#45 Secret Weapon: Angie Cook, RN- Vagal Nerve, Dysautonomia, POTS, and more…

Eric Rieger 0:00
All right, everyone, it is now Episode Number 45 Hello KB MD health family and GCP gut check project fans. I’m Eric here with my co host, Dr. Kenneth Brown. We’ve got an incredible show today. And well, this guy’s always referred to a special secret weapon and I’m gonna let him unveil it here in just a moment. But I’m gonna go ahead before he talks about why this secret weapon is a secret weapon. Let’s just talk that here in just a moment. Angie cook is a registered nurse. She has some issues such as dysautonomia, miles Ehlers danlos, colonic inertia, severe constipation, all of these different things that she’s got experience with that she could actually share a personal story. So, Ken, what brought us here? All right, so

Ken Brown 0:53
this is what Alright, so this episode is very dear to my heart. And people that don’t experience this, you’re going to go out? That’s kind of an odd topic. But I’m telling you, you want to listen to this. Because we know that there’s a connection between digestive health, gut inflammation and the possibility of developing other symptoms, other issues, like dysautonomia, and before you just turn it off? You’re like, what’s that? Like? Whoa, that’s what Angie is going to tell us about today. So Angie, I’ve always referred to her as my secret weapon on the podcast, you can go back to almost one of the first episodes that we’ve ever done one, Episode 45. And first of all, Angie, thank you so much for your incredible diligence to researching and backing everything by science. So I get emails from all over the world. And people say, Hey, can you help me with this? And I will email you and say, is there any chance that you could find this article, and then you find me 50 articles related to that, and we sift through them. So one of the most impressive things is that you’re a patient of mine, that has gone from having some symptoms, to learning so much about it, that you’ve actually gotten your master’s in nutrition. And you realize that part of this process is that you and I are now a team. And I’ve gotten to the point where I’m relying on you for information. And this is my exposition of us saying, look, you know so much more than me about this, we need to get this out to the public. And this is what I want to do. I did Chris kresser, his podcast a couple months ago. And immediately him and I ran to the same conclusion. It’s not about the bacteria. It’s not about this, it’s about the motility. What do we do about that? What is it and so what we’re going to talk about today is the motility about everything. And your history is incredible. Because if you’re somebody who’s ever felt frustrated, by the lack of attention that maybe you’ve gotten in medical community, if you’re somebody who’s felt frustrated that you’re being blown off or anything like that, this is what we’re gonna do. We’re gonna go from Angie’s story about what she has gone through. And then we’re gonna geek out on a level that I am so impressed by. So if you’re shavon Sarna and you’re the CBOE summit person, you’re gonna want to listen to this one if you’re Chris kresser. I got an email from Ben Greenfield just today or yesterday. Yeah, today asking about what different help with some CBOE people I feel like and what I feel like because this hasn’t been done is because you sent me 30 pages of that, I know that you figured this out. This is like the first time ever, these puzzle pieces have been put together. And I’m so excited. So I want to say first of all, I’m honored to be your doctor. Secondly, I’m disappointed I didn’t figure it out. And I have not figured it out yet. Thirdly, I’m super proud of your resilience, of your drive and of your determination to not only help yourself, but ultimately share it with other people. So I’m thrilled about this podcast, we have Angie cook on the podcast, Rn, a nutrition Master’s in nutrition and just beginning her road to helping lots of people I know this and I know that you’re gonna end up writing a book and I know that you’re gonna be the motility expert, and that’s what we’re gonna talk about today. So, welcome.

Angie Cook 4:42
Thank you, no pressure there.

Eric Rieger 4:46
I just want to say that was the most detailed introduction we’ve ever done for anybody

Angie Cook 4:54
i know i kind of want to run into the other room and hide under a cover

Eric Rieger 4:59
in Episode 46 sakes, what are we talking about the stuff that we just did in the introduction.

Ken Brown 5:04
But in all sincerity, it’s that important to me. And it’s that important that you help me. You teach me so that I can help other people. That’s why we’re doing this. Definitely.

Angie Cook 5:16
Thank you. Thank you for having me.

Ken Brown 5:18
Absolutely. So I’m gonna throw it back at Eric and let him kind of lead. And I’m just going to try and pop in occasionally, because I’m a huge superfan of you. So I’m going to try not to interrupt every 30 seconds.

Eric Rieger 5:31
Not a problem, not a problem. So Angie, whenever we are dealing with issues of motility, not everyone necessarily understands what the problem is. So when you began to experience problems, and not really even knowing that it was a motility issue, what did you first experience? And then who did you go to to try to find out answers? And then also you take it from there,

Angie Cook 5:55
right. So I’m to share a little bit about my story. My problems started about eight years ago. And so what happened was at that time, I was actually pretty healthy. I didn’t have any kind of diagnoses, I didn’t have any medications, I didn’t see a doctor on a regular basis for any kind of ongoing reasons. And over a very short period of time, I had sort of what I described as the perfect storm of things happening, and they sort of seemed a little bit unrelated. But the first thing that happened was I started having abdominal pain. And I did have a little bit of trouble with the bowel movements. But my main issue was I just started having really severe pain. So I started by seeing my gynecologist, and I went to him and they found a very large ovarian cyst. So I had surgery right away to get that taken care of. But I still had problems, I still had pain. So then he sent me to another doctor who was a surgeon. And they thought maybe I had appendicitis. So I ended up I did have a problem with my appendix and they removed it. But after that surgery, which was just 30 days after the first so I had two surgeries within 30 days. Both my gynecologist and my surgeon said, Well, we think you’re just constipated. And I was shocked. I was like, What do you mean, I’m constipated. I’ve never had a problem with bowel movements. I’ve never taken any kind of medication. It’s never been anything that has been an issue. For me, it’s always been a non issue. Even though I’ve been having a little bit of trouble, I didn’t really consider it constipation. And so I found out very quickly that I did have constipation, and that the pain was relieved when I took medication. But the problem was that I needed a lot of medication. It wasn’t just like a normal laxative over the counter, I needed very high doses. And it took my body a very long time to do anything once I took the medication. So they told me to go find a gastroenterologist. And that’s when it came to you, Dr. Brown. And all of this happened within about six or eight weeks from where I thought I was fine to where I was severely incapacitated.

Eric Rieger 8:10
So in that, at that point, when you when you end up going to obviously see Ken and you go to his clinic, I’ve gotten to know a little bit more about your story, just simply because not only do you experienced this issue and do a lot of research on it, you do tons of research for for both of us on various topics. So we we’ve exchanged quite a bit. I’ve seen you though, as you’ve moved through and and hit roadblocks and challenges. So this isn’t just as if you went to Ken’s office, and then Oh, you’ve got constipation, allama gi, this must be pretty easy to fix. In fact, you’ve probably encountered a much different scenario what was

Angie Cook 8:49
right. So when I first started, started seeing Dr. Brown, we did all kinds of tests. And you know, I mean, Dr. Brown, you’ve been amazing, because a lot of patients with motility issues when well let me back up. So what we ended up finding out was that I was diagnosed with colonic inertia. So basically that is a diagnosis that is very similar to constipation, but it’s the most severe type of constipation you can imagine. So basically, what happens is your colon just becomes paralyzed and nothing moves and it causes severe pain. Severe bloating, can cause nausea and vomiting. And it can be even a really dangerous issue because if you can’t move anything, you’re at risk for obstructions and other complications and things like that. So early on, I knew that my problem was really severe. I started seeing Dr. Brown we went through all the usual tests, and then I got this diagnosis. What’s interesting though, is that I found later on that I didn’t realize it at the time, but I had some things going on with my neck. So about a year or two after I was diagnosed We realized my neck problems had progressed, I actually had several spinal cord at several discs on my spinal cord that were herniated, but I had one that was actually herniated, and it was pressed into my spinal cord. So it was causing severe myelopathy. So I really think that that probably triggered some of my problem and contributed a lot to trigger this kalinic ownership, you know, starting so.

