Facilitated

12| Is This Normal? Functional Medicine Takes on Your Most Embarrassing Health Questions

• The Facility Denver • Episode 12

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Dr. Mitchell and Kate tackle the health questions you're too embarrassed to ask anyone else, exploring what's normal versus what's common when it comes to digestive issues, hormonal changes, and more. We differentiate between everyday health occurrences that are merely common versus those that actually reflect optimal biological functioning.

• Travel constipation relates to disrupted routines and nervous system changes rather than just diet
• Poop mechanics matter - proper positioning and relaxation of the puborectalis muscle enables complete elimination [heyo, Dr. April!]
• Vaginal discharge should change throughout your menstrual cycle and signals healthy hormonal function
• Spotting during ovulation can be normal, but persistent spotting before periods may indicate hormone imbalance
• Histamine responses can make you feel "hungover" without drinking alcohol
• Alcohol is a carcinogen that forces your liver to prioritize its detoxification over fat metabolism
• The distinction between "common" and "normal" is crucial in understanding health optimization

If you're dealing with unusual symptoms, remember nothing is too awkward to discuss with your healthcare provider, if we're your healthcare provider! Stay curious about your body's signals and what they might be telling you about your overall health.

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Want to take the next step with functional medicine? Learn more about our new patient process and lab testing at www.thefacilitydenver.com

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Stay curious, stay proactive, and we’ll catch you next time!

Mitchell:

Welcome to Facilitated, where we bring you real stories, strategies and science from the world of functional medicine. I'm Dr Mitchell Rasmussen, a functional medicine practitioner.

Kate:

And I'm Kate Daugherty, a certified nutritionist. We are the owners of the Facility, a functional medicine clinic here in Denver, Colorado.

Mitchell:

We help people improve their biology and get out of their own way. We help people improve their biology and get out of their own way. In my view, our work is about getting to know the person with the condition much more than it's about understanding which condition the person has. As I always say, diagnose the biology, not the disease.

Kate:

On this podcast we break down complex health topics, share real patient cases anonymized, of course and explore cutting-edge wellness strategies so you can make informed decisions about your health. Quick heads up before we dive in this podcast is for education and general information only. We're here to share insights, not to diagnose or treat. So if you're dealing with a health issue, chat with a qualified healthcare provider before making any changes. All right, let's get into it.

Mitchell:

Is it recording?

Kate:

It's recording.

Mitchell:

Do you remember when you sang the national anthem yesterday?

Kate:

Yeah, I didn't sing it well. I'm glad you know that from a sound perspective, but also from a lyric perspective yeah, how did that start?

Mitchell:

you told me you can't. Well, it started by you telling me you have to have subtitles on on a show I am just not a oral processor or auditory processor, so I'm not great at speaking what is in my brain?

Kate:

Shellfish. But for some reason I can type things exactly how I want to say them, but when I go to say them I can't say them right. But same thing when I try to sing song lyrics.

Mitchell:

And you were saying you have to sing for your daughter yeah, lucy likes to be sung to sleep.

Kate:

I was thinking about it last night. You just started ripping the national anthem last night, trying to because I was confident that was a song that I knew the lyrics to, because everybody knows right, but apparently I don't. You don't want to do it on air do you?

Mitchell:

No, I'm good. Good try the subtitle thing. I started that watching Love Island UK because I simply couldn't understand what they were saying and now I feel lost without subtitles on the show. I read something once. It was like sometime in your mid-30s you turn subtitles on and then you never turn them back off.

Kate:

Mike and I were watching a show last night and the subtitles were on, of course, and he said can you turn it up a few notches? I can't hear it. And I turned it up. It was on one volume, level one, and I said that's perfect. He said no, I needed at least a four. I think there's like 30 notches to go.

Mitchell:

Do you? I find myself, though the shitty part. I find myself staring at subtitles.

Kate:

Yeah, I don't care.

Mitchell:

You kind of like. It's like this well-filmed show and I'm just staring at words on a screen Like why don't I just read a book? I would so much rather read than watch shows anyway okay, is that what we came in today to talk about? No literally last night. I was just. I told christine about it. I started laughing like you just started singing the national anthem because you prompted me and it was a little, I would say, flat is that a tone thing?

Mitchell:

yeah, well the tone wasn't great good thing I'm not a singer, yeah well proof that so nice long weekend coming off, memorial day yeah, this is the last week of may.

Kate:

June 1st is like a couple days away and it is chilly outside you're probably listening to this in june.

