Dr. Vincent Pedre on the Importance of Gut Health and How to Improve Gut Health Naturally
04
March

By Adem Lewis / in , , , , , , , , , , , , , , , , , , , , , /


Dr. Pedre, thank you so much for being here. I know we’ve met a couple of years ago and I’m so excited to actually
be able to sit down with you on camera and — Finally we made it.
— and ask you all of my burning gut health questions because…
– How long did it take to schedule this? Oh, like eight months or something,
between lots of world travel and whatever else but more formally, you are a board-certified
functional medicine doctor, board-certified in internal medicine practicing here in New York City
where we both live. You are international Spanish faculty at
the Institute for Functional Medicine, certified in yoga and medical acupuncture,
which I love and also, the Chief Medical Officer
of United Naturals and the author of Happy Gut, a book focused
on the role of gut health and the microbiome. Very busy, lots going on,
so thank you for taking the time. First up, as I said, you’re functionally-trained
doctor focused on gut health, which in the grand scheme of medicine,
is a very new focus. How did you come to be doing that? I’m sure it wasn’t on your mind when you first
decided to be a doctor or maybe it was. I almost didn’t become a doctor
because I had this deathly fear of needles and after I took the MCATs
to go to medical school, I had this complete like…
I’m not going to say break down but I realize, “Okay, wait a second,
I like everything about medicine but I can’t be in the room with a needle.
I pass out,” like drawing blood, getting a shot, so I told my parents,
I went home after the MCATs and I said, “You know, this medical school thing,
I don’t know if I can do it.” You know, I was kind of chickening out and of course they said, “No.” We’ve probably sat… I remember that day,
we sat in the living room with my mom and dad and we talked for an hour
and they pretty much convinced me that, “Yes, you’re going to become a doctor,”
and I thought, “Okay, I’m just going to put the elephant
in the room to the side, which is my fear of needle and I don’t know how I’m going to do with blood
and all that,” and I started thinking about that and thinking,
“Okay, how am I going to conquer this?” And in my family, there was no belief system
around taking medication for psychological ills. It was more like you figure out
how to conquer your mind, like how do you master what you’re feeling inside,
so you can be positive, so you can feel less anxious, whatever it is. So I started doing research
and came upon a book by Dr. Herbert Benson, which has been a very popular book over the ages,
The Relaxation Response and it was well-researched in Harvard,
how breathing can lower blood pressure, can lower the fight or flight response
and I started learning about the internal mechanism that was
happening to me, which was the fight or flight whenever I had a needle coming at me. And so I started doing all
the exercises in Dr. Benson’s book and that was so key for me because at the same time that I did that,
I started doing yoga. I discovered Dr. Andrew Weil,
his book Spontaneous Healing. I read Dr. Deepak Chopra’s book,
Quantum Healing and this was in an eight-month sabbatical
that I had before starting medical school because I had finished college early,
so I had time to just kind of go home, sit around,
really start to think about these things and think how am I going to conquer this
so that I can get my hepatitis B vaccine series, which is required to go to medical school and so, I spent the next eight months
doing guided imagery meditation and really mastering that so that by the time
I started my first year in medical school, I was meditating almost every day
for 30 minutes. Basically, by the time I got to medical school and we were… the first year
of medical school was so fast. I mean, one semester in medical school,
it’s like two semesters in college. It’s like taking eight classes at once and everyone knew me as the Zen guy
and I didn’t reveal my secret. I mean, mind you, this is ’95 and meditation is not really
the ‘in’ thing back then. It’s not that maybe, I felt a little
embarrassed as a 21-year-old meditating but I felt, you know, this is kind of out there. I don’t know that I want to share it
but meditation and yoga got me through medical school
and I knew when I read those books that the type of doctor I was going to be
was going to be shaped by that and was going to
incorporate that in some way. I didn’t know where that trajectory would end
but I admired people like Deepak Chopra, who didn’t have a road paid for them
but paid their own path through it and along that journey, I discovered functional medicine
after I did my residency training. You know, I trained in medical acupuncture,
then that got me into really returning to the idea of systems biology,
so the body working as this balance, rather than being broken down
into organ systems, which is the way we learn as an internist
— internal medicine. I went from a position of like, “Oh, this is your heart,
so you take heart medication. This is your liver, so we’re going to
take this medication for it,” to be like, “How do we look
at the body as a whole?” and that’s really the way
I always wanted to practice medicine and was shaped by my experience
before I went to medical school, so I almost think like I opened my mind before it could be closed
by the Western medical school training. And so, the that gut
microbiome focus came when? That really started in about 2006
when functional medicine came into my radar and I started learning about the microbiome
and all that and realizing, then backtracking and thinking about
what happened to me as a child because I always had a nervous stomach,
which then became an IBS-like situation and I had been on probably two or three rounds of antibiotics as a teenager
every year for like, five to seven years. My immune system was shot. I mean, I would get sinusitis,
bronchitis, pneumonia over and over. All the doctors were thinking
my immune system is weakened but really, the problem was my gut. I had leaky gut. I had developed a sensitivity to gluten,
as well as dairy. I was lactose intolerant
but also, I was dairy intolerant — dairy sensitive, so sensitive to
casein and whey. And it wasn’t until I discovered
functional medicine that I was able to go back and think about what had
happened to me in my life. I had done certain things
because I was always interested in nutrition, so I’d already in medical school started
experimenting and took dairy out of the diet and noticed that I wasn’t picking up
as many viruses when I took dairy out, so I was always kind of… interesting
how a lot of things that I’ve learned have been motivated by my own experience
and that one was motivated by me wanting to hack like how do I not get sick
and how do I not have to take antibiotics, I wanted to not have to take antibiotics
but it wasn’t until I learned functional medicine
that I kind of made sense of my life and what had happened to me as a child
and what I thought was my normal at that point. I was in my 30s by then — early 30’s. What I thought was going to be my normal
for the rest of my life was not my normal and I know there are a lot of people out there
who have gut issues who just resign themselves and think, “Well, this is the way
my body operates,” and what they don’t know is that that’s how your
body operates if it’s not working properly. If your gut is leaky,
if your microbiome is imbalanced. I had gone through experiments
of changing my diet and stuff. For example, when I first moved to New York City
and mind you, the food that they feed residents in training at hospital
is not healthy. I’ve heard that. I’ve seen that.