Ken Brown 10:25
So Angie, let me just stop right there when you say it caused myelopathy, which is different than when if somebody’s listening, they’re like, well, I had a bulging disc, I didn’t have constipation. Yeah, explain briefly what you mean by that.

Angie Cook 10:37
So I actually had three discs that were a problem, my see four or five disc, the five, six and the six, seven. So the way I found out about it was I had a lot of left upper extremity pain, numbness, it was just I felt like maybe I had torn my rotator cuff. But I was also having all these gi issues. And I even thought maybe I had a mess because I couldn’t feel my legs very well. So what happens is normally when a disc herniated it herniates to one side or the other, and that’s what causes Radiculopathy. And you can have that in your upper extremities or your lower extremities. And that’s when you get that pain and the numbness and tingling and all that. But my disc at the top does the C four or five discs actually herniated back instead of to the side. So it was pressed halfway through the spinal cord. And when I ended up having surgery, The surgeon said it was very bad that anything like a simple slip or fall, that disc could have fallen or could have been pushed all the way through the cord, there would have been no forgiveness that could have been paralyzed. And he said that it had been pressed into the spinal cord for so long and so hard that when he removed the disc, and actually there was a hole on the spinal cord, it started gushing spinal fluid everywhere. So it was more than just like a simple disc that it’s herniated to the side causing problems. That was the problem with the two disc below. And that’s kind of what alerted me. Something’s going on. I need to see a doctor. But the main problem was the desk that was pressed into the spinal cord.

Eric Rieger 12:10
And so you feel like this was probably a catalyst that ended up resulting in, right.

Angie Cook 12:15
I mean, once this happened, I could look back and see that there were several warning signs, I didn’t have an injury or anything like that. Probably what happened is I had very severe osteophytes, which are bone spurs, and they started pushing the disk out of alignment. And I was having headaches, I was having migraines, I had started noticing that I couldn’t really feel things. Like if I was shaving my legs and I cut myself I couldn’t feel it. I didn’t know it until I saw myself bleeding. But by the time that I realized that it was a problem, and I was having all the other symptoms it had progressed to the point I was actually having trouble walking. And I couldn’t feel anything below my waist. And I was actually having the fecal incontinence at night in my sleep. So it was very severe.

Eric Rieger 12:59
Man, I am so sorry that you had to go through really any of it. Just Yeah,

Angie Cook 13:04
so I’m sure that that probably contributed to the colonic inertia. But really, at the time that this happened, I didn’t know much about any of this. I was a nurse. I’d been a nurse for a long time, I’d never heard of it. I when I got the diagnosis, I started going on Google to try to read and I just got very frustrated and hopeless. I felt depressed because there really wasn’t a lot of information out there. And every time I asked someone Why did this happen? You know, no one could really explain it. They just kind of said, Well, we know motility issues happen, we just don’t always understand why. So it was it was very hard. But since then I have joined several discussion groups and support groups online and met a lot of people and when I read stories, one thing that I do see is that generally people with motility issues have one of two scenarios. They either have always had motility issues that just progressed to the point where now they’re severe, or they are like me where several things happened. And it could be different things, not necessarily the same things that happened to me, but several things happened with their health. And somehow those issues are issues that we know can create intestinal inflammation or increased permeability, and that that probably caused the dysmotility.

Eric Rieger 14:25
So with this, basically a physical manifestation is what we’re talking about. And it’s very mechanical, we have a disc herniation. And then you’re saying that it’s do your best estimation that ended up leading to the GI issues. And we haven’t talked about it yet, but I bet you that you’re probably going to talk a little bit about maybe food selections and different things like that was a was a road that you went down to see if you could correct constipation. It’s a very natural thing for people to do. Do you feel like that you were able to get anywhere and maybe why you weren’t and I’ll let you take it from there.

Angie Cook 15:00
Yeah, so the one thing about colonic inertia is that it isn’t the same as constipation. A lot of times people have constipation. You can have them maybe increased their fiber in their diet or, you know, people have CBOE they’ll they’ll try all kinds of different diets. But colonic inertia doesn’t really respond to any of that, in fact, if you try to increase your fiber is severely exacerbates the pain and the problems I mean, even to this day, I can’t eat as much fiber as I would like, I have to be very careful, even if I’m making a smoothie or juicing something where it’s still liquid, but it has a lot of fiber, that’s going to mess me up. And that’s very common. People with colonic inertia, or gastroparesis, which I also have developed, will will say the same thing.

Ken Brown 15:48
So let me interrupt you right there, because of the path that we were going down when I was doing my research on SIBO, small intestinal bacterial overgrowth of bacteria grown where it shouldn’t be. And that was a recurring thing between you. And I’m like, why are you not responding to anything? Yeah, this is like, I’m crushing it with my other patients, they think I’m amazing. And you’re like, nothing. And that’s where we kept going. And so this led to you not giving up me not giving up and then saying, Okay, what else is going on? So when we talk about colonic inertia, you’re saying the word over and over, but what do you really mean by that?

Angie Cook 16:31
So again, it’s like a very severe form of constipation, it basically means that your colon is paralyzed, it’s not moving. So what happens is, when you eat, your food goes to your stomach and your small intestine, so you can digest and absorb it, but when it gets to the colon, it stops moving. So you have this buildup of waste. And if if you can’t do something to get that to move, then you’re going to end up with an obstruction or something like that. And that’s very common with patients like this. They get in very dire situations, I can say, one of the best things that you told me in the very beginning, the best advice I received was to always take what I needed to take to make sure that I was going every day. And I took that advice to heart. And that was sort of my, you know, my guiding principle that I used. And I learned very quickly, what was normal output. And if anything changed, then I knew I needed to change, I needed to stop eating, go on a liquid diet, increase my medications, I needed to do something right away to get that corrected. And unfortunately, I see a lot of patients that you know, and of course, this isn’t to their fault, because this is a very, very hard problem to manage. But it is not uncommon for patients to go a week, two weeks, three weeks, a month, and they have not had a bowel movement.

Ken Brown 17:55
We talked about this that my wife loida is she’s on sabbatical now for 16 years. But it’s she’s a rehab doctor. And so they deal with spinal cord injuries, one of the first things that they address when somebody has a spinal cord injury, which essentially is what you’re describing you had a spinal cord injury because it herniated into the desk, which is you need to stay and you need to essentially make sure that your patients have bowel movements, because the nerves are not telling you. So colonic inertia is essentially a nerve issue where you’re not having the peristalsis.

