more recent treatments like rifaximin and neomycin, and some of the drugs have not, can be effective, but we also need to learn more about why the overgrowth occurs in the first place, and then develop some better approaches to that long-term.

Ken Brown:  Exactly. And that’s one of the reasons why it’s really fun to start looking at this natural space because when I developed Atrantil, we were looking at these three polyphenols, [and] the polyphenols are those molecules that make vegetables and fruits very colorful. The thing[s] that are very prevalent in the Mediterranean diet. So these polyphenols, I love talking to registered dieticians because they just get so into this part of it because they understand the antioxidant, the anti-aging, the anti all these other beneficial things. And there [are] new terms coming out all the time, like how your bacteria will break them down into postbiotics and stuff.

But it’s so exciting to sit there and look at, okay, this is a frontier that in my world, I’ve just waited for a drug rep to show up and go, “Here’s a pamphlet.” And now I’ve got scientists calling going, “We should do a study on this.” And I’m like, ah, like most of us, if I just had more time and money, I would love to do it.

What Are Postbiotics?

Chris Kresser:  Yeah. So you threw out a term there, “postbiotics.” It might be unfamiliar to folks. They’ve heard of antibiotics, certainly, it was the first one. Then probiotics and prebiotics. So what are postbiotics for those who aren’t familiar with that term?

Ken Brown:  This is the new frontier in the microbiome space. And I was taught this by several different PhDs and talked to one CEO who’s actually at the head of this, and she’s trying to develop a company to look into developing a supplement that would feed this. Postbiotics, by definition, are anything that your microbiome will break down into different molecular structures, meaning the metabolism of undigested food. That undigested food can be fiber; it can be large molecules, like these polyphenols that we’re talking about. Anything that makes it to the colon can be digested by bacteria. Another example would be sugar alcohols. When my patients come to me and go, “I’ve had diarrhea ever since I started this protein shake.” I’m like, “Can I see the label?”

Chris Kresser:  Yes.

Ken Brown:  It says erythritol or whatever.

Chris Kresser:  Xylitol, yeah.

Ken Brown:  Yep. That essentially is the bacteria breaking it down and turning it into basically a laxative.

Chris Kresser:  Yeah. Just [a] public service announcement here. Those are often in keto products, as well, for all the listeners. If you switch to [a] keto diet, and you’re having unexplained diarrhea, that could be one potential cause. And I’m not knocking keto; as you know, I’m a big advocate of it in certain situations. But that is one, for people with GI issues, that can be a problem.

Ken Brown:  Yeah. It’s just one of those interesting things [about] postbiotics. And the reason why is because [it] is in linking the two different fields. My society, the American College of Gastroenterology, came out about two months ago with this consensus statement that really, we don’t see the benefit in probiotics that are there. And the society’s recommendation is that probiotics probably are equivalent to placebo. And what I tell my patients is, if it works, great, stay on it. If it doesn’t, let’s try something different. I just bring that up, because what you’re going to see is this scientific push toward, well, if it’s maybe not the probiotic creating this change, is that possibly your microbiome, which is creating this new beneficial product called postbiotics. So that’s the whole postbiotics thing. I’m being called by, if you get on, you email one PhD, [and] the next thing you know, you’re getting another. This is sweet, but it’s a lot of information.

Atrantil as a Treatment for SIBO and Other GI Conditions

Chris Kresser:  Yeah, there’s so much to learn. And again, it’s an exciting time to be in this field, because I think we’re making great progress. And we already have far more tools now than we had even just five years ago, to help people with these kinds of conditions. And I want to talk a little bit more about Atrantil specifically now because there’s a huge challenge right now in the Functional Medicine world, which is there are too few of us as Functional Medicine practitioners. So even people who want to see a Functional Medicine practitioner and have the means to see one, there [are] often long waiting lists, or there are no practitioners available in their area. And then the other issue, of course, is just accessibility and cost.

Many people can’t afford the private fees that have to be paid to see a Functional Medicine provider, and there isn’t really good insurance coverage in most cases. I think that’s probably a little different for you in your world because you’re a conventionally trained gastroenterologist. But for the average person who’s seeing a general Functional Medicine practitioner, that cost can be a huge obstacle. And people have heard now about SIBO; they want to get tested [and] they want to get treated, but that’s not necessarily possible with their local doctor and they can’t see a Functional Medicine specialist.

So I’m excited about Atrantil because it’s a treatment that I feel like I can ethically recommend to people. It’s safe. I don’t think it’s going to cause harm. It’s got clinical research behind it and it works really well for a lot of people. It’s affordable, it’s accessible, and for those 95 percent of people who hear about this stuff but can’t access a Functional Medicine provider, get SIBO breath testing and then get the appropriate treatment, which still could be Atrantil. We use it in our clinical practice, as well. I think this is a great option for people out there, not just people with SIBO. I want to be clear about that. [It’s also great for] people with gas, bloating, and IBS-related symptoms.

