Gut Health 101 Ep.1: The Surprising Connection Between Oral Health, Mental Health, & Chronic Disease

Welcome back once again. We're so excited to be here.

Myself, Dr. Aaron Harman, Dr. Jensky.

Yes. We're going to talk about all things gut health over the next several episodes. Everybody's heard these days. I feel like that your gut is really important. You know, Hippocrates, the father of Western medicine, said death begins in the bowels. Something like the 8th century BC. Ancient Chinese medicine, Ayurvedic medicine said the same thing 2500 BC. What does the gut mean? What is it? So hopefully the next couple episodes you'll grasp what it means, the context, and learn things that you can actually apply to your health. As always, if you like this Share like us, Follow us. We will be doing a question answer session at the end like we did previously. So if this arouses questions you have, please drop them into wherever you're looking at this. And then there will be a little gap between the last episode and the Q and A session so we can put those together and answer those questions for you. So with that, all things gut. So a few opening remarks. The gut and I wrote these down here. 80% of the immune system is in the GI tract. 75% of all neurotransmitters come from the GI tract, especially serotonin. Serotonin, like 90% of serotonin, 50% of dopamine. It's the primary interface between our immune system and the outside world. Actually, it's a huge, huge thing. So if your gut's not right, your body's not right, you know? So first of all, I want to define, I want to walk through this from the, from the mouth, from the top to the bottom. Right. From the mouth to the anus and walk through different body parts. Start the mouth. Why don't you say a few things about the mouth? There's cool things. I'll drop a few extra nuggets in there and I want to basically go through each section. Mouth, esophagus, stomach, maybe mention the liver, Large bowel, small bowel. Yes. Just so people at the end of this conversation today will know when they hear the gut, they'll have like a picture of, oh my gosh, this amazing thing. It's not just your stomach. Yes. Or your intestines, the ovary, or your colon. But it also includes your teeth. It's the hollow tube that starts up here and finishes. Absolutely. Yeah. So, so why don't you start with the mouth and tell us some.

So I think that more and more people are starting to kind of understand the importance of the mouth beyond Just your teeth being white and pretty and straight maybe. But the reality of how health implications may start or stop with good or bad oral hygiene and how that translates into the distal aspect of that intestinal tract. So, meaning if your mouth is off, then your GI microbiome might be off. If your mouth is off, you might have chronic inflammation. If your mouth is off, you might have a pocket of infection. It might harbor some toxins in the form of heavy metals from previous filling. So, you know, the mouth is incredibly important as the initiation of that GI tract that we refer to as the gut. But also with regards to things like overall health well being, it's how we start to break food down, it's how we start to mix it with saliva. So we're starting to kind of not only mechanically disrupt it, but also chemically disrupt it a little bit before we get to the point where we're swallowing it and it goes down the next next aspect. So what else would you kind of bring to the table with regards to the mouth?

Well, like, yeah, I like the, the cool details. Like for example, when you chew and your teeth actually engage with teeth, you're actually activating nerves at the root of your teeth that activate your brain. And it has such a big impact on brain, your brain, that if you actually don't have your teeth, that's associated with an increased risk for dementia. You know, that just is crazy. The bacteria in your mouth, for example, um, there's great. Nitric oxide is all the rage these days, right? People like, you know, there's different products you can take. People know about nitroglycerin, people know about Viagra that works in nitric oxide. But you have to have a healthy oral microbiome that engages in your mouth as you break up green leafy vegetables and beets and nitrate rich foods that then go to your acidic stomach. If you don't have a healthy oral microbiome, you can actually see elevated blood pressure. There's literature showing that people use mouthwash, Listerine type stuff. I shouldn't say that. Probably alcohol based nuclear bombs. Nuclear bombs, yeah. That it actually can be associated with an increased blood pressure, increased insulin resistance, at risk for diabetes. Because of the impact. Your oral microbiome seeds, your gut microbiome.

Yeah.

And all of a sudden now it makes sense. Historically, we knew that people's health, you could look in someone's mouth, look at their teeth, look at how inflamed they were and know this person's a healthy person, an unhealthy person, and so. And then As a clinician, there's these cool little things like if someone grinds their teeth, if they have a narrow dental arch par, they're more likely to be hypermobile, but also more likely to have sleep apnea. So all of a sudden your mouth does become like a window to your, your body's physiologist, clinicians, we have the, the cool insight of being able to look at people's teeth.

And what about tongues? How much information do you get from looking at a tongue? You know, if it's coated, if it's scalloped, if it's got fissures, you can diagnose B vitamin deficiencies or excess, you can determine if someone's got, probably got yeast overgrowth without even seeing oral thrush. So there's a ton of information there. And I like how you brought the nitric acid nitrate component to it because it already alludes to all the moving parts that are involved because you can have a great oral microbiome and you could be eating your greens and your beets and chewing mindfully, but if you have low stomach acid, you're not converting it as well as you should into nitric acid, nitric oxide. So. So there's moving parts and things that you have to kind of consider with this beginning in the mouth. And when you go nuclear with these mouthwashes that are a little bit more chemical based or alcohol based, it's like taking an oral antibiotic. It's literally with all the collateral damage, you might kill some bad bugs and have fresh breath, but you're going to kill a bunch good bugs too. What are the ramifications of that? Isolated bugs like P. Gingivalis and what's that associated with? Dementia, Parkinson's. There's bugs that have been isolated associated with pancreatic and gastric cancers from the oral microbiome. If someone has a chronic elevation in their hscrp, there's immune, immune mediated activation and inflammation. Where's that coming from? And you're looking at their gut and you're managing their stress and you're ruling out chronic infections. And then all of a sudden you shine a light in your mouth and you're like, oh, that's where it is, right? And you do something about that and that solves the problem. It's, it's pretty amazing how important it is.