Mitchell:

Right, it's been. Yeah, it's been rainy and it's been my favorite weather. But I just went and spent four days in Phoenix. It's an uncalled for level of heat. I love the heat. It's like 90 at 8 am, you best believe. I brought multiple sun shirts, hiding from the sun for the most part.

Kate:

Yeah, well then, you had the audacity to ask me am I tan the second?

Mitchell:

you walked in yesterday, but I am a little tan. I got about 10 minutes a day when the UV index was below five. All right, I love that feature on Apple. Now you get the UV index so you can hide yourself away when it's too high.

Kate:

Well, we have a fun episode today. I think it's fun.

Mitchell:

You're already calling it out, yeah.

Kate:

Putting the pressure on. Yeah, we enjoy doing the Q&A, but this one is themed with embarrassing health questions, things that you find yourself wondering Probably most of you at some point but don't have anyone you want to actually ask the question to. I even drew some inspiration from Google just typing in is it normal? And seeing what the top searches came up, so I'm flying blind.

Mitchell:

The only one that I was told was asked you don't want to ask it?

Kate:

No, I don't. It's too embarrassing for me.

Mitchell:

Shout out to Kate's sister Kelsey, for that one. And what's funny is it was when you said we're going to do this. I said, for example, and I said that, and then of course she asked it and I could speak on it. And I said that and then of course she asked it and I could speak on it. So I wish we would.

Kate:

I'm sorry that one's going to remain unsaid.

Mitchell:

Okay, the rest of them? I've got no idea, so this will be interesting, fun, fun. I was just going to say that.

Kate:

Okay, let's jump in with is it normal? Fill in the blank, okay. Is it normal to not poop when you travel?

Mitchell:

well, I think I will have the same. Let's just insert this first part in, for probably all of these Common and normal are very different from one another. It is common to lose urine as a woman after giving childbirth, but it is not normal. It is common to be on seven medications in America, but it is not normal. It's common to not poop when somebody travels and very common, but how I look at it is. Routine is everything when it comes to the GI tract. You know the gut is the second brain and we know that motility is largely governed by the parasympathetic nervous system as well as serotonin Within the GI tract. Peristalsis is triggered by serotonin production and you have to be under good vagal nerve tone, parasympathetic tone, in order to have normal motility. So I often say not pooping when you travel is much more about out of routine and not being comfortable, maybe in the places that you have to go to the bathroom, versus a lack of fiber or a lack of magnesium, things like that right, those are tools that can help keep you regular.

Kate:

But yeah, you're right, it's most likely the, the nervous system component there.

Mitchell:

So things you can do get on some you know, talk to your doctor, get on some magnesium citrate, maybe two to 600 milligrams a day for a couple of days leading up to travel, and keep that going. I mean we give magnesium citrate for constipation. Sun fiber when you travel can be really helpful, but food adequately, all of the basics, and that will help garner a little bit of parasympathetic tone. Um, but it is not normal.

Kate:

No, unsurprisingly, there are a lot of poop questions, so I'm gonna stay in the poop lane, okay, okay, is it normal to feel like I need to poop but can't? Context like have the urge to poop, and I? I think this question is am I constipated?

Mitchell:

well, we have people that think they're constipated and they poop twice a day. Right, um, if you feel like you have to poop but you're not, maybe there's an internal hemorrhoid or something causing high pressure within the bowels.

Kate:

Right, I always think about poop mechanics. In that case, do you understand the proper way to eliminate, which is a delicate dance of contraction and release and we could ask Dr April all about this.

Mitchell:

but the puborectalis muscle tends to be a little bit taut and tight in a sitting position but when you lift the knees up like on a squatty potty, that tends to help that relax and kind of tilt the colon or tilt the rectum so that elimination is easier. Um, I just got a call from my brother.

Mitchell:

my little nephew last night playing baseball broke his leg oh no so he's calling me right now because they went to the sports medicine doctor. Yeah, bode and send me the x-ray not a little crack in his tibia, a full, oblique fracture. I think they're going to have to externally stabilize it it's pretty bad, poor guy. Yeah, my dad, my brother, drove him home and he just kept saying I can't, I can't let go of my leg. I'm so happy that Matthew, my older brother, brought him in Sure enough full break through his entire tibia.

Kate:

Who knew baseball was a contact sport?

Mitchell:

Yeah, well, he said they were playing defense, practicing that and the base running was such a minor thing, but little kids taking the base running so serious, and he slid funny and snapped that thing and they said it was loud. Yeah, anyway, sorry, I just looked down and I said call me after you go to the sports medicine doctor. They're going to see a PA today, which I love Shout out to my PAs Compassion and I'd say hard work and they don't get the credit they deserve.

