Episode 249: Anu Simh

Foreign.

Welcome to the Life's Best Medicine podcast where we are finding hope and healing one episode at a time. No appointment needed, no rubber gloves and no coping. Just a healthy dose of life lessons to help equip you for this wild journey we call life. Hey everyone. This is a friendly reminder that we are here for entertainment purposes only. We may not even be that entertaining at times, but this is not medical advice. You know, talk to your doctor, check with your healthcare professionals before making any lifestyle changes or, you know, medicine changes. What we're talking about is our clinical experience and what we've seen. And so if you really want our advice, you can consult us. You can actually consult me as a doctor or you can consult my guest and get all your questions answered. But we can't give free medical advice because we can't pay our bills with that. But we can help to educate you a bit and allow you to think a little bit and always reach out to your medical professional before making any lifestyle changes. Thank you. Oh my goodness, everyone, it's May. That means summer's coming. Swimsuits and fancy clothes and all that kind of stuff. So gosh darn it, we gotta fix all the problems we did during the holidays and everything. So hopefully we're all staying on track. And I just want to thank Health Code for sponsoring this episode. They're helping us get into better shape and eat good nutrition and have some sweet stuff too along the way. So they have tons of recipes at their website. Get help. G-E-T-H-L-T-Com and also we have a promo code, Met Health for Metabolic Health. M E T H E A L T H and so please help those guys, you know, buy their products, use it. If you have parents who are getting older like mine, this is the best thing you could possibly do for them. You know, give them good nutrition and give ourselves good nutrition to prevent all these other things that are coming our way as we get older. So thank you Health Code. And also try the berberine if you haven't tried it yet. It's a great berberine and it has anti inflammatory in there. So you know, that's really good too for metabolic health. So thank you for listening and enjoy this episode.

When I stepped on that scale and saw the number £278, it was like a punch in the gut. I was just sick and tired of being fat. Sick and tired. I knew that I had to make a change. I started to read about the low carb diet and I decided to give it a try. The weight started to fall off me. I added Health Code on a daily basis to my diet. It's a high protein, healthy fat meal replacement that is simply delicious. And it's easy to make. And after I have one, I don't get hungry for hours. My strength has improved. My VO2 max has gone up 7 points. I have higher energy levels throughout the day. I want to be healthy enough to throw my grandchildren up in the air and go on hikes up a mountain with them. And I totally believe that Health Code can be an important part of that. I believe Health Code is the best meal replacement shake ever formulated. I wouldn't be taking it otherwise.

Try healthcode risk free. Discover a new path to wellness. At Arizona Metabolic Health, Dr. Brian Lenskis offers advanced medicine and personalized care treating the root causes of your health concerns, not just the symptoms. Whether you're seeking direct primary care, effective diabetes management, or medical weight loss with a holistic approach, our team is here to guide you every step of the way. Visit ArizonaMetabolicHealth.com today to learn more about our innovative health solutions. Hello and welcome back to the Life's Best Medicine podcast. Today, a guest. I'm really excited about someone like, we're on opposing sides of medicine, maybe right functional medicine on one side, which I've gravitated more towards than my traditional internal medicine training. Allopathic and so anu Sim, awesome to have you.

Thank you, Brian.

I'm really looking forward to it. So great to have you.

Yeah.

Nine arms of Wellness. First of all, let's talk about nine Arms of Wellness. Tell me about that.

Yeah, it's interesting. You know, when I started working with clients, I realized that I like most of us and this whole science world, we think it's nutrition is like the biggest needle mover, but that was not clicking for a lot of clients. You know, they came in very stressed, their sleep was compromised. You know, they were, you know, not mindful in their daily habits and things like that. So I kind of realized, just working with clients that this is more than just food. It has habits. Exercise, sleep, all of this matters. So that's how I came up with the nine arms.

Yeah, that's so important because I think that's one of the things that, you know, I'm a co host on the low carb md, but if I start talking about faith or, or sleep or stress, I go, we don't talk about that. We just want to talk about the nutrition side.

Yeah.

When you start realizing, look, if we're from my Perspective, we're looking at insulin resistance, high sugars, high, you know, eating the processed foods. If we can cut that out, we do better. But if you're stress intense and hate the world, you're not going to have the benefits that you will when you find your peace.

Yeah. And the thing is, it is science back too. I mean, neuroscience and everything supports what was once just ancient wisdom. Right. You know, about, I mean, just, just let the matter of sleep, for example, you know, it's finally getting its due. You know, we're talking about sleep and how important it is. But even a few years ago we weren't, we weren't talking about sleep, you know, it was just something, we were just so busy working so hard all hours of the night and really not respecting our circadian rhythm. But that's also shifted. So I feel like, you know, we're finally getting to that point where we respect that it is not just one thing, but there are so many components and it's multifactorial and being optimally well requires us to pay attention to all of these things.

Yeah, and, and nutrition happens to be one of those. And you know, looking at the gut microbiome, I love to pick your brain on this for a while because the gut microbiome, you know, and I can ask you, because I'll ask leading questions for a second here. How about the effects of stress and not sleeping on the gut microbiome?

Oh, big, big time. You know, I mean, when you think about stress, your, your nervous system, you're in fight or flight, you know, and it doesn't matter. You've had the best low carb meal or a high protein meal or a plant centric meal, it doesn't matter. But if you have stress, and especially chronic stress, it does affect the microbiome. 90, your happy hormone serotonin is made in your gut. The gut and the brain are constantly talking to each other more the gut sending messages to the brain. And when you start, when, when this chronic stress, there's inflammation and studies are showing us that some of these very incredible serotonin producing bacteria could be lost. So when there's imbalance in the gut and there's, you know, there's dysbiosis, which is another word for imbalance, we end up feeling more anxious, low depression, things like that. And we never think about it, we always think about it as a, more of a mental thing, but it is really, everything is starting in the gut.