Then the last tidbit, little pearl, is the idea of, of leaky mouth. We have leaky gut, leaky brain, leaky sinuses. We got all kinds of leaky renal.

Tubules, leaky blood Vessels, leaky skin.

I know. And so leaky mouth. And clinically, when you see someone. Do your gums bleed easily? Are they inflamed? Are they receding? Do you make calculus? Dumb tartar build up in your mouth really easily. And something people can do easily at home is check their mouth pH. Your mouth pH is acidic. That means you're growing bacteria in your mouth that will make calculus, will make. Make cavities easier, will break down your dentin easier. If your mouth is mouth is alkaline, all of a sudden you're actually inhibiting the growth of those bacteria. So all of a sudden, I mean, your mouth is this. No wonder you can have a dentist who spend their entire life on just one body part. It's really all that goes behind. Your mouth is a part of your entire immune system. Part of everything is.

We're still learning.

It's amazing.

Yeah, it's pretty amazing.

So next we'll talk about the esophagus. The esophagus. I might start this morning. One of the newer things I learned recently is that your esophagus is primarily innervated by your parent sympathetic nervous system. So all of a sudden, things like EoE, neosophic esophagitis, which is basically this breakdown of your leaky esophagus, I guess, and you start to have these reactions with food can be a marker of low parasympathetic nervous system activity or elevated sympathetic nervous system activity. The esophagus is not just a tube from your mouth to your stomach. It actually has neural integration. It of course makes mucus. It helps surround the food. This with a mucous ball going into your stomach. But you know, the main, main thing people think about with their esophagus is reflux. Maybe you can talk about a little bit like what that means, but reflux or heartburn, it's more than just where those happen. It has other things, but maybe you can address.

Absolutely. And as someone who had eoa, right. I can straight up tell you that it's miserable, but also curable. In my opinion. Conventional medicine might tell you that it's treatable. I can say it's curable. Why? Because I don't flare anymore. Because I know what caused it.

When was your last flare? After we had it?

Years ago.

Years.

And this is a combination of me working on my gut, working on my stomach acid, which was hypochlorohydric. So low, identifying food triggers, managing my stress, going back to getting into more of a parasympathetic tone. I mean, that was the one thing that I think was the missing piece of the puzzle. When I got my stomach acid right and got my stress under control and got my HPA axis back functioning appropriately and I wasn't kind of stuck in that fight flight freeze. It was a game changer for me. And honestly, even though they are far removed, these episodes, I remember that I was kind of intuitively learning towards the end when I would flare from time to time, that in those moments where you feel like it's normal to be panicked because this is food getting stuck in your esophagus, and maybe it's going to come up to my airway and collapse or occlude my airway, in those moments when I would get more stressed out or scared, it would get worse. And if I would breathe and calm myself and say, look, it's not, it's below my airway, I can feel it. I can literally feel it start to move on its own and resolve just from kind of doing some breathing or tapping into some sort of peaceful place. That aside, things like esophagitis and reflux. So gastroesophageal reflux disease, or gerd, is essentially when stomach acid is refluxing up out of the stomach, which has a protective lining that protects from that hydrochloric acid and is meant to be there, versus the esophageal lining, which is not. And therefore it's caustic to it. So it burns it and you feel that burning sensation along with the burning sensation, you can have other symptoms. But because the esophagus itself is mostly a smooth muscle, as it's contracting, you can have spasming, and that spasming is sometimes what you're feeling, whether it be chest pain or mid back scapular pain. Sometimes it impacted food bolus, but over time, the constant damage to that esophagus can lead to a change in the epithelial lining. And you start to get something like Barrett's esophagitis, or you get scar tissue, which we'd call adhesions. Sometimes you can get something called a Schottzky's ring, and eventually Barrett's can become adenocarcinoma, the esophagus, which is cancer. So the whole point being, keep stomach acid where it belongs and not where it shouldn't be. And that's by maintaining a nice tightness to that lower esophageal sphincter, making sure your stomach acid is adequate, chewing mindfully, slow, slowly, not eating your food as quickly as possible, making sure, you're eating the right amount of food, not too much, not eating close to bedtime and all these other things that you can do. But esophagitis is very, very common. We see it a lot. And then all of a sudden you get put on an acid suppressor and that leads to a whole host of other problems. I mean, I was on a PPI for 10 years and it wrecked me. Took me, remember how long it took me to get my gut right. It's because of that and ultimately nutrient deficiencies and other things that occurred. So it is where food spends the least amount of time during your digestive process because literally you're chewing and then it shoots on down. But it's really important that you get it right. Yeah.