Angie Cook 18:33
So Exactly. In fact, I actually worked in a rehab when I was in nursing school, and I worked on the spinal cord injury floor. So I helped patients every night with their bowel program. So it’s very familiar with that. And patients who do have spinal cord injuries, they have a bowel program where they will have some sort of regimen that they follow. It’s usually either every night or every other night, but it’s all about doing some kind of intervention to make things move so that that’s a regular, you know, just a regular regimen they follow. And basically, I had to do the same thing, I had to go on a lot of different medications, very high doses. And for me, because I work during the day, I made the decision that I came home from work, I took all my medications, and then I was in and out of the bathroom all night long. And sometimes, you know, all evening as well as all night long. I did sleep a lot. And I did that for about seven years. And then unfortunately, when people have colonic inertia, it’s so severe that when you fail all the medications, the only option is to remove the colon and that’s what ended up happening to me is that even though I was trying very hard to manage it, I got to the point where the medications were not as effective. I was having a lot of side effects. I was having a lot of electrolyte issues with low potassium, which is pretty serious if that continues. And so about a year ago, I ended up I did have my colon removed.

Ken Brown 20:01
So I just want to clarify this for anybody who is dealing with even constipation, just simple constipation, and they don’t want to talk to their friends about it, they want to do anything you mentioned a couple things we’ve, we’ve packaged a lot right in there. One of those is support groups that you do online forums and things like that. But it shows that how important it is that digestion is not just the absorption of calories, it’s also the elimination of waste, which is a necessary process. So when I talk to my patients, it’s like look breathing out co2, you know, if you want to think that, that pooping is embarrassing, or whatever, guess what happens when you can’t, you can actually die from it. And what what we were dealing with during that period was oh, my gosh, this is crazy. We’re throwing everything in the kitchen sink, and your colon is not working. So if anybody’s listening to it, and they’re maybe blown off by their doctor and such This is it’s a very real thing, which is why I was so excited to have you on and tell your story. It’s really,

Angie Cook 21:07
it’s really hard and you feel very alone, it’s not socially acceptable to talk about your bowel habits, it’s always considered taboo and you know, too much information kind of thing. And so no one can really understand this unless you’ve actually been in that desperate situation. So you feel very isolated and alone and affects your quality of life. And every way imaginable. I know that for me, personally, my social life was greatly affected. You know, anytime that I wanted to do anything, like meet a friend for lunch, or, you know, go out to dinner, I actually would plan ahead, I would fast for, you know, two or three meals. So then I could go to a restaurant with someone and actually eat a meal, and then come home and then fast again. So I mean, the impact on your quality of life, you just you can’t describe it. It’s very isolating.

Eric Rieger 22:00
You find yourself just basically planning life around regular life. It sounds

Angie Cook 22:05
Oh, absolutely.

Eric Rieger 22:06
Yeah, that sounds that sounds not ideal. So not too fast forward. But what I feel like that you’ve really done an excellent job at summarizing is that the traditional way for you to try to find relief for constipation, which would be increasing fiber making certain that you’ve had enough fluids and, and the normal things that we would tell most people, if they’re having a constipation issue, you just choose better food, essentially, it obviously wasn’t working for you. And so we’re now going into a situation where you talked about basically it’s a it’s a paralyzed movement, or lack of movement of a food bolus, especially by the time it enters into the colon. So talk a little bit about that. Once you discovered that your situation wasn’t going to have an easy remedy. And it really is more or less going to be affected by a mechanical structure, nerves. It really changes probably the landscape on what you Angie we’re going to do for yourself to figure out, okay, the ballgame is different. I’m not just not eating fiber, I’m not just not selecting the best foods, my body essentially is not responding the right way when there is something in the colon. So what did that do for you when you kind of found out or discovered?

Angie Cook 23:29
Well, definitely, when I started realizing that this was my new baseline that, you know, I wasn’t going to ever go back to the way things were that at some point, I was going to have to manage this in some way for the rest of my life. And that’s when I really started getting interested in gut health and doing research, I became a complete nerd started spending a lot of my free time, you know, reading journal articles and trying to learn to educate myself, I had heard that, you know, all gut, all health begins in the gut. And I wanted to understand more, what did that mean, specifically, and I knew that this was something I was going to have to manage. So I knew there wasn’t a lot of great answers. And I just figured that there was it, it just figured that I needed to understand it as much as I could myself to help myself because nobody else had that much motivation. So it really kind of made me turn into this nerd. And then of course, I got interested in nutrition and that’s why I went to get my masters. But it was all because I knew that this was going to be my baseline that I had to learn somehow to live with it.

Eric Rieger 24:30
Okay. And then knowing that you had to find this new place to live in what what did you find that the deficits were now you know, it’s not fiber lack and and and you’ve prepared yourself on how do I support myself and others like me with nutrition? kind of walk us through what you began to discover on like, what the issue actually was, where it wasn’t, it wasn’t just a lack of focus. I’m sorry.

Ken Brown 24:55
Well, yeah, let me just clarify this because you mentioned something in passing. You had your colon taken out. Hello, yeah. Since we had my colectomy so I mean, that’s pretty big. I would like to like read probably on the podcast now because then you were cured, right?

Angie Cook 25:07
No, no.

Ken Brown 25:08
Uh oh

Angie Cook 25:09
yeah. So um, you know even that that was my first symptom somewhere along the way. I did start developing other problems. I don’t have all the problems that you listed at the beginning of the podcast. Yeah,

Eric Rieger 25:21
may have misspoken in there. But yeah, that’s our shot of time together. But

Ken Brown 25:24
But your because of your research, what I really want is anybody who has CBOE or pots, or Ehlers danlos, Ehlers danlos, or mast cell activation syndrome or malls. And if you’re like, I don’t know what any of those are. Don’t worry, if you don’t know, consider yourself lucky. Because if you do know, you know, you’re suffering. And so we’re gonna eventually get to the science of where everything you did, I believe has found this puzzle piece to get there. But I just want everyone to know that you had the surgery, but you weren’t completely fixed.

Angie Cook 25:59
Yeah, no, I’m not. So at some point, during the years, I did start developing symptoms of gastroparesis, which is basically the same thing that I was describing with the colon, but it’s with the stomach. So your stomach becomes kind of paralyzed, where anytime you eat food, or you drink anything, it just stays in your stomach for much longer than it needs to. And it doesn’t move and it causes a lot of pain, it can cause nausea, it can cause vomiting. So I developed that and actually for the last several years, the problem with that is, it’s aggravated by position, so it has prevented me from eating later in the day. I usually try to eat everything I’m going to eat by the middle of the afternoon. If I eat like a dinner, then I’m taking a chance that when I go to bed at night, I may wake up no 234 hours later in pain or even vomiting. So like the last several years, I’ve actually kept a bowl next to the bed, because I’ll wake up and I’ll already be starting to vomit. So I develop gastroparesis. I also developed several symptoms of dysautonomia, which have come and gone throughout the years. It’s not something I deal with every day, but I’ll have flare ups where I’ll have a lot of symptoms and then and a little while, kind of get better and then it’ll kind of come back again. So I have dealt with quite a bit of that. And when I had my colon, I sort of just lumped it all together that Okay, my colon doesn’t work. So I know I have all these other problems but it’s all just kind of related. And then when I had my colon out, obviously that part got better because now I don’t have a colon. I don’t have to take as much medication I’m not you know, having to do the things that I did before. But I still have the gastroparesis. I still have some overall slow motility in my stomach and my small bowel and I’ve had issues with dysautonomia off and on this year, I’ve learned more about dysautonomia and really recognize that there are some symptoms I’ve had that I never recognized before

