Tips to Improve Gut Health for Anxiety, Depression, and Autoimmune Disorders with Dr. Burdette N.D. and Pamela Wirth

Tips to Improve Gut Health for Anxiety, Depression, and Autoimmune Disorders with Dr. Burdette N.D. and Pamela Wirth

Pamela: Hi, this is Pamela Wirth with the Encourage Your Wellness podcast. Today, I have Dr. Cheryl Burdette with me. She’s the Director of Education at Progressive Medical Center, which hosts the naturopathic residency at one of the largest integrated clinics in the Southeast. She’s also the founder of Precision Point Diagnostics and is an expert in gut health, among other areas. Welcome, Doctor!

Dr. Burdette: Thank you, Pamela. Thanks for having me.

Pamela: Tell us a little about how you got into your role. When you’re training to become a doctor, there are so many paths you could take. How and why did you choose your specific focus, and what are some of the exciting things you’re working on and have coming up?

Dr. Burdette: Absolutely. Going back to college, my interest in integrative medicine began there. I was dual majoring in Psychology and Premed, and I wondered if there was a way to combine mind and body in medicine. One of my last classes in Psychology was called Biofeedback, Self-Regulation, and Meditation. In this class, we did experiments with college students where we used sensors to measure body temperature and provided biofeedback, which is external feedback about internal processes. Students could see visual changes related to their body temperature and earned a dollar for every degree they could adjust it. This showed them they could control something usually considered beyond our control, like body temperature.

While body temperature might seem academic, this strategy can be applied to other functions like blood pressure or anxiety. There are even biofeedback devices for Attention Deficit Disorder that help with focus. This experience impressed upon me the importance of the mind-body connection. Since there wasn’t much internet access at the time, I used Peterson’s guides to look for integrated or natural medicine. I discovered naturopathic medicine, moved to Seattle, Washington to get my degree, completed my residency at Cancer Treatment Centers, and then returned to the South to integrate this approach in an area with less exposure to it compared to places like Washington or California.

Pamela: Awesome, that's a lot. From there, what have you found about the gut? What do you find that is really important for you to continue? That's kind of like a known thing—maybe some people understand, maybe some people don't. How and why is the gut really becoming so much more of an emphasis now than it was, say, over a decade ago?

Dr. Burdette: Because of the science that comes forward, and that's always been really important to me to make sure that we're following evidence-based types of recommendations. Just as important as finding something that's natural or a functional medicine or a naturopathic medical approach that works, to me, is ruling out things that aren't efficacious. 

I've been lucky enough to practice at Progressive Medical. It's a large integrated clinic with 20 practitioners under one roof: MDs, NDs, dietitians, chiropractors, all of us working together. That clinic has been around for about 30 years now, so it's a very active place where I got to see lots of patients. Because we are so large and see so many patients, we also decided to start our own laboratory. We birthed Precision Point Diagnostics out of the clinic. The reason for that is because we were really interested in some of this gut-based approach to what happens in the body but couldn't always find the lab testing that would match what we needed.

We are particularly interested in this area because it's such a huge area of opportunity. If somebody has been in pain or experiencing inflammation or various headaches or a decreased quality of life, we might think, okay, to get out of pain, that's an anti-inflammatory, maybe that's a steroid, and for sure that is one approach. But it happens to come with pretty significant side effects. 

What we see through gut-based interventions and gut-based practices—and what I mean by that are changing diet and various probiotics and various amino acids, and we'll get to that part—but those gut-based strategies have as much potential and as much strength as an anti-inflammatory as something like a PPI or a steroid does, but without the side effects. So it gives us a way to calm this inflammation without a reliance on medications that really should be used more short term, not over and over again, and gives a pathway for people to treat the root cause of what's going on. 

Because behind a diagnosis like depression, behind a diagnosis like anxiety or even pain, is something that's creating inflammation, and gut-based inflammation is one of the largest sources of that. So if we can change the foods that we're eating, if we can change an inflammatory microbiome, we have this opportunity to change that terrain. I talk about how the gut is our first interface. It's this area where we're going to interact with the outside world with foods and nutrition, and there's going to be this opportunity to either accept what they give us or to become reactive to what it's seeing. It is literally a huge opportunity. The gut is the size of a tennis court, so it's a huge opportunity to change the way that we interface with the outside world to make our internal selves healthier and less inflamed.

