Loose Bowels, Low Stomach Acid & Dysbiosis with Tom Malterre and Angela Pifer

 
Nutrient lab we discussed during our webinar:

 
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Join Angela Pifer and Tom Malterre for a lively, clinically rich discussion on the deeper drivers of chronic digestive symptoms, food reactivity, reflux, gastritis, dysbiosis, low stomach acid, bile issues, nutrient deficiencies, mitochondrial function, and the gut terrain.

Angela and Tom are both functional medicine-certified practitioners, co-graduates of Bastyr University, and have each been in clinical practice for 21 years. In this Q&A, they walk through real questions from the community and connect the dots between stomach acid, mitochondrial health, mast cell reactivity, mold/mycotoxins, nutrient status, gut permeability, bile flow, GLP-1 medications, plant diversity, and rebuilding digestive capacity.

If you’ve been stuck wondering why your gut isn’t healing, why you react to so many foods, why reflux or gastritis keeps coming back, or why restrictive diets only help temporarily, this replay is worth watching.

1. Where to Start with Mold, MCAS, SIBO/SIFO, Dysbiosis, and Only a Few Tolerated Foods

Timestamp: 8:25

Angela and Tom discuss how to prioritize care when someone has multiple overlapping issues, including mold toxicity, MCAS, SIBO/SIFO, dysbiosis, bile issues, and severe food restriction.

Key points:

• Angela emphasizes stabilizing mast cells and histamines before pushing mold detox too aggressively.
• Tom brings in the “cell danger response” and explains how mitochondrial shutdown can impair digestion, detoxification, gut repair, motility, and food tolerance.
• They discuss early morning light, circadian rhythm, DHA, sleep, amino acids, and gentle mitochondrial support as foundational steps.

2. Low Stomach Acid, Bitters, HCl, and Mitochondrial Function

Timestamp: 15:25

This section explores why some people need ongoing bitters or HCl and why the body may not resume strong stomach acid production quickly.

Key points:

• Tom explains that stomach acid production depends on zinc, histidine/histamine signaling, and mitochondrial energy in the parietal cells.
• Angela adds that mold toxicity and chronic stress can inhibit vagal tone and disrupt the enteric nervous system.
• They discuss the importance of nutrient testing, amino acid status, and supporting mitochondrial function rather than only adding HCl.

3. Bile Reflux, Diarrhea, Fat Malabsorption, and Urgency

Timestamp: 24:53

Birgitta’s question opens a discussion on bile reflux, diarrhea, urgency, colon resection, and fat digestion.

Key points:

• Tom explains how poor bile acid recycling and fat malabsorption can contribute to urgency and diarrhea.
• They discuss options like TUDCA, ox bile, digestive enzymes, and assessing fat digestion.
• Angela adds practical tools such as soluble fibers, PHGG, acacia, psyllium, short-term Imodium when appropriate, binders, and bile acid sequestrants when truly needed.

4. Gastritis, Acid Suppression, and Protecting the Stomach Lining

Timestamp: 30:48

Sherry asks whether Prevacid is the right approach for gastritis when many people actually have low stomach acid.

Key points:

• Tom explains that blocking acid can create downstream issues with nutrient absorption, microbial balance, and digestive function.
• They discuss supporting the stomach lining first with nutrients such as zinc carnosine, glutamine, electrolytes, amino acids, and glutathione support.
• Angela adds that HCl should not be used aggressively when gastritis is active, and that soothing agents like sodium alginate, DGL, and Reflux Raft may help protect the lining while healing.

5. B12 Deficiency, Low Stomach Acid, and Nutrient Testing

Timestamp: 41:30

Maya asks why she may need frequent B12 injections despite negative intrinsic factor and parietal cell antibody testing.

Key points:

• Tom explains that B12 absorption is highly pH-dependent and can be disrupted by even mild stomach acid insufficiency.
• They discuss why serum B12 alone may not be enough and why markers like methylmalonic acid can give better functional insight.
• Angela mentions the Heidelberg test as a way to evaluate stomach acid output, and Tom discusses high-dose oral B12 and forms such as methylcobalamin, hydroxocobalamin, and adenosylcobalamin.