Kate:

So poop.

Mitchell:

Yeah, sorry.

Kate:

This one is related to the previous. Of course it is. Is it normal to pee and poop at the same time?

Mitchell:

Like in the same moment yeah I'm trying to picture. I mean typically one comes before the other mechanically it is normal, right?

Kate:

we just talked about the position you're in, the, the contraction and the release. All of that anatomy is very close. So usually when one area gets stimulated, it's normal. For the other one, however, it's not normal if you can't control. So you should be able to control if you are peeing or pooping and stop one or the other, but it's completely fine to do them both at the same time and I mean, if what you're asking is if poop, say, with a woman, if poop comes out of the vagina, oh my god, well, like a fistula, gotcha.

Mitchell:

Yeah, if there's that's like with that whole question on vaginal flatulence or queefing, which you're probably going to pull this out, but if you have fecal matter coming out of the vagina or pus, then you could have a fistula and that's not that uncommon.

Kate:

So that's not what we're asking right, no, does it come out of?

Mitchell:

the same Okay.

Kate:

Wow, you're in a different google sphere than I was I lived on webmd as a kid this career.

Mitchell:

There was signs early on that I was a curious boy all right.

Kate:

Is it normal to poop after every meal?

Mitchell:

no, also if you eat. We have people tell us this if you eat and then you poop right after it runs right through me right, you've got dozens of feet of acidifying material and enzymatic action and bile emulsification of foods and an intestinal movement through multiple sections.

Mitchell:

The small intestine alone has three sections. The colon has multiple turns before the rectum. You're not pooping out what you just ate, no. But if you do poop right after you eat, I look at that almost as a as an immune response to whatever was just consumed. And it could be.

Mitchell:

It could be a microbe that was picked up like food poisoning, or you probably eating something that you're allergic to or sensitive to yeah, and the body is pulling water to the colon, because typically, if you poop right after you eat, it's going to be, it's going to be loose. And the other exception would be with coffee.

Mitchell:

Right, that's really common because some of the chlorogenic acids very stimulating yeah, will create that, or even nicotine after a meal will sometimes cause that increased motility. But you know you should not be pooping after every meal unless you eat once a day. Right, but I think what do they say on the Internet? Pooping three times a day to every three days is air quote normal.

Kate:

What do you think about?

Mitchell:

that Kate.

Kate:

There is a wide spectrum, but I think three is a lot I think two is probably perfect yeah is it normal to feel like you don't get everything out?

Mitchell:

it's common. I would be really interested in some sort of rectal situation going on, like an internal hemorrhoid that might be, or even, you know, potentially some sort of tumor or mass. If it feels like you're not getting everything out, there could be something going on in the distal colon that's causing that sensation almost like a space occupying lesion.

Kate:

Or less nefarious. Going back to poop mechanics, just not being in the right position to eliminate everything in one go.

Mitchell:

Yeah, but that's not what Google is going to tell you.

Kate:

Of course not it's always worst case scenario.

Mitchell:

That joke. I have a little bit of a headache with some low back pain. 10 minutes on Google, I have brain cancer mets to the spine. That's what Google will give you sometimes.

Kate:

Is it normal to have diarrhea when you're nervous or anxious?

Mitchell:

when you're nervous or anxious? I mean, let's the hierarchy. Is it normal to have anxiety? Whoa Right, I mean, that's something that I've struggled with. Yeah, it's pretty normal to have either constipation or diarrhea when your moods are off. It's pretty common. They call it anxious poops.

Kate:

And even the butterflies in your stomach feeling. That's a nervous system reaction that you're feeling with anxiety, excitement, sometimes too.

Mitchell:

In case you, as a listener, have not figured this out by now when, in doubt, go to stress if you're not getting better and you're trying all these supplements and these diet changes and you're exercising and it's probably your stress, it's probably your sleep okay, moving a little bit away from poop into another system down there.

Kate:

Is it normal to have discharge every day? I think we're talking vaginal discharge here. Well, it can be, yeah, so vaginal discharge is actually a good sign. It keeps everything really clean. It keeps the pH well balanced, but you will have shifts in it according to your cycle. So normal discharge is clear to white, stretchy or slippery and it doesn't have an odor. It will go from dry to a little bit creamy to a little bit stretchy, that egg white consistency, to dry again and then a bleed. But red flags with it are if it's yellow or green, if it's thick and cottage cheese like.