– It’s crazy, you know, that there is this discord between Western medicine
and the connection of diet and health. So for our noontime
science lectures or presentations, they would serve pizza
with Coke and Diet Coke. Maybe once a month, there would be a salad. Maybe. But mostly pizza,
which is basically makes you comatose when you’ve been working overnight shift
or you’re exhausted and little did I know that
that was poison for my gut. And when I started figuring this all out
and I started doing experiments, at one point I told my friends they weren’t
going to see me for a month and I went in and bought organic produce,
cooked for myself, stopped ordering takeout and no pizza — none of that —
and the change in my health was dramatic. So I’ve always been kind of searching and tuning
into how can nutrition make us feel better and really functional medicine,
for me, refined that. So then I discovered really
the importance of the gut microbiome and for me, interestingly, the patients that I found amongst the most challenging
to work with were gut patients. Because from the western model,
if you have IBS, you have like this umbrella diagnosis that seemed very amorphous
and perhaps, intuitively I thought could be caused by many different things,
but in Western medicine, you use one or two or three different
medications to treat this umbrella diagnosis and you don’t really dig down into the roots
to see what is causing what we’re seeing because people can present
with the same type of looking symptomatology but the underlying root cause can be different. You could have a yeast overgrowth.
You could have bacteria overgrowth. You could have a parasite.
You could have a mix of things. You could have stress affecting it
and I know we’re going to talk about that. I became really fascinated with gut health and the patients that were coming in with gut
because I just really wanted to figure it all out and then with the new toolset,
with functional medicine and microbiome and all that, I started working on diet
and working on how can we fix the imbalances in the gut microbiome,
leaky gut syndrome and before I knew it, you know, I was just doing what I enjoyed. I had become somewhat of an “expert”, you know? And I say it in quotation marks
because I always believe there’s more to learn and this is an evolving field,
so you can’t ever stop learning but that part of my practice grew
and that’s what really got me passionate about gut health
because I saw what dramatic changes you could make in somebody’s life
if you could affect their gut health. It had a ripple effect on
so many other health issues and it’s just something that you can make
such a big difference in people’s lives and that was the inspiration
for writing my book, Happy Gut. I think that people talk
about gut health daily because I do but that’s actually not true for most people, that they sort of understand the basics of it. When we talk about poor gut health,
is that just an imbalance in good and bad bacteria in your gut or could there be other reasons
that somebody has poor gut health? When we’re talking about poor gut health, you have to think
there’s many factors that go into that. So yes, there could be
an imbalance between bacteria but there could also be an imbalance with yeast
and there could be parasites as well. There could be one, two
or three different imbalances. Okay, if somebody has like three different imbalances,
they are really struggling? Yeah and if they have three imbalances, you can pretty much guess that
the person has leaky gut. Now, overlaid on that is the way
an entire system functions. So when you eat, digestion starts
in your mouth by chewing the food. The act of chewing
and even the smelling of the food and the thought of the food actually stimulates
your digestive juices in your stomach. You start producing hydrochloric acid. That’s going to be ready to digest
the protein that arrives with pepsin, which is the peptidase, so it breaks down protein and right there is one place
where things can go wrong. If you’re not producing enough digestive enzymes or digestive acid, you have low stomach acid,
you may not be digesting your protein properly. And if you don’t do that,
then that creates a downstream effect through the entire system because we really need
that stomach acid to be working for that first stage of digestion for many reasons
but even just to break down protein into its component amino acids,
which then help stimulate leptin secretion, which tells your brain that you’re full
— that you’ve eaten enough. One of the most highly prescribed
and even, just over the counter — one of the most predominant
medications out there — are anti-acids. People are taking medication
or being prescribed medication that reduces the natural state of the stomach,
which is designed to protect you from harmful bacteria and from yeast
that inevitably is in the food that we eat. We can’t get away from yeast in food. Sometimes, you might be eating berries
that are just on the border but you’re not going to see… You’ll see it when it’s really moldy
but you’re not going to see the very early stage. We constantly have to protect ourselves
from stuff that may be coming in through the food and the stomach acid
is the first line of protection for that. If you’re raising the pH of the stomach
— so lowering stomach acidity — you’re losing that and then that creates
