Is Lymphatic Drainage a Missing Link for Gut Health?

Intro:

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DrMichaelRuscio:

Hi everyone. Today I spoke with nurse practitioner, Stephanie Grutz. We discussed a few things. The importance of the lymphatic system and what one can do to make sure they have adequate lymphatic drainage. We also discussed her personal experience with FMT, fecal microbial transplant therapy for Crohn’s. A few interesting things there. Also, something that’s a little bit more hidden in this episode, but it’s kind of reflective of one of the points I repeatedly try to make in the podcast, which is, it’s easy to kind of gloss over the foundationals. So she did an FMT, she found some impact from it, but it was interesting that when recalling the various therapeutics she’s done, she felt that the Elemental Diet was probably the most effective of all the therapies that she had tried, and that wouldn’t have popped up unless I had asked the question about it.

DrMR:

I think it’s interesting sometimes when something is so well acknowledged that we can kind of gloss over it. I certainly don’t think that was her intention. It’s just we’re going to be talking about a few certain things like lymphatics and FMT and someone could have easily missed the fact that Elemental Diet was a big mover for her. In any case, this was an interesting discussion about lymph and also about FMT, and I hope you will find it interesting and insightful okay. Onto the show.

DrMR:

Hey everyone. Welcome back to another episode of Dr. Ruscio radio. This is Dr. Ruscio. Today. I’m here with nurse practitioner, Stephanie Grutz, and we’re going to be discussing a few things. Gut health, the lymphatic system, and how this ties into digestive health, some advice for GI workups, and also a bit on fecal transplant. So a few interesting directions for us to go on stuff. Thanks for being on the show today.

StephanieGrutzFNP:

Yeah. Thanks for having me Dr. Ruscio.

DrMR:

A little bit about your background before we get into all the nitty gritty.

SG:

Sure. So I’m a board-certified family nurse practitioner. When I was in my early twenties, I was diagnosed with Crohn’s. From there, I kind of continued my search for seeking and finding the answers. So that kind of led me away from Western medicine and into an integrative approach to my healing. As I was seeing my patients, I wanted to lead them on a journey of integrative medicine. So that’s kind of what enticed me to go around this route.

The Lymphatic System

DrMR:

Love it. So let’s talk about lymphatics first, because that’s something that we haven’t really discussed much, especially regarding gut health. So in case people haven’t heard of the lymph system, give us a quick refresher on the basics and then what the tie into gut health is.

SG:

Yeah, so the lymph system travels throughout our body like our circulating system, and it basically removes toxins and waste. The most common ones that we think of are like our tonsils. So, you know, when we get sick, we get inflamed tonsils, we get stones. That is one of our lymphatic pathways that helps collect the debris and remove it from our body. Some bigger parts in our body are in the armpit area, the groin and in the abdomen. We have over 450 lymph nodes in our body. 60 to 70 of them are found in our head and our neck, a hundred in our mid-body and around 250 in our abdomen and pelvis. These lymph nodes, again, help collect the junk and toxins from our body. If they’re not working well, then our system can’t clean itself and detox appropriately. So we can be doing all of the detoxing and doing all these things for our body, but if our lymph isn’t moving the toxins out of ourselves, then we can’t get healthy.

DrMR:

For the skeptics, what kind of evidentiary basis do we have to kind of suggest that lymphatic problems are an issue? Sometimes one of the things that is challenging is a given issue or condition may be a problem for one in 1000 individuals. This is something with gluten I criticize quite often. It definitely has been shown to be a problem for individuals, but it’s not a problem for 100% of individuals as some gurus would have you believe perhaps. So, what are some of the stats or what does the case for this posit look like?

SG:

For that aspect, I would say for everyone that I’ve seen with a chronic illness, especially GI issues, our lymph system is in all of us. If it’s not running appropriately, we can’t get better. There are not a ton of studies on lymph drainage, which is unfortunate, but there are some really good ones. There is one that the Journal of Clinical Medicine did in 2018. It was of one hundred patients with ulcerative colitis and they noted that inflammation results in the development of lymph nodes from ulcerative colitis, Crohn’s disease and other inflammatory disorders. So that one is a good reference. Then there’s also another article or research done in July, 2011. That was Current in Gastroenterology, Issue Four. It talked about the role of the lymph system in the pathogenesis of Crohn’s disease. It basically said the lymphatic system plays a role in immune cell trafficking, infection, fat transport, distribution and metabolism, and edema and results in Crohn’s disease as an outcome, if those are not flowing well.

DrMR:

The therapy for this is? Is it some type of lymphatic massage? Is the term, or are the terms massage and drainage used synonymously or do they differ in terms of what they look like?

What does Lymph Therapy Look Like?