6. Autoimmune Gastritis, Leaky Gut, Gluten, and Immune Triggers

Timestamp: 47:26

Alice asks about autoimmune gastritis, which opens a broader conversation on intestinal permeability and autoimmunity.

Key points:

• Tom explains how intestinal permeability can allow food and microbial proteins to enter circulation and trigger immune responses.
• They discuss how antibodies may cross-react with body tissues, including thyroid, joints, nerves, and stomach tissue.
• Angela adds that gastritis can have multiple triggers, including NSAIDs, H. pylori, chemical irritation, and autoimmune mechanisms.

7. GLP-1 Medications, Gastroparesis, Nutrient Depletion, and Muscle Loss

Timestamp: 55:04

A question about dysbiosis in the stomach versus small intestine leads into a major discussion on GLP-1 medications.

Key points:

• Tom explains that dysbiosis can occur in different locations and that stomach acid normally helps protect the upper GI tract from microbial overgrowth.
• He describes GLP-1 medications as inducing a form of delayed gastric emptying or gastroparesis, which can increase stagnation and fermentation.
• Angela and Tom discuss nutrient depletion, reduced protein intake, loss of lean muscle mass, reduced mitochondrial capacity, and why GLP-1 use needs serious nutritional support.

8. H. pylori Without Antibiotics and Terrain-Based Support

Timestamp: 1:07:35

Maria asks whether H. pylori can be addressed without antibiotics.

Key points:

• Tom discusses non-antibiotic tools that may be considered, including bismuth, mastic gum, berberine-containing formulas, and broccoli sprouts.
• Angela adds Pyloguard from Microbiome Labs as a supportive option that uses a Bifidobacterium longum species to help bind and escort H. pylori out.
• They frame H. pylori as something that should be considered within the larger terrain of stomach acid, mucosal integrity, microbiome balance, and digestive function.

9. Plant Foods, Carnivore Diets, Low FODMAP, and Microbiome Diversity

Timestamp: 1:15:46

Angela and Tom discuss whether people with digestive issues should avoid plants, lectins, starches, or carbohydrates long-term.

Key points:

• Angela emphasizes that reacting to plant foods is a warning sign that digestive capacity and microbial balance need support, not proof that plants are bad.
• Tom explains that some people struggle with plant carbohydrates because they’re missing the microbes needed to digest them.
• They discuss low FODMAP diets, reduced microbiome diversity, the importance of restoring beneficial organisms, and why long-term extreme restriction can backfire.

10. Reflux Support, Alkaline Water, DGL, and Natural Devices

Timestamp: 1:24:05

This section covers alkaline water, LPR, reflux, DGL, sodium alginate, and tools to support reflux naturally.

Key points:

• Angela explains that alkaline water may have a specific role in LPR when pepsin is irritating the throat, but it should not be viewed as a broad digestive solution.
• She explains how DGL, slippery elm, marshmallow, aloe, and sodium alginate can help coat and protect irritated tissue.
• Angela also introduces the IQoro device as a potential tool for strengthening upper esophageal sphincter function in LPR-type reflux.

11. Gallbladder Removal, Bile Flow, Histamines, and Detox

Timestamp: 1:41:39

Allie asks about worsening histamine issues, detoxification problems, and bile support after gallbladder removal.

Key points:

• Tom explains how irritated intestinal lining can blunt gallbladder signaling and bile flow.
• They discuss ox bile, TUDCA, phosphatidylcholine, choline, and digestive enzymes as possible bile and fat-digestion supports.
• The conversation connects bile acids with detoxification, microbiome regulation, fat digestion, and downstream inflammatory signaling.

12: Do We Really Digest Plants? Raw Foods, Chewing, and Digestive Capacity

Timestamp: 1:54:20

The final discussion addresses whether humans digest plants well and whether raw plants are harder to break down.

Key points:

• Angela explains that plant cell walls are rigid, so chewing thoroughly matters; ideally, food should be well broken down before swallowing.
• They discuss using a mix of cooked, raw, blended, fermented, and cultured plant foods based on tolerance.
• Tom reinforces that digestion is not just about human enzymes; it also depends on the microbiome, gut terrain, and overall digestive capacity.