And on the, on the, we'll talk about the stomach next. And I want to come back to the PPI thing because that's a big deal. I think people are finally starting to understand these safe medications should not be taken long term. They're safe like for two weeks, not for two years. Right. So in the stomach, you know, stomach is where the first place we think of digestion happening. Even though it starts in your mouth, mechanically, your stomach drops off pepsin, which helps break down protein, hydrochloric acid. People mainly think about it being this acidic environment, but it's also where your oral amylase, your lipase, the other enzymes that they're released by your salivary glands, have more time to start doing their work. Interesting enough, the stomach also releases intrinsic factor, which is a thing that will actually bind to B12 thyme and help you absorb it downstream in your ilium, your distal small bowel. So the stomach a part of this super important. It's kind of where solid stuff now becomes more gush, becomes like Chyme. So if someone gets sick and you throw off, you have that, that bioly kind of yellowish kind of acidic stuff. What else? When you think about the stomach, as far as from a functional perspective, whatever, any other additional things you can throw.

In there, not pathology wise or what else it does? Well, there's also the mechanical disruption, Right. So stomach is basically a blind bag, two muscles at each end, Right. And so, yeah, it's got acid and pepsin and digestive enzymes that have made their way down and now there's food in it. You want the muscle at the top to be closed and you want the muscle at the bottom to be closed. So the lower esophageal sphincter or les, and the pyloric sphincter. And that's intentional so that that bag now can start to mechanically disrupt. You have these rugae that run through the stomach that are mechanically disrupting the food in addition to it mixing with the chemical disruption. And then at some point in time, that pyloric sphincter is triggered to open and release those components into the first part of the small intestine called the duodenum, or duodenum, where it's going to mix with other stuff that we're going to talk about. But these mechanisms are triggered by specific things, and they need to work in unison to do it properly. You could have delayed gastric emptying. You can have gastroparesis. You can have gastric outlet obstruction. You can have too much stomach acid that's creating inflammation called gastritis, or burning a hole in the stomach called peptic ulcer disease, or perforating it, which is obviously a surgical emergency, or splashing back up and causing reflux or esophagitis. And so there's a lot, a lot that can go wrong between those two, those two muscles that needs to go right in order for this to happen. In addition, you have these parietal cells, and they're the ones that are really mainly there to make stomach acid. And when you take something like a proton pump inhibitor or PPI for whatever condition you have, or because you got a little heartburn, you start taking it and makes it go away. And it's over the counter, so it must be safe. And I'll take it every day for the rest of my life. And I can continue to eat my spicy buffalo wings. And now I need even more. So I'll take it twice a day or a higher dose. You are. Those medicines work really well. You're literally telling and training your parietal cells to downregulate, meaning make less of them and make less stomach acid. So you are irreversibly, almost damaging the amount of acid you can make. And now you're creating conditions where you can't digest food as well. You can't activate intrinsic factor so that B12 absorption gets impaired. You can't absorb iron as well. So you might start to see iron deficiency as a subtle tell that someone has low stomach acid. And then you start to see small intestinal bacterial overgrowth or dysbiosis. It's our first line of defense against pathogens. Right? Acid kills these guys. Some get by it, but most get killed by it. So then you're now dumping this stuff into the small intestine, which is now being seen by the immune system. And something that previously looked okay. Avocado. It's good for me. I could eat them. I'm fine now. I'm hypo. Hypochlorhydric. And the avocado presents in the small intestine. And the immune system says, well, you kind of look like an avocado, but not really. Let's flag it as a food sensitivity. Now you're reacting to avocados and that's triggering your eoa. And then it becomes this vicious loop. And so it just becomes understanding where you are in that person's GI tract, where their pathology might exist. What should be happening from a proper standpoint and then intervening and then clinically correlating and. Or testing if you could test for it.

Yeah. And one, one little snippet I want to add on to that that I learned recently, which is one of those things like duh, like you should know this years ago is that proton pumps are like all over the place. They're your mitochondria actually use proton pumps to create the difference that you're at. Exactly. And so now we have information. If you look at drugs that are mitochondrial toxicants in addition to statins, another. Actually 30% of pharmaceuticals are actually mitochondrial toxicants, strangely enough. But proton pulp inhibitors. And so how many people have mito issues? You know, chronic fatigue, brain fog, muscle aches and pains. They fatigue. So they, they, they do things. And also their, their body hurts. Like how many people are dealing with those kind of issues?

And then they gain weight and then they're pre diabetic and then they're on metformin, which is also a mitochondrial toxicant.

Yeah.

Get high cholesterol and they're on a statin, which is also a mitochondrial toxicant. And around and around you.

So. Yeah. And so the, the addressing the gut appropriately without just medicating it. They're needed sometimes or places. If you have a, you know, a stomach ulcer, you take your ppi. They prevented surgery, surgeries. Surgery for stomach ulcers used to be, you know, Bill, Bill Roth surgery used to be a common surgery that all the surgeons learned they would actually cut off the vagal nerve. I don't know my patients have ever had that. You know, it's, it's, it's a rarity now because of PPIs. So in the right situation at the right amount of time, but not in perpetuity.

