Season 8, Episode 3: The Role of Hormones and Supplements in Gut Inflammation with Dr. Inna Melamed

Evelyne Lambrecht: I’m so excited to talk to you today. Dr. Inna is the founder of Digestive Reset, the author of two books, Crohn’s and Colitis Fix and Digestive Reset, and a frequent contributor to professional education platforms. In this episode, we will talk about Dr. Inna’s professional and personal journey and dive deep into inflammatory bowel disease. Inna, what’s leading you up this week?

Dr. Inna Melamed: It’s just knowing that my clients were de-prescribed medications, one of my clients who went in full remission. I mean, in remission. In the traditional world, that’s a big accomplishment. In functional medicine and integrative world, we really take a pride because our contributions are indispensable.

Evelyne Lambrecht: I love that that’s amazing. And it’s interesting hearing from somebody who is a pharmacist. So, let’s get into your background a little bit. I’d love for you to share your personal and professional journey, how you became a pharmacist, and then how you came to specialize in Crohn’s and colitis.

Dr. Inna Melamed: Perfect. Yes. I’d love to share the story. I became a pharmacist for a reason that a lot of healthcare practitioners become health care practitioners. They see a loved one being sick and from a young age. And it’s in my story; it was my grandma. She was sick. What actually happened to her was probably IBD, Crohn’s that was not diagnosed as Crohn’s at those times in Ukraine. She was just it was called colitis. It was one taken from lots of surgeries, lots of issues. I’ve seen her walking into the pharmacies all the time. And then you’re a pharmacist now? With this herbal aroma and this person in the white jacket was a god, right? They that were giving my grandma something that relieves her pain. So that, of course, stuck with me. And that’s what I wanted to do since the young age.

Later on in my story, being a pharmacist, seeing things a little different from the other side now, working behind the counter, seeing people coming back with prescriptions and need for more prescriptions, we now have this drug with side effects on more prescriptions for the side effects. It took a while for me. I still felt very satisfied because yes, there’s that aspect. When you give someone relief or pain and they feel better, how much better can that be? How much more satisfying as a healthcare practitioner? Your advice, I always believed in advice. I always thought, you know, it’s not just about dispensing. Be more seen as pharmacist, as just the dispensing role. It’s never been it’s really, truly, never been just the dispensing role.

100 years ago, people would go to a pharmacist who was everything. He was a doctor. He was a pharmacist. He was an herbalist. To see, I think, it’s an important, very, very important role that can truly be that middle for a lot of health care practitioners. I believe in that role.

But then I was, taking back for, for a while, and then they got sick when I got sick on medications, I, knowing all the side effects, I wanted to do more than just that. And in my story, the medication didn’t truly relieve my problem, didn’t even take care of the problem. So maybe that was in the way, how my journey took me to this route. I’ve done a lot of interesting things. And functional medicine was that final point that helped me recover. I believed in it from day one. I wrote about it on the website, just as free information sharing, and my first clients came to me this way. So that’s how my functional medicine practice started over 15 years ago.

Evelyne Lambrecht: Thank you for sharing that. And I think that’s the story for a lot of practitioners, right? We find ourselves encountering difficulty, whether it’s in ourselves or in a family member, and then dive down a rabbit hole and then encounter functional medicine.

So, I would love to dive more into Crohn’s and colitis, since you are specializing in those and talk about how you approach someone with Crohn’s or colitis? Who is the typical patient who comes to you? Let’s start there.

Dr. Inna Melamed: I think it’s a great question because not everyone, of course, would be that perfect candidate for what I have to offer. My programs do require someone to have an open mind, to see that there’s more than just the traditional medicine. I know that I can easily say who this program is not for. It’s for those that are just interested to give me the pill and that’s all I care about that it even with nutraceuticals, there are people that, oh, I’m interested in integrative medicine. I’m interested in the functional medicine approach. Give me that vitamin, give me that supplement.