a whole bunch of downstream effects. Another example is when you have leaky gut, you’re not getting the proper signaling
from the brush border in the small intestine and for people who don’t understand brush border
is almost like an internal comb. It’s the involution of the inner lining
of the small intestine. It folds and then it’s got
all these finger-like projections and the whole goal is to increase
and create as much surface area as possible in contact with the food so that food can be absorbed
— the nutrients can be absorbed. But when you have leaky gut,
that brush border gets damaged and part of what happens with that damage
is you don’t get the right hormone signaling to the pancreas telling the pancreas
to secrete enzymes to help you digest food. So it becomes this
cascading ripple effects on the system that then can lead
to yeast overgrowth, can lead to small intestine bacterial overgrowth, all sorts of imbalances and then
the gut being the primary center for the immune system can lead to inflammatory
signals that, I say, are system-wide — so inflammation that starts in the gut,
then affects the entire body and you start to see… allergies, asthma, migraines, all sorts of issues that you don’t think
are related to your gut but actually rooted in your gut health. That’s a perfect segue to the question
I wanted to ask you next which is if you don’t have traditional gut symptoms
like bloating or diarrhea or constipation, how do you know if you have a good gut health? How can someone figure that out? That is a tough question
because in our modern world, unless you’re eating super clean and you’ve never been on antibiotics before,
you probably have a disordered gut and a lot of people that may have disordered
gut health are not necessarily aware of it. A lot of times, it depends on your level
of awareness of your body. I have patients who are bloated
but they’re not aware that they’re bloated. Let me give you an example of
a patient case I had, which can be exemplary of the fact that you might be manifesting symptoms
that are outside of your gut but are related to your gut health without
having to have gut symptoms that you detect. I had a patient come in who was from India
and she had developed what would have been classified
as an inflammatory arthritis. She had all sorts of autoimmune markers. Her joints were swelling up. She was achy, she was tired. Right before she came to see me,
she had read my book and actually had started breaking out in hives but I had decided to start taking out
some of the foods that I talk about that could be bad and inflammatory. She took out dairy and wheat. By the time she came to see me,
just by removing those two foods, the hives had really calmed down but she still had joint pains and achiness
and severe fatigue but no gut symptoms. I had to ask her, like no bloating, no diarrhea,
bowel movement is normal, so you know, normally you would say, “Fine. There’s no symptoms in
the GI system so let’s not look there,” but I know that because the inflammatory condition she was exhibiting and because there’s such a strong connection
between autoimmune disease and gut health, knowing that 70% of the immune system lives
and is all around the digestive tract, I told her, “Look, we need to investigate
what’s going on with your gut, your stool, rule out parasites, rule out yeast,
all of that because we need to find what is the root cause
for this inflammatory arthritis that you’ve been classified with
like a seronegative arthritis of some sort. No one knew they wanted to put her on steroids
and she didn’t want to go on steroids. We did the stool study and luckily,
because it doesn’t always come up but we found on this particular stool study
that she had yeast and she also had a parasite. Now, we know these things are going to then
affect the gut barrier, cause leaky gut syndrome and when there’s a leaky gut,
you’re going to get more endotoxemia, so in other words,
there’s a part of gram-negative bacteria on the cell wall that
the gram-negative bacteria that’s released. They used to think it’s only released
when the bacteria die but sometimes the bacteria actually
secret it into their environment. What happens with that is it is
a hugely potent stimulator of the immune system. It turns out we have receptors
for that particular particle. It’s called lipopolysaccharide, an endotoxin and those receptors are on the immune cells
but they’re also in the liver. They’re in the brain
and they’re in muscle tissue and the receptor turns on the cascade that
turns on inflammatory signals inside the cell, so this is a really potent
instigator of inflammation, which could explain leaky gut, endotoxemia. Why she would have this inflammatory
condition with joint pains and joint swellings and she did not have Lyme disease,
so ruled out… You know, always ruling out
other possible conditions. We treated the parasite, we treated the yeast, we worked on healing her gut
and her inflammation disappeared. The joint pains went away. She kept… She basically made it into
a lifestyle for her — changed her diet. Since then, I think over time,
we were able to bring back some fermented dairy like yogurt
and she’s been fine with that. You know, once you feel the gut,
you can start to sometimes reintegrate certain foods in certain types of ways
like a fermented food and now, she’s well. Fatigue disappeared
but she didn’t have any gut symptoms but the clue was she had other body symptoms. Right.