No, I mean like case in point, I, as an xer doc, they can be life saving. Someone comes in with an upper GI bleed. Right. Someone with liver Failure and esophageal varices, they're on a protonic strip, right. You are giving them blood products, they're going to endoscopy suite to get this bleeding stopped. They might have a progressive ulcer that's bleeding. I mean the reality is, is that these can be life savings. That's where they're useful. But when they're over the counter and you're taking them every day or you're being prescribed them and a well meaning practitioner doesn't tell you that this should be short term and you should stop. Ten years later, my story, I'm still on it and I'm like what am I doing? And then I learned from my functional provider, he you that you probably shouldn't be on this. Then you have to learn the hard way how, how difficult it is to wean. And it took me a long time to get off those without having rebound reflux. And I had to do that slow wean with H2 blockers, with natural agents, with food sensitivity identification and then get to the point where I was off all things and relatively asymptomatic. And then when I actually started putting stomach acid back in is when it was a game changer. When my hypochlorhydria that was self induced iatrogenic from meds was corrected by the addition of me swallowing betaine HCL with pepsin. I'm no longer bloated, I no longer have yeast overgrowth, I no longer have as many food sensitivities. I'm no longer this and that eoes going away. I mean it was a game changer. So.

So stomach's important. Yeah. I thought we were going to be done like five minutes ago. We kept on going. The point is like you buy is infinitely complex. It's, it's amazing.

So that's not even all the stuff really.

No, no. I mean I just had five other ideas. Pop them ahead. But we need to move on. So oh so small bowel. So let's sit here for a bit, particularly the upper small bowel because this is where the liver starts dumping its stuff in. This is where the pancreas dumps its stuff in. And I briefly alluded to the vagal nerve attached to the GI tract. One thing is that the biggest nerve that innervates most of your internal organs is actually the vagal nerve, which is part of, it's the largest, most encompassing nerve or part of your parasympathetic nervous system. So as we talk about liver and we're not talking about the spleen liver and the pancreas. So what's going on the upper part of the ilium of your small bowel, what kind of things are going on there from a functional perspective? Like what's going there from functionally, but also maybe throw some clinical things in there that you.

Sure, I. This is probably the aspect of the GI tract that we talk about the most. And I mean when we do stool testing, stool testing is really giving you an idea of what's going on in the colon. But you can extrapolate data about the small intestine by checking things like a pancreatic elastase to rule out pancreatic insufficiency, or fecal fat to look at fat malabsorption, or you can get a breath test to evaluate the small intestine. But there's, there's ways to infer even without a breath test, the goal being for the small intestine, it's, it's all about nutrient extraction, right? So it's the food that's already been pre processed is now being let out of the stomach into the small intestine to meet these digestive enzymes coming from the pancreas, Lipase, amylase and protease. So the macronutrient breakdown of carbohydrates, fats and protein that are already pre processed, like I mentioned, combined with bile salts coming from the liver through the gallbladder and then being converted from primary to secondary bile salts by the bacteria that reside in the small intestine. So there's this brush border that increases surface area and then a couple thousand peacekeeping bacteria, usually Lactobacillus and food and your immune system and these digestive components. And it's all about trying to package, process, pull it across. Is it good, is it bad, is it right, is it wrong? Do we want it? Is this good enough? Or do we need to break it down more and then let it through to get into the bloodstream to go where it needs to go. But a lot can go wrong in that process, which is to say that if your microbiome is off, you have what's called small intestinal bacterial overgrowth, if there's overgrowth of bacteria, or small intestinal fungal overgrowth, or potentially pancreatic insufficiency where you're not making as much of those digestive enzymes as you should, or fat malabsorption or inadequate protein breakdown. So you have what are called these putrefactant products of protein, where it's just basically protein sitting, fermenting, festering in the gi Tract creating more dysbiosis and bacterial overgrowth. So there's a whole ton that can go wrong. But you can kind of individualize what you do. And one stool test can provide you with a lot of that information, plus or minus a breath test, and you can start to kind of work on that person's case. What are some things that you want to add to that?

Well, one thing is that this is where immune tolerance occurs. So, you know, you take that hamburger or that piece of fruit, and you've broken it down into its most simple constituents. And here's where it's exposed to your immune system and your. In your small bowel as you go through that, that leaky gut, it's called the intestinal barrier. And if you get too much, that's actually increased intestinal permeability. And these, these little patches, these pyre patches, these conglomerations of the immune system. 80%. 80% of your immune system is around your small bowel. Why it's supposed to learn. Yeah, that's hamburger. Yep. That's papaya. Yep. That's mango. Ignore, ignore, ignore, ignore, ignore. Yep. That's a little. Maybe a little staff. It's not supposed to be here. I'm gonna ignore that. Maybe it's a little yeast. That's not supposed to be here. I'll ignore that too, because I'm a smart immune system. What happens is if you get more exposure and some inflammation, the immune system starts to get a little mad, and now you start recognizing. Actually, I'm not sure is that really trend or foe. You start developing these igg responses to that and start getting inflammation. And eventually that can lead to your immune system being really mad and ticked off and overactive. And now you get crossfired. You know, there's. There's a lot of interesting stuff that came up from Dr. Bojdani's work at Sarch Labs with cross immunity, where, you know, you have someone's a birch allergy. Everything you breathe, you swallow. So people don't realize, actually, my reflux gets worse during allergy season if I drink milk, for example, or if I don't drink enough water. And there's this combination of, like, everything you breathe, swallowing, everything you eat, you swallow. But there's also this cross talk where if, like, you eat a little birch, a little bit. Yeah. And all of a sudden now you're having this crazy anaphylactoid, like, response from this little small fire here, a little small fire there, you come together as a forest fire. And so all of A sudden gas, bloating, foam. Post, postprandial, you eat and you feel like brain fog, you feel tired. You know, personally, if I eat too many carbs, you know, I usually get like, super, have a lull. And even like there's interesting data looking at, even if you eat. Like there's one particular study I went to my training, they talked about a hamburger. You have these things called endotoxins, lipopolysaccharides, they're basically toxins that gram negative bacteria make. And saturated fats actually pull them across your, your, your barrier in your GI tract.