So functional medicine in integrative medicine is more about you, your body as a whole, emotional physical attacks. And so, a lot of aspects it’s a multifactorial, a root cause for Crohn’s and colitis. So yes, it’s definitely for those that understand and appreciate that there might be changes you might have to address or most likely will have to address lifestyle changes, your sleep, your stress reduction techniques. In my programs, I have that as a whole module stress reduction techniques alone. I know I’m not a practitioner of any of these stress reduction practices yet, I could share what worked for me as a coach. And I can definitely share even the words of affirmation or intention or tapping. I can share those that worked for me to heal my gut. So, people that are interested in doing more than just give me the pill, interested in understanding more people that are loving to go after the root cause. Like let’s do more labs. Let’s find out. Maybe there is a possibility that I have something, pathogen, bacteria, virus, Candida, fungal infection that still wasn’t found. I think it’s incredibly important to find.

Evelyne Lambrecht: Yeah. So, tell me about your typical patient who comes to you. What do they present with? And then where do you start from there?

Dr. Inna Melamed: So my clients, it could be a kid from 5 or 6 years old that the mother wants to do more for, to someone for ninety years old that also wants to have a little more anti-inflammatory, herbal support that is not available through their regular practitioner or even anti-inflammatory support that they’re concerned about.

Maybe there is a drug interaction, maybe there is therapeutic duplication, maybe there’s something there that not an expert wouldn’t know. So, it would be someone who is interested to go after the root causes. Do the functional medicine diagnostic, go through a program that’s been proven to work step by step, from nutrition to anti-inflammatory to toxicity and detoxing, to figuring out what’s going on in those labs, and then a good program that will take them from flare to hopefully a remission.

Evelyne Lambrecht: I want to go back to something that you said I haven’t heard this term used before, therapeutic duplication. But it is something that we list like in our drug nutrient depletion and interaction checker. Right. Because it could be considered a positive interaction at times. Right. But it’s also something to be cautious about. Like if you are taking metformin, but then you’re also taking berberine or other blood sugar lowering nutrients, people need to be aware of that. So, I’m curious if you could speak to the role of the pharmacist in this context. When should people work with a pharmacist to uncover these? Or is it the role of the practitioner treating? Is it the role of the patient? I know some pharmacists also do not have the time to even spend on, well, maybe severe drug interactions, yes, but maybe not drug nutrient interactions. And I don’t see depletions very often. Can you speak more to that?

Dr. Inna Melamed: Absolutely, it’s incredibly important to catch those. And yes, in the pharmacy dispensing role, it’s practically impossible to go and spend so much extra time to get that list of supplements that no one has, right? No one has that list, only that patient client has it.

The doctor will give them a prescription list. The pharmacist will receive that prescription list. That’s it. What’s in between is an incredibly gray area. What the patient client has and taking. There’s such room for functional medicine pharmacists who are in between the doctor and the regular dispensing pharmacist. Unless a pharmacy would offer a role to a functional medicine prescription of a pharmacist in that setting to spend that extra time.

So go into the room to spend the time to list those, to go through the checker and see. Do you know how many times I would catch 2 or 3 different supplements that have enormous amount of vitamin E, vitamin D? These are not water-soluble vitamins. Vitamin D can go in, incredibly high doses and can become a problem. Although a lot of us are depleted. But once it’s really, really high, that’s a problem too. Your body, it doesn’t get rid of it right away. Vitamin E can cause bleeding in high, extremely high doses.

I’ve seen multivitamins and then another blood sugar supporting supplement, and then another, energy supporting supplement that all has vitamin E and such doses. I took a minute. Oh, let me breathe. These are not to be combined together. We are really missing a lot of these patients. We are missing elderly. I have a great, amazing number of elderly patients, clients that are really into and they understand, and they have a background, some of them in health care and they still would miss and not know what they’re taking.

Someone who’s a doctor, a retired doctor, a veterinarian. These are educated people. They need those functional medicine pharmacists to sit down and figure out and check and make sure the duplication doesn’t happen. It’s not a joke.

Evelyne Lambrecht: Do you think that if you were to go back into the pharmacy world and you’ve worked in community pharmacy, I think you said Walgreens?

Dr. Inna Melamed: Rite-Aid.

Evelyne Lambrecht: So, do you think that knowing what you know now, it would be possible to implement some of that? Because I think if pharmacists maybe just focused on, say, know like the top five medications and their depletions, that could be a way. But do you think that you would have done it differently or would do it differently now if you were to go back to those settings?