– You’re not going to have… If you’re healthy,
if you don’t have any joint pains, if you don’t have any gut symptoms,
then likely you don’t have to go investigating to see if there is a problem with your gut
but if you’re a woman that, for example, gets yeast infections really easily or if you just go on a round of antibiotics,
you are immediately getting a yeast infection. What you need to think of is that
you have a yeast imbalance and even though the yeast infection
is happening intravaginally, what it means is you have
a pool of yeast inside your gut and that needs to be fixed or that needs to be healed and rebalanced,
so then you don’t keep getting yeast infections. So there’s always clues that
something could be going on but that’s another example you might
be getting yeast infections but you might not have any gut symptoms and nothing major that you would think of. You have to investigate
what’s happening inside your gut. So I asked the question because I have a father and some other people I know
that get a lot of colds easily and I’m always trying to explain
that this is really, either just an inflammatory response to the foods that they’re eating
or this is a gut problem and… – Let’s connect this. I find this really interesting. There’s an embryological relationship
between the formation of the gut and the formation of the airway. Now go into Chinese medicine and acupuncture,
the two are on the same energetic chi meridian, so they always interrelated gut health
with respiratory health in traditional Chinese medicine dating back 2000 years,
which was based on observation. I find that really fascinating
because then, from my clinical experience
and work with patients, when you fix the gut, you can improve
what’s happening in the airway. Now of course, things are complex
and there’s internal and external, so if you’re reacting to your external environment in some way, you might have to deal with that. You know, for example if there was mold
in your environment and you’re mold sensitive, that could be a trigger but there’s always the other flip side of it is
if your internal environment and if you’re already turned on high alert…
I used to say, you know, kind of like, “Are you in yellow,
orange or red alert internally?” then you’re going to be reacting to stuff
that’s coming through the environment and I’m an example of that
because I used to suffer from spring allergies. I never knew what allergies were,
growing up in Florida, until I moved to the northeast
and went through my first spring. I was like a faucet, eyes were red, sneezing. I’m like, “What is going on?”
I never had this my whole life, But I had never been in the northeast
and exposed to pollen and this type of stuff growing up in Florida,
where there’s really only two seasons, which is hot and less humid.
That’s it. When I fix my diet, my allergies disappeared.
– That’s so interesting. And that’s just a testament to what I’ve seen
in my patients that the internal milieu, the internal environment affects how you react
to your external environment. Because if your internal environment in this
kind of constant smoldering inflammation, low-grade inflammation,
maybe a little bit of leaky gut. There’s food sensitivities,
there might be some gut microbiome alterations, then your system is on higher alert and again,
thinking back to they’re both are internal — the gut and the airway
— that’s where we have our secretory IGA, which is a type of immunoglobulin
that we secrete into the mucosa and if the alert is set off in the gut, the alert is going to be high
in the respiratory tract as well. That’s how the body works. Just to make it simple
and make sure I understand it, if you’re eating the wrong foods
or you are drinking too much or you’re travelling too much
or you’re making it difficult for your gut to operate the way
that it wants to and digest properly and it feels on high alert,
then you’re going to be more susceptible to any little virus that might pass you by. Yeah, you have to think like if you’re,
maybe, a bit inflamed and producing too much mucus because you’re having dairy, for example,
you’re going to trap more viruses in your airway and you’re going to be
more predisposed to an infection or maybe you’re more predisposed
to getting congested and then developing a sinus infection,
which could be viral or bacterial. Given all of that, I’m sure
somebody listening to this is like, “Well, do I to have a good gut?
What’s going on?” Besides seeing a gut health specialists
like yourself, for people watching this, what would you say is like
the first one to two steps of trying to figure out how your gut is doing? You know, give it a report card score
or something like that. I think you’re asking about like
direct-to-consumer testing. There’s…
– Well, that or elimination diet or like some way to…
– Yeah, I mean, start with my book, Happy Gut
and do the 28-day program. That’s super easy but even on a simpler note,
because that’s a more comprehensive elimination diet,
you could start with eliminating one or two foods and the top two that,
especially in the United States, are problematic are wheat gluten and dairy. Those are the top two. And for some people,
because a lot of times I get asked, “If we take out cow’s dairy,
can I have goat dairy?” and turns out that there is
a cross-reactivity between them about 50%, so in other words,
if you’re reactive to cow dairy, 50% of those people will also be
reactive to goat milk as well. So we used to think…
– And sheep, too. Yeah, but sheep is less. Sheep is actually less than goat milk
and interestingly — this is kind of a fun side fact — you may know the answer to this
because you do a lot of interviews but which milk is the least reactive to humans
because it is the most like human milk? I think I know. Camel milk.
– Yes. Yes, I do too many interviews.
Actually, no I’ve read that. I didn’t learn that from an interview.
Actually, I have thyroid antibodies. Not very high but I would like to have
no thyroid antibodies, so I was reading about what helps and this was mentioned
in the article I was reading. It’s really big in the autism community
and with children with autism there is usually… A high percent of them have some level
of gut dysfunction going on, leaky gut or microbiome disturbances
and they end up developing food sensitivities and there have been some studies showing
that giving them camel milk actually helps heal the gut lining
and reduce the food sensitivities. Interesting.
– So it’s really fascinating and I think probably the likeness to human milk that has also the types of short-chain sugars,
oligosaccharides that help feed and promote the good type of bacteria like the Bifidobacterium in the gut,
which are healing for the gut. You mentioned direct-to-consumer gut testing like stool kits like Viome
and things like that. Do that work the same as stool kits that…?