Yeah, it's amazing stuff like IRO bowel syndrome, you know, back in the Day, I remember them saying, oh, they're just nutty. They're stressed, there's nothing there. They scope them and everything looks good. And the more you're around, the more you realize anyone with irritable bowel syndrome, it gets worse when they're stressed, tense, not sleeping, you know, going through a hard time, a divorce. And so there's actually new data showing the more stress you get, the more you have the leaky gut. And all these lipopolysaccharides and inflammatory markers leak across there and cause irritation to the nerves, which causes real pain.

Yeah, definitely. And ibs, sibo, all of them have something to do with, you know, that intestinal permeability, or leaky gut, as we call it. And the endotoxemia increases, all of these lipopolysaccharides could enter the bloodstream causing more of that inflammatory response. And no matter what you eat or anything, if you have that kind of inflammatory response to food or lifestyle or anything like that, it's just going to cause more problems. And so the important thing is to nourish your microbiome. I think we, we are at a place from research, from a research perspective that the gut microbiome plays a huge role and taking care of it and nourishing your microbiome, feeding it. Right. Not just by feeding it the fuel that it requires, but also through your lifestyle, you know, matters incredibly. Yeah, yeah.

Exercise, you know, sun exposure, all these things will affect the gut microbiome. And when we look at these chronic illnesses that we're all afraid of, like Parkinson's disease and Alzheimer's, autism, you know, and you start seeing they all have in common a very narrow gut microbiome. Unhealthy gut microbiome.

Yeah. In fact, post stroke, there's been studies that show that the gut microbiomes changes, you know, and so it becomes very important to start nourishing the microbiome right away to, to prevent that exacerbation of, you know, you know, like an inflammatory response in the gut. So I think you're right. You know, all of these mental, you know, that, that kind of issues, but also gut issues and cds, they're all kind of connected. I mean, even just you, you mentioned insulin resistance and, you know, that is connected to the gut microbiome, GLP1 hormones. What are you feeding them, Brian? The past few years that I've been researching for the book, the one thing that kept coming up in all of the research is feeding them the fuel that they really need. And that's Fiber. And that's where I feel like we talk so much about macros. I mean, right now we have so many wars going on. Oh, high protein, low protein, vegan, whatever. But I think in this mix we forget the importance of micronutrients and nourishing our bodies because if we are lacking these micronutrients fiber and things that we can't make, vitamins and minerals, we're really having some pretty big deficiencies. Think about bone health. I know some of my male clients will say, oh, isn't that just an old lady problem? No, it can start in your 20s. I have 20 year olds who already show on DEXA scans that they're losing bone bone density. And by the time you're 30, you've done all of your development of your bones. So it's really imperative that we have that micronutrient rich food. And in that mix I will add fiber. I think fiber is key to so many different things that I could talk all day about fiber.

Yeah, I think that's such an interest. I think this is a really important one because I, where I see a lot of fighting going on. You have the carnivore community and what's interesting is I have a lot of people I've talked to that went carnivore because they had so many gut problems. So they eat meat only and they get better and they feel better and their mental functioning gets better. To have other people on the other side of the spectrum who go more vegetarian, vegan diet, and they feel a lot better and their gut gets better. And so the argument is, oh, you don't need fiber. And so I think long term, if you want to, if we're, if we're talking about the gut microbiome diversity, I would think that if you're only eating one thing, then you're going to have much less diversity in your gut which is correlated with all these other chronic illnesses.

Absolutely. And I don't know, I mean, I think if you are feeling really unwell, your gut is having all of these problems, it just makes sense to avoid them. You know, eliminate certain triggers to see if your gut is going to do better. And short term, I think it really helps. Most of us go through an elimination diet, but when you are on long term, you know, restrictive diets, I call them restrictive because that's what they are. The microbiome really takes a beating. I mean, if you don't have polyphenols, flavonoid rich foods to, to help them grow and have that diversity. So I Think a big part of really describing a healthy MIC microbiome is to really understand that it needs to be a resilient microbiome. And a resilient microbiome is one that can fight your battles, you know, can bounce back, let's say, go to Mexico, eat anything, you know, have Montezuma's revenge, take some antibiotics, come back and be okay. Why is it some of us can and some of us can't, you know, and that could be related to the microbiome and its diversity. So species richness in the gut, species evenness, all of that is very important for a resilient microbiome. And I don't see how you can do that without giving them the fuel that they really need. And I think when people say I'm on this diet or that diet, it's kind of like perturbing because you're just put on this earth, you know, in all this bounty to be eating everything. Right. You should be able to eat everything. Why do we have so many intolerances? That becomes the bigger question. Why are we so affected by food if we have way more food intolerances today than we did in the, maybe the 60s or 70s? I mean, are we pointing to certain things, maybe having foods that our biology does not understand? You know, is it really food? You know, the ultra processed crap that's kind of, you know, comes into our lives and takes on such a big role? I mean, they are so hyper palatable and so hedonic. It's so impossible to say hi no to processed foods. Maybe that's the only way to do it. I'm divorcing you. I don't want any part of it. Because it's really hard to just say, let me just take one bite of a cookie. Because we are just so enamored by it. That has the right mix of food fat and, you know, salt and sugar. Sugar and all that.

Yeah. And then the gut microbiome actually can make you crave more of that. That's what's interesting about, like, Candida can release toxins that make you want to eat more sugar. So it feeds it because they want to survive too.

And then it's the pathogenic bacteria that really thrive and it's the beneficial bacteria don't recognize it as food. So then again, that imbalance in the gut increases. So.

Yeah. And the other thing is, I'd love to hear your take on postmenopausal women and their. The changes that they're going to have in their gut microbiome.

Oh, Big time. You know, there's in fact I was reading a study where they said that postmenopausal women's bacteria starts resembling that of a man. You know, it changes to that extent. And of course, you know, one of the big things we see in postmenopausal women is that belly fat. It could be a cortisol response, but it could be also the strobalome and just see a bunch of bacteria in your gut that are really responsible for estrogen detoxifying. But when your estrogen tanks, there are other things that are happening in this detoxification pathways. We have xenoestrogens coming into our world from plastics and things like that that can really affect the microbiome as well as. And of course all of the slew of chemicals and pesticides that cause cause problems. So.