So tell us a little bit about how you even discovered the polyphenols that are in the product and what kind[s] of problems you were trying to solve for when you created this product.

Ken Brown:  So I agree with everything that you just said right there. And when we sit and look at this, when you were saying accessibility to healthcare, one of the things that I’m really excited about is that Atrantil is natural, and it is over the counter. But we also realize that it may be a little difficult for some people. And so we’re going an extra step. We’re actually meeting and we’re trying to see if Atrantil could become part of a conventional solution, meaning part of insurance companies and such, because I think that would bridge the gap. That would open up so many doors for more natural treatments in lieu of just immediate whatever traditional medicine is there.

So it’d be really exciting to see if we can get Atrantil out to many other people. But the whole process of how it came about is polyphenols. Remember that polyphenols are these potent antioxidants. And so when I started to develop this, and we found that a lot of these polyphenols are being used in cattle to decrease the gas production that they were burping up as ruminants, that’s when we were able to dig up all this data and go look. Not only is this safe, but we know that these molecules are actually beneficial for your overall health. So when we did the clinical studies on IBS-C, irritable bowel with constipation, the bloated irritable bowel constipated person, then we showed that we had an 88 percent response on this. And then I did another study where we looked at people that had failed all pharmaceutical options.

So in that study, [there were] very similar results. We had four out of five people that got better. That being said, it’s the true symptoms that we’re looking for. So if you bloat up after you eat, 15 to 20 minutes, that’s classic for what we’re pretty good at treating, what we’re really good at treating. And other aspects of it [were] the hard part[s], when we came out. And we launched the product, [and] a lot of people were trying it out of desperation for other things like functional constipation, or they wanted it as a weight loss product. All these things are part of something much bigger. It shows that people are searching for a solution. And they’re kind of moving away from the traditional doctor thing.

So what you’re doing, I think, is amazing. And you say that we lack some of these practitioners, and I love that you have a program that allows people to do that so they can be part of the solution. So I agree with everything you said.

Chris Kresser:  Yeah, it’s simultaneous efforts, right? To train more practitioners, but also come up with interventions that are more accessible and DIY. And I’ve always taken both approaches. I’m not one of these people that always says you’ve got to see your doctor for every answer to every question. I get really frustrated by that. Because first of all, a lot of doctors don’t have the answers, as we both know. And second of all, we want to empower people to be able to take control of their health, and having to see a doctor every time you have any kind of problem is not the way to do that.

So let’s get a little more specific about the polyphenols in the product and how they work specifically. Because that also speaks to why they’re effective for IBS-C, and IBS-M, like gas and bloating and constipation or a combination of constipation and diarrhea, rather than just being something that’s only for people who have diarrhea or loose stools.

Ken Brown:  So it’s funny because when I was trying to figure out how to fix the bloated, constipated person, I had a very, very myopic view of what we were doing. And I just said I want to fix this bloated, constipated person. And these are my natural ingredients. And I did not realize that what I was playing with [was] Mother Nature’s secret weapon. So I’m trying to fix this one problem. And then after we got done with the study, we did our second study, and [when] we finally had our first run of production, everybody came back and they wanted more. And I was like, but do you feel better? And they’re like, yeah. And so then I realized that, wait a minute, these molecules are something special. And that’s when you start looking into it. And you go, oh, they are Mother Nature’s secret weapon. A stable polyphenol.

So first of all, what is a polyphenol? It’s the most ubiquitous molecule in the plant kingdom that makes plants very colorful, and they’re there to protect the plant from [ultraviolet] rays, viruses, bacteria, and insects. As it turns out, it is a molecule that as humans, our microbiome loves, and we can digest certain polyphenols that then do amazing things in our body, and then other polyphenols, our bacteria break down. And then that’s when we talk about those postbiotics. But what they can do is that they augment so many things. And the first question I get from everybody, at this time, is hey, what about my immune system? Talk to me about polyphenols in the immune system. Are you getting the same thing? Everybody talks to [me] about this.

Chris Kresser:  Yeah, it’s a big topic right now for sure.

Ken Brown:  So that’s what I get. And I answer every single time. Remember that 80 percent of your immune system is actually in your gut. So if you do not have a healthy gut, then you will not have a healthy immune system. No way around it.

Chris Kresser:  Absolutely. Yeah. Alessio Fasano made that clear years ago, right? That the gut is a trigger for most autoimmune conditions.

Ken Brown:  Absolutely. And that’s all based [on] his data on the tight junctions, intestinal permeability, zonulin. Love that stuff. Because now when patients come to me, I can say, “Hey, this was actually shown; this is discussed in multiple articles.” And then when I sit there and talk to one of my partners, perhaps, they’re like, “Well, there’s no science on it.” I’m like, “No, there’s actually a ton of science on that.” And then they’ve learned that I will, I’ve got a huge Mendeley account. Do you use Mendeley for your journals?