So eating too much coconut oil, cue the ketogenic diet.

The ketogenic diet, you will actually pull a lot of these lipopolysaccharides across. And part of this keto flu people get is actually.

Yes, endotoxemia.

Yeah, linotoxemia. And so all of a sudden now, now you're activating your immune system more. If these get to your brain, you get inflamed brain. And now you got inflamed gut and inflamed brain. And so listening to your body, when you eat, do you feel better after your meal? Do you feel, can you eat a meal, Sit down for a few minutes, do your little pasta digiorno, your little walk, you feel great, or does it take you two to three hours to recoup? All of a sudden now your basic symptoms become, become markers for like, you got sibo.

Yeah. Is it a dysglycemic response? Is it lipopolysaccharide? Is it a food sensitivity? Is it one of these things? For sure, yeah. I talk about the, the immune response in the small intestine in patients all the time. And really what we're talking about and what Dr. Harmon was referring to is essentially these T regulatory cells, and those are the tolerogenic T cells, they're basically promoting tolerance. But the best way to understand it is it determining self from foreign, good from bad, right from wrong. And that's how I kind of say it, meaning not only are you going to know what's good and what's, what's right versus what's wrong and what's bad, but it's also kind of where autoimmunity starts and stops. And if you start to have leaky gut, or what we also call intestinal permeability, you start to have a little disruption in the tolerogenic immune response. You start to get a little bit of dysbiosis or sibo. You're shifting your immune system towards a Polarization that can not only trigger an uptick in things like a TH2 response. Now you're having histamine reactions, but also this TH17 response that is potentiating an autoimmune phenomenon and that becomes self perpetuating. So these hollow space infections, as we refer to them, like dysbiosis or sibo, take your immune system teeter totter, at least the adaptive T cell branch that should be balanced and they imbalance it. And your TH2 polarized histamine responses. I'm reacting to everything, or maybe I'm activating mast cells and all the stigmata of that. Now I'm tagging those TH17 cells and my tolerance is going down even more because you're creating oxidative stress and the body just starts to say, everything's a Trojan horse, I'm gonna flag it all. So you get those cases where a patient comes in and you see their guts inflamed. You're like, well, we gotta put the fire out, but we gotta figure out who the arsonist is. Let's do food sensitivity testing. And you do food sensitivity testing and it's 50 foods. And they're like, what do I eat? Well, A, this just means that you're really leaky and you're really immune reactive. And no, I'm not gonna ask you to remove all 50 foods because that's just malpractice. And B, this is really telling and you gotta see what you're reacting the most to when you add by subtracting and you start pulling those high ranked foods out and heal the gut. Test again and it's down to 20. Do the same thing. Test again, it's down to 10. And then you get to the point where it's these are the foods I should eat, these are the foods I shouldn't eat, and these are the foods I can sometimes eat. And then you just live your life. And, and food sensitivities aren't gonna necessarily kill you. They're not allergies, they don't lead to anaphylactic shock, but they will contribute to that chronic inflammation and disruption of your immune system and potentiation of autoimmunity and all the other extraintestinal manifestations that you alluded to. So it's really, really important to identify those.

The one thing I think it's important to say here is like people hear about this, they're what's the food sensitivity test you do? Or where can I get that test done? And the gold standard, if you go to see an allergist and you've got, you know, eoe, for example. The standard. Now, if you have a food sensitivity is still an elimination diet. Maybe for eoe, it's a six food elimination diet. Um, if you have an autoimmune issue, it would be a autoimmune paleo kind diet. But I think it kind of goes back to what you said, removing the big players. Because once you get, you know, and the big players, gluten, dairy, soy, corn, sugar, tree nuts, like chemicals, toxins, cereals, I'd kind of add onto that list of things. But if you remove the big players, your gut's going to. Your body wants to do what it was made to do, wants to self heal and self repair. And so that's always been a hard thing for me to tell patients, like, okay, you should. I do, I do. I'm working less and less food sensitive testing at this stage than I did, you know, 10 years ago. Because it's like, you know, regardless, you know, what is the clinical response, elimination diet can help us do that. You know, by the way, if you do elimination diet and you feel better and you lose weight and you feel less achy, then all of a sudden we've learned more.

Yeah. You know, it was at least one of those things.

Yeah.