And detergents and lotions and all the emulsifiers that we have in our food. So yeah, you know, so what do you advise people coming in, middle aged females stressed out, you know, going through all the menopausal stuff? What kind of changes do you do right off the start that you think are helpful?

You know, that's a great question, Brian. It really depends on who's asking the question. If a client comes in and I immediately see that they're very anxious and nervous, you could see the anxiety, right? You can hear it. They're not able to stop talking. They're just going in different directions. They're just, they're lost. They feel really exhausted by all of this information out there. They don't know what to make of it. Then I really let the client decide. What would you like to do first? What would you like to focus on first? And at the back of their mind it's always that dreaded belly fat. It is this how my body is changing? I'm not as sexy as I used to be. All of this that is there. But when you really sit and talk to them, it is, they just want to feel good in their bodies. They want that health back. They want to be able to go for a walk and not have joint pain. They want to be able to sleep at night without night sweats or, you know, hot flashes and things like that. So it really depends on the client. And I usually say let's start small. If you're not sleeping well, let's focus on sleep. If you're stressed, let's focus on some breath work. Let's talk about mindfulness, things like that to help you with that stress. If you're having a bunch of problems with allergies with your food. Then let's start there. Let's start eliminating some of these triggers and see if you're going to feel better. Will that joint pain decrease? Is it gluten related? Is it cross reacting with something else? And then if you're constipated, which is a huge problem with a lot of women, then we start looking into the gut microbiome, we test it and I have to say it's not a diagnostic test yet, but we have a good idea of the distal colon and what kind of microbes are in the feces. And then from there we can decide how much, what kind of diversity is in the gut. You know, do you have the keystone species that are so important? Are they the big players? You know, and if not, then we get a good idea. And this is where I think there's some research about. I know the carnivores out there are not going to like this, but when we talk about animal protein versus plant protein and things like that, the one thing that we know as far as the microbiome, it is very adept at using fiber as its fuel. But when you don't take in the fiber and you're just eating a largely protein based diet, they're not going to say no to the protein, they're going to eat the protein. But they may produce some healthy compounds, but they also produce some toxic metabolites like hydrogen sulfide, polyamines, ammonia and things like that. And those are not good for us and it could affect us and be detrimental to our health. So I always say eat for your palate, choose the protein or the diet that you really, really like for, for your well being as you see, but also nourish them, you know, and that means a small part of that plate has something for them every day, you.

Know, see more and more that people who are more on a carnivore diet are going, they're adding in more fermented vegetables. At least they're, they're kimchi and sauerkraut and they're adding in, you know, some kefir or maybe some, some Greek yogurt.

So easy, super easy to do that. And they can still have a very healthy lifestyle because you're cutting out all the crap. You know, they're not taking in the sugar or the flour and all of those things. And maybe the big, big ones that really affect them are the beans and lentils and things like that. And they're probably nervous about the phytic acid and things that we could go into an entire conversation about that because there's a lot of controversy about that as well. But I would say a good place and even fermented foods, you have to go slow because it can really just bombard your gut if you don't have the right microbes to digest it.

Yeah. And anytime you change it, that's one of the things I hear. Someone will be carnivore for a long time and then they'll have vegetables one day go see, I had gas all night and my stomach hurt. That so I'm allergic. You're not allergic. You just don't have the gut microbiome to digest that yet. But with time it can improve.

I see this a lot, Brian, especially with like with the CGMS now and people are kind of mono eating to see how cgms, which is the. In a continuous glucose monitor and they say, oh, I can't eat this, my blood sugar's spiked. So I'm not going to touch red pepper, I'm not going to touch this. But when do we ever eat like 4 or 5 of pears or 10 apples or something like that? We don't eat like that. We eat a balanced meal with different things. We have enough protein in the meal and we have enough good fats and they are going to help you with that, you know, kind of balance that blood sugar spike. And so it's the same thing. Right. You know, it's just about balance and having that Goldilocks principle with when it comes to nutrition as well.

Yeah. And that's been the argument in the low carb community. And you'll see that too. They'll say net carbs or total carbs. And people are debating it. It's like really how much fibers in the to hold that sugar in the gut too? Because if you want to feed your distal colon, you want to hold it there right to instead of absorbing it all through a leaky gut. Maybe.

Yeah. I mean, I think at this point it's all anecdotal. And of course science begins with anecdotes and I do agree with that. But we don't have solid science behind it. But what we do is we have very good science behind the microbiome. We have some good science between for these polyphenolic compounds. And we know that fiber that's coming from things like chia seeds, nuts and seeds really can even decrease your LDL by five to six points. And again, that may just start trigger another conversation. Is LDL really a marker for heart disease or something like that? So where do we go?

Yeah, but I think what we can say is all these other things increase loneliness, stress, worries, not sleeping, all these other factors we have involved. And if your gut's a mess, guess what? You're going to be more stressed. I was reading a study that they did in Germany. They took some college students and all they did, they came in happy and everything's great, divided them into two groups and they just injected them with a little lipopolysaccharide. And all of a sudden the ones who got that little tiny pin drop were depressed, anxious, stressed, crying, hated the world like within an hour. And you think, oh my goodness, if your gut's a mess, you're absorbing that your whole life every day.

Yeah, I mean, you think about it, all your instincts, everything you're messaging comes from the gut. You know, I've seen this with people who don't sleep well. There are studies that show that when you don't sleep well, even for one night, it really affects the gut, the microbial diversity. So because we have a circadian rhythm, and if we're not following our circadian rhythm, it affects the circadian rhythm of the gut microbiome as well.

So, yeah, you know, it's interesting because, you know, my, my office managers really has been diving into functional medicine a lot. And you know, there was one of our patients who was, every time there was a full moon, he would have panic attacks and anxiety and all stuff.

Yeah.

And she said, I'll bet you have a parasite or you have a gut microbiome issues. And he did have a lot. And so it's amazing how, how they do cycle with, with the, the circadian rhythms.

