Food As Medicine - with Dr. Josh Axe | The Empowering Neurologist EP. 16

Hello everyone, and welcome to The Empowering Neurologist. I'm Dr. David Perlmutter. Today we're going to be chatting with Dr. Josh Axe. Dr. Axe wants us to eat dirt, maybe not exactly literally, but he has a thesis that we're going to explore. In fact, it is the title of his new book, Eat Dirt. And to be sure, It's not about going out and eating dirt, but it's about the importance of understanding microbes in our world in terms of how our microbiome is affected, the microbes throughout our living systems, how they interact with our health, how they influence our physiology and our risk for disease. It's a very compelling book, and we're going to talk about that today. But let me tell you a little bit more about Dr. Axe. He's a doctor of natural medicine. If you're on the internet at all and you're looking up a topic by— you're very likely to see his work. He is a nutritionist, an author, and he really has a passion to help people not only get well using food as medicine, but stay well and preserve their health. He operates one of the world's largest natural health websites, which you probably know about, draxe.com. We'll have a graphic for that later in the program. He's been a physician for many world-class athletes, and in fact, in 2009, he began working with the Wellness Advisory Council and traveled to the 2012 Summer Olympic Games, which were held in London, where he worked with some of America's finest athletes. He's an expert also in herbal medicine, nutrition, digestive health, and as you would expect, of course, athletic performance. He's been seen on many television programs around the nation, including CBS programs, NBC, and of course, Dr. Oz. In his spare time, when he's not blogging and informing us all, he competes in triathlons and cross-trains. His wife is also very much an athletic— an avid athlete, and we're really looking forward to today's interview. Thank you, David. So let's welcome Dr. Josh Axe to the program. How are you doing today?

Hey, great, Dr. David. Thanks for having me.

Well, I am delighted. I, you know, as a plus for doing this type of work, I get to read people's books early on when they first come out, or even before they come out. And I was very, very taken by your book. What a compelling title, Eat Dirt, and it really does say a lot. In your introduction, you talk about kind of an epiphany in your life, a pivot point. That occurred when you were 24 and your mother had some health issues. Can we just jump right in and talk about that?