SG:

So typically lymph therapy consists of, again, like you said, lymph massage or drainage, but they’re all doing the same thing. What I love about the lymph system is that it can be as simple as deep breathing every morning to move the lymph in your gut versus something as heavy as an actual lymph therapy session or using lymphatic pumps, which they have available to move the drainage around.

DrMR:

That’s a great point and I think worth mentioning, which is deep breathing and then also many forms of exercise will naturally facilitate pumping and movement of the lymphatic system. Correct?

SG:

Yeah. So there are rebounders. So if you have a small trampoline at home or if you don’t, you can just do it on regular floor, just pumping your legs is actually moving the lymph. The lymph doesn’t have the vessels like our cardiovascular system. So it really needs assistance from the contraction and relaxation of our muscles to move throughout our body. So doing that. Doing castor oil packs can help move the lymph around the system. Again, yoga, deep breathing, dry brushing. I’m sure a lot of listeners have heard of. Dry brushing is taking a soft bristle brush and you go from your distal extremities, fingers and toes up to the center of your body, where all the big lymph nodes meet.

DrMR:

We have all these things that we can use for someone’s digestive health. Elimination diet, low FODMAP diet, maybe an Elemental Diet, intermittent fasting, probiotics and anti-microbials, immunoglobulins, antibiotics and antifungals, herbal anti-inflammatories. There are a whole host of things that we can use like sleep and exercise if someone’s not doing those things. When are you looking at lymph therapy as being the right recommendation for a given individual?

SG:

Throughout their whole treatment. It’s part of the healing process for my patients. Some part of the lymph is always moving. You have heard of Herx reactions when they’re doing an antimicrobial or antifungal, they don’t feel good when they’re doing those treatments. I tend to find if they’re not detoxing well, that’s when they feel the sickest. So if they incorporate these therapies throughout their healing journey, they tend to do a lot better.

DrMR:

Okay. It seems reasonable to me that the less expensive and more minimally invasive the therapeutic is the easier it is to kind of incorporate into someone’s care plan. So some of these things sound quite simple. Deep breathing, obviously. I would be quite hesitant to tell someone not to do that. Also doing some things like rebounding, jumping, squatting, dry brushing seem like they’re darn near cheap and probably have a lot of secondary benefits. I’m wondering if this is something that you’re recommending people do more formal kind of lymphatic massage, or you’re starting with some of these basics. My underlying motivation with this question is just trying to give people what the minimal therapeutic intervention can be to get better, because it seems the field is kind of adrift in over-recommendations. An “if one is good, 10 is better. If 10 is better, 20 is best” and people end up just living these crazy lifestyles because of all the dietary recommendations, supplement recommendations, lifestyle recommendations. Help know help us better kind of wrap our heads around that bit.

SG:

Yeah. Honestly, I try to meet the patient where they’re at. So I’m giving you maybe 20 things, but I really want them to pick one thing that they will do consistently depending on their budget, their time, their effort, all of that. Something as simple as water intake, lymph is 95% water. Dehydration leads to lymphatic blocks. If that was the only thing someone could do, that would be something. Even appropriate clothing like bra straps and tight belts around the belly, that inhibits the flow of lymph. Being more conscious of that stuff is super easy.

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SG:

I do recommend to my patients that they receive lymph therapy from an actual physical therapist or certified lymph therapist. Usually, that’s covered by insurance, which is a nice benefit for the people that have that. It’s something where people go in typically one to two times a week for a couple months and they get the formalized lymph therapy. And I think that that’s important because when you’re at home doing something on your own, you really want to know how superficial the lymph actually is. It’s not a deep massage, it’s very gentle. It doesn’t take much to move that lymph. So having someone do it, I think is just good for the self care, it feels good and it’s people are more active and actually will do that.

DrMR:

Does it have a relaxing feel to it like a massage would? I’m just wondering if the listener or the reader is trying to project themselves into what this would feel like. Is it some essential oils, some candlelight, really relaxed? Is it, you know, different? What does it kind of feel like on the user end?

SG:

So it just depends on where you go to get the massage. Sometimes there ars actual massage therapists that do it. So it will be in a massage setting. The people that typically are reimbursed by insurance are more of like the outpatient therapy settings. So there’s not a candle lit room or essential oils, but you’re laying on a big table and you’re laying down comfortable and they do hand techniques. So it’s just like getting a massage, a very light massage, but it feels good. It’s relaxing. It’s one of those things that you leave there and you can feel energized for the day.

DrMR:

Gotcha. Okay. Uh, what else about lymph or lymph therapy do you think people should know about?