Yeah, it's definitely, they're connected. I mean, like even just one, one night of erratic eating, eating at past a certain hour can make you the next day eat more than 500 calories of these hyper palatable foods. So we are so diurnal, you know, respecting our circadian rhythm and being, having these, you know, nervous system regulating kind of habits are so important. So when I heard on your, on your show that, you know, you talk about spirituality and you know, about relationships, I feel like all of them are connected. Having good relationships, having, having love, you know, and joy and peace, you know, all of that is connected.

Helping other people, all those things, you release oxytocin, you lower your cortisol, you lower your stress hormone. So why do you want to be in that bad environment? If we're on the other side of the colon, we're looking at insulin resistance. And, you know, high sugars, high insulins, metabolic disease, that your body's not working right. The more stressed you are, the more that's bad. I mean, the diet is just one factor out of all these. Like you said, the nine arms. We got eight other arms to look at.

Yeah. And I mean, like insulin resistance and those blood sugar spikes on a cgm. I have definitely seen that when I'm under stress. Oh, my gosh, I can eat the best food. It'll kind of shoot up. Or one night of not sleeping well, the next, I don't know if it's because I'm searching for something that's. I'm definitely not looking for broccoli.

Well, that's in this. You're right. The studies do show that. When I was in residency, I remember looking at my wife and I said, I'm telling you, one day they're gonna, they're gonna figure this out. But when I'm on call night in the icu, first of all, we eat more than we normally do because we eat because we think we're not gonna be able to eat again because we're gonna be up all night, and then we have a break and, oh, we better eat something. And so the next day I would watch all my, my, the co residents that I worked with, and all of them were eating everything. Junk food, terrible stuff. And now we have more and more studies coming back saying, yes, it, it makes you really crave more sugar and, and processed foods when you're sleep deprived. So if we don't work on that, we're always going to be on that, you know, anxious, and you want to eat everything the next day.

Definitely. Yeah. So that's why they're. They're super connected, I think.

You know, when you think about when you're. And this is what it was. A, A friend of mine said it one time in a conference. I thought. I never thought about it that way. But no other animal except us humans eats when we're stressed. When we get stressed, we eat because we're calming our nerves and getting that dopamine hit. And, you know, a deer doesn't stop and eat when it's getting chased by a lion. It doesn't. You know, zebras aren't stopping to eat something. They're getting out of there.

Well, I mean, rest and digest is when we should be, but.

And it's hard, like you're saying, but when we're busy and hectic and your life is crazy and that's. Those are the people I've Seen have struggles trying to get their lifestyle changed because you just don't have time to take care of yourself. And a lot of those people are also the caregivers. They're caring for everyone else except themselves. And they feel bad if they take time to relax or just spend time doing what brings them peace.

And I think from a microbial perspective, what you eat, but when you eat and how you eat are all important. When you eat is really important. You know, I mean, like ancient wisdom, like traditional Chinese medicine or Ayurvedic medicine, really, really, that focuses on that, you know, like eat with the sun when high noon when so you have, you get the digestive power of the sun. I mean, makes a lot of sense. You know, it could be ancient wisdom, but I see such a connection to microbiome health. You know, it's, it's incredible. How, how, how did they know that? I, I remember my grandmother, you know, when always say, eat your cabbage with mustard seeds. And today we know that it's the myrosinase and mustard seeds that make us, that help us digest the, you know, glucor, you know, the cabbage, the sulfur compounds and cabbage. We didn't know that in those days, but somehow she had that wisdom. To know that these two things together is going to make you feel better and produce these anti cancer compounds, it's just, that's incredible to me.

Yeah, that's, that's a really amazing thing because I've noticed that too. I go to Guatemala for medical trips and I was there and we were in this remote village. They don't have TVs, radios, nothing, and they're just there. And then this guy comes in and he was, what he was describing was diabetic neuropathy, you know, diabetes, peeing all the time, being thirsty, and his eyes get blurry and he says, it's the weirdest thing he's telling me in Spanish. My wife brings me this tea. She puts three leaves in there and boils it. And when I drink it, my feet don't hurt as bad. My vision, I'm not peeing as much and I'm, I'm not, I feel great. I'm like, really, like find that out.

Yeah.

It turns out it was guava leaves. It was a guava. He came back an hour later, goes, it's guava. He goes, she put the guava leaf from the fruit. Not the fruit, but just the leaf.

Yeah.

And, and so I was messing around with, you know, seeing the, in clinics, trying with some people and seeing their sugars come down when we were following it over the next couple hours, go, wow, that is pretty wild. They just knew it. They just know it.

I actually have four or five different guava trees, and I make guava because that's an ancient thing from India as well, that we use guava leaves. Another thing from, I think maybe even Central America is episode. You know, it's incredible for the gut. You know, I just remember going on one of those trips and having a nightmare of a gut issue. And the person, you know, my friend's mother said, I'm going to make you a tea. She makes this tea. And the next morning, I'm fine.

Yeah.

I said, what the heck is this? This is great. This is wonderful. And she says, episodic. And I started growing here, growing it here in Californ, California. And I love it. This is one of the herbs that I tell all my clients, please grow it. It's so easy to grow this. All you need are three to four leaves. When you're cooking your black beans, add the epazote in and it'll make a difference with the flatulence that you experience with beans. It's incredible.

Wow. So that's good. Those are all great. Those are great tips. Do you have any other. That you just say, look, okay, I think we can agree, okay, let's. Let's cut out processed food, all the garbage, like fake foods and dyes and emulsifiers and all that kind of stuff. But if you come to. If someone comes in who's really struggling, are there certain things you go, you know, most people will benefit from adding this to their diet.