Yeah, absolutely. I think I see this all the time to where when I'm doing interviews, I find a lot of people get in the health field because of crisis in their own personal life or their own family's life. It was really the same with me. I grew up in a family that was always into fitness. My dad was a semi-pro water skier. My mom was my gym teacher in elementary school. She was a swim instructor, always really active. 40 years old, she was diagnosed with breast cancer. We lived in what I call just the conventional system of the time. Whenever we were sick, we got put on antibiotics. We didn't know anything about diet or nutrition. I mean, never paid any attention. My mom went through the conventional system. She went and she had a mastectomy. She went through several rounds of chemotherapy. I can still remember to this day watching her hair fall out and thinking she had aged 20 years in 2 weeks. Saying to myself, man, I never want to see anyone have to suffer through that again. And that's really what caused me to go into the field of natural medicine. And so from then on, actually, my mom, for the next 10 years after she was going through chemo, or after she had went through chemo, she just continued to get worse and worse. She got put on— I know she was on about 3 medications. She got put on an antidepressant. She was diagnosed with an autoimmune disease, Hashimoto's thyroiditis. Struggled with chronic constipation, chronic fatigue syndrome, and then just was, again, tired all the time. This went on for 10 years. Finally, 10 years later, I got a call from her. At this point, I was actually working as a nutritionist in Orlando and just started my medical training. She called me up and she said, hey, I've got really bad news, and she started crying. She said, I've been diagnosed with what they believe is cancer again. They found tumors on my lungs. She said, what do I do? And I said, I'm going to fly home. Immediately flew home, and we really just talked it through. And and we consulted with her oncologist and just said, you know what? Give us three months. We want to try some things naturally. And and he said, okay. And so we just radically changed my mom's diet. I'd been learning some things at the time, but we started juicing vegetables. She started doing bone broth, blueberries, and and a number of foods. We started doing certain supplements. She started doing turmeric and something called soil-based probiotics and vitamin D and. medicinal mushrooms called cordyceps and, and many other things. And, and the other big thing was, again, in changing her diet, we had her start doing this, this type of kefir. If you can— and I know you've taken care of a lot of patients— but one of her symptoms was she was having an average of 1 bowel movement a week, and that had been going on for 2 years. And after 2 weeks, her bowel movements started to regulate. She started going once a day, and then eventually it was, it was even more than that. So that was a big step. And the other thing was my mom was chronically stressed. She was a special ed teacher teacher, and you could just— I mean, you could see the stress coming off of her. She dropped down to part-time and then had the summer off, so we really got to take care of her. And she followed this program and protocol for 4 months. We went back to her oncologist and he did a CT scan, and he called us 2 days later and he said, this is very unusual. He said, it's incredible, actually. He said, your tumors— the largest tumor went from 2.5 centimeters down to 1.2. He said, I want you to go ahead, and I don't know what you're doing, but keep— go ahead and keep doing it and come back in 9 months. And we went back 9 months later and we saw further progress. And today my mom is cancer-free, in the best shape of her life. She's in her mid-60s. She lives now in a place called Auburndale, Florida, just outside of Lakeland, and has great health. And so, you know, she's actually ran a few 5Ks with me in the past couple years and finished 2nd and 3rd in her age group. And so, you know, this just really, you know, that was big for me. And just, just getting ready to graduate. And something I've told my own patients for years, Dr. Perlmutter, is that I'm gonna take care of you like I would my own family. And one of the things that I really saw and experienced with my mom is that she was so overwhelmed by her diagnosis, she was almost paralyzed. So when I flew home with her, I made her her own cookbook, and I went through her pantry. We did this sort of like kitchen makeover with every— getting a lot of the bad stuff out. I taught her how to make smoothies and how to use her crock pot. I mean, this— she didn't know how to do a lot of that. And went shopping with her. And so I started doing the same thing with my patients, started doing shopping tours with them and, and did cookbooks and that type of thing. But, you know, that's— that was part of her transformation and why I wrote the, you know, my book Eat Dirt and why I practice the way I do today.

Well, you said several things that really caught my attention, and the first, not in any particular order, was the notion that The oncologist said to you, I don't know what you're doing, but keep doing it. In my ideal world, what would happen is the oncologist would say, I don't know what you're doing, but tell me what you're doing because it works. And, you know, here's probably metastatic breast cancer, and we know what the survivability of that looks like, and it's not very favorable. And here your mom made this incredible progress to remission. In an ideal world, you'd think people would want to know how in the heck you accomplished that. I guess you didn't convince the oncologist to learn about it, but fortunately, you put it in your new book, which is really very exciting. Yeah. You also said something I think that was really very interesting, and that is, you said your mom became very constipated, fatigued, and developed Hashimoto's thyroiditis, as if those issues were seemingly disparate. I mean, you know that they're not. But, you know, in our modern world of reductionism, we look upon fatigue, constipation as a gastroenterologist's problem, thyroiditis is obviously going to be the endocrinologist's issue. But yet, you know, here you then worked with her nutrition, basically worked with her gut, and your first quote in the book was, all disease begins in the gut. You worked with her gut and everything resolved. So it's sort of a broad stroke approach. centered on the gut for seemingly very disparate issues.

Yeah, absolutely. And I know that, you know, one of the— actually, I know my mom has read your book and loves it, by the way. I know she read Grain Brain here pretty recently, and I know you cover this so well. But, you know, it's absolutely true. You know, another just sort of side note, my mom lost almost 20 pounds in her first 30 days following this program, and it wasn't because we were trying to make her lose weight. It's because We were trying to get her body in that perfect healing environment. I know that the emotional stress coupled with her toxic diet and the things she was eating, it was essentially the perfect storm for her to be sick. I know that the constipation was something— that was the other thing about my mom too. She knew she had the health problems. She was also always stressing about her health problems and her constipation and all the other things she was going through. Yeah. Several goiters on her thyroid and had cysts on her liver. I mean, she spent as much time stressing about her health as anything else as well. So when we started following— when she started following these protocols, I mean, it's amazing. I know you see the same thing. It's amazing how fast the body can heal when you remove all of the stressors. And that's one of my biggest lessons as well. If somebody really is willing to go 100%— because that's the other thing, if my mom We're in the position where she said, you know what, Josh? I'm going to do about 50% of what you asked me to. I don't know that she'd be here today, or I don't know that she would be in the great health she is, but I think that's another important thing to think about.