Dr. Inna Melamed: An amazing question and really difficult to answer, because when you’re in the community setting, like this load the prescription, and really time constraining and no computer system flagging and no input of which, there are supplements are taken. You have an idea. Like I said, it’s a major gray area. I would love to have the conversation with the patient/client depending where I am. Yeah, I would have love to make that impact. It’s just right now it’s getting easier with the computer systems, hopefully picking up on more things. When I started out, in the early 90s, late 80s, one of the pharmacists in the community setting were just switching from a typewriter.

Evelyne Lambrecht: Oh, wow.

Dr. Inna Melamed: So, I came a long way because things are definitely better today. But yes, most community settings are still not there yet. There’s room, there’s place. And I’m hoping this is going to happen very soon.

Evelyne Lambrecht: And I know there are programs now where it does flag potential depletions. So that’s promising. And I’m sure with the use of AI that’ll continue to evolve.

So, let’s talk a little bit more about Crohn’s and colitis. So, I’m curious, when a patient comes to you, I’m sure they’ve already done several labs. So, I’m wondering what are the additional labs that you do? Do you look at genetics? Do you just do a stool test? What serum markers are you looking at? Tell me more about your approach.

Dr. Inna Melamed: Right. I really like to see as a first marker to see where calprotectin is. And thankfully, now it’s, also accepted by tradition world. When I started my practice, it still wasn’t. When I was asking my clients to do a stool test that had calprotectin as a marker, the traditional gastroenterologist still didn’t do it.

Thankfully, that’s part of the practice today, which is great. It’s an amazing marker to see flares, to now remission or just improvement? Where did we go from this number to the other?

Evelyne Lambrecht: Is that both in Crohn’s and colitis, that calprotectin is the number that you’re looking for?

Dr. Inna Melamed: Correct. And it’s with that IBD umbrella. You do see different, with Crohn’s. You see higher numbers on calprotectin. Often with colitis you see two common markers, a little lower calprotectin and higher than average higher than normal but lower than Crohn’s often. But with ulcerative colitis, you constantly see fecal blood in stool. With Crohn’s, you don’t often see that. But with colitis patients, you see that more often.

And there are other things that obviously separate the two symptoms, right? The way you present, even, with the area, it’s often different in colitis and Crohn’s patients.

Evelyne Lambrecht: And then do you do genetic testing to do other stool testing?

Dr. Inna Melamed: There are genetic testing that can be done for immediate relief. I always believe in quicker fixes, especially when someone comes in with pain, when they come in with diarrhea and severe fatigue. I am all about let’s get to those quickly. And genetic testing, they could be hit or miss if, if you’re familiar, with Prometheus lab. So, we don’t do that that much anymore. It was a big hit. Oh, my goodness. We can now test between Crohn’s and colitis or intermediate colitis. And understand which one is this after that test. And with all this different data coming through and the change. Right. Because originally it was one thing as we pull the more data in things have a looking different. Now no one’s even looking at the Prometheus lab anymore.

It’s more about presentation symptoms still, it’s how you’re feeling. So, I believe there will be more weight to the genetic testing. Maybe a little later. We still have a lot to figure out. And with genetic testing, where I’m also, I’m a little uncomfortable is when, you can find them now, the markers in genetic, mutations, genetic changes. Snippets. But for majority of them, you can’t do much about. Yeah, like with MTHFR. That’s easy. We find them. The issue you have to both copies affected. We supplement you with a good methyl folate or hydroxy B12, depending on who and where you are. And you’re practically methylated as someone that doesn’t have that problem.

But that’s just a few, a handful of issues that we can fix like this. So doing genetic testing will not do much for my kind of client. Patients with Crohn’s and colitis. You know, it’s not going to get me to quick fixes that I like. So, stool test. Yes. Hormone tests. Absolutely. Because adrenals must be taken care of for someone with Crohn’s and colitis. That’s a given. That’s inflammation. I often do micronutrient testing because most of my clients are depleted and unfortunately still not fully tested currently by the traditional world. Some physicians are in integrative positions. They will do that, but a lot of it is still missing.

I really do find some food sensitivity testing to be important. I know we were going back and forth and food sensitivity testing, whether it’s it even has a room today, because if someone has a leaky gut, they will show up automatically with a lot because that’s what’s going on, right? All these foods are coming through abdominal cavity, and they are showing up as affected and causing inflammation in the system. We have systems confused, less leaky gut, less food sensitivities. So, is there a point to do food sensitivity testing? Some practitioners today will say no because first, let’s heal the leaky gut. I say many times yes, because if something one food that’s causing tremendous food sensitivity, like turkey, that they’re eating almost every day, let’s remove that and that will reduce inflammation. So, to me that makes sense.