Ken Brown 28:03
can you define dysautonomia,

Angie Cook 28:04
dysautonomia basically, your autonomic nervous system does everything in your body that you don’t have to think about. So it controls like breathing heart rate, your digestion actually, gastroparesis is considered a symptom of dysautonomia. But when you have that, one of the things that can happen is I’ve had pots type symptoms. So the definition of pots is basically postural orthostatic tachycardia syndrome, which all that really means is that when you stand up, your heart rate goes way high. But it’s really more complicated than that what happens. And what it’s like for me is I can be sitting here where I’m at right now working doing my job, and I have a little Pulse ox, I’ll check my my heart rate, it’ll be in the 60s. And when I’m having a flare up, I can get up and I can walk to another room in my house, get a drink of water, come back. And I will have felt like I had just ran a marathon. When I checked my heart right now it’s gone from 60 to like 131-140. And you just feel like you’re swimming underwater, and it’ll stay high for maybe 30-45 minutes. Another symptom is heat intolerance, which I’ve also had for several years, but at several episodes this year, where it’s not just been that I’m uncomfortable when it’s hot, but my temperature actually will raise it’ll go higher several degrees and then I can’t, my body can’t cool itself off. So another problem that goes along with that is people with dysautonomia will lose the ability to sweat. So when I realized that I’m thinking back, I don’t remember the last time I sweat. So that kind of goes with the heat intolerance. When you get hot, your body can’t cool itself off and you know my face look at Red and my temperature will go up, but my body can’t cool itself back down to normal temperature and things like dry eyes. Dry mouth, dry skin, I have all of those almost every day. And those are all because the autonomic nervous system controls all your glands and the way that it functions. And when you have decided Nami, you can have problems with that.

Ken Brown 30:14
Is there any people with dysautonomia that have worse symptoms that are life threatening?

Angie Cook 30:20
Oh, absolutely, you can progress, it can be very severe because you can’t regulate your heart rate, or your breathing. So there are people who have it much worse than I do. The other part of Potts is that there are people who struggle with dehydration on a daily basis and require IV hydration every single day. Along with that, you can also have symptoms just taking a shower can be overwhelming to your system and take a long time to recover from. So yes, it can progress to where it’s life threatening.

Eric Rieger 30:53
So just by description, and a little bit more technical, the symptoms that that he is describing that you’re describing Angie is just it, it allows me to think of on the autonomic nervous system, we’re really talking about one side that’s really becoming deficient, there would be the parasympathetic side. Yeah, the autonomic nervous system. So of course, we got fight or flight, and we have rest and digest, we really depend so much on rest and digest really, more for better function throughout the rest of the day, when that is not being I guess, in tuned, if you will, for the better part of the day, we can suffer like this, and our glands don’t work. And we don’t, we don’t sweat when necessary. And our heart rate does raise so yeah, it. Unfortunately, it does seem like it all comes back to one side. And from all the notes that you sent over, it seems like that’s what you spent a lot of time drawing the parallels and tying it back to, to one specific source, do you want to kind of go down that road?

Angie Cook 32:02
Sure. So, um, like I said, I had my colon removed about a year ago, and then when that when I had that done, and then I started realizing I still had problems, that’s when I started thinking, Okay, these problems are continuing, I need to start figuring them out. So I started researching different areas. And I’m going to kind of say, it’s almost like an onion. So like, when you start peeling back one layer, then there’s another layer, and it just kind of keeps going. But um, the first thing I started looking at was small intestine dysmotility. And I actually found several studies, where the researchers use the model of a post operative alias, to study what small intestine dysmotility is all about. So when you have surgeries, particularly an abdominal surgery, the intestines are manipulated. And if you’re having intestine surgery, then of course, they’re cut, and your body perceives all of that as an injury, and it creates inflammation. So what I learned was that in all these different studies, I looked at that inflammation always causes pro inflammatory cytokines to be released, which you want your body to do that whenever there’s inflammation. But specifically, what I found is that, even though there was a number of different cytokines that were released, that were creating inflammation, that all of them seem to down regulate acetylcholine, which when you’re talking about the parasympathetic nervous system, that of course is controlled by the vagus nerve. And you need acetylcholine for the parasympathetic nervous system to function. And so as a result of all those cytokines down regulating acetylcholine, then the person developed an alias, which is basically your small intestine is going to freeze up, it’s not going to move and you have dysmotility. But then in all the studies I read, what I found is that the researchers were looking for a way to reverse that. And so they were using different medications. And all of the medications they used, reversed the alias. And even though I found like three or four different studies, and the medications were all different, the common thread was that all of the medications had a mechanism of action that actually increased acetylcholine. So that kind of was an aha moment for me because I realized there’s a connection between inflammation driving these pro inflammatory cytokines, which can cause dysmotility and down regulate acetylcholine. But if you can replace this, either citicoline or you can somehow increase that, then your motility can be restored.

Ken Brown 34:42
So this is where I, I feel like I may have failed you eight years ago when your inflammation started. If we describe it as a nerve thing from your neck, and you change the motility of your intestines, then it is quite possible that Let’s say a bacterial overgrowth acebo creates low level inflammation. And so your cells that protect us go, That’s not right, they start sending out what you’re calling inflammatory cytokines, which just mean your immune system has a very complex process where it says, we need to recruit more cells, we need to do this and they start sending out these different cytokines like TNF alpha, which, that’s tumor necrosis factor, which is good if you’re fighting a virus or a bacteria or you’re doing things, but it actually, you found some great studies on how some of these cytokines have a direct effect on acetylcholine. Can you get into that?

Angie Cook 35:52
Yeah, so um, well, first, let me explain another part of this that I found that’s really interesting and that adds really some important information is that when I was looking at gastroparesis, I found a couple of different studies that were describing how gastroparesis and let me back up for a moment. So gastroparesis is basically when your stomach is not functioning, and it’s a nerve problem, but most doctors identify gastroparesis as being a complication of diabetes, because in diabetes, what happens is that you can have nerve damage and so a lot of people who have diabetes and have nerve damage will develop gastroparesis, and it’s actually a barrier or a problem that a lot of gastroenterologist don’t realize that you can have gastroparesis and not be diabetic because I’m not diabetic, but I have, I have it. So, what I found is that in people who have idiopathic gastroparesis, like mine, where, you know, I don’t really know why I developed it, that and those people who also seem to also have dissident naamyaa, because gastroparesis is considered a symptom of dysautonomia. So it’s really highly likely you’re going to have other symptoms as well, that in those people, what they were finding is that they could trace it back to where those people had had either some type of virus, like epstein barr virus, Lyme CMV, or maybe they had gastroenteritis, and we don’t really know what caused that that could be. Usually it’s viral, but it could be bacteria, too, that they had some sort of illness that preceded the development of the gastroparesis and the dysautonomia, and that when they ended up treating them, they would treat them with different kinds of medications to help reverse that immune process, things like ibig. And I think one study I saw it was a very, very small study, I will admit, they used intera gam, which is a medical food but it’s I GG, but when they did something that helped the immune system recover, then that actually improved gastroparesis and dysautonomia. So that was kind of another aha moment that, okay, so when you have these things develop, it could be that there’s some sort of pathogen that actually started this inflammation, that the inflammation is just continuing. So it’s driving the symptoms, and until you’re able to control the inflammation and deal with it, then you’re going to continue to have problems. But if you can deal with it, then you might resolve the symptoms.