Chris Kresser:  Yep.

Ken Brown:  Yeah, I’ve got this huge Mendeley account. I’m like, “What topic do you want to know? I will flood your inbox with articles. Don’t challenge me with no science.”

Chris Kresser:  Yeah. So the interesting thing about it for me, when I was learning more about it and doing my own research, which, of course, I do, I want to come back to the studies you’ve done on Atrantil because I, again, one thing I really appreciate about the way you did this, which is, unfortunately, unusual in the supplement space, is that you did clinical studies before you even released the product. And [you] have been researching it since then.

Usually, supplements are just released, claims are made with no scientific backing, or this is my favorite when they say, “Here’s our research,” and I click, and it’s a Word document. Like a white paper Word document, or something like that. I’m like, wait a second, this is not research. This doesn’t meet the standards for research. But the product works, as I understand it by breaking down hydrogen, and then hydrogen is the fuel source for methanogens that produce methane.

Ken Brown:  Correct.

Chris Kresser:  And when you, if you understand that mechanism, then it makes sense that it wouldn’t work only for methane-predominant conditions and constipation and IBS-C, but it would also work for conditions [that] have hydrogen overproduction. Because two of the compounds of the three are breaking down hydrogen.

Ken Brown:  Exactly. So that works almost like a hydrogen sink; it steals the hydrogen, which decreases the bloating. But it also is preventing the methane or the archaebacter[ia] from adding the other hydrogens there. So after we did the clinical studies on that, and that’s where I say I’m myopic, because since then it’s just really changed. It’s grown, [and] it’s only become better. And our studies probably don’t do it justice. And I need to find some time to be able to publish some more things.

In fact, this is cool. I’ll just tell you, nobody knows about this yet. But we were learning so much about the gut health and the immune system, and I was talking to my nurses at my hospital, at my endoscopy center, my surgery center, and I just realized how scared everybody was. And I was like, well, this is crazy. I know the science behind this. And so we launched. I got my team to agree that we launched a frontline program where we just gave bottles away and said thank you for doing this. Here’s why. If you cannot have a healthy immune system, and I would feel remiss if one of the nurses that I worked with came down with something, because they’re working real hard, and so on. And that was it, we just gave it away. And it was perfect; it was cool. And then [with] the survey afterward, the feedback we’ve gotten is incredible that so many people didn’t realize how good they felt after they started taking it. It fixed the bloating in many.

But a lot of these frontline workers felt better going to work knowing that they had a healthy, at least a healthy gut. And that’s where everybody should feel, honestly. Everybody should feel like they are eating appropriately, [and] they’re taking care of their gut. And you’ve got this. You’re not going into any place knowing that if you don’t have a healthy [gut], you don’t have a healthy XYZ.

Chris Kresser:  Yeah, the gut’s the canary in the coal mine, isn’t it? It’s often where problems start to show up. And I think that that awareness is starting to take hold, at least in the group of people that are our audience. It’s not quite there in the general public yet. But Parkinson’s [disease], for example, [is] a condition that is strongly linked to gut health and changes in gut motility. And it’s not entirely clear whether that’s, there’s probably a bidirectional relationship there where changes to the brain and nervous system affect the gut. But we also know there [have] been prospective studies and other studies that show that there’s also probably a causal relationship between changes in the gut to eventual changes in the brain and nervous system that are diagnosed as Parkinson’s [disease].

Ken Brown:  So that would honestly be my opus as my career. If I could figure out a way to protect the brain and make dementia just gone, that would be my opus.

Chris Kresser:  Yeah, absolutely.

Ken Brown:  Because that brain–gut connection is so fascinating.

Chris Kresser:  Well I think that’s where we’re headed. And it’s so interesting that this connection was well-known back as early as the 1930s. There were some researchers at Duke that talked about the gut–brain–skin axis. I discovered this when I was doing some writing and research several years ago, and I was blown away that the gut–brain– skin axis was a thing. It was known in the 1930s, almost 100 years ago.

These pioneers at Duke talked about even using probiotics to treat these conditions. That word wasn’t prevalent by then, but they talked about, in their study; they talked about using cultured milk, yogurt, to treat these conditions. So, sometimes in science, it’s about rediscovering things that were known but lost in the past.

Ken Brown:  You know, I’m sitting here thinking, as I’m like, I’ve got no excuse. I’ve got the internet. These cats were doing it in ‘30?

Chris Kresser:  They were doing it in the 1930s. I’ll send you some of the papers.

Ken Brown:  No, it’ll make me feel horrible, like I’m underachieving.