Well, I would say, if I could. The next hour, if I could say, I would say fiber, fiber, fiber, you know, because this is the. The most. And fiber really meaning when. When people think of fiber, we think of one thing. It keeps you regular. But fiber is way more than that. And you need different kinds of fiber. You need soluble fiber, as the name suggests, something that dissolves in water and makes that kind of viscous, this gel, like, thing, and incredible in so many different ways. Definitely for your cholesterol. It's great for your gut. Microbiome, just brilliant things. Insoluble fiber is the fiber that you get, like in the stock of the plant, you know, hemicellulose, lignins and things like that. And they're the ones that kind of bulk up your stool and keep you regular. But you need both. And most plants have both soluble and insoluble. And getting different kinds of fiber really helps. So let's say beta glucan comes from oats. Oat has become almost like a dangerous thing today. You know, don't eat oats. But it can't be that for everybody. Maybe some people have glycemic response to oats, but, you know, but oat bran, the bran of it has beta glucans. And beta glucan is a soluble fiber that does so many different things for us. And the biggest thing it does, Brian, is when you eat things, fibrous foods like that, and we don't get to digest it. We don't have the capacity to digest. It goes into your colon and the trillions of bacteria there feast on it and they produce something called short chain fatty acids. And these are very healthy compounds that really help us in so many different ways. Immune system. 70% of your immune system is in the gut, as you really know. And it becomes like a training ground. Your microbes are training your immune system to have the right response. This is a friend, this is a foe. Don't do anything here. And all of that comes from feeding the microbiome what it wants so it can do a job for us. And not just the short chain fatty acids, but also vitamins, neurotransmitters. Just all of that is thanks to our microbes. So feeding them that and prebiotic fibers, fermented foods, herbs and spices. Every culture has herbs and spices. So in my book, for example, I don't stick to. This is the only kind of cuisine that's going to help you, I think cultural diversity. We are a melting pot in this country. We have every kind of cuisine available to us. Go find things that really that you like. I mean, I love Mexican food, being in California, and I find all of your little secrets. What did your grandmother cook? Did she have this? And if she cooked the meat, what did she add into it? Just become very curious about other cultures and they will share things that are so incredible that we can use as pearls of wood. Wisdom, you know, that's passed on from other, other cultures and generations.

So, yeah, it's amazing. I mean, just seeing these in different cultures and. And if you go to a different place, you can get sick from the food because you're not used to digesting. I was seeing somewhere in Japan, I think they have certain gut microbiome that will digest certain. Right. They'll digest things that we can't. Seaweed, we can't digest. But they can.

They have very specific microbes that are even tofu. You know, they have tofu digesting microbes and we can, we can actually nourish and grow keystone species. I think everyone's heard of Akkermansia. It's gotten a lot of press for, especially for blood sugar balance and weight loss. And if you have even a little bit of Akkermansia, there's no need to take a supplement. You know, I mean, you can't really, you know, you could actually grow it, you know, by having foods that are rich in polyphenolic compounds like pomegranate, green tea, dark chocolate, things like that can really up your Akkermansia population. So food is the biggest needle mover when it comes to the microbiome health. Even 24 hours is all it takes to change your microbial composition.

How about fasting and microbial diversity?

Fantastic. The diversity increases. They really love that there's restricted eating. I haven't really looked. I haven't found anything that says the time restrict, restricted eating in the early hours versus late hours, if there's a difference. But knowing, but I'm, this is just a hypothesis, but it, knowing that the microbiome has its own, you know, circadian rhythm. I, I'm thinking that, I'm guessing that they prefer the early eating hours as well. So. But restricted eating, time restricted eating does help the microbial populations.

And there's so many other things that we do from a western medicine standpoint. Antibiotics. You see, people like, anyone has a sniffle to get antibiotics, they're tired, they get antibiotics. And, and I see this overuse of antibiotics which destroy the gut microbiome and also antacids. If someone has an upset stomach, they're on, they're put on a, you know, Nexium for 30 years and no one ever see that.

Brian, that is my biggest, you know, I told you I have a podcast called bad medicine and Dr. Canelo and I talk about that a lot because I see a lot of clients coming to me and I ask them, you know, how long have you been on this ppi? Oh, I don't know. Many, many years. And have you talked to your doctor about just maybe weaning off it or at least seeing do you really need it? But that conversation hasn't happened. So a lot of practices, they are just put on something and that we never look beyond that. And I don't blame the doctors. I think it's a system. If you, if you have.

I do. Because sometimes you look and say, why are you on all these? I mean, I see seniors that come in, I look at their med list and go, oh my gosh, you're on, like, why are you in this medicine is for the side effect of this medicine. You don't even need this one anymore. And then they give you another one because this one. And you think, and go. Because everyone's afraid in Western medicine to take a medicine away because we think that that's saving everyone's life. So if you don't give someone antibiotics, you're afraid because if they get an infection, they're going to come back and say, my doctor won't even give me antibiotics.

Yeah, no, but what I mean is that they're so busy, they do they have maybe 15 minutes with a patient. I can see how some of these things just go unnoticed because it just becomes my patient has a problem today. Let me focus on that. Everything else is to the. You know, I want to believe that, you know, because I, I don't think it's negligence sometimes it's just the way it is.

This, you know, well, and, and I get it because I was in the, in the system for 20 years of my career and I saw it. It was just, you want to fix the acute problem, you don't have time to fix all this other stuff. But they don't talk to you about diet, nutrition, stress, sleep. So when we start talking about nutrition for treating some of these, these conditions, you think, wow, we're seeing dementia, improving, Parkinson's, getting better, all these things. If we look at lifestyle and stress and human engagement, you know, mental, using your brain, you know, playing games, having fun, going and enjoying life a little bit.

It, yeah, just having fun. You said that. You said it. I mean, you put on this earth to have fun too, you know, let's not forget that, you know, And I think we need, in this health system, we need a team. And that's where people like coaches, you know, nutritionists, all of them have a part to play. And I think it's teamwork, you know, and that's where I think our biggest problem is. You know, internists don't talk to specialists. Specialists don't report back to family medicine doctors. I mean, there's just such a mess there, you know, and so in that the poor patient loses because everyone's prescribing their own medicine and the patient doesn't know who to ask for guidance. I mean, I just had a client recently who had. Was one, her nephew, I think died of cardiac arrest very young, 20, 22. And she was, was like, she immediately thought, oh, there's a genetic component. Went and got her ekg, all of that done. And then she came to me for weight loss and one of the first questions on the intake that I asked is like, do you have a good lipid profile? What is, what do you lipids look like? And she said, oh, I was never tested for that. For me, that's bad medicine.