Evelyne Lambrecht: And when you’re doing stool testing, I’m curious, what are some of the interesting patterns that you see.

Dr. Inna Melamed: Yeah, they often see those two species of commensal bacteria, good bacteria that are practically depleted on both Crohn’s and colitis at frenzied times. And I can see, oh, those are good guys. We need them in abundance. We need them to decrease inflammation. And we really want to make sure that they’re there. And when the body’s fighting another pathogen, if you’re already depleted on these good soldiers that are fighting for you, you’re now in the worst-case scenario. So, I see especially frenzied. So, with the studies, we’ve seen that frenzied say for, I’ve been researching this forever, probably over ten years in research papers. Akkermansia depletions came up later, but now there are a lot more studies on it for many reasons. There’s a company that’s producing the supplementation. There are a lot of different factors, but they both equally important. Regrowing a frenzied strain does change someone’s state of disease, from flare to remission.

Evelyne Lambrecht: Okay. So, with the prausnitzii and with the Akkermansia, I haven’t seen prausnitzii much like as a supplement, but Akkermansia definitely yes. A lot more popular. And so, I’m curious, in your practice, do you find that you see benefit when you use Akkermansia? Just Akkermansia in your patients?

Dr. Inna Melamed: I definitely see Akkermansia making a difference for patients, clients. Especially if you understand that it needs support of a prebiotic, of antioxidants like dry cranberries or blueberries or pomegranate seed. Some companies have that in the bottle. Put together, as a perfect blend to give that great addition to help Akkermansia be in that gut microbiome graph that stays there, not just help you for the meantime, which is great. That’s wonderful that it’s there to help you for the meantime.

But our goal is to improve that gut microbiome for now, for later, for good. And so those combinations together, whether it’s regular blend or live blend of, caramel and say it still needs the support of that wonderful prebiotic blend to stay in.

Evelyne Lambrecht: That’s really interesting. So, taking polyphenols with it is necessary or helpful for the Akkermansia to stay? Okay interesting.

Dr. Inna Melamed: I think we’re going to give a gift to people listening to this just by understanding that they need polyphenols on top of Akkermansia to actually make that difference in gut microbiome health.

Evelyne Lambrecht: And do you have patients take that at the same time, like literally take the supplement? Or do you find that people can also get that benefit through diet?

Dr. Inna Melamed: Diet is great. Because I’ve done this for this long, I’m able to see the results, and I’m able to see what happens when someone takes Akkermansia alone, what happens when someone takes Akkermansia and eats well and adds the polyphenols regularly. I have clients that are amazing. They take stuff so seriously. They send me their food diary, pomegranate seeds, Monday, Wednesday, Friday. They’re that good. So, I’ve seen if you are really good about taking polyphenols, you would also get a lot of a lot more benefit. Yet many people will not be doing those that much. So that’s where polyphenol blend comes in. And I’ve seen the difference just with Akkermansia alone. For some it will make a difference, for some it will not. Then I would add polyphenol later. And then we hit the target.

Evelyne Lambrecht: Very interesting. And then those polyphenols obviously have so many other benefits beyond what we’re talking about. So that’s great. Any other supplements that you focus on? I know one of the big things that you, you told me you focus on is like digestion itself. And actually the patients or the clients who come to you, they are unable to digest their food. So do you use bitters, do you use digestive enzymes? What are you usually looking at?

Dr. Inna Melamed: Yeah, one of the first things I start many, if not most of my clients because they come in with digestive problems are three things. Enzymes. Milk thistle for initial liver support and L-glutamine. Those strain their lining. Those are the three minimal, bare basics to start. And that’s what I teach my pharmacists that are taking my course in training. You’ll want to start those kind of patients clients with those three basic enzymes, milk thistle, and L-glutamine.

Evelyne Lambrecht: Okay. Great.

Dr. Inna Melamed: Bitters can be great, but they’re often not tolerated well for some. I’ve seen people without gall bladders that actually need bitters more than others not doing well in bitters. They get nauseous. It can get too much for them. So I usually don’t start with bitters. But bitter herbs are wonderful in the diet. If you want to get nutrition involved with bitters or even apple cider vinegar to help you with that acid production, fantastic. But bitters I usually hold if needed.