Ken Brown 38:25
This is well, this is so interesting, because we talk about all these people that certainly seek out functional functional medicine doctors, because they get so frustrated, it’s the chronic Lyme person. And the reality is the chronic Lyme person has the fatigue, they’ve got the gut issues, and they get told, you know, no, you don’t have the Lyme titers, you’re not there. But what we’re saying is that a virus can start the inflammatory cascade and doesn’t quite get turned off. And now we’ve got an inflammatory cascade and an acetylcholine imbalance that came with this,

Angie Cook 38:57
right. And actually, so the next part was I started looking a little bit more specifically into the macrophage. So there’s a lot of research right now about how the macrophage can drive a lot of intestinal inflammation and other problems in the intestine. So what I learned is that the macrophage actually comes from a type of white blood cell called the monocyte. And what happens is that when that monocyte enters the tissue or the Oregon and there’s some kind of pathogen, it then becomes the macrophage. And it’s a cell that its job is to try to help you attack or defend yourself against some sort of pathogen or inflammation or whatever might be going on. So what I found out is that one of the main cytokines that the macrophage releases is that TNF alpha, which can cause inflammation anywhere in the body, but specifically an intestine. It’s a really big problem. So Dr. Brown, I know you treat a lot of patients with IBD and That’s sort of like the model of the most extreme severe type of inflammation you can find in the intestine. And one of the types of medications they use for patients like that are TNF alpha inhibitors. So they’re specifically targeting TNF alpha to try to lower that cytokine, because that’s what’s driving the inflammation. So then when I started reading about this, I also read some articles that were telling me that TNF alpha specifically can cause to sudden naamyaa. So I thought that was really interesting. And then when I started getting further into it, what I found was that TNF alpha and acetylcholine have sort of this really interesting relationship where they oppose each other. So TNF alpha will lower acetylcholine, but then acetylcholine also lowers TNF alpha. So I was a little confused, because it’s sort of like what came first the chicken or the egg? And if one is opposing the other, then why do we have a problem. But what I was learning is that when you have too much TNF alpha, then it actually down regulates to see the coaling enough to where you don’t really have acetylcholine, and then that, in turn, allows the TNF alpha to to remain and persist and continue to cause all these issues. And the really interesting part of this, it’s kind of getting a little bit more into the geeky science, is that when I started studying how this works with the vagus nerve, so we talked about the vagus nerve, and one of the most important functions is that it helps regulate the autonomic nervous system.

Eric Rieger 41:31
I just want to say something really quick. Because we’ve mentioned the vagus nerve. But I think, just to clarify that Vegus nerve is the biggest nerve it’s going to be releasing as you’re pulling, correct. Okay, I just wanted to clarify.

Angie Cook 41:45
Well, it’s the biggest, longest nerve in the body. And it is it does need to citicoline. Correct.

Ken Brown 41:52
Okay. So just just to clarify that vagus nerve 10th, cranial nerve comes out, and actually innervates it’s the grand highway. So innervates all the organs when your vagal nerve doesn’t have its nutrients. So it responds to acetylcholine. Am I correct? In that words, need to see to Coleen to conduct itself. So,

Angie Cook 42:13
right, right. So it’s the the nerve that connects that whole gut brain pathway, no.

Ken Brown 42:25
Brain all day long.

Angie Cook 42:28
So what’s interesting about the Okay, so what’s interesting about the vagus nerve is that not only does it help to regulate the autonomic nervous system, but it also has a huge anti inflammatory component. So there’s something called the colon nergic, anti inflammatory pathway. So started, yeah, so I started reading studies about this. And basically, what the research is explaining is that in the model of sepsis, which is when your whole body is fighting an inflammation and infection, that typically the spleen is the one where the macrophages in the spleen are releasing all these cytokines. And that if you were able to stimulate the vagus nerve, that, that acetylcholine will help lower that inflammation. So like they’ve done some studies with sepsis, where they’ve tried to treat it with Vegus nerve stimulation, and it’s helped to control the inflammation, reverse the sepsis and, and, and help the patient get better. In fact, there’s actually studies right now on COVID that they’re doing that is along the same lines. So then we also I found out that it’s not just the spleen and the vagus nerve that have this colon ergic anti inflammatory pathway, but you can have it between the intestines and the vagus nerve as well. So this part is where it gets a little geeky, I’m gonna try to explain it, I’m gonna do my best. But basically, the macrophage releases the TNF alpha, which, of course is going to can be communicated to the vagus nerve through that gut brain connection.

Ken Brown 44:08
Let me just clarify one thing, the macrophage the way that it works, is it is it phagocytosis. In other words, it’s it eats and goes, Oh, my gosh, we have an invader. And so it just goes help help help. And it sends out this signal, which is TNF alpha. Right? Oh, my gosh, oh, my gosh, help, help help. I’m holding this guy. We’ve got a burglar, we need help. And that’s the start of it. Okay.

Angie Cook 44:34
Right. So this is where it gets a little geeky. And I’m going to admit, I’m not a Vegas nerve expert. But there’s something called the preganglionic pathway. And that’s basically when you have that signal coming from the gut to the vagus nerve, and that’s when you can have that TNF alpha being communicated to the vagus nerve. But then you have the vagus nerve that is going to try to send a signal to say, Hey, we want to release acetylcholine and as you It turns out the macrophage specifically has a receptor and it has a really long name. It’s the alpha seven nicotinic ganglionic receptor or acetylcholine receptor, something like that. It’s very long name. But basically what it is, is that it has a receptor that specifically is sensitive to see the cooling. So if I see the calling is released, and if it is, so that postganglionic nerve is going to be really close to the Oregon and really close to the macrophage, if it’s going to release acetylcholine and it lands on that receptor, then it’s going to tell that macrophage, Okay, stop with the TNF alpha. Everything’s okay, lower the inflammation be okay now.

Ken Brown 45:40
So a negative feedback loop where the vagus nerve tells the macrophage chill out, we got this handled is basically what it’s saying, right through this anti inflammatory acetylcholine receptor likes inhibitor thing or whatever, right?

Angie Cook 45:59
So what’s really interesting, though, that is, if you don’t, if you have too much TNF alpha, then you don’t have enough acetylcholine to oppose that. So then you can continue having all this inflammation

Ken Brown 46:13
for chronic inflammation begets more inflammation, yeah.

Angie Cook 46:16
Right. So if you have too much TNF alpha, then then all of a sudden, there’s not enough acetylcholine to fight that. And then that’s where the inflammation can persist.