Pamela: Yes, so in my journey with my son, the doctor explained that we needed to fix his gut, and this was over 10 years ago. That was kind of a wild thing; I was like, "Okay, well, I'm not quite sure what that all means, but sure." The doctor said that his body is inflamed and that we need to reduce the inflammation because it is housed in the gut. This helps control what’s going on in the brain, as well as the immune system and the rest of the body. I'm oversimplifying things, I know, but when you first look at how to attack inflammation, you can’t get rid of every single inflammatory thing in your environment; it's so hard. Do you have a particular place that you like to start with people?

Dr. Burdette: Yeah, absolutely. I think a lot of ground can be gained. Back to the example of your son, many of us have difficulty wrapping our brains around how this connection to the gut really works. That’s because we’re all brought up in this reductionist style of medicine where we look at the heart as a compartment, the liver as a compartment, the brain as a compartment, but not at the interactions. It turns out there’s a very significant interaction between the gut and the brain.

There’s a communication that happens, driven by gut bugs, which are bacteria. These can either be good bacteria, which you might think of as a probiotic, or bad bacteria, which we’ll group as dysbiotic bacteria. Bad bacteria shed lipopolysaccharides that stimulate the vagal nerve, which communicates from the brain to the gut, but 80% of its communication is from the gut to the brain, only 20% back down again. So if we’re shedding these lipopolysaccharides, that nerve sends a signal to the brain that says, “Game on, there’s a war going on. Let’s be inflammatory, pull more white blood cells to the area, and create this fire designed to kill this pathogen.” That’s okay for an acute infection we need to get rid of, but nowadays, there’s so much assault on our healthy flora from a sugary diet, a diet that’s too fatty, chemicals in our food, medications we take, or simply from being under more stress. Stress decreases blood flow to the gut, puts us in fight or flight, not in the rest and digest branch of the immune system.

We’ve got this battle going on that sends a signal to our brain, causing inflammation in the brain as well. It directly causes various cells in the brain, microglia, to become inflamed. This inflammation blocks the ability to make certain neurotransmitters locally in the brain, such as serotonin or dopamine, which give us a sense of well-being. GABA gives us a sense of relaxation. We are no longer as good at making those neurotransmitters and start to make others that are more neuroexcitatory or cause more aches in the body.

This happens because of evolution. A few hundred years ago, you would be much more likely to die from diarrhea. We are wired to respond to what’s in the gut. If you get an infection that starts in the gut, it sends a signal to the brain to say, “I don’t feel good; get away from the tribe, go to the back of the cave, and don’t infect the rest of the people.” This had its place when we were more likely to die from diarrhea, but now, with so much assault to our normal flora that would usually compete with lower-level dysbiosis, there’s more opportunity for an imbalance to occur. Many of us are fighting this gut battle, which directly changes neurotransmitters in the brain. It’s an underexploited way of treating people.

Everybody knows that if there’s a treatment for depression or anxiety, they would likely start with medications known as SSRIs, selective serotonin reuptake inhibitors. These can be game-changing for some people and a bridge to where they need to be. But what’s the reason they’re not producing enough serotonin? That’s often related to the gut. By changing the microbiome and the serotonin produced in the brain, we create a platform where someone can back off medication or not need it anymore. It’s not that these medications are bad; they have their place. But we also want to ask why this is happening in the first place. When we address what’s going on in the gut, that is often the reason for some of the changes in neurochemistry that we see.

Pamela: So, I think that’s awesome. I’ll give an example and then ask a question. In college, I was feeling kind of down, so I went to student health, and they had me start taking Prozac. What they didn’t ask, and I probably should have shared, was that I was drinking too much beer and eating too much pizza. My theory now is that when I eat a lot of that stuff, I feel really crummy. How much of this can be fixed by removing inflammatory foods for a period of time, such as gluten, dairy, and high-chemical foods (maybe opting for organic), and incorporating things like prebiotics and probiotics? Or do you really need to start with a test and go from there?

Dr. Burdette: I think the literature is pretty strong in this area in terms of dietary changes. You will see positive outcomes in depression and anxiety from studies looking at removing processed foods or increasing fruits and vegetables. Other studies look at removing dyes and chemicals, and in all of these areas, you see positive outcomes. For anyone struggling, I would absolutely start there. 

For most of us, we could always work on getting more vegetables into our diet. Think about what you had yesterday; the recommendation is to have five servings of fruits and vegetables a day. Most of us are not hitting that mark. I would encourage anyone who doesn’t feel well to make those changes because the data is favorable that this will be helpful. 