Evelyne Lambrecht: And with the digestive enzymes. I know that a lot of practitioners are fans of starting patients with that. It can make a big difference for so many things and for nutrient absorption, which is a huge issue like you talked about. Do you keep your clients on that for the long term, or do you find that it’s a couple months and then they’re actually making sufficient enzymes themselves or no?

Dr. Inna Melamed: I think it’s an amazing question. And we could have a conversation and that alone is one of my favorite topics. It’s not just digestion though. When we talk about enzymatic insufficiency, pancreatic insufficient care, now it’s becoming a thing again forever. When I was discussing this with clients that took it back to their gastroenterologist practitioner, enzymes, that doesn’t work, or no one needs it. Or if you need it at all, you need it in huge doses. So a lot of people with digestive problems, or at least chronic digestive problems, needed a lot in the beginning. Often as they get better, they need less of it. I’ve had clients completely off of them. I’ve had clients that need to take them on as needed basis when they go out to eat, when they, have a larger than average meal.

The answer to your question would be it really depends. I cannot name two or 3 the same clients that I recommend the enzymes for. I really work with everyone individually. I personally take enzymes when I eat out.

Evelyne Lambrecht: But not which not with your daily meals, just when you eat out?

Dr. Inna Melamed: Most of the time, unless there’s a season change. So, I’m still a Crohn’s patient, even though I’m in full remission, even though I’m doing incredibly well for close to 20 years now, I still have the genetics, I still have that predisposition. And I still can cannot allow myself to go that way again. So, I’m really careful. So if there is the season change and I know that’s a higher risk chance to get that flare, I’d be extra careful. I’ll take more. I take it before dinner time if my dinner is later in the day. Because we produce enzymes practically according to the circadian rhythm you do produce just like the cortisol, right? You pump cortisol a lot of that in the morning, a little less in the afternoon and very little at night. That’s how you supposed to if everything’s going well.

And the same with enzymes past 3:00, 4:00, not that much is produced. So the fact that we are eating dinner and dinner in this country is the largest meal of the day, the way we traditionally eat, it’s completely wrong. Our breakfast should be the largest meal of the day for many reasons for, hormone balance, for digestive health breakfast.

Evelyne Lambrecht: And then, I want to talk about the glutamine a little bit. Going back to that, do you just do like five grams of glutamine once a day, or do you are you a fan of using more for a period of time to kind of like, get that inflammation down and strengthen their immune system?

Dr. Inna Melamed: I start every one at about 3.5g to five grams, okay. As an initial dose, a couple of reasons why. You do have people with anxiety that sometimes are sensitive to amino acids, including our glutamine. So we watch it start and we watch, if they’re doing well with 3.5g to five and they’re in severe flare, I really like to now crank up those doses, double, triple for a short period of time to help them make that aligning stronger.

And then you could start reducing the dose it can be taking on a daily basis. For someone with Crohn’s and colitis, it should be considered as a daily routine supplementation because the predisposition to the illness is not going away. You’re born with it. You could handle it. You can reduce that flare. You can go completely in remission. Yet you want to just prevent, preventative measures are often the best way. So this would be your prevention supplement.

Evelyne Lambrecht: Ok. I want to get into diet a little bit. And then also hormones. And I want to talk about a few more supplements too actually. So to wrap up the supplements piece, do you find that there’s anything you know besides what we already talked about that you know, that gets you some great wins, especially in Crohn’s and colitis. Just any supplements that like really get you a great win with patients when it comes to Crohn’s and colitis.

Dr. Inna Melamed: With Crohn’s and colitis patients, like I said, I start with those three. I really like immunoglobulins or Crohn’s space that that has tremendous data. There’s even, prescription immunolin. Right. The immune globulin supplementation. It does have great data. We’ve seen how it reduces inflammation and flares. Depending on each person there’s boswellia, curcumin for decreasing inflammation. It’s a hit or miss because it could be irritating. So, I could use those for people already that are doing much better. Just like have that last but last cherry on top of the cake. Right? But first you wanted to go gentle. Something that is tolerated better is a butyrate compound, in the different forms and liquid forms in pill form, depending, that it’s a child or teenager, or adults that cannot swallow pills too. So butyrate is also very anti-inflammatory and helpful for Crohn’s and colitis people, especially colitis, when they come in with a cold blood.