Eric Rieger 46:29
So then, you’re good.

Angie Cook 46:31
So then the goal is that you want to somehow help the vagus nerve or help help support acetylcholine in order to where it will help decrease that inflammation, and then it restores that parasympathetic function. So like, for example, this was a big aha moment for me. So TNF alpha is a direct inhibitor of intestinal motility. So, if you have too much TNF alpha, you’re basically lowering acetylcholine. But if you take pro kinetics, which most pro kinetics, the mechanism of action is going to do something to increase acetylcholine, then that helps restore the motility. So that was kind of an aha moment for me because if you think about CBOE experts, they’re always preaching will even after you clear the CBOE, you need to stay on a pro kinetic. And now to me that I understand why that makes sense.

Ken Brown 47:27
How does that affect the migrating motor complex?

Angie Cook 47:31
Okay, that’s something completely different

Ken Brown 47:37
talk to us about the meaning of life and what you get us

Angie Cook 47:45
all about motilin and all of that, but there is something called Tributyrin. That will help that. And as a matter of fact, before I forget, I want to give a shout out to a friend of mine in a discussion group. Her name is Rachel. And she and I have been going back and forth on a lot of this issue. So she’s been helping me and find ideas of what to research. Well, thank

Eric Rieger 48:05
you, Rachel.

Ken Brown 48:06
Yeah, right on Rachel.

Eric Rieger 48:07
That’s actually really awesome. Well, that is I mean, it. I’m just impressed that honestly, that you’ve pieced together so much about the dependence that we have specifically on this Vegas nerve. The acetylcholine that essentially there are lots of yin and yang opportunities. Biologically, we talked recently about oxytocin and vasopressin. I mean, there’s lots of different opportunities there where biologically, we have things that go back and forth. So

Ken Brown 48:41
yeah, this is what’s interesting. Clearly the body has its checks and balances everywhere. And the common theme that I’m hearing is that when you have too much chronic inflammation, acute inflammation, we’ve got these things built up to protect us from acute invader. What happens is when we end up in this chronic inflammatory state, then things get out of whack. And what you’re describing is this Eliot model from Well, in my world from CBOE to dysautonomia through acetylcholine in the vagus nerve, am I right overgeneralizing that?

Angie Cook 49:18
No. And so there’s one other part that I’ll just throw in there, if you’ll be okay with that,

Eric Rieger 49:23
go for it like that.

Angie Cook 49:24
So,

Ken Brown 49:26
I mean, you’re joined as a vampire, I love it.

Angie Cook 49:31
Okay, so another thing that I learned this year that I had never heard of, um, well, let me back up. So I had heard I had heard a few years ago, that there are some doctors that are now recognizing that when you have dysmotility, that this is an autoimmune issue. Like you can have autoimmune gi dysmotility. And personally, I never really thought about it or wanted genders and not that I didn’t want to understand it, but didn’t try to understand it, because I didn’t really see that that was going to apply to me I kind of figured I knew why develop dysmotility. But I learned about a condition this year and it’s called autoimmune. autonomic ganglia. Obviously, I’m going to have to refer to my notes. But it’s that’s a really big word. And it’s a big mouthful. And it actually you can just abbreviate it by ag. But it’s an autoimmune condition. And what was really interesting to me is that it can actually be, it can actually happen after an event it can happen after a virus after an illness after surgery. It’s not something that you necessarily have to have your whole life it actually can develop it can be acquired, and typically there so I’m going to just read you the list of symptoms. The symptoms include dysautonomia, as well as extra autonomic or outside of the autonomic nervous system manifestations. It can include diffuse gi dysmotility, which includes both gastroparesis and colonic inertia, orthostatic, hypotension, pots, dry mouth, dry eyes, dry skin, urinary retention, or some type of difficulty voiding, difficulty regulating your temperature. And you can also have CNS symptoms, which are those of like the brain symptoms like things like anxiety, depression, cognitive difficulties, which we call brain fog, sometimes. And it’s also usually can co exist with other autoimmune conditions, including fibromyalgia, and hashimotos, which is a thyroid. So I thought that was really interesting, because I hit on a lot of those. And so they’re actually antibodies that you can test for, it’s a blood test, and it’s was initially developed by the Mayo Clinic, but you can now get it through other labs, and they will test for the antibodies. But the interesting part is that only about 50% of the people who they consider to have this will actually test positive for the antibodies. So when they when you have this condition, the way they treat it, is things like ibig, steroids, there are some immunosuppressants they do plasma exchange, it’s kind of some pretty heavy duty stuff. But it’s all to target the immune system. And the reason the antibodies matter is because even if you don’t test positive, if you’re considered sero, negative and you don’t have the antibodies, you can still they show that you can still have improvement if you do the same treatment.

Eric Rieger 52:31
So just because it’s done to take doesn’t mean they may not have that problem.

Angie Cook 52:34
Correct. So what’s really interesting, and this is something that my friend Rachel had taught me about is that her theory is that maybe because she’s, she’s aware that there have been cases where people will test positive for the antibodies, and then later they’ll test negative. And so it’s very inconsistent. And so her theory is maybe the antibodies are detected only when you’re at your worst, or when you’re having some sort of like, major flare up. I don’t know, we’re just speculating, we’re just wondering,

Ken Brown 53:07
that’s a super interesting theory. But yeah, let’s liken that to celiac gliadin, my seal TTG antibodies, when you’re eating a lot, your antibodies go out, when you back off, your antibodies go way down. So if you’re having a lot of ganglionic acetylcholine receptor antibodies, which are detected in the blood, for whatever reason, due to inflammation due to the trigger, I mean, what were this onion that I think you’re starting to peel back, Angie, and you’re doing an amazing job explaining this is, this is so high level, that as we’re peeling this back, we may end up getting to record where there could be a trigger that we could avoid. So that this doesn’t have that,

Angie Cook 53:50
thank you for mentioning that because I forgot to mention that the antibody that they’re testing for is an antibody to the acetylcholine receptor, the ganglionic acetylcholine receptor coming

Ken Brown 53:59
back to your original thought that it all comes down to a super colon effect in the vagus nerve, the inner balance between TNF alpha and acetylcholine, and now we’re talking about people developing antibodies to prevent the acetylcholine that’s floating around to even attaching to that receptor.

Angie Cook 54:17
Right. And it actually made sense to me, because when you go back, so when I was reading about aiag, so you know, basically, you’ve got somebody with gi dysmotility, and obviously saw the dysautonamia and and all the other things that we know sometimes go along with it, and they’re treating it by things like ibig, or plasma or, you know, some sort of immunosuppressants. It kind of went along and was consistent with the studies I found on gastroparesis, where they’re saying that this is triggered after a viral or possibly bacterial illness, and that it triggers the gastroparesis and the dysautonomia, but the way they treated that was also with IBIG, and things like interrogate anything that was going to help reverse that immune response. So like, if you’re getting to where you’re actually thinking, Okay, this sounds like something I could have, then to me, there’s two ways to think about it. You can actually support this either coaling by doing some things like pro kinetics, and there’s certain supplements, but thought,

Ken Brown 55:17
after the restroom really quick, we’re going to talk about treatment, you guys are gonna recap that aspect and make it palatable. And I’ll just be,

Eric Rieger 55:24
we’re gonna recap this aspect to make it palatable. So,

Angie Cook 55:29
okay,

Eric Rieger 55:30
how do we what kind of salt and sugar do we put on this thing to make this more palatable that he he leaves and laughs at me as he or no,

Angie Cook 55:39
right?