From there, if you’re seeing some improvement but not quite where you’d like to be or want to dig deeper to know exactly which thing you removed was helpful, this is when testing becomes useful. Yes, start with the standard things that we all know we should be doing: the five fruits and vegetables, 30 minutes of exercise five times a week. That has really good data for improving focus and concentration. Exercise is another evolutionary thing. We are wired for it to affect our brain because when you hunted and gathered, that’s when the brain needed to be turned on the most—to spot the deer or the berry and ensure survival. Exercise increases something called brain-derived neurotrophic factor, which helps the brain work better.

So, these foundational pieces—diet and lifestyle—really do matter. However, for many of us, changing our diet might not yield the improvement we hope for. This is when having something that identifies which foods are creating inflammation can be useful. Unfortunately, in this world where our immune system is confused, it might start attacking healthy foods, which can create inflammation. For example, my colleague Dr. Agoli recently had a patient who thanked him profusely, explaining how her quality of life improved dramatically when she removed broccoli from her diet. This seemed backward because we know broccoli is healthy, decreases cancer risk, and has antioxidants. However, for this patient, her immune system was confused and attacking broccoli, creating inflammation.

So, individualization can be useful, but I don’t want that to suggest that if you can’t get a test, it doesn’t matter. The literature is very clear: more fruits and vegetables help, more exercise helps, and less processed food helps. These are basic starting points that are effective for a large part of the population.

Pamela: No, I think that’s awesome, and the exercise is really big too. Whenever I exercise, sometimes I find myself smiling—it just makes me feel happy. Not everybody feels that way, but it makes me feel good.

Dr. Burdette: Especially when we’re done.

Pamela: Yeah, true. In your research, how long does it typically take? From our experience, it took about a year to turn our son's gut around. In your research, do you find there’s a certain time period or an average time period that it takes most people? It was frustrating for us when we were going through it, and we needed to be patient. Is that typical or not typical? Do you have any research around that?

Dr. Burdette: Yes, so when someone has a more extreme or chronic condition, it often takes that time frame you’re suggesting—six months, nine months, even a year—to really see the full change we’re looking for. Now, if we’re talking about someone who has just noticed a drop in energy, not quite feeling themselves, or a bit of fuzzy focus, that person will likely see significant improvement in about three months. However, I’d still encourage someone to stick with those gut-based practices, likely working with a clinician. Initially, it might be more aggressive, but then you’ll move to a maintenance plan. Still, staying with it for six months to a year is typical for more chronic or aggressive conditions.

What we’re trying to do is get the immune system to not be confused, and that takes a couple of steps. First, we need to remove whatever is causing the immune confusion. In the gut, that’s likely to be either a food or a pathogen. Two tests I often start with are looking at food sensitivities and stool testing to assess the microbiome. From there, we change the diet, shift the microbiome, and work on calming the immune system down. Calming the immune system can take a bit longer, typically six to nine months.

I liken this process to allergy desensitization. For example, allergy treatments by injection often take a year or two. To truly change how the immune system interacts with the outside world, it takes time because you’re retraining it. To improve gut health, you need to build that tissue, which requires patience. Just like you don’t get to go to the gym once and have beautiful biceps, you can’t take supplements once or twice and have a robust gut lining. It takes time and patience. 

Also, a reminder that it’s not suppressive medicine, which is more what standard care is. We’re good at suppressing symptoms with medications, and there’s a place for that, especially if someone is in horrible pain. For instance, if someone has colitis with frequent bowel movements, there’s a need for symptom suppression to avoid quality-of-life issues and prevent scarring and absorption problems. But the goal is to address the root cause so that you don’t need medication forever. Training the immune system does take time. It’s like growing a garden or building biceps—it’s something you work on every day, and improvement happens slowly over time.

Pamela: Thankfully, we are starting to see more and more tests coming out. There is some conflicting information out there. In your experience, when you're testing the gut, does it always have to be through stool? Can you test some of the inflammation or immune system function through blood? Do you find that you need a combination of tests? Are there options through saliva or urine? It’s interesting to think about the different options.

Dr. Burdette: Yes, you’re right. There’s a lot out there, and I use all of those tests, but it depends on the question I’m asking. I really like saliva tests for adrenals, which are glands that sit on top of your kidneys and produce adrenaline. If people have issues with energy and I want to measure their adrenal function, saliva tests are often best. If I’m looking at metabolites, such as how people metabolize estrogen (which can affect breast cancer risk), urine tests are useful because metabolites show up best in urine. So, the choice of specimen depends on what we’re trying to assess.