Kate:

If it smells fishy, if it smells super fishy, itching or burning or other red flag signs with your discharge, that's when it's time to test. There are intervention, natural interventions like boric acid or specific probiotics for your vaginal microbiome and specific tests you can do for it. But discharge for the most part is normal and you should see changes in it throughout the month if you're ovulating and a test we often do is a is actually a home analysis of the vaginal microbiome.

Mitchell:

That's way better than what you would get at a gynecologist's office without having to go in the evy test and they can.

Kate:

that's where they can formulate specific probiotics for you, or even antifungals and things like that. Okay, another female question Is it normal to spot during ovulation?

Mitchell:

I mean, when you ovulate, you will have some estrogen changes that can absolutely lead to a little bit of spotting Right, bit of spotting right. What I what I do not like is if before, a woman's bleed, like the day or two before it, if they're spotting, because that really makes me concerned that, keep in mind, you can have a bleed without ever ovulating, right. We see that with women on birth control and they say I have a period and it's not really a period. It's a withdrawal of estrogen on those sugar pills that leads to a shedding of some of the tissue because estrogen holds on to blood vessels and tissue. So back to the anovulation. If you spot right before you bleed, that tells me that you have a relative imbalance between progesterone and estrogen. Keep in mind, the progesterone created during a cycle is actually due to the ovulation of an egg and ovulation is necessary in order to have good hormone balance. I said hormone balance, oh my gosh. I mean you talk a lot about this with our clients. So I mean, give your two cents.

Kate:

Yeah, that tiny withdrawal bleed, that little spotting is more likely if estrogen is higher than average or if you have bigger swings, there's a more dramatic swing in the drop-off. But what's not normal is if it lasts multiple days, if it comes with pain or if you are actually skipping the bleeding window and you're only getting those little spot withdrawals. So that was. I think we're in line with that answer. Yeah, but you you mentioned hormone balance and cycles. We had a instagram question about the aura ring and I will expand this into various trackers, but how accurate are they for tracking ovulation?

Mitchell:

I mean the temperature change during ovulation or just before is, in my opinion, a really good marker of ovulation. But if they're not tracking temperature and they're just basing it off when you bleed, everyone's everyone's post ovulation until bleed phase is quite variable, so I don't think that it can't just be based on days. It needs to be based on a true temperature change yeah, a lot of the wearables use multiple metrics.

Kate:

They use the temperature change, hrv, resting heart rate to predict fertile windows and it is more accurate over time once you see patterns of when is the period actually happening, when is the temperature change typically happening in the cycle, and it retroactively identifies ovulation, but it's not as sure as something like an LH test.

Mitchell:

Which we frequently have people do.

Kate:

Right, especially if trying to conceive, that's where a test strip can help you get ahead of the window, whereas, like I said, with the Oura ring it's more retroactive. It is still helpful to see these patterns of ovulation, to better dial in your hormone rhythms and to respond to where you are, what phase you're in, so that you can change self-care habits, nutrition habits, around what phase you're in Exercise, all of that.

Mitchell:

I would say working with a woman's menstrual cycle is a bit of a dance right. We see a ton of that either on a urine hormone test or on a serum hormone test. In my opinion, it's all about being able to go through the different phases during a cycle for a woman and to have a balance between progesterone and estrogen and it often gets labeled estrogen dominance, but what we'll see. We just saw it yesterday on a gal post-birth control syndrome. Her estrogen was quite high for an ovulatory phase, but her progesterone was in the tank. So one thing that we want to work on is but the estrogen was air quotes, normal, but relative to her progesterone it was much higher and that imbalance was leading to stress, anxiety and even some bloating. We know that mast cells going a little bit off there, but mast cells which secrete histamine have an estrogen receptor. So we know that wide variations in estrogen levels can lead to more histaminic type symptoms. We see that during the perimenopause phase, but we also see that during menstrual years, where either high or very low estrogen can cause histaminic changes.

Mitchell:

I love histamine. I know we talk about histamine a lot with patients. I love histamine. I know we talk about histamine a lot with patients.

Kate:

So is it normal to feel hungover when you haven't had a drink?

Mitchell:

No, no, it's not normal to feel hungover.

Kate:

But what could be causing it?

Mitchell:

I mean so many, and by hangover you mean a headache.

Kate:

Yeah, you know that hangover feeling.

Mitchell:

No.

Kate:

Oh, come on.

Mitchell:

I don't even get hungover on the rare chance that I drink, and I think it's because I take care of myself.

Kate:

Okay, well, this was a leading question, because histamine response can make you feel like you're hungover when you haven't had anything to drink.