Yeah, yeah. I mean, not checking that, not checking fasting. And they go, you're not, you're, you're not diabetic, you're not pre diabetic because you look fine. Yeah, but you can't tell because some people, especially of Asian and Indian descent, they can.

Exactly. Yeah.

Yeah.

But this, this woman's Caucasian. And I said, go to your doctor, see if she, he can off order an apob, an lp, you know, let's see what your small LDL looks like, all of that and then come back and let's have a conversation. Her LP was like 260. Her APOB was sky high. Forget about all the other things. Her triglycerides were really high. And then the doctor felt very embarrassed. And then we were able to squeeze in a request for a cardiologist. So I sent her to a cardiologist to get a good checkup. And that shouldn't be. There are certain things that need to be done as like protocol, I think.

You know, but you're right. There's so much that we do in, in Western medicine. You know, I see people have an upset stomach and then they're on, on the ppi and then they get osteoporosis, they have dysbiosis like crazy. And we're seeing a lot of bad gut microbiome. But it's hard because the doctor told them you can never come off this medicine or you're going to die, basically. And so they're afraid to.

Yeah, and everything takes time. Right. Even weaning off of PPI is not something you do drastically. It has to be done, you know, with time. Talking to the patient. How is he feeling? Is it, you know, changing the dosage every day? And that requires an incredible amount of time and, you know, consistency and, you know, and it's just not available these days, you know.

Yeah. And how are you approaching if someone has like, we know they have leaky gut, like their zonulin super high, they got, you know, all their inflammatory markers are through the roof. Are you using supplements for that? Like L glutamine, things like that, or just doing it through a nutritional approach?

Well, for most people I say let's not focus on the bad guys, let's focus on increasing the good guys. I Mean, how many pathogenic bacteria are you going to go after? Does it make sense to me even from all of the studies that I've gone through? So I start really helping them with nourishing their microbiome. If there is an symptom like let's say diarrhea, you know, and everything else comes back okay, H file ore no problem. None of, none of those that are C diff. All those guys, yeah, all the bad guys are just ruled out by regular office visits, you know, where they don't have to spend $400 for. I won't name the test, but the test. And so if they're, they can get, get it covered by insurance, then what I do is say, okay, let's start with something like glutamine and some Saccharomyces boulardi, you know, to help diarrhea. And once the system calms down a bit, we slowly start increasing. We do an elimination and add. And the big part of the elimination is adding these foods back because not especially young people, how long are they going to be without eating pizza or cheese or something like that, you know, and that's just so part of the culture. So I, we add it back to see how their body responds to it. If they have a reaction, you know, if it's, it's sensitivity, then if it's really bad, then I have them add back the gluten and go get a celiac test done for patients who have celiac disease. Other times the patient decides, I don't want to do this anymore. I feel so much better without the gluten or the dairy. That becomes their choice. I let them make the call and we really kind of increase all the micronutrients so they feel nourished.

So yeah, I've always thought of the gut microbiome. It's kind of like if you have a neighbor, a town, and the gangs take over and they run everything. So you got a few bad guys and all the good people are hiding. So once you get all the enough nice people, you don't have to get rid of each, all each bad guy because the nice people are going to take over again. Right.

It's a great way to describe it. I think that's what it is. And it's also, you know, I mean, functions. We want enough bacteria in there that are doing. There's something called functional redundancy. So your microbiome could be very different from mine. Maybe our phyla are about the same, the main phyla that you have and I have, but we could have different species doing different things for us. So it's not important to eat the same foods as long as we are nourishing them and your body responds to it. And it, it's increasing diversity. I think that is the bigger picture that I'm going after.

Yeah, it's what works for you. Is that what works for the guy down the street or whoever the, the, the other leaders in the community are? Right, yeah. How about other things like apple cider vinegar, kimchi, sauerkraut things are there. Certain things you go, yeah, these are great to add into anyone's diet. That helps.

Well, that's the thing. It's so bio individual. There are people who cannot handle fermented foods. They are at a place where they can add fiber, but fermented foods are a no, no. So we go very slow. So I say let's start with like half a teaspoon of sauerkraut. Let's see how your body responds to it. Let's see what kind of. And then if they start doing better, then we add other things. Kombucha or fermented foods, or making very specific yogurts like Lactobacillus ruturi is such a well studied strain. A lot of my clients will come to me and say, oh, I just got this really nice fancy yogurt. But it's very important to see what kind of microbes are in the yogurt. Just because it says probiotic cultures doesn't mean a thing. You know, you're just spending big bucks on a product that's not going to do a darn thing for you.

Yeah, you better just make it yourself and do it so you know it's there and you can ferment it as long as you want and not, you know, just because they have turnover, they're trying to get the product. So some of them, I think they ferment for four to six hours and they just ship it out in the heat.

And certain bacteria like Lactobacillus rutoride requires a certain temperature. But there are some good yogurts. Like for example, if someone's struggling with, you know, constipation, BB lactose 12 is a good strain. And certain. Can I mention a brand name?

Sure, yeah.

Yeah. Nancy's Yogurts has it. I think it's one of the few yogurts that, that, that has BB lactose 12. So that's great for people. Some of my clients. So maybe have a little bit of that yogurt with psyllium husk on It. And some chia seeds and some sunflower seeds. And that's a great start for your day with fiber. You know, you have insoluble fiber. Insoluble fiber. Protein, from the Greek yogurt. So. And, and fat. So you're covered. Macros and micros.

Yeah. And there is some talk too. That was one thing, you know, I, at least it was theoretical. I think there was a couple docs talking about that. The possibility if you starve Akkermansia for too long for it not giving it carbohydrate, not giving it sugar, that it can start eating the mucus layer to survive. And then you get leaky gut and you get all these other problems by being too restrictive.

Yeah. It is a mucus loving bacteria. So this is where the Goldilocks principle is very important. So you don't want too much of Akkermansia or too little. But all the tests that I've seen so far, Brian, I've never seen anyone having too much Akkermansia. Maybe a few people, but mostly it's very low or non. Not detected.