SG:

Just that if lymph isn’t working effectively, there can be accumulations in the body of toxins, infections, heavy metal, dead cells and debris. So just know that, like I said at the beginning, lymph is really important at removing the waste that is accumulating in the body. So making sure that the pathway is open is really important. Just like having a bowel movement, at least once a day, drinking enough water, flushing, sweating through saunas, all of that stuff can help open the detox pathways and that’s kind of what we’re trying to go for when we’re healing.

GI Workups

DrMR:

Yeah, definitely reasonable. We had also discussed the topic of GI workups, which is a pretty broad topic. That could probably be a three or four podcast series in and of itself. Are there a few kind of choice items within GI workup that you wanted to touch on?

SG:

I don’t know typically where your audience is coming from with the workup background. When people come to my clinic, we’re always testing for infections, heavy metals, physical, mental, emotional stress, biotoxins, genetics, food sensitivities, and the immune system overall. So typically that’s what we do with our workup. We have an extensive blood workup that we do for our patients. It seems like when someone has an autoimmune disease or chronic illness or cancer, there are multiple things that got flipped on at one time. So it’s not just working with one thing, healing it and being healthy. Again, it’s looking at the whole environment and cleaning up the whole environment.

DrMR:

Is cancer something you’re seeing somewhat frequently in your practice?

DrMR:

Yes, very much so.

DrMR:

Gotcha. Okay. And we had also discussed fecal transplants and I know you recently had, had received a fecal transplant. So why don’t we talk more about that?

Fecal Microbiota Transplant (FMT)

SG:

Sure. I always joke that I’m my own n of 1, my own research project. So I’ve done a thousand things. If you could think of one thing that you could do for Crohn’s, I would have done it naturally. I’m one of those people that wants to test the waters before I tell my patients that this is something that I would recommend or not. Fecal transplant has always been on my list of things that really look good. The research out there, especially for like C. diff, the infection, it’s about a 98% cure rate. It’s really effective for that. Now, when it comes to research for Crohn’s and ulcerative colitis, the effective rate does decrease because it’s not dealing with just one bug. It’s dealing with a whole plethora of environmental stuff that has to be dealt with. Resetting our microbiome when our microbiome is damaged to me is always a reasonable thing to think about.

SG:

So I actually had to go to Mexico to get my transplant because I didn’t test for C. diff and C. diff is the only legal use in the USA right now. So the donor stool came from the United States, went to Mexico, really nice place, had the transplant via colonoscopy. Then for the next two days I did what we call “crapsules” which are fecal transplant capsules. So I did those for two days and then kind of got sent home to see what my gut would do with that sample.

DrMR:

And how did it go?

SG:

It was good. I have small intestine Crohn’s. From all of the research that I have done with it, that’s one of the hardest to treat, especially with a fecal transplant. When we’re doing enemas, we’re getting into the colon and when we’re doing capsules, we’re actually getting into the small intestine. At the end of my experience, what I feel like, and there’s not a lot of studies unfortunately, but I feel like the small intestine needs a longer duration of capsules to really be effective, but it has helped. Just like everything else. It’s helped me a little bit.

DrMR:

How symptomatic were you before? That’s an important question to ask. There’s likely a law of diminishing returns, like there is with any other therapeutic. So if you don’t mind me asking, what did your symptoms look like going into this?

SG:

So last August I got a GI bug and it led to loose stools and inflammation, something that triggered my Crohn’s to reactivate and it wasn’t going away. So that’s what kind of made me decide because I was super symptomatic at that point. So I wanted something to calm my system down and it did that.

DrMR:

You feel like it was effective in kind of calming that flare?

SG:

Yeah, for sure. Again, like I said, I’m the N of one. So, when I’m doing the fecal transplant, I’m also doing infusions and ozone and everything else that I can also get my hands on that makes sense as well.

DrMR:

Now, did you isolate the variables? I’m assuming you’re doing all these therapies, but if you were only initiating the fecal transplant at one point in time, you could somewhat isolate for the impact of that. What are the other confounders look like?

SG:

Yeah. So I did do that. A couple of weeks before I went and had the transplant, I actually had IV antibiotics, antifungals, UV light therapy, and nutrient therapy just to kind of clean out my gut because again, I was symptomatic. Then when I went down there, I had my transplant and then I really, just beyond the basics of what I was doing, I just let the transplant take over. So I let that happen for like six to 12 weeks. So I wasn’t throwing the kitchen sink at it. I really do things very systematically when I treat myself sure.

DrMR:

From the antibiotics, did that lead to any benefit?

SG:

You know, I think that I didn’t notice a big difference at using the antibiotics at that point.

DrMR:

Right. You did the one colonoscopy administration and then you did the two doses of the crapsule post?