Chris Kresser:  Yeah. No, but what’s encouraging is that there’s so much research now that is, and we, of course, have better tools now for illuminating the specific mechanisms of these connections. And I do think that in the next 10 or 20 years, we’re going to totally revolutionize the way that we treat these conditions. And a big part of that is like you’re saying, is going to be maintaining good gut health. And that will start with reducing antibiotic exposure during childhood and aiming for [a] vaginal birth when it’s possible, and if not taking steps to see a healthy microbiome, which Dr. Blaser and his wife, whose name, unfortunately, I’m not remembering right now, who’s, I think, an OB/GYN, and she’s explored different ways of basically seeding a healthy microbiome and women in C-section births.

Ken Brown:  Wow, cool.

Chris Kresser:  There’s so much that we’re learning about this and the reason that Atrantil is cool is that, there are many reasons, but that it’s not, the polyphenols I think have pleiotropic effects, right?

Ken Brown:  That’s exactly it.

Chris Kresser:  It’s not just about breaking down hydrogen. But we’re finding that there [are] so many other things that they do, and they probably even, going back to the root cause of SIBO, may have some impact on the gut nervous system that we don’t even fully understand yet.

Ken Brown:  Yeah, totally. So when you start looking at this, it almost seems, you’re exactly right, a pleiotropic effect is exactly what goes on. Because I’m seeing this over and over again; you can’t outsmart Mother Nature.

So when you look at how a whole molecule, a whole plant, does something, and then somebody wants to patent it, cuts off a portion of the molecule, makes a pill out of it and then puts it back out, it’s never as successful as the whole molecule. And I’m thinking like CBD, cannabidiol versus Epidiolex, the pharmaceutical agent that does really [well] in this one thing. But it has side effects and things like that. So the polyphenol, if you have a large, stable polyphenol, and that’s why we chose the three that we did, the one that throws everybody off when we first launched is Quebracho Colorado.

Quebracho Colorado is one of the largest, most stable polyphenols in both an acidic environment and a basic environment. And what that means is a lot of times people take supplements, but they’re like, wait a minute, have they done the pharmacodynamics on whether this gets absorbed? Does this get destroyed by acid? Does it get destroyed by [the] base when it goes into the small bowel? Can it survive the pancreatic enzymes? And so on. So when we were doing this, this large stable polyphenol called Quebracho stays in the small bowel, which is why it [has] that one effect. The beauty is that since it’s so large and stable, it survives until it gets to your colon where your microbiome does some really cool things. And that’s where we’ve got papers to show that a large stable proanthocyanidin like this kicks off smaller phenols, terms that other people have heard of like quercetin, or yeah, [epigallocatechin gallate] (ECGC), the green tea extract, and so on.

So those are, they combine to form almost like LEGO pieces. I’ve described it before [as thinking] of a large LEGO model of something. I don’t know, for some reason whenever I say this, the Millennium Falcon comes to mind. And then as it’s going through, certain LEGO pieces can be digested in the GI tract. So you’d knock off a couple. And then what’s left is a large chunk of it, that then gets LEGO pieces knocked off, those get absorbed, and that’s the beneficial aspect of these molecules. It’s super cool.

Chris Kresser:  So they’re having a postbiotic effect, as well.

Ken Brown:  Exactly. So it was just so cool to think about this one particular problem and then realize, well, wait a minute, that’s why I think this frontline program that we did, and we’re going to end up publishing the results on this, that people were so overwhelmingly pleased, probably. I get it; they got free stuff. But they were also pleased because some of them had improved gut health, [and] others just felt better. And that’s where I think it comes down to. It’s that all these combined effects ultimately do something.

Chris Kresser:  Right. And, as I mentioned before, like the two ways to get energy, food and oxygen. And if your gut is, if you’ve got gas and bloating, then that’s a sign that you’re not breaking down and absorbing and assimilating nutrients the way that you should be, right? It’s a pretty front and center and immediate sign of that. You don’t need any other studies or even tests to tell you that, right?

Ken Brown:  Right.

Gut Health, Nutrient Status, and Stress

Chris Kresser:  And from a certain perspective, that’s the blessing of that is with other conditions, you do need testing to confirm what’s going on. But in this case, if you’re bloated and gassy, and have diarrhea, constipation, whatever, it’s a pretty obvious sign that your digestive system is not working optimally. And if that’s the case, it probably means you’re not absorbing nutrients. And here I’m talking about both macronutrients like fat, carbohydrates, and protein that fuel our body, but also all of the many micronutrients that we know are critical for health now, also enter through the digestive tract.

So, if you think about that and you understand it, it makes perfect sense that if it’s not just about reducing gas and bloating, it’s about improving your nutrient status, which then basically improves every aspect of health because our health is primarily determined by our nutrient status.

Ken Brown:  Absolutely. And speaking of nutrient status, one of the common mistakes that I get from a lot of my patients is that they are very self-motivated and many of them are type A and they’re going to fix this problem. And they will put themselves on, let’s say, a very restrictive diet like [a] FODMAP diet.