– I’m going to say, there’s a lot of controversy and honestly,
between what is direct-to-consumer and the ones that I can use
as a practitioner, it’s an evolving science
and an evolving understanding. There was a study done a couple of years ago. It was published, I believe in Cell
and they actually went in endoscopically and they did lavage at different levels
of the digestive tract and looked at the microbiome
that could be found through PCR, so through DNA testing,
to see what is living there. You can’t always find everything through culture
because some things are anaerobic which means they don’t like living in oxygen,
so they won’t even grow in an oxygen environment. It’s very difficult to culture those anaerobes, especially there’s a big number of them
that live in the large intestine. Just to make sure people understand
what that means. Culture meaning a stool sample. Culture meaning like they take
your stool sample and then they put it on a petri dish that has some type of sugar
that bacteria would feed off of and they see what grows, so they look at
the different strains that grow. My point was that they took samples
from different parts of the GI tract and then they compared it to a stool sample
and they found that the stool sample wasn’t always representative of
what could be found in different parts of the GI tract, especially higher up,
like in the small intestine. A lot of times, you didn’t see the bacteria
that could be cultured or actually PCR’ed from there in the stool. I’ve heard that before.
SIBO is sort of… Because of that, a lot of people
don’t know they have it. A lot of people know they have it and you can’t reliably diagnose it
from a stool study. Is there a difference between
direct-to-consumer stool testing and practitioner-ordered stool testing?
– There’s a lot of crossover. For example, there’s a company,
Sun Genomics that is doing customized probiotics based on
whole genome analysis of the stool and they’re using some sort of… decision tool to help them figure out
what probiotics to give. My only thing with that is then,
you know this particular study that showed that you’re not going to
find everything in the stool that is actually in all layer,
all levels of the GI tract going up to the small intestine. So you could argue that
it’s not a perfect system but we’re not going to put everyone through
a procedure where they have to get a tube into their…
– Right. I said a whole genomics seems quite invasive,
right, compared to just a stool test. But even the… You can do whole genome analysis
from a stool study. Oh, okay.
I didn’t realize… So they just basically looking at the entire…
across the genome. They’re like break it down
and then they look at everything that’s present and they can identify different bacteria
and I’ve had patients who have done and use the Sun Genomics
and they have all these bacteria that come up and still, I think we’re learning
how can we clinically use this and will it help the person
and will it be useful? There’s also another company
that’s really interesting. They’re out in Israel.
They’re called DayTwo and I believe that they’re also… I think they’re direct-to-consumer.
You can do it. What they do, it’s whole genome analysis
but then they’re looking only at sections of the type of bacteria that are in the stool that have to do with the way
that you process carbohydrates and what they found through research is that
not every person with sugar metabolism issues or diabetes is the same. Some are more sensitive to
carbohydrates from certain foods and some are more sensitive to other foods and they think that it’s related
to the microbiome that’s in your gut. So they differentiate what type of bacteria
are in your gut and they have some research showing that by identifying
which bacteria are there and which ones are going to produce
more sugar from processing the starches from different vegetables
or foods that you eat, that by changing the diet,
you can lower blood sugar. And that’s really fascinating
because we know that metabolic syndrome, which is the early stages
leading up to diabetes, that it is not a disease of just the pancreas. It’s not just internal, that it has to do
with the microbiome as well. The people reversing type 2 diabetes
are often doing so through diet, which really to me is just changing their gut… Microbiome alterations. And also, one big person
who’s treating diabetes is Dr. Fung and he’s doing it through intermittent fasting. Sometimes with 24-hour fast
and look, when you’re doing an extended fast, one thing that you’re doing
is you’re lowering endotoxemia. You’re lowering inflammation
because when you’re not exposing yourself to food,
you’re not having that influx through the fat that you eat
that can also bring in more lipopolysaccharide. There’s something called postprandial,
so after you eat, endotoxemia, there’s a certain element of that
that can happen to all of us. It may be more with certain foods
like a burger and French fries and a soda and a milkshake versus if you’re eating a salad
and a bowl of broccoli. With it, you’re not going to get
as much endotoxemia and they’ve shown that in different studies. You talked about parasite,
fungus, viruses, bacteria. What’s the best way for someone
to prevent one of these organisms or several of them from taking over
their gut environment? There are certain things to do that
if you can choose, it’s better for your health. Now, one of the first things I will say is
avoid taking unnecessary antibiotics but at the same token, as a doctor,
I have to say antibiotics have saved lives and I’ve seen in my own patients,
where antibiotic was the only course that could be done
or the infection was going to win. I’m not anti antibiotics. I’m just anti the excessive use of antibiotics. A lot of people get a cold, a little sniffle
and they go to the doctor and they say, “Oh, give me an antibiotic.