Yeah. And the other concerning one is a lot of people are having low bifidobacterium, which has a huge role in immune function.

Yeah, Bifidobacterium is low. What I'm seeing is a lot of the unhealthy metabolites from proteolytic fermentation. That's huge. And keystone species are all lacking bifidobacterium. And one thing that we look for, especially in IBD and cases like that is Proteobacteria. You know, you don't want too much of it. Yeah. So a gut test really kind of gives you a starting point. You know, if not anything, it's curiosity. Who's in there, you know?

Yeah.

You know, I mean we, we are not at a place where we can say it's diagnostic, of course, but if we get an idea whether we have, let's say for example, the hearts of tribe, the hunter and gatherer type, they have 1500 species. We have like a poultry 270 to 80, you know, and this is, I'm talking a healthy American. The kind of people who come to me, I don't think I've ever seen anything more than 140. And the lowest I've seen is 22. Yeah. Can you.

That's scary. It is. It is scary. And people don't realize it. And that's why we were talking beforehand. You had a doctor chastise me for talking about the microbiome. Saying there's no data. I'm like, there's a ton of data on this stuff and, and diseases that are specific for certain microbiomes. And so, you know, I think this whole thing of microbial diversity is really, I mean that is the thing that I keep seeing coming back and back and that sounds like doing your research from Flourish from Within. Tell me about your book so we don't forget about that.

Well, yeah, my book came with my passion. I really had gutted shoes along many moons ago and, and this is, I'm talking Brian, at a time when we didn't have in Internet or we didn't have chat GPT and things like that. So I had to go to UCSD research and that's where I fell in love with the microbiome. And we're talking human microbiome project, you know, just the early infancy from there to now. The immense knowledge and researchers. Thank you, researchers. It's like amazing how much, how much information we have in every aspect of our life and how it's connected to the microbiome. The gut brain, the gut immune system, the gut cardiovascular issues, gut insulin, I mean just you name it, there is a connection. And it will would be prudent to take notice and at least say, what do these guys want? These are our forever guests. They're not going anywhere. You know, they have a place.

They're going to outlive us.

Yeah.

When we're gone, they're still going to be doing their thing.

They're going to be doing their thing. And this is an heirloom that we pass on to future generations. So if you think about that and if you think about your children and your grandchildren, this is the best thing that you can pass on. The more diversity, the more species, the more disease keeps them healthier. So that became my mission. I 2 out of 3Americans do not know what the microbiome is. And that was my mission to change that. So Flourish from Within. The first part of the book is all about the microbiome in very simple layperson's terms. Nothing too scientific, but just enough. But it's based on evidence based and research based. I don't romanticize the microbiome. We tend to do that sometimes in certain circles because we love it so much. But then the second section is about a diet that I propose. It does not really talk about macros, it just talks about how do you feed your microbiome. You follow the diet that you want, but this is how you feed your microbiome. And finally, about 50 recipes to support.

Awesome. Do you have any favorite recipes microbiome that you say, oh yeah, this is like for my go to.

Well, it's not about a recipe, but it's more my approach to working with clients because we all make goals, but we don't really kind of go after the goal. And that's the same. Let's say your goal today is to add 40 grams of fiber every day. I mean, you may stick to it for a few days, but then life gets in the way. You have a lot of patience that's forgotten. So my job is convenience leads to consistency. So I format a recipe, be this, this and this, add all of this. It's like a formula so you don't forget. So if I tell you take beta glucan every day, you may remember it for a couple of days and then you forget about it when you're. Because that's not habit yet. It's not a procedural thing like brushing your teeth. So until it becomes procedural, I think formatted approaches, really building a system around how you eat is, is very important. You know, if not, you're, you're just going to, it's not going to stick. There's no way.

And for people who aren't going to change their diet, they go, look, this is what I eat. Are there any like supplements that you like as far as to get a good fiber mix for them? You know, a capsule or a powder or something like that. I don't mind you saying the brand name because there's a couple that I use.

Well, I think, I think anything could be a food supplement like Psyllium Heart Musk is a supplement that I think everyone, especially with someone with an insulin response who's insulin resistant, should add some soluble fiber or high cholesterol. I would definitely say add something like a fiber pill or adding psyllium husk powder. That would be great. I personally don't, I'm not a big fan of believe it or not, I'm not a big fan of too many probiotics because they're all transient in nature. As long as you're taking it, it's fine. When you stop, you know, the efficacy goes away. So it's better to feed your microbiome.

Give them a good polyphenol, good, good substance to grow.

Yeah, yeah. Just. It all comes from our food. You know, why not do it? But if you really must. The one that I would say has always worked as sacraments. Boulardi. So if you're going, traveling anywhere, pack it because it really does help with, you know, travel related diarrhea. A simple. And I think the probiotic, the strain matters a lot. So look for strains, you know, it's very important. We always get kind of attracted by the shiny new object, the marketing, all of that. But the more important thing is what, what strain is in the bacteria that, that plays back to anything worth of Bifidobacterium, lactobacillus reuteri. If you're, if you're concerned about your vaginal health as a listener, then Lactobacillus crepitus, you know, things like that really kind of bring balance to vaginal health. Sperm has its own microbiome. Sperm health, you know, is connected to gut health. So you really, there's no escaping this. You have to start with the gut. But it has incredible, you know, benefits for every aspect of your flourishing. And that's, yeah, I think that's so important.

I think these are the things that we started out talking about these things. So the way I'm looking at it too is okay, okay, you want to, you want your garden to grow nice, so you're planting all these nice seeds, but then you're putting chemicals and poisons on top of them. They're not going to grow, right. So it's one of those things like, okay, first of all, we got to take away what screwed up our gut microbiome in the first place, right? Take those things out. If it's excessive alcohol or processed foods or food dyes. And the other thing we didn't really touch on, I would love to have you.

We can do a list of things that really, and I think top of the list is ultra processed food.

Yes.