Eric Rieger 55:44
No, no joke, though. Angie is, as Kim was pointing out this amount of research and really pacing and building, he says, peeling the onion back, but we had to put this onion together. I mean, there’s linking all these things together, as is I find very, very interesting. And actually quite, I don’t know, built on common sense the Vegas nerve is, is I think Vagus is vag us and is Latin for wandering, is not such a big as it basically means it’s everywhere. Our parasympathetic nervous system is essentially run by that 10th cranial nerve to basically keep everything in check for us. So you piecing this together, and finding all of the common pathways back to how it relates to your situation. And yeah, it is a gut paralysis issue. But it seems like that we’ve simply just lost the the autonomic function of one very delicate, yet incredibly important nerve, which services, everything throughout the body. And you’ve been able to not show us that. Yeah, these are symptoms of something that’s failed. But this is what’s happening. And this is how we can actually overcome it. Because no one’s ever talked about, how do we build back kind of this wall that’s fallen down lots of times, I think people just are just kind of shoved to the side because you don’t always have somebody in your corner to help out and work through that problem with you there.

Angie Cook 57:20
Right? Exactly.

Eric Rieger 57:22
So,

Ken Brown 57:23
so palatable, was the wrong word. Did you guys choose salt? Lawrys? would you do it?

Eric Rieger 57:27
It tasted great. While you’re gone? The conversation?

Ken Brown 57:30
I can’t talk about parasympathetic this long without my bladder going on parasympathetic. Okay, so the really cool part is you put a lot of thought into potentially helping this process, what are your thoughts on this and you’re not being held to it because this is all in, there’s not enough research out there, which is probably something that we got to figure out as a team, what to do. So what are some different things that you have found to try and help increase the acetylcholine?

Angie Cook 58:02
So I think first of all, pro kinetics, and I know there’s a lot of functional practitioners that want to hear about what kinds of things to try but all of the prescription pro kinetics actually work by increasing acetylcholine with the exception, I think of a rethrow myosin, which is the MMC. But I think that’s important because that’ll help promote the motility and now that I understand kind of why acetylcholine is important for motility, and then how it can be impacted by things like inflammation, then that makes me understand even more that those pro kinetics are important. I actually also found a supplement this year called huperzine. So I’ve been taking that and that’s an a colon esterase inhibitor. So it basically prevents the enzyme that’s going to break down acetylcholine, which also helps the port having those levels something like vitamin B five, I think that supports I think some of there’s some other ones be one also might I think they’re in the pathway of synthesis seratonin I actually read or actually five HTP rather,

Eric Rieger 59:15
which that’s the building block to build serotonin right? is five ht I’m sorry, that’s the building block that our bodies use or can use to to build more serotonin correct. I kind of like a precursor, right.

Angie Cook 59:28
So I’m losing my notes, but I do remember so serotonin, our five HTP helps to build serotonin. And then so your five ht four receptors, we haven’t talked about that, but five ht four receptors are in the gut, and that’s the target for the pro kinetics. But five HTP will also target the those receptors and those receptors once they’re activated. That helps promote us. See the colon as well. So it’s a long winded way to say that five HTP can help. Um, but the other thing that’s really interesting is that’s all to try to help promote acetylcholine. But maybe there needs to be some more work on getting that inflammation down to begin with. So maybe, you know, I don’t know something like entera gam, or there’s some over the counter versions that I think are similar, SPI and things like that. Maybe we talk

Ken Brown 1:00:32
a little bit greater on that. So there’s what you’re talking about is taking in colostrum, IGA, G, things like that, that we might experience using some of those things in gut health has not been very successful in the sense that I think it’s you need to hit it from a multi angle approach and decrease in the inflammatory aspect. Your situation is a little bit different in that you, I think you had a neurologic event which led to this whole cascade, but we have so many people that eat a very pro inflammatory diet. And if you’re listening to this and you’re waiting in line in a fast food restaurant and a drive thru or something, please understand that when you have that high fructose corn syrup, or you have those poly unsaturated fatty acids, like corn oil and soybean oil, right, that is a pro inflammatory thing that could potentially lead to some intestinal inflammation, which then leads to a macrophage getting turned on, which then leads to TNF alpha being spread around which then leads to acetylcholine dropping and Oh wow, Angie just figured out how intestinal inflammation can lead to pots dysautonomia, which is something I treat so many patients with this, and I share patients with a well known doctor here in town, Dr. Suman who treats pots we share these patients. I’m like, why am I sharing patience? With this cardiologist? I think you just figured it out. I think you did an incredible job of walking from A to k. And I think we can go from cadence. Yeah.

Angie Cook 1:02:10
But it has been very eye opening.

Ken Brown 1:02:13
It’s incredible

Eric Rieger 1:02:15
what a bit it just simply makes sense. We’ve been talking and he you’ve helped us with with the research on some of the other shows we’ve pieced together, but high fructose corn syrup, soybean oil, Saffron, safflower, safflower oil, all of those different ingredients. Unfortunately, they get subsidized, which means that they are in everything we see, we’ve seen these numbers of people who have dealt with just various gi issues. And unfortunately for Angie, hers is definitely one of the more extreme circumstances but it just comes down to where is all of this new information coming from Why is the American Western diets such a culprit. And it’s not just because people just want to eat these substances inherently, could just be bad and perpetuating this inflammation that you’re trying to run from. And if you can’t recognize, just like you said, Angie, we need to find out what’s causing the inflammation, because we can keep trying to patch it up. But if the flood keeps coming in, it’s going to

Angie Cook 1:03:19
be looking at TNF alpha one thing. I’m not an expert, but I know that there’s a lot of research about toxins in our environment, and how they can impact you. So like just something simple, like BPA, I found an article that says that can increase TNF alpha. Yeah, so you know, I mean, I’m guilty of it. I drink water bottles all day long. But you know, maybe that’s something I should rethink, I don’t know.

Ken Brown 1:03:43
Well, this is gonna be a moving target. And there’s a couple things I want to make sure that we get out there. First of all, thank you so much for coming on the show and talking about this. I believe that this is just a high level introduction to a lot of things that I’m trying to wrap my brain around and I can only imagine that it’s it’s a lot of information for people to try and grasp what’s going on. But for those people who are struggling, this is a huge, huge opportunity to at least start heading down a different path. Which means and that path I’m talking about is many of my own colleagues gastroenterologist. I get second opinions all the time where they go to a doctor and they say, I don’t believe in CBOE, here’s an antidepressant. Now, we’re going to go one step further. We’re going to go I believe that if we don’t fix your CBOE, your intestinal inflammation, your diet, then you can end up in this situation and right now, I’ve got so many people with pots and malls and you know, and we didn’t even touch on the Ehlers danlos epi genetic phenomenon, all that that is next podcast, so you have a week. To learn.