Give me a Z-Pak,” just to nip it in the bud but what are you really nipping in the bud? Most likely, it’s a viral infection if
it’s very new or it could be the flu and antibiotics don’t work for that. And you can use antiviral. My first point is
avoid unnecessary antibiotics. The second one would be to stay away
from antacid medications as much as possible because that’s going to alter your stomach acid
and that’s your primary means of protection food that’s coming in. If you’re having acid reflux
and that is the reason that you’re seeking to take some sort
of antacid medication or a proton-pump inhibitor, which is bigger class
that used to be only prescribed and now, it’s all over the counter, then you need to look at why you’re having it. You know, a lot of times what happens
is people want to have their cake and eat it too. You want to be able to go out
and have your chocolate cake and have your glass of red wine
and not have reflux, maybe you need to fix the diet
and so, that you don’t have the reflux, heal the gut
and then you can tolerate those things. Those would be the two primary things,
I would say, and then we know that… gluten is an inflammatory food,
regardless of whether you have celiac disease,
which is an autoimmune intolerance to gluten, versus what we call non-celiac gluten sensitivity,
regardless of whether you have celiac, non-celiac gluten sensitivity
or you’re normal. What they found in the study is that
it increases gut permeability in all three groups. You’re going to have
a worse impact if you’re celiac. Second worst, if you’re
non-celiac gluten sensitive but you would think
the normal would have zero impact to gut permeability from gluten
but they don’t. And it’s potentially, that if then
you have the right genetics, you could evolve from being normal
to being a non-celiac gluten sensitive, which is what I am, for example. So avoiding wheat gluten, especially in the US,
where there’s such a high-gluten content in the type of wheat that’s used to make bread
and flours, would be the third point. Fourth point is about whether eating raw food
is good for your gut or not and I find that if a person has disordered gut,
so they’re not producing enough enzymes to help them break down food,
eating too many raw foods can actually be really tough for their gut, especially like greens,
like salads, things like that. They’re very difficult to break down. They have thick cell walls
and we don’t have the enzyme power to do that,
especially if the gut is not in good health and the microbiome is not there
to help support that breakdown. Then a lot of what I do with my gut patients
is actually have them eat cooked vegetables first. The more disordered they are,
the more cooked the vegetable and as they get better,
we can start going into steaming and not being as overcooked. You have to think of cooking as
the act of digestion outside of the body. The other thing that you can do
sometimes with raw and you may or may not get away with it
depending on how healthy the gut is is using a high-speed blender
and breaking down the cell wall, then drinking it — that’s a little bit easier
than eating the raw vegetables themselves but if your gut is not in good order,
you’ve got to start with cooked vegetables and then slowly, that would be a sign that the gut is getting better
as you are able to tolerate eating salad. And what would be the typical symptom? If your gut is not doing well and you eat a salad,
you feel like it sits in your stomach forever, you can’t digest it well, you get bloated, you get uncomfortable,
maybe you get abdominal pain. So that was four, right? So five is dealing with stress and that to me,
I call it the elephant in the room because a lot of people
have a great deal of stress but they don’t really identify it
because it becomes part of their normal and they just get desensitized to
the effect of stress on their gut and honestly, from all the work I’ve done,
you can have the perfect diet, you can take the perfect supplements. If you don’t work on the mind and that mind-gut connection,
then you can’t fully heal the gut. Amazing. So within healing the mind
to heal the gut, would you say some of
the main tools are meditation and… Meditation is key. Honestly, doing anything
that gets you into a meditative state, that gets your body into
the parasympathetic state, it could be going on a hike in the woods. It could be going by a river. It could be, for me, it’s going to the seashore
and being at the seashore where the waves are crashing
that lowers my stress levels. Getting out in nature is a big factor
but I also live in the city and I advise my patients it’s hard to get
out into nature easily. So meditation, going to yoga class… painting, drawing, playing music, everybody has to find what speaks to them. You know, I try not to be dogmatic and say,
“Well, this is the only thing you can do is meditation.” There’s a lot of things that can be done
that get you into that mindfulness state, lower your fight or flight neurotransmitters,
the epinephrine and norepinephrine and bring your cortisol down and if you don’t do that,
you can’t fully heal the gut. You know, I have some type A patients
who come in and they want to continue living their type A life and they’re eating
the right food but they’re eating it at their desk at work rushed, doing other stuff,
you cannot digest if you’re not resting. You have to rest to digest
and you have to be in this relaxed state in order to heal the body,
not just the gut but the entire body. I just theorize that if you can’t get into
that parasympathetic state, which is the relax kind of Zen state,
then your body is going to be in this high alert and your immune system
is going to be on high alert. You can’t get into the recovery processes
that allow your body and your gut to heal,
so I can’t emphasize that enough that that is one key component
that can never be ignored in gut healing. You can’t bypass that by saying,
“I’m eating the perfect diet. I’m taking the right supplements.
I’m seeing the best doctor,” but still have gut issues. Well you haven’t
dealt with the mind-body connection and it could be also dealing with the emotions
and things that… You know, we know that
the gut is the intuitive center. It’s almost like we energetically take in
the world through our gut. You can’t bypass that
in any gut-healing protocol and I put that in my book, Happy Gut
because a lot of times people think like… it’s a diet program or it’s a cleanse but it’s actually a full mind-body system
to heal the gut. You can’t do it without working
on the mind as well. The other thing I preach is gratitude,
getting out of negative thought patterns, so really getting into a space
of expressing what is good in life, especially if you’re just seeing
everything as bad and that works also well for health
like visualizing what your good health looks like and what it would feel like to be like that
because a lot of times people can get stuck
in this chronic ill mentality and you assume the persona
of the chronic illness and you start to disconnect
with the fact that there’s a piece of you, the essence of you that is not your illness,
that is not chronically ill. Wow. So fascinating. Last thing on that just because
I’m such a visual person, can you describe the connection between,
say having like leaky gut and you know, parasites
and food sensitivities and high stress. I know that there’s something called
the vagus nerve, like how does the stress actually impact what’s going on in there? Absolutely. We know, for example,
that if you’re in a car accident or some sort of collision,
where you can get a concussion and you’re knocked out, within 30 minutes,
you have vagal nerve malfunction and that malfunction actually causes leaky gut. There is an effect.