Mitchell:

Well, when you look at how histamine is metabolized in the body, there's multiple enzyme systems, right, we've got that arm, that histamine, n-methyltransferase, which is a methylation system, and then we've got aldehyde dehydrogenase, diamine oxidase. We've got multiple layers there. So if you're getting other histaminic symptoms, you know the largest source of histamine in the body is the GI tract Histamines. One of its jobs is to call blood to an area because there's a threat. You think about an allergy.

Mitchell:

That's an over-exaggerated immune response to a non-noxious stimuli. We see the same thing with inhaled allergens. If someone's allergic to mold and they're exposed to it, if someone has gut dysbiosis or SIBO and things like that, you'll get more histaminic issues and this will present as common questions. We ask Do artificial smells or fragrances make you feel nauseous? Do you get a lot of bloating after you eat leftovers? Do certain buildings make you feel bloated or headachy or nauseous? We find sometimes people it's not even their houses, it's their work environment has an issue with mold in the ducts or in the carpet or in the drywall and they become more histaminic and hungover type feeling at work.

Kate:

And I also notice it in patients who say oh, I went to wine night with my girls and we had a charcuterie board, but I didn't drink any wine, but I felt hungover. Aged cheeses and aged meats are a very high source of histamine.

Mitchell:

So that could be a culprit there.

Kate:

Yeah histamine is so central to most of the people we see as issues. I have another Instagram question for Dr Mitchell. How'd Mitchell get those abs?

Mitchell:

he's blushing um, well, well, I set myself up for that because I got out of the cold plunge last weekend and my girlfriend thought I looked good, so she took a picture of me and posted to her Instagram and then spent the next three hours telling me you should just post it. And I said I'm not that guy. I like to work in silence and kind of like, not show that. But I did and I got it. So feedback All but one were from men, which I appreciated. How do I get those abs? I mean partly genetic, for sure. Even when I was holding more belly fat I still had abs, which was kind of weird. So there's a genetic component. But I mean compound exercises, a lot of instability, training, but then you cannot work a bad diet that's what I was gonna say diligence to your routine and you see how I'm dialed in.

Mitchell:

You know I, I'm very conscious of what I'm putting in my mouth and then rarely drinking, you know you. And then I think about this a lot like I'm so proud of myself that I and I don't have a kid, so it's different, but I so prioritize my sleep. That's never been something that I allow to be taken from me when life gets busy, whether it be social engagements or you know the occasional time dog in the middle of the night's puking and things like that. I can't imagine, you know, if I have a kid, you know I this will change.

Mitchell:

Yeah, I do worry about that because I'm so interested in good sleep. But I mean it's stress management, it's I eat protein for my body weight. I move every day, you see, even at lunch, like I go walk up on the treadmill after I eat a lot of times, and I make sure I prioritize rest and relaxation and then I'm not drinking freaking carcinogens three nights a week. You know I mean, oh, but I like drinking. Yeah, drinking has benefits socially, it's fun. But have you ever heard the saying that when you drink you take yesterday's happiness, you take from yesterday's happiness for today? There's never. You're never better the next day after you drink? You know, and it's, it bothers me how ubiquitous alcohol is in our society and it's a carcinogen. And what do we know about the liver? We see it all the time. We saw it yesterday in a guy, 38 years old liver enzymes through the roof purely from drinking.

Kate:

Right. Your liver is going to prioritize detoxifying alcohol before anything else.

Mitchell:

So you cannot burn fat if you're getting rid of alcohol. So be judicious about the times you want to drink. And a big thing. You know, going to Phoenix last weekend I traveled with my liposomal glutathione and my binders and I sandwiched because I knew I would be drinking during the weekend Memorial Day, and it was fun. But you know, go to bed sober, stay hydrated. Glutathione gets depleted in the liver when you have alcohol so replete that Maybe bind some of the toxins that are floating through the GI tract with high-quality binders. Stay hydrated. You know I'd get up cold plunge or exercise while we were there and manage the load of toxins coming in. But thank you to whoever asked that I'm flattered. Was it a guy? Yep, yes, we work.

Kate:

we work out for the boys. All right, friends, that is a wrap on this round of questions. You google at 2 am and pretend you didn't. If your body's doing something weird, odds are you're not the only one. Keep the questions coming. Stay curious and remember nothing is too awkward to talk about, at least not with us. Catch you next time. For more about what we do at the Facility, check out our website, wwwthefacilitydenvercom. You can also follow us on Instagram at the facility Denver for extra tips behind the scenes, fun and updates on new episodes. Thanks for listening. Now go facilitate your own health and we'll see you next time. Bye.