That's like you and I going into Home Depot and eating something there. I mean, that's pretty much what they're looking at. Like, what the heck, I don't know what this is, you know, so ultra processed foods, and by that I mean your sugar and your flour and processed foods and meats and things like that that they don't recognize, you know, as food. Then emulsifiers, artificial sweeteners. I'm just, just, actually just naming the things that have been studied as salt. High salt has been shown to really affect the microbial composition as far as drugs, PPIs, antibiotics, all of them really have a pretty nasty effect on the microbial composition. Hyper hygiene, you know, I mean, if you're washing your hands a hundred times with an antimicrobial soap, stop it. You're not in some remote part of Africa, you know, dealing with, you Know, you know, diseases and infections. We live in the first world, so.

And even being in the dirt and working in the garden helps with your gut microbiome.

Garden is great. I mean that's one of the reasons I garden as much as I do forest bathing, being in nature, walking on the beach, anything like exercise. Guys, if I did forgot that athletes. Studies have shown that athletes have a much higher, higher diversity, microbial diversity compared to those fast who are couch potatoes. So that one thing should get you walking today. Just walk, you know, get yourself out there, pick something that you like, it doesn't care. You know, if you like dancing, go dance. You know, if you want, you want to do strength training, that really does help. And postmenopausal women, strength training is absolutely, it's so important, critical, critical. And it does help with the microbiome as well. So there's an added benefit there. So. Yeah, and sleep, I would say sleep is really important. And one thing, I mean I think. Did you see Brian, there was this, I think this 110 year old, the oldest woman who just recently passed, they checked her microbiome and it was that of an infant because. And they kind of attributed her longevity to her microbial health. Because as you age, as we age, our microbial composition changes because what happens when we get older? We are probably in assisted living or we're not eating a variety of foods, we probably have dentures, we don't have the textures foods. So all of that can decrease the microbial composition. So this is amazing that this woman had the composition of an infant. So I thought that was pretty cool.

Yeah. And now unfortunately, now the infants are being born with the microbiome of an old person. Right. They're missing all this diversity already. And then you say, oh, why is it, what happens when we get older? What's going to happen if we don't fix this problem? So what you're doing is such important work. That's why I was excited to have you on because we really have to look at the gut microbiome. There's so much science out there. Sabine Hazen is a doctor who does a lot with the gut microbiome and some of her research is mind blowing about amazing personality changes and all these things with depression and anxiety has a certain gut microbiome. And so I think we're, we're and as you say, it's like we're, we're just taking a shot in the dark. We can look at the microbiome and, but we're looking for patterns. Maybe you know, patterns of why we're not digesting. Right. Why are we, you know, why we're afraid of certain foods. And, and really a lot of stuff we call food is not food. And that's what we have to get back to is like if we just all agree to get rid of all the process as, you know, terrible stuff, and then follow whatever spectrum works for you, where you feel the best.

Exactly. I think that that's so sensible. I mean, because food is so social, food is cultural. Pick the things that really make your palate happy, you know, and I, by that, I mean healthy, unprocessed foods. Because this is new to us. Even in the 1970s, we didn't have. Obesity is the biggest chronic disease that we have. You know, regardless of what, how you get to losing your weight, you know, that doesn't matter. Low fat, high protein, low carb, whatever, lose the weight, but don't lose your diversity at the same time. Maintain your microbial diversity so you're optimally well. And I think that's everybody's birthright.

Yeah, Smile, have fun. Don't take life so serious. All these things that we're talking about, these are real critical. It sounds so, so woo woo. But it's real. It's like what we have to do. And I'll have to ask you, Anu, what's your, what's life's best medicine for you? Like, where do you go in life's hard? What motivates you? What keeps you going? What would you tell people matters in life?

I think for me it's joy. I, I think being at peace. You know, the other day someone asked me, where is home for you? I said, home is where peace is. You know, if you're at peace, peace, and you're joyful, that's life's best medicine, I think, you know, because then you're not concerned about what the other guy said. Someone's on you. I mean, you don't care about anything, you know. Yeah. Because you're at peace. And you, you love everybody because they're all kind of representations of this universe. I truly believe that that's.

Yeah, yeah, I think that, I think there's, I think there's way more truth in that to that than we expect. Because my dad is 85 years old and he smoked two packs for 50 years, drank, he did everything, but he never let anything bug up. He goes, no problem. I'm not worrying about it. Nothing ever bothered. I'm like, how in the heck are you still alive, man? He goes, you Know what? Just take it one day at a time. Appreciate what you got. Enjoy life. You could get away with a lot of other stuff, but obviously I'm not recommending that because you could live 80 years longer.

But that's, that's more anecdotal.

But, yeah, it's anecdotal for sure. Absolutely. But I tell them that I go, you're just lucky or something. But, but there is something to that. When you don't get worried about every little thing you're doing and every, you know, you can worry about you.

Brian. My mom's 93, and she is a true representation of being present to life. I mean, she's never been concerned about anything or, you know, she welcomes everyone. She loves everybody. Like, this month I have over 35 people coming in to see her. You know, everyone loves her, you know, and that's because she's positive. She doesn't complain about, oh, I have this pain, I have that pain. Just her life is just always like, I'm so grateful. Yeah, yeah.

And that's the thing is being grateful and appreciated and counting your blessings and saying, okay, I may not have everything, but so many people right now are listening, are worried about, my neighbor has a bigger house, they have a nicer car, they have nicer kids, whatever, don't worry about it. Enjoy your life a little bit. You know, cut out the processed food, enjoy life. Go for a walk on the beach, listen to the birds, whatever makes you happy. If you like collecting rocks, I don't care. So thank you so much. It's so great to have you. And just to remind people when your book, when, when it's coming out and how they can get it. And, and we'll, we'll put all the links in the show notes.

Also, my website is 9Arms of Wellness.com and my book will be sold where all books are sold. And also on my website, you can pre order it now. And also my Instagram handle is @9armsofwellness.

Awesome. Anu, thanks so much for joining me. Such a pleasure having you. It was a great discussion. I learned a lot from you. So thank you.

Thank you, thank you, Brian.

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