For gut-based inflammation, two pillars I use are a food sensitivity test, generally done through blood, and a stool test, which looks at the bugs in your gut. It’s not always necessary to do both at once; you can start with one and see what changes occur before deciding if you need the other. However, if symptoms are more aggressive, like you experienced, we might want to address inflammation quickly. Knowing both the food and the pathogen causing the irritation allows us to move forward faster. If I only know one and the other is still irritating the gut, I have to work harder to build the gut lining back up. The decision depends on the individual’s symptoms, logistics, finances, and how aggressively they’re presenting. My two favorite tests are a food sensitivity test and a stool test.

Pamela: Okay, now back to food sensitivity. I’ve had arguments with other parents about the blood food sensitivity test versus the scratch test.

Dr. Burdette: That’s a fuzzy argument. The tests we do look at all aspects of food sensitivities, but you don’t need to poke someone to get that information. Scratch tests look for allergies mediated by IgE, which are immediate reactions. For example, if you eat something and your lips swell, you get a headache, or have shortness of breath, these reactions are mediated by IgE. Scratch tests and blood draws both measure IgE reactions and correlate well.

However, the issue is not whether to use serum or scratch tests but that allergies are just one part of the immune response. There are multiple ways the immune system reacts to foods. Research over the past 20 years has shown that the immune system can react not only immediately but also with delayed reactions, ranging from 3 to 72 hours later. This delayed reaction can be hard to pinpoint, as you might have symptoms like headaches or gut pain from something you ate a few days ago.

The argument that IgG testing isn’t supported would have been valid a couple of decades ago, but it’s not the case anymore. Just as you would want to know both good and bad cholesterol for cardiovascular disease because they tell you different things, you should know both immediate and delayed food reactions. Knowing both helps people reach a solution more quickly.

Pamela: Well, and I think another interesting thing to think about too, and the way this was explained to me, is if something shows up in the blood test but not in the scratch, it could be that it provides a low-grade inflammatory effect on your body. There’s incredible evidence growing that these low-grade inflammatory responses within your body can lead to long-term major illnesses later in your life. Not only short-term depression and anxiety, but also longer-term conditions like Alzheimer’s and other brain disorders. So, I'm not sure what kind of research you've done in that area, but it's certainly something that I think a lot of us will want to keep an eye on.

Dr. Burdette: That's 100% correct. You have to get to a pretty high level before you see immediate symptoms. As you said, there can be this subacute inflammation going on that gets harder to associate with a particular food. The testing can be really helpful to ensure low-grade inflammation isn't occurring, which can create ongoing stress to the brain.

Pamela: Yeah, what else have I not asked you about that you want to share?

Dr. Burdette: Oh, I think this really opens up a lot of avenues for people because a lot of times people have tried various medications in terms of modulating neurotransmitters or other ways of getting out of pain. I don't think you're fully out of options until you've really explored gut-based health. It has so much potential to calm down inflammation, which can decrease neurotransmitters in the brain. That inflammation can also leave us in more pain, cause more fatigue, and even be a reason for weight gain. It means there’s this whole other avenue to explore that can really put people in a place where they feel more well. Also, I think for a lot of us, it's empowering to know what we can do when we change our diet. Just like your experience, in terms of maybe those weren’t the best food choices for you, but even if you eat a piece of pizza here and there and know that’s the way it’s going to make you feel, at least it’s not this giant mystery. We’re not unclear about what's going on in our body. So, having a tool like changing our diet, which is under our control, can give us stability not just physically but mentally, in terms of knowing there is something we can do about it.

Pamela: Thank you, Doctor. If someone wants to talk to their physician or find a physician who might understand what some of this may mean to really get to their gut health, do you have any suggestions on where to find a physician or what kind of physician someone should ask about?

Dr. Burdette: Yeah, well, like I mentioned, I co-founded a lab, so if you're looking for someone who uses that style of testing, you can reach out to us at precisionpointdx.com, and we'll put you in touch with a doctor in your area. Otherwise, there are some other good sources to find people who walk the walk and talk the talk. I would suggest The Institute of Functional Medicine (IFM). They have a really good resource base to look for people who are integratively minded, as well as the American Association of Naturopathic Physicians (AANP). Naturopathic.org is where you'll go to find people who have gone to accredited medical schools, done residencies, passed boards, and are licensed as primary care physicians in their state. There are more and more of us; we're still a minority, but there are ways of finding people, and likely there's somebody in your area if you look at one of those organizations. And like I said, we can help you out at the lab too at Precision Point.

Pamela: Super. Thank you so much, Doctor. We really appreciate having you on today.

Dr. Burdette: My pleasure.

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