Angie Cook 1:04:57
Add I will just quickly add a no master list. Something that is also really common with all of these symptoms. So I didn’t really have an opportunity to I haven’t gone deep into that. But it was interesting to me what I did learn is that so typically when you think of mast cell, you think the mast cells releasing histamine. mast cells actually also released a high amount of TNF alpha. And then the macrophage, you know, we’re talking about how it releases TNF alpha, it actually also releases a high amount of histamine, histamine. So it kind of is like adding fuel to the fire. I mean, it’s all it’s not just one cell and once one inflammatory cytokine. It’s kind of like that whole generalized and immune response.

Ken Brown 1:05:40
So I want to encourage anybody who’s listening to this, that even if it didn’t quite fall into your wheelhouse about what you have, but if you have know anybody who has bloating or digestive issues, or autoimmune issues, or anything related to pots, dysautonomia, or CBOE, share it with them, because this is a community that Angie, you’re involved in multiple support groups, and you’re crushing it right now. And I feel like your life struggles are going to make a difference in hundreds of thousands of lives. And I appreciate you not giving up I appreciate you saying, I’m going to learn more about this, even though I got a bucket next to me for the last seven years that I vomit in, when I don’t time things right. Because these nerves don’t work. I think that’s number one very brave of you really cool. And then you’ve become you kept saying, I’m not an expert, you sound like a dang expert to me,

Eric Rieger 1:06:41
I would definitely defer to you. I can’t thank you enough. Thank you for coming on. It’s just so much information. But it’s it’s all so relative can be used immediately by by many and something else that crossed my mind. Whenever you were talking about what do you do to avoid inflammation we, for decades ago, we talked about the dangers of smoking, right? We talked about you shouldn’t smoke, you should inhale because it’s going to cause these elasticity issues with lungs and people could you know, one to one, everyone can admit that smoking is bad. Well, not understanding the dangers of the things that are coming into our food and causing the tops of long term inflammation. That’s that’s the new problems of like smoking, because now what he is doing is showing us that you have to get the triggers that are causing your chronic inflammation under control. Or just like you said, Can someone who has IBS or CBOE if you don’t address it, and we don’t find out what it is while we’re trying to get your acetylcholine back into balance. And you continue to have these these inflammatory episodes, you may find yourself with a much much more severe situation.

Ken Brown 1:07:56
Yeah, I guess that’s the thing I want everybody to take away here is that just because a doctor pat’s, you on the head and says, you’ll be fine, we’re now showing that if you leave the chronic inflammation going, now, not only does it lead to possibly the typical things that we talked about chronic inflammation, which is cancer and autoimmune diseases, but this kind of stuff, which is life altering, debilitating, shut you down, make you depressed, make you isolated, and it takes quite honestly, Hero like you to just step out of that and go now I’m going to talk about it. Definitely, we’re gonna throw it out there.

Eric Rieger 1:08:35
So thank you very much, Angie,

Angie Cook 1:08:37
thank you all for taking the time to dedicate to talk about this. This is I feel like I’m very passionate about motility disorders. And one of the reasons I am is because when you talk about digestive health, there’s a lot of attention about IBS or IBD. But not very many people talk about motility disorders, they don’t really know what it is. And when you’re a patient, it’s very isolating. And so I love anytime that we can do anything to promote awareness.

Ken Brown 1:09:02
So your notes for the podcast, breathable publication, yeah, they were just saying, I think that we’re gonna have some people if you want Angie to publish this so that you can digest it, journal and make it formal. So you can walk into your doctor’s office and slap it down and be like, Look, that’s me.

Angie Cook 1:09:23
Like months of research, just doing it and then coming back and then doing it again. And then kind of revisiting it all it takes a long time.

Ken Brown 1:09:32
Isn’t that interesting? Because the articles that you send me will look at stuff and I’ll look at 50 pages of references and you’re like this person put their life into it, right? And that’s what it takes when somebody gets passionate enough like this, that you just go No, I’m going to put this out there and the first step is just talking about it a little bit superficially like this. We didn’t even nearly get into the detail that you have in here which is awesome, just like this podcast. There’s like five podcasts here. Yeah. And so hopefully a, you know, I’m gonna hopefully, Chris kresser will listen to this and he’ll have you on and then you can go into more detail with him. His audience is a little bit different. And then you just keep working your way. And then next thing we know, we see Angie on Good Morning America the session,

Eric Rieger 1:10:18
we can watch. Well, it may, who knows? Because I mean, I think that there’s a lot of people who could just simply be helped by this. And not only that, I think there’s a lot of researchers who will probably see this and say, that’s the connection that we need to make. And ultimately, this whole show isn’t just about learning and sharing experiences, it’s about helping people. And that’s,

Ken Brown 1:10:36
I mean, we start Yeah, we start moving away from Oh, um, let’s use osmotic laxatives to Oh, let me check to see if you have a G. If you do now, I know that we need to increase your acetylcholine. And if we do that, we need to at first make sure that you do not have a chronic inflammatory state, and do not have increased levels of TNF alpha. Right, then once we do that, then I can start giving you some pro motility agents and things like that, because we’re going to try and correct the background buzz, the background noise that’s going on. And as somebody who I’m into this, and I didn’t know any of this. So I know my colleagues don’t, there’s probably a few people at the Mayo that work in the motility clinic. And, you know, some people at Northwestern and a few people that that I’ve, I’ve read some stuff, but they’re going into this kind of thing, like now, I think you you have a moral obligation to put this out there, so that other researchers can then run with it and say, didn’t see it from that angle. Everybody gets so myopic in medicine, I mean, they just sit there and just you’re like, this is what I’m looking at. And you forget that it’s more than just the thing they’re looking at. And I’m guilty of that. 100%. Having doubt in yourself and being open to other ideas and angles is the key to medicine. It’s the key to growth, human growth, not just in medicine, but in love and relationships and everything.

Eric Rieger 1:12:04
Submit your questions to Dr. Kenneth brown about love and life.

Ken Brown 1:12:09
And I will forward them immediately to Angie cook.

Eric Rieger 1:12:15
Angie Thank you so much. I think that’s gonna do it for episode number 45. And this is definitely not our only show with you because I have a feeling won’t be that much longer until we’re going to build out another podcast and it’s just another just great angle of some Yeah, I’m

Ken Brown 1:12:31
gonna hoping that once we start sharing this with some of our audiences that they’ll come up and go, Okay, yeah, let’s talk about Okay, so now I’m like that. Now do a whole show on how to fix the problem.

Eric Rieger 1:12:43
Definitely.

Ken Brown 1:12:44
So but I think that you telling your story is very, very genuine. It validates where you come from, it gives hope to other people. And I want to thank you for being so candid about it.

Angie Cook 1:12:57
Thank you for having me.

Eric Rieger 1:12:58
You bet. Thanks, Angie. All right, what episode was 45? Please Like and Share gut check project fans. We appreciate you joining us today. Special thanks to Angie cook, registered nurse and Master’s in nutrition for joining us today and sharing her or just incredible journey, her story and most of all, her research and her willingness to to look out for others.

Ken Brown 1:13:25
So absolutely. So please email us and tell us to make sure that Angie, publishes this.

Eric Rieger 1:13:34
See you next time.

Ken Brown 1:13:36
Bye everybody

Angie Cook 1:13:37
Bye