Evelyne Lambrecht: And with the butyrate, you start with that as well? If somebody is in a flare or is it something that you do after a period of time when you’ve worked through other things?

Dr. Inna Melamed: I usually start that for, when I see a cold blood.

Evelyne Lambrecht: Okay, okay. And how quickly do you find that that starts working?

Dr. Inna Melamed: I typically retest if someone’s in the flare up at 3 to 6 months. So on the retest most of the time there’s no cold blood whatsoever. So I take it as, as a marker, that it worked because we use it for that.

Evelyne Lambrecht: That’s great. I have a lot of practitioners who, in my area here in San Diego who love using butyrate, and we talk about it a lot on the podcast for various conditions. And I always think, okay, I got to take butyrate too. There’s always something new to try, but it’s just wonderful that it’s even available as a supplement, especially for people who cannot tolerate fiber for whatever reason or as you’re working toward incorporating more fiber in the diet. So, very interesting information coming out on butyrate.

Dr. Inna Melamed: And it’s definitely easier on the gut than the fiber supplementation. My people, my Crohn’s and colitis people are having very hard time with fiber supplementation in any form, even in the most mild one, like a case, for example. They’re still having trouble. It came in the market and it was, it was great because again, with Crohn’s and colitis people, you do want to give them immune system support even like globulin. So there but for example, colostrum. That’s also something that would be ideally used as an anti-inflammatory immune system support. Yet it’s a dairy being right supplement. And it’s not for everyone especially Crohn’s and colitis. Many do not do well with dairy. So that has to be taken into consideration.

Evelyne Lambrecht: So it’s great to have the immunoglobulins that are serum, bovine derived rather than a dairy source. So since we talked about fiber I want to get into diet a little bit more. I have two questions. One, are there certain dietary patterns that predispose people more to developing Crohn’s and colitis? And two, what are your general recommendations for diet in your Crohn’s and colitis patients?

Dr. Inna Melamed: Beautiful question. Again, at least in our conversation. For the diets I usually try with many of my Crohn’s and colitis, clients come in and they already tried paleo or a special, carbohydrate diet. The list goes on. What we’ve seen in the studies is that one worse culprit would be standard traditional American diet. Because there’s not that not a lot of vegetables, there’s a lot of good quality fiber and not a lot of good quality fat. We’ve been seeing changes, but I’m thrilled that there is no more cereals, cereal that pyramid that we saw in the 80s, 90s, early 2000s. But that was just cereal killers, right? There were it was insane. That definitely tilted the numbers of Crohn’s rise.

If you are going to look carefully with that pyramid, we’ve seen the rise of inflammatory bowel disease, chronic inflammatory illnesses and so forth diabetes with that pyramid. So standard traditional American diet that is going to put you in the higher risk right there. And then, and if you’re looking for that one diet to improve, and if I have to go through most of them and name just one, I would say Mediterranean would be top priority. Although not everything on that list of Mediterranean that goes well with Crohn’s and colitis patients, especially things like eggplant. And that’s like one of the staples. And eggplant is really irritating to a lot of my clients.

Evelyne Lambrecht: And with the Mediterranean diet, do you find it to be so helpful primarily because it is anti-inflammatory, and so it’s getting those flares down?

Dr. Inna Melamed: It’s a perfect blend of macro nutrients, not micronutrients. Now macronutrients you have, you got fiber from vegetables. You have your quality fat, and you have plenty of good clean, lean protein. So that’s truly how anyone with prediabetes who wants to get out of that to be eating, if they’re looking to go the other way.

Anyone with any inflammatory illness, including inflammatory bowel disease, that if you want to reverse, if you want to go the other way, stay within that macronutrient ratio and you’ll see that big difference. And that’s what Mediterranean diet with.

Evelyne Lambrecht: All right. And then let’s talk about hormones a bit, I know that you work on that quite a bit with your clients. And I’m curious what are some of the correlations that you see? I know that you’re a fan of the Dutch test. So what are some of the patterns that you see maybe in estrogen, testosterone, progesterone, estrogen metabolism that correlate with, maybe gut testing that maybe we don’t usually think about?

Dr. Inna Melamed: Great question. And, I spent a lot of time teaching my students in my school. Those are really intricate, very, very detailed things that if you learn well, you could be really helpful to people with these illnesses. Number one methylation. So if you’re having those higher that estrogen dominance, often you have methylation issues and you need that support of methylation.