And, and the key is, like, everybody should kind of be eating that way anyway. Right. Anybody that comes through these doors, at least in my patient population, I have very few that are here feeling good at baseline, that want optimization, it's great when I have those. But most people are coming here because they're sick. And so you're gonna see clinical improvement with removing things that are clearly contributing to intestinal permeability and inflammation. So you take gluten away as much as they boohoo, they eventually feel better, and then they're like, thank you for that. You take dairy away, they boohoo way more about that than they do gluten. By the way, I thought it would be the other way around. You take the big players out, but no one should be eating extra sugar. No one should be doing processed food. Refined. I literally write this a million times a day. No refined carbs, no processed food, no added sugar, no trans fats, no seed oils. And then, oh, by the way, I think you should be gluten free and dairy free. And if we hit a wall, then maybe we'll progress to testing to see if there's something that's not on the radar because garlic pops up or broccoli pops up. Wheat broccoli's good for Me. Yeah, it is. But right now, your immune system thinks it's a bad player and you can't eat it because you're reacting to it. Or at least that's what the numbers say. Let's remove it. See how you do. And then there's always clinical correlation of reintroduction. And if you eat it in over three to five days without changing any other variables, feel fine, it was a false positive. Eat it. But if you don't, you're still reacting to it and it's got to come back out. And then you test again down the road and it's creating those piles that I previously mentioned. And the testing, it's. It's got its limitations, but it's pretty good as a guide sometimes, especially when people need visual evidence, not just, hey, take away the things that I think are most delicious because you're looking at igg, but there's igg subtypes, there's complement that plays a role with the immune system, IgE, which is allergy and totally separate intolerance, which is you can't break it down because you're deficient in the enzyme that's totally separate. So there's a lot of moving parts. If you simplify, makes it easier and people tend to do better.

Yeah. One of the things that's interesting enough, doing some igg testing, I picked up a fair amount of Alpha gal, which is this really bizarre thing where, you know, someone's beef ige pops up, then someone's pork ige pops up, then you're like, that's kind of weird. Then you order this Alpha gal test and it's positive. Then you're like, oh, my gosh, this is. This is a totally different beast. Now, I've had patients who I've done that with and removing all mammalian sugar, basically. What, you know what alpha galactoside is? Can you talk a little bit about Alpha gal? Because I know. I feel like people know what is in Virginia just because it was discovered actually at UVA here. But it's a lot more common. I think people give it. And since people aren't screening and looking for it, or they don't know that if the beef and pork IG pop up, you automatically have to do this test. Could you talk a little bit about that?

Yeah. So it's from a tick, it's from a lone star tick. And basically it creates what's called a meat allergy. And you're reacting in an IGE fashion. So that's type 4 hypersensitivity. And the Potential for anything from my mouth feels weird to anaphylactic shock. You're reacting to these sugars, this sugar in mammalian meat. And so you can't eat red meat. You can't eat pork. Some people can't even eat chicken. Normally, it's usually the red meat and the pork component, but then it goes to dairy products, gelatins. So I have patients that come in saying, yeah, I have alpha gout, but I don't eat any of these meats and I'm fine. But they have all kinds of GI issues and skin issues and autoimmunity. And I look at their supplements, and every one of them's got gelatin in it. And I'm like, you're eating it and you're still contributing to this burden. So it's one of these things that makes it very, very complicated because it goes beyond the actual whole food, and you have to look at what's the filler, what's in it. Giving that person collagen sometimes becomes a problem, so it becomes kind of difficult depending on the individual. But it's, as far as I know, it's something that they have for life and won't go away. However, I've seen patients how their numbers get better. I've had some patients go and see acupuncturists or chiropractors that did acupuncture, do auricular pinning. That has absolutely improved their symptoms. And I have some who are able to just freely eat it despite their numbers being off. And so it really depends on the situation.

There's not a correlation with the number because I've seen patients who have elevated numbers who have minimal symptoms. The ones. You know. One of the things that brought to light early in my career was individuals who would get exercised, induced anaphylaxis, where they'd eat something and go exercise and have these, like, you know, just such a weird thing I see over and over again. That's one of the subtypes of people with alpha gal, which is such a bizarre thing to think about. Yeah. So again, we can still stay on the small bowel for probably a long time, but let's go to the colon, take the next step downstream. The colon. I love butyrate. People don't talk about the microbiome. Usually it's the colons where they're sitting and all these firmicutes and bacterias and all that kind of fun stuff. Right. I want to. I want to sit on butyrate for a little bit because that is one of my favorite things, short chain fatty acids, how important they are for brain health, how important they are for actually healing your gut. They actually improve mitochondrial function. It helped this thing called the peroxisome, which is a little organelle, which means small organ that actually burns off bad fatty acids. So you can actually. Your body makes butyrate to help you burn off these inadvertent bad seed oils, trans fats you're not supposed to be eating, helps you burn those off and other toxins. Talk to us about, like, what determines how much butyrate our body makes and the impact it has on our entire metabolism. Yeah.