Chris Kresser:  Yeah.

Ken Brown:  For a really long time. And I’m like, I admire your tenacity.

Chris Kresser:  Tenacity, yeah.

Ken Brown:  But you’re going to end up with some micronutrient deficiencies if you don’t broaden your diet a little bit.

Chris Kresser:  Right. Usually, for my patients [who] are even more hardcore, it’s like [autoimmune protocol] (AIP), low FODMAP, ketogenic, low salicylate, low histamine all combined.

Ken Brown:  Oh my gosh. I was going to complain. I’m going to shut up right now.

Chris Kresser:  I get it and I was one of those people. When you’re sick, and you’re trying to figure out what’s going on, and you find something that makes you feel better, at least temporarily, you’re going to stick with that. And especially if you don’t have the help and guidance that you need to find other solutions.

So it’s definitely not knocking our patients. But that’s a good example of why we need more of these kinds of interventions that can provide relief and help people get back to a broader, more nutrient-dense, and varied diet. Because I think what you’re pointing out is that there are potential downsides to long-term restrictive diets. I have no problem with the low-FODMAP diet temporarily. But if someone’s going to be on that for years, or if they’re going to be on [an] AIP, keto, [or] low-FODMAP variation for years, I think that’s not optimal. And it’s way better to correct the digestive issues so that people can eat more food and enjoy more food, too. That’s important.

Ken Brown:  Absolutely. That’s eating, enjoying, socializing. If there’s ever, we’re in this period of COVID[-19], where stress is through the roof. When you’re stressed out, you automatically affect a lot of different systems and neural peptides, one of them being oxytocin.

Chris Kresser:  Yeah, I just saw that study on oxytocin and stress and digestion.

Ken Brown:  Right? Yeah. So basically, we get stressed, you change your intestinal motility, and sometimes you can develop bacterial overgrowth. They were looking at gastroparesis and then they realized that in these rats that they were looking at, if there [were] higher levels of oxytocin, then the motility improved. And I’m sitting here just going oh, my gosh, I was reading that and just went, we have got social distancing. The perfect scenario, chronic stress.

Chris Kresser:  Oxytocin depletion and stress.

Ken Brown:  Yes. All of it. NRF2 depletion, and that’s a whole separate thing. And so I’m like, look, at least have an Atrantil and hug somebody, you know?

Chris Kresser:  Yeah, seriously. Someone in your household maybe or, but it’s true. That’s exactly what I was referring to before; I’ve become very interested in the connection between stress and the gut. And actually, it’s funny, we’re talking about this, I wrote an email about [it] this morning, [which] will go out tomorrow or sometime this week. That I think that this connection between stress and understanding the gut as a nervous system organ is one of the elephants in the room when it comes to GI conditions.

Ken Brown:  Well, I’m going to throw this out. Because when I said that I’ve had a very interesting group of patients that I’ve collected, they’re amazing people. But they’re so smart. And I’ve got graduate students.

Chris Kresser:  Yeah.

Ken Brown:  And I’ve got business people and they’re sick, and they’re helping each other now. And I’m watching this. So I’m laughing, I’m sitting there thinking, okay. At some point, we[’ve] got to rent a plane, go over, everybody gets trained by Chris, let me come back. But this is going to be the dream team of people that will figure out the motility aspect. Because they’re thinking outside the box, and they’re amazing. And it’s going to be really cool. It’s really cool to watch when people say, “We’ll figure this out, and we’ll tell you how to tell other people.” I’m like, that’s cool. That is going to be really neat.

How to Use Atrantil: Dosage and Duration

Chris Kresser:  Yeah, that’s good. That’s what we do. We learn from our patients and the scientists and the researchers are on the front line. I want to talk a little bit about practicalities here. Since I do recommend Atrantil to just not only my patients but friends, family members, [and the] general audience, I want to talk about some kind[s] of tips and tricks for how to use it since this is something you’ve been doing for a long time.

Now we both have clinical experience with it. Where should people start in terms of dosage? And maybe that answer is different for different people depending on what their complaints are. What’s the upper limit that you think is safe in terms of daily dosing, and then let’s talk a little bit about [the] duration of use and what a maintenance dose might look like after the initial problem has been addressed.

Ken Brown:  Okay. So if you’re somebody that has these gastrointestinal issues, remember what we were talking about before, if you can even tolerate it. You’re like, “Yeah, it’s not a big deal. I’m used to it.” Remember that, if you don’t have intestinal health, you don’t have other health. So keep that in mind. So I think it’s a much bigger audience like we’re talking about.

Chris Kresser:  Yeah.

Ken Brown:  So if you have intestinal issues, which seems similar to what we’re talking about bloating after eating, in our clinical trials and since then, we’ve treated hundreds of thousands of people and we’re getting very similar results. The P values [in] our trials were pretty good. So we know that we can extrapolate that.