The pulsation from the vagus nerve that helps maintain the integrity
of the gut border and the vagas nerve is very sensitive
to our modern lifestyle and stress is one of those things
that’s going to alter vagal nerve tone. There is that connection
but there’s also, when you’re in this hyper-mode,
the fight or flight state, it’s actually like an attack on the gut
and it increases secretion of zonulin and it causes the connections
between the cells. If you imagine the tight junctions,
the cells are sealed like this and there’s no space between the cells,
so only the nutrients that can get absorbed through the cell
can get through. But now, you have the effect of stress
or gluten or dysbiosis – an imbalance of good and bad bacteria –
causing inflammation in the gut or stress itself kind of like
an attack on the gut and that it increases the space,
so it loosens the tight junctions, so now you can see
there are holes in between the cells. These are microscopic spaces
but they’re big enough for then partially digested proteins to get through
and that’s where we see food sensitivities start to evolve and then the body
doesn’t react to amino acids but the immune system does react to proteins
and if the protein is a certain length, every protein is a chain of amino acids,
if it’s greater than a certain amount of amino acids,
it’s going to then look at it and say, “This is a foreign invader.
This could be a bacteria,” and it’s going to attack it as if it is a bug
that’s trying to get into the body. It doesn’t matter that it’s food
and that causes, again, the whole cascade of inflammation
that we’ve been talking about. I’ve never had somebody explain
the physical connection. Now, I totally see it
and get it, so thank you for that. I know I have to let you go soon,
so I want to ask one last big gut health topic that people, you know, write in to WellBe
about all the time and that is probiotics — both probiotic food
and then probiotic supplements — and basically saying,
“You know, I might have gut problem,” or, “I want to optimize my gut.
Should I be taking a probiotic and what kind of different
probiotic foods should I eat?” and, “I thought I shouldn’t have dairy
but isn’t that a probiotic?” There’s a lot of confusion
and also, the quality — There could be so many —
– I know. There’s so many ways to break it down. – Should everyone be taking some sort of a probiotic supplement
and/or eating probiotics foods? Or is that really just for people
that have identified a gut issue? I’m going to say that almost anyone
could benefit from taking a probiotic at some point… because 99% or more
of the people on the planet have been on antibiotics at some point. As much as I don’t want to be on antibiotics,
I had to go on antibiotics this year because of an infection around my tooth,
so these things crop up and then, I put myself on probiotics afterwards
and that would be the same advice that I give to anyone
who has been on a round of antibiotics. You have to look at probiotics
as transient residence in the GI tract. They don’t create a permanent residence
but they do alter the gut barriers, so they help with leaky gut syndrome and they also communicate
with other bacteria that are in the gut and they can help promote the growth
of other good bacteria in the gut. So in that way, probiotics can be really helpful
and along with taking, you know, I think part of a balanced diet
is including fermented foods of different types. The question is, you know, do I have dairy
or do I not have dairy? It depends on, are you lactose intolerant? Do you have a sensitivity to dairy? In other words, you eat dairy
and it causes somebody’s symptoms and the only way to discover
that would be through an elimination diet like the one in my book, Happy Gut
but any elimination diet, where you take dairy out and then reintroduce
and you have to be mega observant and see, you know, if you have some cheese
when you’re reintroducing, does it cause a runny nose,
does it cause congestion, do you feel tired after it,
like an hour or two later? You have to look for small details of that
and that could predicate whether you can have a regular yogurt,
like I say, a store-bought yogurt or even better, make your own yogurt
at home with organic, grass-fed dairy or maybe with goat milk
or even coconut-based non-dairy. So there’s a lot of different options
and there’s no one right answer for everyone, so I’m always trying to give the information,
so the person can use it to then be their own doctor
and because you know your body best but you can only know your body
if you’re paying attention. I love that. Yes.