So separating the small intestine from the large intestine is something called the ileocecal valve. And that's down in the right lower quadrant of your abdomen, which is adjacent to the appendix. So the terminal ileum connects to the cecum, cecum has the appendix coming off of it, which we now know is a command hub for the microbiome of good bugs and bacteria, not a vestigial, inconsequential organ. And then there's that valve that presents backflow of bacteria from the colon up to the small intestine. So where I said we have thousands of bugs in the small intestine as peacekeepers, and it's about nutrient extraction. Colon is where the magic happens. When we talk about the microbiome, a GI microbiome, that's really what we're talking about. And there are trillions of bacteria there. And there's a couple of phyla that you alluded to, Bacteroides and firmicutes. And then there's really important players that make a lot of these short chain fatty acids, with butyrate being the most important one. So there's faecali bacterium, presnutsii, there's Akkermansia, Clostridium butyricum and a couple others. And the goal being that when they're there and they're implanted and they're growing and they're happy and you're feeding them prebiotics, polyphenols and phytonutrients, they are then creating these short chain fatty acids. And there's butyrate acetate and propionate. Butyrate is the kingfish of this. It's the biggest player. And it's so important for all the things you mentioned. Plus It's a natural GLP1 agonist, so it's going to act like Ozembic to regulate your satiety. It's going to help with weight management. It's Going to help with blood sugar, insulin sensitivity and the like of that metabolic flexibility. It's fuel for those colon cells and the terminal ileum, so they work better. It's anti inflammatory, it's detoxifying, it's anti cancer, it's anti dementia. Pick a bad thing and butyrate is anti that literally. And we are in a state of profound epidemic deficiency. We measure these. That's how we know that. Now, I know we only have our practice, but I would probably say that if we talk to other functional providers that are doing these, you know, stool testing, they would probably say that most people come through their doors have low short chain fatty acids or low butyrate production. So first things first is when you see that in an individual, I'm trying to assess the lay of the land. Is this an issue with their microbiome? And if you can see that, you see it. And in the past, we used to have to just kind of try to blindly support these bugs with the foods they like. Now you can take them in probiotic form. You can get Akkermansia, you can get Clostridium butyricum, you can get capsule forms of those butyrate producing, short chain, fatty acid producing bugs. So you can put those in, although you still have to feed them so that they implant and grow the things that they like to eat. When I say the three P's, what I'm really alluding to is colorful fruits and vegetables, but mostly vegetables, prebiotic fibers, things like asparagus, things like artichoke, things like chicory, things like under ripened bananas. That along with resistant starches. That along with things that are colorful, the phytonutrients or the polyphenols and olive oil and chocolate and coffee. You're eating those. We take what we need because they're good for us. We kick the leftovers down the pipe. They munch on those. They make these things that make us more operational. And then we want to eat more of those things. We feed them, they feed us symbiosis. The cool thing about taking butyrate is that it can help people start to move that needle. But you and I, you had taught me this, this was a crazy statistic that when we're giving butyrate, we're giving it in like 500 milligram capsules. How much is the gut making in a day?

Between 30 and 50 grams.

30 and 50 grams, right. So like take that ball and run with it.

Yeah. So it's like you might take your, you know, gram, your two capsules three times a day. So that's like maybe 10%. And so all of a sudden, fiber, you gotta be putting the fiber. It's not just, it's not just fiber, it's also these colors, polyphenols. And one of the interesting things, you know, you know, you talk about this whole thing of hormesis and curcumin and these really beautiful things, resveratrol, and how they have this hormetic effect and they affect our, our, our metabolism in a very positive way and they affect our immune system. But most of those actually are not absorbed. You know, we do, we get these special, special resveratrol that's you know, liposomal or special curcumin, that's whatever, liposomal, whatever, so you can absorb it. But actually most of those are supposed to get down to your colon to feed these bacteria. So yes, systemic, you know, polyphenols have an anti inflammatory effect, but in your diet they're supposed to get your colon, they feed these bugs. So all of a sudden, you know, there's a whole new nutrient class that's not a vitamin, it's not a mineral, it's not a short chain fatty acid, it's this, it's the color in foods and the different colors actually feed different bacteria.

Flavonoids.

Yeah, exactly, exactly. So, and one other thing about Buty I want to mention here that I'll learn some of my training is that, and this is more important for kids, like your autistic kids, when you have, you know, increased gastrointestinal intestinal permeability, you're releasing these endotoxins, they actually will go to the brain, to a leaky brain and cause white matter edema and swelling. And what is nature's, what your body's antidote for that, that's butyrate. So all of a sudden your body actually makes the antidote for the toxins that are made in it. And it's just this beautiful synergy. And oh, by the way, if you don't make enough of that, there is a type of curcumin called desmethoxy curcumin or C3 that acts like butyrate and protects these parts of white matter in your brain if you're not making enough of that. But ultimately the fix is easy. It's fiber. Now it might be 40 to 60 grams of fiber a day, which is a hard number to hit. But that's, that's a big part of getting your gut to work the right way.

If you care, if you care enough about your health, it shouldn't be that hard. It is. Because of how we've grown up or the societal standards for eating. Even if you're someone who eats healthy, it's still hard to hit that number because of just how we eat. And ultimately, like, for myself, I don't even eat enough food in a day to hit my fiber marks by food alone. So I put fiber powder in my smoothie every morning to kind of close the gap on what I need. So the reality is, is that fiber is one of the broadest, if not the broadest short of health that you can. You can swing therapeutically.

Yeah. So short chain fatty acids. The microbiome. So I don't want to talk about the microbiome too much here because we'll probably talk about a little later, but let's just briefly talk about the microbiome because it's. It's a big, big player. The. The bacteria in your large bowel act. They're. It. They're as metabolically active as your liver. So if you have an unhealthy microbiome, guess what it's like having an unhealthy liver. Um, you know, we've already talked about how they. Half of all. About half of all pharmaceuticals are detoxified. In this microbiome, a lot of chemicals, fire, estrogens and chemicals are actually detoxified. There's actually a phase three dog detoxification, which is literally the. If you have the right kind of bacteria in your gut, hormones.