So if you’re having issues, two tablets, three times a day, with or without meals, we have found that some people are sensitive because of the nature of it. Then probably with meals to start and then see how you tolerate. So I recommend that. Two capsules, three times a day with meals. And you’re going to do that for at least 20 days. And that’s because what I have seen is that people will get much better. And then they stop seven days in, eight days in, and then they’re like, “Oh, then it started coming back.” I’m like, “But if we’re dealing with this, bacterial overgrowth, let’s just eradicate this. Because even when you’re taking it, remember that you are ingesting these very beneficial nature’s secret weapon polyphenols so that you can get these benefits.” So that’s the bloated person that’s had issues for a long time.

Chris Kresser:  Now, let me just interject too on that. We know from research that methane, archaea, and bacteria in the small intestine can be pretty tenacious, and the risk of recurrence is high, especially if you don’t treat properly. So I definitely have found that in my practice, as well. One of the biggest mistakes people make is stopping too soon. And then it just comes back. So definitely, I would err on the side of taking it a little bit longer than you think you should for that reason.

Ken Brown:  Absolutely. And in fact, even though I was part of the studies with Xifaxan, all of my clinical practice is double the time that the [U.S. Food and Drug Administration] (FDA) approved Xifaxan for. So I do the same thing with Xifaxan; if I’m using it, I will use it longer.

Chris Kresser:  Yeah, I am sure you’ve seen the same studies; there was one out of Korea that showed the duration of Xifaxan needed correlated with the breath test value at 90 minutes. Which makes sense, right? If you have severe bacterial overgrowth, it’s probably going to take longer. But the FDA guidelines just say 10 days for everybody, or 14.

Ken Brown:  Yeah. On a super quick thing, just as clinician to clinician, the whole breath test thing, and I know that you’ve had multiple experts on there. What I like to use it for is almost like a [hepatobiliary iminodiacetic acid] (HIDA) scan. If it’s really positive or really negative, okay, let’s sit and talk.

Chris Kresser:  Yeah.

Ken Brown:  And I’m having some fun with adjusting how my patients take Atrantil based on the timing of the gas.

Chris Kresser:  Interesting.

Ken Brown:  If it’s further down, I’m like, let’s take three, three times a day because I want a higher load in that area.

Chris Kresser:  Yeah.

Ken Brown:  If it’s up high, well, that’s one of the things we’re trying to figure out. How do I get you to open up without getting the tannin astringency to get going? And I’ve actually completely reversed two people where it was all about the location of where they’re having their issue.

Chris Kresser:  Interesting. All right, so returning to, we talked about two, three times a day is pretty standard for GI issues. You just mentioned a case where you might use three, three times a day. That’s for someone who had access to a SIBO breath test, and we saw a late hydrogen or methane spike. What about for just general people who don’t have access to breath testing? Is there anyone who would benefit from taking more than two, three times a day for a short period of time?

Ken Brown:  Well, what we know is, that these molecules do not get absorbed and so they’re going to go to your colon and then do what we talked about before. So if it is a situation where somebody has these issues, and they take two, three times a day and they end up with a die-off reaction in the beginning, then sometimes we back off and say let’s ease into it, and then you can do that. And I’m sure that you’ve talked about the whole die-off reaction before. And then there [are] other people that, as we talked about, probably bloat, and when I listen to them, and they’re like, “Yeah, about an hour after I eat, man, I’m just miserable.” If the person says 15 minutes, you have an idea of where it’s going on. So there is, to our knowledge and I’ve taken obscene amounts of this over the years. When we were studying it, I took a whole bottle one time (I don’t recommend that for anybody), just to make sure that there were no other side effects associated with it.

So as far as taking too much, two, three times a day is what we studied. So that’s what we would recommend. If you took a little more than that, there’s no real reason to believe that there’d be any type of toxicity or any type of side effects from it. So it’s extremely safe because these are molecules in nature.

Chris Kresser:  Yeah, I can speak to that because I didn’t perform the study. I have a little more freedom than you do.

Ken Brown:  Well it’s funny, because you meet with the scientists, and you realize the crazy amounts that they’re giving in other studies. There’s actually, the beauty is you’re going to hear a lot about this, because there [are] currently studies going on in South America, and there [are] studies in China, and there [are] studies in Italy right now, where they’re looking at this exact molecule that’s in Atrantil for other things. And a year from now, we’re going to hear a lot about this.

Chris Kresser:  Yeah, we tell our patients to start with that same dose, but there have been several patients who felt like they got a significant benefit at that dose. And then just on their own, even without consulting with us, they decided to increase it to maybe up to four, three times a day, and they got a better effect.

Ken Brown:  Well, even then, so I was with Mark Pimentel at a dinner and we were talking. He goes, “You know what’s crazy is we submitted for this, our phase two trial,” he’s like, “but I think a much higher dose of 900 milligrams, like three times a day on mice works even better.” But in that world, you put your stake in the ground, you go, we’re all in on this.