Often with cortisol being depleted completely with inflammatory illnesses, inflammatory diseases, chronic inflammatory issues, not just IBD, not just Crohn’s and colitis. You have to support adrenals. You have to support that cortisol. What I don’t love to do is something that everyone’s jumping on is cortisol being high at night because cortisol is not, the bad guy. It’s a good cortisol is important. It’s anti-inflammatory hormone. I don’t I don’t like to reduce it. If, if I ever use supplementation to reduce nighttime cortisol, for example, to improve sleep, it has to be something that will not truly reduce the entire cortisol production.

So adrenal support is important. Methylation support is important. What I see and touch test often markers for possibly depletion of like organic acids B, C changes. A lot of these are affected Crohn’s and colitis B’s D is affected often. So a lot of these markers again that’s a whole different conversation. But we do see a lot of help just looking at the markers on the Dutch test and improving that hormone balance.

Evelyne Lambrecht: So prednisone is used quite a bit right in Crohn’s and colitis. Can you talk about that link in this context?

Dr. Inna Melamed: Absolutely. So thankfully it’s used less. It was used tremendously before biologics came. And I still have clients that with me for many, many years that were really overusing prednisone that now has osteoporosis so bad from that because it takes the calcium out. And the supplementation wasn’t started on them early enough. That wasn’t recognized. And now it’s gotten better. We use less of that, but it’s still used, used plenty. And it does deplete and affects the bone. So yeah, a problem on its own. And when you use prednisone, if you do, for example Dutch test, you’ll see those cortisol levels are artificially high. It was that arise from the medication alone. So how true are those results? We have to take that into consideration.

Testing someone after the medication. You have to give it time to go after you stop prednisone. Give it a good 30 days. To, to see the true production of adrenals. So that has to be taken into consideration when someone comes in to you right after the drug on the drug or waiting to see the true representation to do the test later.

Evelyne Lambrecht: So in regard to other medications like the biologics, to be truthful, I don’t know a lot about them. I don’t really know how they work. I don’t know about side effects. Can you just share briefly what we should know about biologics?

Dr. Inna Melamed: These are amazing drugs for those that are like, give me the pill. Remember we talked about that at the beginning. These are also incredible opportunity for kids. For example, that in the growth spurt age and there was not much time to do what I do between the lifestyle changes and the sleep and the diet and something that takes a long time. My work is not an overnight success. That will be a success, no doubt, and long term for a short burst of anything else. But it does take time and this one will work faster.

And if a mother, for example, comes in and is contemplating starting a therapy course, a lot of people now are concerned studying this. There’s a lot of side effects on biologics, effectiveness is nowhere near 100%. We know effectiveness is still questionable. But since they do work and a kid needs to grow, and this is the time, there’s no doubt that has to be started.

Otherwise, lifestyle changes should be tried and other things should be considered. Often I if interestingly enough, I do, I do see that still nothing replaces nutritional approach. Even, a recent study, a 2024 study on biologics, we saw people taking biologics alone and taking biologics with poor diet that they were depleted until selenium and Vitamin D, those two. So poorer outcome was in those depleted nutritionally versus not. So nothing replaces that right drug does not replace good diet. If anyone’s going to take anything out of our conversation today with the pharmacist. Drugs do not replace good diet should be the key takeaway.

Evelyne Lambrecht: Yeah absolutely. And with the hormone part do you find that you need to do like direct hormone interventions, or do you find that when you lower the GI inflammation with the things that we talked about, that some of that hormone balance is restored just by working on the gut?

Dr. Inna Melamed: Amazing question. And it’s a chicken or the egg situation- hormones and gut. Which one comes first? Every case is different for me. I do often. I mean, I was trained by Doctor Kalish, and his step by step was adrenals first, always. And I do believe in that. Still, yet with Crohn’s and colitis because we want to help them right away, we take reroutes. And one helps the other. So once you have someone on, great hormone balancing, program that will reduce inflammation and you will have that decrease of gut inflammation because of that. But if there is a gut inflammation already, you need to put that fire out to get better hormone balance. Right. One helps the other.

Evelyne Lambrecht: Great. Well, I have so many more questions I could ask you, but I think we covered the most important parts. But we are out of time. So let me just get to our signature questions for you. What are your three favorite supplements that you take?