There's an estrablum. Right. A whole subset of bugs that are dealing with estrogen.

Yes. And one interesting thing, there was this interesting study looking at fecal microbial transplants, which we talked about somewhere else before. But the concept is if you want to do an organ transplant, you actually can do a fecal transplant. Well, this one study is looking at. They took someone's stool, they put this filter, it filtered out all the bacteria. So they're only left with the postbiotics. And they had the same impact on this, on the animals they did this with, as if they got the bacteria. And so all of a sudden, it's not just the bacteria, it's the. All these posts. And we talk about butyrate propionic acid, acidic acid. But there's enough of these other things that they have a massive impact on our metabolism. Yeah.

Awesome.

Yeah. So I think the microbiome is just. It's. It's associated dysbiosis, associated with Alzheimer's, dementia, inflammation, cardiovascular disease. Let's talk about metabolic Syndrome, briefly. That's a. I love that. Yes, let's do that. Because metabolic syndrome, a part of that, a big factor in that is dysbiosis. So that's your high triglycerides, low hdl, high DL hypertension.

Hypertension, central obesity.

Yeah. Your gout, your kidney, your kidney stones, your sleep apnea, your pcos, your osteoporosis. So that's, you know, a lot.

Yeah.

And literally a big driver of that is your gut issue, is these bacteria dysbiosis in your gut. So all of a sudden all your diabetics, all your hypertensives, all your diabetics, all your high cholesterol gout patients. It's really interesting, some of the gut tests you're talking about, there's an oxalobacter, it's a bacteria that breaks down. Yeah. If you don't have enough of that, you can be more prone to making kidney stones.

Yeah. And so calcium oxalate.

Yes, I know. So somebody cool.

But then you see like methanobrevobacter, this archae bacteria, and we see things with emo, or you see some of these sulfur producing bacteria and then you see the short chain fatty acid ones. But we know that some of them synthesize vitamins. We know that some are fighting the war for us and keeping the peace. Right. Because there's opportunists abound and they're trying to pop up their head. You know, Candida always wants to be in charge and they're just like, no, they plant a little bit of whack a molecule. But if you think about it and you simplify it based on what you just said, liver doing heavy lifting, metabolically active central detox, organ microbiome, metabolically active as. Metabolically active as liver detoxifying as well. And then all of a sudden there's a disruption in that microbiome. We use the term dysbiosis and potentially some of those are gram negative. Usually there are, but usually others as well. And now you're making a bunch of lipopolysaccharide that gets into the portal circulation that's hurting the liver and causing inflammation. Your liver's not working as well, your gut's not working as well. Those are major detox pathways. You're still breathing, you're still sweating, and maybe your kidneys still work. But if those aren't working now, you're stockpiling toxins, inflammation, oxidative stress at the root of what? Every chronic disease state. And if you have dysbiosis, you bet your Ass. You have leaky gut. And if you have leaky gut, then everything else is leaky and you're at potential risk of things like autoimmunity and chronic neurodegenerative conditions, cardiometabolic disease. I mean, I have a lot of patients that come through with cardiovascular disease that have perfect gut function. And then I do their stool test because everybody gets a mandatory stool test. And those are some of the worst ones. And then I'm like, look, if you get this right, your cholesterol is going to start to get better and your A1C is going to start coming down.

How? Just watch.

And it does. And it's like they don't necessarily always understand it, but they don't care because they see the numbers coming down. It's like, it's pretty magical sometimes.

It's interesting because fatty liver disease, which used to be called non alcoholic stenohepatitis, now they're calling it mash, metabolically associated, you know, hepatitis, but it's actually driven by these lipids, high saccharides. And so now we're seeing, working on the gut microbiome, stool transplants, butyrate, using other things like that as ways to actually help patients with fatty liver disease. And it's really. Oh, there's something else. I was like popped in my head in relation to the fatty. Oh, yeah, my. Some of the interesting literature now with primary bilocerosis, sclerosis and cholangitis, which are these rare autoimmune issues that like all rare autoimmune issues are becoming more common. There's a direct correlation with the gut microbiome and there's actually certain treatments to use Tutga towards the deoxycholic acid, or udco, which is your sodiol, which is a bile acid extract, to actually help these rare autoimmune issues because of their secondary bile acids having impact on the gut microbiome. So, so many cool interventions using butyrate therapeutically, using tutka therapeutically, using probiotics, using butyrate therapeutically, all of a sudden we have tools to actually, in addition to food, in addition to diet and stuff, to actually change this, this in a, in a medical, therapeutic way. While we're saying the foundations though, you gotta get your fiber, you gotta get your colorful fruits and vegetables, all that kind of stuff. So cool. So that's, that's the gut from the mouth to the anus. So the hope, the hope of that is like after listening this, you'll have an idea. When we say gut, this is what we're talking about. Yeah, it's a lot. It's a lot. It's not just take your probiotic. It's not just. And this is the reason why food, which we'll talk about later as medicine, becomes a super huge. Because it can impact every single solitary aspect of what he talked about. So if you enjoyed this, please share it like it. If you have any questions, please post them below. And when we get to the Q and A session, we'll answer those and otherwise. Take care. We'll talk to you soon.