Stool Donors

SG:

Yes. So 35 capsules, two days in a row. It was interesting. It was from one stool donor. Just to talk to your listeners about being a stool donor, there was someone that quoted it’s easier to get into Harvard than it is to be a stool donor. That is very true. I mean, I think that maybe 1% of the population is actually suitable to be a stool donor. There are a lot of studies on that when they first started doing the fecal transplant, they would, they would really take about anybody’s stool. Then they would realize, this one study sticks out in particular, there were obese people donating stool, and then someone of normal BMI receiving the fecal from them. After their transplant, the person with a normal BMI actually increased their BMI and they were overweight. That was because they were getting the microbiome from the obese person.

DrMR:

Yeah. I think it was Dr. Neil Stollman, who was on the podcast. Someone criticized the finding of that study. There were some confounding variable that I can’t recall because this conversation was maybe two years ago. I know this study that you’re referring to. There was someone, it may have been Mark Davis also who had made this criticism, but there was some other confounding variable that seemed to maybe account for that. Your point is well taken and I fully agree that we want to have the most vetted donors that we can. With that study in particular, I do recall there was something else in there that kind of pulled back the strength of that conclusion.

SG:

Yeah. That’s interesting. I’ll have to look at that. I think like the biggest thing is really to understand the importance of the person that’s donating. Our microbiome is who we are. I mean, it’s our immune system, it’s the health of our gut, which is the health of our body. So, you know, making sure that we’re getting someone that even has a right mental health, because our serotonin or dopamine, all of our neurotransmitters produce our microbiome. Like we need to make sure that the people that are donating have a solid foundation.

DrMR:

Yeah. Fully, fully agreed.

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DrMR:

Then there’s also the perspective of maybe having multiple donors so as to present different stimuli to the microbiota. Also to your earlier point, and I tend to agree with this, for certain conditions, and I believe there have been a few studies that found longer duration of followup or repeat administration led to better results. Were you able to finagle anything like that with the clinic in terms of getting some of the crapsules to take home or were there regulations in place that barred you from doing that?

SG:

So there are abilities to get them home, but you have to be in Mexico to do it. The crapsules are kept at, I don’t know, negative 60 degrees or something. They’re in the specialized freezer. So it’s something that has to be consumed pretty quickly. But again, with being in Mexico, you have to do it right at that time and there are a lot of stipulations to travel with that.

DrMR:

Yeah. I mean, rightfully so. Traveling with poop is probably something that throws up some flags at customs. So, while we’re picking into what you’ve done…immunoglobulins? Elemental diets? Again, if you don’t mind me asking, are these things that you’ve explored and do you have any experience with those?

The Elemental Diet and Crohn’s

SG:

You know, the Elemental Diet I did for a short stint in the beginning of my diagnosis. That was probably the single most helpful thing that has change my pathway. That helped like the acute stuff. When I was originally diagnosed, it was a bunch of things. I had to deal with heavy metals. I had to deal with co-infections of Lyme and mold and all of those biofilms and everything like that. So it’s literally been just weeding down the things that are causing the inflammation in the body and being healthy. And I feel like from all the work that I have done in the past six years of just laying the foundation and cleaning things up, my immune system is strong enough now to where I can handle the things that I wasn’t able to handle in the past.

DrMR:

Yeah. That’s great. Awesome. Okay. Anything else that you want to discuss or make people aware of?

SG:

You know, just to tell people that if you are struggling with any health disease or GI issues, you know, keep looking for the answers and don’t stop. Just keep trying things because one thing might work for someone else that has zero effect on you and you just never know what your thing is that will take you to the next healing level. So keep trying and don’t give up.

Episode Wrap-Up

DrMR:

Yeah. That’s well said. People sometimes do get discouraged using the Elemental Diet is one example. There’s a small handful of people who react negatively to the Elemental Diet and they hear about all the other great results people have had. When they don’t have that same great result, they throw their hands up and they almost want to give up, which I understand. It’s just important that you keep at it, you keep your goal in mind. The analogy I often use with my patients is it’s like a Rubik’s cube and we’re gonna keep twisting and turning that cube until we get all green on one side. For some people it’s three turns. For other people it’s eight turns, but eventually you can get there. I just love your message there that you want to keep your head up and keep going toward pursuing your goal because there’s most likely something out there that will help even if the path up to finding it sometimes feels like it’s uphill both ways in the snow. I totally appreciate that. Where can people track you down online?

SG:

You know, the best is I’m always trying to produce content on Instagram. I’m TheHealthyPractitioner on there. Otherwise, you can go to my website at www.balancehealth.me.

DrMR:

Awesome. Well, definitely thanks for taking the time and I hope you can get some more crapsules soon.

SG:

Michael, have a great day.

DrMR:

Take care.

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