I tell people that a lot. There’s no one diet for everyone
because everyone just wants the prescription. There are commonalities — There are like general diets
and we know that certain diets work well for certain things, like I say to my patients,
being vegetarian could be good for some people. For some people, it isn’t
and I’ve had over the years patients change their dietary pattern,
becoming more in tune with what their body needs and starting to feel better. I mean I have a patient
who’s a vegan who had a blog — actually, Instagram account
that was all around her being vegan and then her iron levels were low
and she was tired and I think hair was falling out or thinning
and she started bringing meat back into her diet
and she felt better. Iron levels started coming up. Of course, that created outrage
among her vegan followers but honestly, you need to honor
what your body needs and everybody’s body speaks a different language
and there are generalities but within that, you have to find
what is it that is suited for you. The other thing I wanted to mention in terms
of probiotics is that you have to remember that a lot of really,
the foundation for promoting a diverse and healthy microbiome is through the foods
that we eat that are rich in prebiotics. It’s the vegetables, the greens
but even bananas have prebiotics. Blueberries have a small percent of prebiotics. Chicory root has prebiotic in it. Jerusalem artichoke,
also tubers are really great. Like, root vegetables, rich in fiber. They also help nourish
and promote diverse microbiome. So you have to remember that,
yes probiotics have a place in health, especially if you’ve been on antibiotics or if you have yeast overgrowth,
recurring yeast infections but the other thing is really the diet and what you’re eating and making sure
you’re getting enough fiber in the diet to feed the microbiome. Fiber being the prebiotics,
that you were just talking about. Prebiotics are basically fiber
and fiber is basically short-chain carbohydrates. They’re like sugars but they’re sugars
that we can’t digest so they don’t get broken down in the small intestine. They go to the large intestine
where they get fermented by the bacteria and then they produce all sorts of
by-products that are really good for us. Amazing. How about quality?
On the probiotics topic, does that really make a difference
— it’s all kind of Bifidobacteria, for example, the same
or does the supplement quality really matter? I think that is something that we’re really
going to get into is understanding quality. For example, I’m working with United Naturals
on a symbiotic that we’ve created and also, a leaky gut formula
and one thing that we did is we sent the top 10 probiotics
on Amazon to get it analyzed, to see if they actually have what they say
and I think it was about seven of them didn’t have what they said was on the label,
so yeah, I mean, quality is important. Strength of the probiotic
can be important depending on what your underlying condition is,
so you might need a really high-potency probiotic that is 100 billion,
even all the way to 400 billion if you have uulcerative colitis
or inflammatory bowel disease. All of those factors are important. Does the company makes sure
that the probiotic blend is strong and has the potency that it says
it has through the expiration date, so you know that what you’re buying
is going to be okay? Because a lot of people don’t realize
is that once it’s manufactured, it’s a living product,
so it starts to decay over time. You start to lose the potency in the capsule. So a lot of companies what they do
is they actually put more in the capsule than what the…
guarantee is on the label say it’s 30 billion. The capsule might start at 100 billion. The reason for that is because
there’s going to be decay over time and you want to make sure
that there’s 30 billion cfus or colony-forming units,
which is the strength of the probiotic at the time of expiration, so that’s true
that it had those 30 billion all the way, even though, you know, most of the time
you’re going to be buying probiotics that are not expiring for another year or so
but those are considerations in looking at probiotics
and do they need to be refrigerated? Do they not need to be refrigerated? If you travel, you’re going to want one
that doesn’t have to be refrigerated? Yeah, we could go on and on. I’ve written about this
and I feel like every time I look at it, I feel like there’s more to talk about. There’s a lot of complexity and confusion
but I agree. Just to simplify, at least what I do is
I have a probiotic that needs to be refrigerated at home
and then I have another one that doesn’t for — For travelling.
– … when I’m traveling. It makes a lot of sense.
– Right and also I find when I’m traveling is when I’m potentially putting my gut
in the most danger and also eating the worst. So some people say,
“Well, just take it when you’re home,” but I actually find when I’m traveling,
it’s when I really needed it the most, so that’s important for me to have that. And actually, that’s a great thing for you
to bring up because a lot of people, especially women, will suffer
from constipation when traveling and having a probiotic with you during travel
can help kind of mitigate that. And also, changes in water and food. There’s different bacteria
that predominate in different countries and sometimes that can kind of
create a little havoc in the gut. Well, this has been so informative. I could have you here for another seven hours
because I have so many questions and I think so many people do. Just the Microbiome Project has just opened
everybody’s mind to how much this matters for every part of health
and thank God for people like you to give us more information
because it is very complicated. The last thing I would ask you
is something called our Get WellBe talks. Each expert or each person I interview,
I want to know, you know, what are the absolute ‘can’t miss’ things
that you do in a day and it could be just one thing,
two things, three things, whatever that you do no matter
how busy you are — travel or no travel
— so that you keep yourself well. I get WellBe by making sure that
at some point during my day, I take deep breaths. And it could be a pause between seeing patients,
where I just pause and I make sure and it’s kind of like
a moment of centering for me. In many ways, it’s a reset button
and I’ll stop and I’ll take three deep breaths. I’ll stop whatever I’m doing.
It could be in the office. Sometimes, it could be
in my commute to and from work. I use that if I feel like I’m kind of like
amped up and I need to kind of ground and center myself and that goes back
to the very beginning, which was the breath is what rescued me
from my fear of needles, so I find it to be very grounding
but it’s something that everybody has — you carry it with you and it’s an internal
power of your body to create internal relaxation and you can do it just by taking that pause. It’s almost like that little moment,
even just three breaths, it could take up to 20 seconds to take
but it’s a moment of the day that’s yours and for me, it’s very centering. I love that.
You’re making me take deep breaths right now as I was listening to you say that
because I don’t think I did today yet. Thank you so much again.
I so appreciate it. I want to have you back for six more sessions
and I can ask all of the follow-up questions that people will have but glad to get you
here now, so thank you again. Finally, it’s such a pleasure to be here
and to be with the GetWellBe community.


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