Well, I always say halfway measures work halfway. If you were to ask somebody, well, do you want your cancer to be 50% gone? I think it kind of drives home the message that you really got to go all in.

Yeah, absolutely.

You talk about in your book, you know, you really focus on the fundamentals of the leaky gut, which has now entered mainstream parlance. You know, for those of us involved in functional medicine who've been talking about this for a couple of decades, you know, we were kind of ostracized for the notion of a leaky gut, even relating to the gut, much less related to systemic issues like autoimmune conditions, etc. But on page 39, you mentioned this kind of vicious cycle, how the idea of a leaky gut is self-perpetuating, how it makes things worse that then get, you know, create this feed-forward cycle. Could you tell us about that?

Sure. Well, you know, one of the things that I really started noticing in patients is that a lot of similar symptoms came up, and I started running blood work and blood analysis and sometimes urinalysis on patients and looking at things like, you know, IgG testing and stool testing and organic acids, looking at Maybe specific vitamin, mineral, and organic— and amino acid deficiencies. One of the things that I noticed is it's almost shocking how many food sensitivities and intolerances people have. I really started noticing that that was— if I did a test, pretty much everybody has something, and of course dairy and wheat show up very often. That's one of the first, what I would say, in the cycle. One of the biggest things I start to see in people is that there's this— Yeah. We have this immune response and then inflammation, and then that can really turn into— typically intestinal inflammation, and that intestinal inflammation can then turn into that zonulin production and those gates staying open within the intestines and things such as undigested food particles like gluten and toxins and pathogenic bacteria leaking through into the gut, into the bloodstream, and then circulating causing issues. In Nashville here, I speak at a lot of autism support groups and really saw this early on, you know, and this is really what kind of triggered me along with my mom into focusing more on the gut because I noticed with all of the children I took care of on the autism spectrum, they all had some form of dysbiosis or major digestive issues. And so when I really started working with those kids and I— first thing I did is put them on a gluten-free and casein diet and then we started doing things like glutamine supplementation and some other things, but really just saw some fantastic results and so But, you know, I had a mom come in to me, and she's— and after just 1 week, she said, this diet that I put— you had me put my son— she said, he went from speaking— he only knew 3 words, he said 40 words. She said, I walked in his bedroom, and he said to me, hey, Mom, I want breakfast. She said, I'd never heard him do that before. And so really seeing that connection that I know you hit on in your book Grain Brain is that, you know, these things can affect the entire body when you start getting these proteins in the bloodstream that aren't broken down, it can cause, you know, it can cause brain issues, but also it can cause thyroid issues, it can cause joint issues, it can affect every single area of the body. And your body will let that go on for so long until where finally it creates this autoimmune, this automatic response, and your body can even start attacking its own tissues because it's recognizing that protein like a gluten But also saying, hey, there's similar proteins we're finding within the thyroid, and it's causing inflammation or obviously disease there as well.

Molecular mimicry. Take us back then to what does it mean, Eat Dirt?

Sure. I use the title Eat Dirt, and one of the big reasons is I walked in my mom's kitchen. My mom was shopping at the farmer's market, and she was Scrubbing her— in fact, as a kid, my mom had me do this. She would have us scrub our potatoes to where they didn't have skin on them. The same thing with carrots, we'd peel them.

Lucky she didn't scrub you.