Chris Kresser:  Right.

Ken Brown:  So even then, I wonder if even higher doses of like Xifaxen would be more effective.

Chris Kresser:  Yeah, it’s possible. So okay, so then what about, you mentioned 20 days. That’s like the therapeutic window. Let’s consider two different scenarios. One scenario is after 20 days, they’re like 80, 90 percent better, and they feel like, okay, I’ve achieved that goal. What should that person do? And then the other scenario is, after 20 days, maybe they’ve had some improvement, but it’s like 40, 50 percent, and they still feel like they have a ways to go. What should that person do?

Ken Brown:  Those are two great scenarios. So you have somebody that’s 80 percent better. And from a holistic perspective, I’m really happy that they’re better. Can we take them to 100 percent on the usual stuff, modify the diet a little bit, make sure they’re sleeping, and so on. But we do know that, and this is from my own experience, not published. This experience from me and all my other colleagues, that if you’re 80 percent better, and you continue to do this, one of the reasons why I spoke with a scientist in Italy about this, and they said, “But of course,” because what you’re doing is you’re increasing the microbial diversity over time.

So when you give your microbiome polyphenols, then these bacteria say, okay, we need to diversify here. If you give your microbiome a Big Mac every day, then the bacteria that loved Big Macs say, we’re cool. Let’s just stay right here. So we think that that may be one of the beneficial long-term effects with that. And so 80 percent stick with it.

Chris Kresser:  So yeah. What does a maintenance dose look like for those people, if that’s what you would suggest?

Ken Brown:  My maintenance dose for the usual antioxidant and anti-aging, anti-inflammatory would just be two every day. So I would say 95 percent of all my patients take at least two every day and at any given point, they’re taking two, three times a day, depending on how they feel.

Chris Kresser:  Right. Kind of up and down, depending on what’s going on.

Ken Brown:  Yeah. And so what’s intriguing to me is that person that shows up, and I’m going to say, I may have misheard you, but did you say they’re 20 percent better?

Chris Kresser:  No, let’s say someone who’s 40, 50 percent better, and so they didn’t achieve the goal that they set out to achieve. Is it safe for them to do another 20-day cycle at that dose or what would you suggest in that case? Like if they still feel like they’re improving. I guess we could break that down further where after 20 days, you got one person who just doesn’t feel like they’re improving at all and they stop. Then they don’t feel like they’re getting [a] benefit. But I’m talking about a person who’s been gradually improving over that 20 days; it’s just been a bit slower than they hoped for and they’re still improving. So they don’t want to stop. Should they stop at 20 days or should they keep going?

Ken Brown:  No. Not at all. In fact, I think this is something that a lot of people have different times of when they do this. So one of the hardest things is that I want to tell my patients, “Look, we [have a] 100 percent money-back guarantee. Commit to this thing. Just do it. So don’t take two capsules.”

And this happens in medicine, also. I’ll prescribe a drug and [patients will] come back and go “Well, it didn’t help.” “How many doses?” “Two.” “No, this is not how this works. Commit to this.” This is feeding your microbiome; this is changing the intestinal lumen so that you have what you need to absorb your nutrients, have a healthy immune system. And what we know is that there’s no other pharmaceutical agent that does this, at least right now. I think Dr. Pimentel’s about ready to launch his unabsorbed statin product.

Chris Kresser:  Is that 010 codename? I don’t know what the actual name is going to be. But yeah.

Ken Brown:  Yeah, exactly. And then, two capsules every single day is there. Now the final group would be me, which is I’m gluten intolerant and so I generally am Paleo all the time. But occasionally, when I do eat some gluten for whatever reason, I get pretty bad distress. So we do know that these molecules, and it’s been looked at with smaller phenolic molecules, where these polyphenols bind to gliadin. And then your body doesn’t quite absorb it the way it should, because it’s got this little gel around it.

And so gluten intolerance is why I always carry it around with me. And then, a little while ago, you mentioned as far as timing, dosing, amount, basically, everybody I’m within speaking distance to is on this, and they’ve been on it for years and years. So I’ve got employees that were with me in the very beginning and we’ve all been taking it. I’ve been taking it, [and] my family has been taking it. So we know that I’m probably like eight years into the original beta samples of taking it, so I’m probably the most extreme version of trying to figure out if this thing’s going to hurt anybody.

Chris Kresser:  Right. And remind me of the timeframes in the study. What were the periods studied?

Ken Brown:  So we launched the product five and a half years ago, which means.

Chris Kresser:  No, I mean, how long people took it in the study.

Ken Brown:  Oh, I’m sorry. They took [it for] about 14 days. I think it was 14 [days], two weeks, to keep it easy.

Chris Kresser:  Yeah, that’s the problem with studies, they’re so darn expensive, right? You want to find a study that’s a year-long [study] of people taking something that’s going to be prohibitively expensive in most contexts.