Dr. Inna Melamed: I mentioned those already. I do love my enzymes, my milk thistle, and L-glutamine.

Evelyne Lambrecht: Okay, so everything that you give your patients you’re still taking as well. What are your favorite health practices to keep you healthy and balanced?

Dr. Inna Melamed: I have a lot of stress reduction techniques that I incorporate into my life. From journaling to or tapping to hypnotherapy. I see a practitioner once in a while. That’s a big one. I do love a good schedule, and I do need my day off a week completely unplugging.

Evelyne Lambrecht: Yeah, I find we didn’t get into it as much today, but you did mention it a few times. But we know that that stress reduction is just such an important part of lowering inflammation and such an important part of every protocol, whether it’s for gut or hormones or anything else.

And then last question for you, what is something that you’ve changed your mind about through all of your years in practice?

Dr. Inna Melamed: At least a few things, but one big one, two big ones were, do not do the killing phase. The pathogens, until a client is ready. That’s important because, original thought, 15 years ago, we saw a pathogen that we would jump. Many, many, especially my clientele with Crohn’s and colitis were not ready for that.

And the second, over the years, SIBO testing was exciting when it just came out and I don’t feel that way whatsoever.

Evelyne Lambrecht: Really? Wait. Okay, tell me more about that.

Dr. Inna Melamed: Well, the result is questionable, treatment is questionable. You still have to go back to basics to address all the stuff before. And once you heal all the stuff before on, the bacteria just balances itself out. Plus, there’s so much more that can be done. Oxygenation. There’s so much can be done with the supplementation for preventing or even going after SIBO. Overtreating SIBO is now is a bigger problem than undertreating it. It’s like antibiotics or most of the supplementation or really harsh supplements or antibiotics or prescription items that are just taking out the gut flora.

Evelyne Lambrecht: Do you find that some of the clients who come to you, they have been diagnosed with SIBO?

Dr. Inna Melamed: I sometimes okay, sometimes, yeah, very rarely. But now I hear gastroenterologist. They’re taking that in and they’re testing possible. And then they are getting positives and they’re putting them on all these harsh antibiotics. And then it takes forever to get them back into balance. So I find that to be a catch-22.

Evelyne Lambrecht: Because a lot of times with the SIBO, it’s like a symptom, of something else. Right? That’s one of the schools of thought. And that’s what you think?

Dr. Inna Melamed: Yeah. Okay. I also like to look at methane, the bacteria numbers against the SIBO results method of bacteria numbers and GImap because if that’s not high, please read those results again. Let me be sure.

Evelyne Lambrecht: Okay. Interesting. I know we can have a whole topic on SIBO, but now I have to ask you another question. So when it comes to, say, the trio smart test, which I like, right. Because it is a breath test and it is measuring hydrogen, methane and hydrogen sulfide. I think the solution that’s used is glucose, right. But you can also do it with lactulose. And do you think that sometimes the results are questionable because of the substrate that’s used, but maybe it doesn’t even matter?

Dr. Inna Melamed: It does matter. Plus it’s going to cause so much irritation for someone who’s in distress already. It’s not like it’s a colonoscopy prep, you know that, it’s an upper GI. It’s a small intestinal. There’s a lot less room in the small intestine, so it will get stuck in there. It’s tricky. Yeah, it’s a whole conversation right there.

Evelyne Lambrecht: Interesting. Well, thank you for sharing your thoughts. I really appreciated thank you for sharing your expertise with us. Where can people find more information about you?

Dr. Inna Melamed: So my website is digestivereset.com. If you’re interested to become a client, that’s where you go. If you’re interested to become a student of my school, you go to melamedinstitute.health and, that’s where you’ll get more information on my school.

Evelyne Lambrecht: Wonderful. Thank you so much for being here today. I really appreciate you sharing everything with us.

Dr. Inna Melamed: Thank you.

Evelyne Lambrecht: And thank you for tuning into Conversations for Health Today. Check out the show notes for resources from today’s episode. Please share this podcast with your colleagues. Follow, rate, leave us a five-star review wherever you listen or watch. And thank you for designing a well world with us.

Voiceover: This is Conversations for Health with Evelyne Lambrecht, dedicated to engaging discussions with industry experts, exploring evidence based, cutting edge research and practical tips.