Ken Brown:  It really is. And when you start looking at, okay, well, what is the benefit? Well, now we’re getting something really cool because I said before that we’re meeting with companies about getting on [the] formulary. What if insurance companies start saying, “Okay, we believe that you have to fail Atrantil before you can get put on X, Y, and Z.” Well, that’s a really easy way to determine, okay, does the science, does the research match up with the other aspects? Because those insurance companies do all the homework; they look at all that. And that would just be so cool to start having accessibility for a lot of different things like, well, whatever. All different kinds of products that you use on your patients.

Chris Kresser:  Yeah. Any other things that people should be aware of in terms of taking this? Like, any contraindications or any just things to keep in mind?

Ken Brown:  I’ll just say what I tell all my patients. It’s not been studied in children, and it’s not been studied in pregnant or lactating women. So the FDA requires us to say that they cannot be used. I tell anybody who is on an anti-rejection medicine as if you were, like, an organ transplant [recipient] or something like that. Or if you’re on a blood thinner, because those have very narrow therapeutic windows. I say I don’t even want to.

Chris Kresser:  Yeah, let’s not risk it.

Ken Brown:  Let’s just not risk it. Exactly.

Chris Kresser:  Yeah. Well, as I said, it’s great to have this option for people because we know just from analytics, that of all of the issues. I’ve always been a generalist, as you know; I’m not a specialist in one particular condition focus area. But having said that, gut health is the number one interest among my podcast listeners, email subscribers, blog visitors, social media followers, etc.

And it’s been frustrating for me in the past to know that there’s, I’m only able to help directly a teeny percentage of those people. And then even through the training programs, both the practitioner and health coach training programs, fortunately, we’re able to help more people through those. But it’s still just scratching the surface. So having a research-backed, clinically validated intervention like this, that people can order from the internet and is pretty amazing. And I wish I had a similar tool for some of the other conditions that I treat.

Ken Brown:  Well, I wish that I had some more resources and more time, and we would collaborate and build a natural research company that would fund itself and it would be so cool to come around and do that.

Chris Kresser:  It’s on a very long list, right? Of things we want to do.

Ken Brown:  Which, by the way, you act like you don’t, you’re like, I wish I could help more people. I think that all of your listeners, your very loyal listeners, most of my patients, I would say almost all of them listen to you. And so the idea that your tribe can share and recruit more people who can understand this kind of thing, this is where you keep growing. And I love that.

Chris Kresser:  Yeah, it’s my mission. And so, I’m just grateful for whatever we’ve been able to do as a community to help folks out there. So along those lines, I want to tell people where they can learn more about Atrantil and buy some if they are interested in trying it out. So the link is kresser.co/atrantil. So that’s a-t-r-a-n-t-i-l. My confession, I was pronouncing that incorrectly for a good two years, I think.

Ken Brown:  If we have more time, that’s a whole separate conversation.

Chris Kresser:  That’s my only complaint about you, Ken, is why the heck did you call it Atrantil? Anyways, kresser.co/a-t-r-a-n-t-i-l. And Ken has been very generous and his team in offering up to 38 percent off on your order.

Ken Brown:  This is extremely, this is sitting with the team, 38 percent off and it’s because you make a huge difference. And we just want to get this out there. So this is a very unique opportunity.

Chris Kresser:  I had to abuse Ken to get him to make this offer. So I hope you guys take him up on it because it’s not something that you would typically have access to. So yeah, and let us know how it goes. Send us an email or post [a] comment on social media. Send a question in [to] ChrisKresser.com/podcastquestion. I’m very curious to hear how it works for you because it’s been so effective in both our clinical practice and just also among the general audience of people that have been taking it. So yeah, I look forward to always learning.

Ken Brown:  And I’ll go so far, when I see my patients, if they have classic symptoms and they don’t respond, that’s when I start going, “Okay, let’s sit down, let’s start looking for zebras.”

Chris Kresser:  Exactly.

Ken Brown:  So if you don’t respond, please go talk to your doctor still.

Chris Kresser:  Yeah, definitely there might be something else. Ken is also an expert in inflammatory bowel disease. That’s another ball of wax. It doesn’t mean you won’t benefit from Atrantil, but there’s obviously other stuff going on there that may need to be addressed. So kresser.co/atrantil. And, Dr. Brown, [it was a] pleasure to speak with you again. Thanks for coming on the show.

Ken Brown:  Oh, thank you so much. It was my honor.

Chris Kresser:  Hopefully, we can meet up again in person one of these days when that’s a thing again.

Ken Brown:  Yes, my oxytocin levels are decreasing. I need some social interaction.

Chris Kresser:  All right, well, thanks for listening, everybody. Keep sending your questions in to ChrisKresser.com/podcastquestion, and we’ll talk to you next time.