Yeah, no, exactly. I mean, she was just— and my grandmother was this way too. Like, she would have a, uh, it was like if you've seen the movie What About Bob, she always had a handkerchief like with doorknobs. So that— my mom was a germ freak growing up. And I walked in the kitchen, I said, Mom, I said, just eat dirt. I said, you know, stop scrubbing everything, stopping it, you know, just going overboard with the antibiotics. And so this was a couple years ago, so it made me think of the title of the book. But also, you know, I'd been recommending soil-based probiotics for years, and then I came across a journal reference where they talked about how soil-based organisms that are found on our food today can actually help break down polysaccharides and actually help digest starches, which I thought was fascinating. And there's another great Japanese study where the researchers said and showed in the study that people in Okinawa and different areas of Japan were better able to break down seaweed. And I thought that was fascinating as well. In fact, in the study they said it's, you know, by constantly consuming those, it's like your body has a new set of utensils. It's better at, you know, digesting those than people in, you know, in North America. So, so in Eat Dirt, it really is about Really balancing things out to where— I understand that sanitation is key. It's part of the reason why our lifespan has increased so much, but we've really swung this pendulum too far in the other direction where we've become so anti-dirt and anti-germ that we've started— we're trading, I guess, certain basic infectious disease for now autoimmune disease and some of these other things that are happening within the body. Really, Eat Dirt is about increasing your exposure to good microbes on a regular basis. There's a great study, I think it's published in the Journal of Environmental Sciences, and they talk about how if you have a dog or cat, specifically in children, it decreases your risk of asthma and allergies by 52%. There's other similar studies on people that live on farms having similar benefits. In Eat Dirt, I go through ways of increasing your microbial exposure, like having a dog. eating raw local honey. In fact, raw local honey contains over 200 natural forms of pollen and microbes, which is beneficial. I talk about not just getting good bacteria in your diet, but also good fungi such as medicinal mushrooms and good viruses, which are often referenced as bacteriophages, which are found in the ocean, and even good types of yeast like Saccharomyces boulardii, which is commonly found in probiotic— certain probiotic supplements today, which is a yeast. And things like that. So I said, you know, don't, don't be anti-germ, don't be antibacterial, be pro-germ and pro-bacteria and start getting, you know, these good healthy exposures. And I use honey as one of those examples because, you know, people talk about how honey helps allergies and it's been shown that in medical studies, but it's not just necessarily any honey. I think it's important that it's raw and it's local and actually has pollen and not waiting until you have allergies. Ideally, you'd be doing it year-round. In a way, it's a— Yeah. So, it's sort of a micro or nature's immunization over time when we're getting these natural exposures on a regular basis.

That's right. Sayer Ji was on the program several months ago, and on his website, GreenMedInfo, he has a really interesting discussion about how honey may act as a reservoir, allowing us to really store these microbes and therefore their genetic material and reinoculate ourselves. I want to go back to something you said earlier, and that was when you're doing laboratory evaluation of patients, and you mentioned that they may have a wheat allergy or they may not. And I'd like you to elaborate on kind of the differentiation between having an out-and-out allergy to wheat versus the concept that gluten, and specifically gliadin, may represent an issue for people even beyond having a wheat allergy.

Sure. Well, I, I think I understand your question. Um, when it comes to, um, obviously there's different forms of testing as well. You get IgE, which is typically allergy, IgG, which we know is more of that sensitivity testing. And by the way, I, I, I do that testing. I look at it for myself. I don't believe it's always 100%. It's not that it's not accurate, but it's not— it doesn't 100% tell us if somebody's actually intolerant to the food. I've actually— I think I've seen to where Maybe if somebody eats a food too much, it can show up versus not having exposure to it. I still think it's a good test. I still think it can show us some different things. If we're talking about— I'm going to answer this question how— if you want me to answer it in more detail, I'd love to.

No, you're doing great.

One of the things I'm thinking about right now is that I don't think I don't think gluten for most people is well tolerated, and I think it can cause allergies and food sensitivities in a majority of the population. I think the bigger problem today that we run into has to do with, in many cases, food preparation as well. I think that's an issue. I think that if we go back and we consume a natural form of gluten, or let's say it's lacto— it's sprouted and lacto-fermented to where it is completely broken down, or As in Chinese medicine, they talk about putting it in a one-pot or a crock pot and really cooking it slowly. I found for myself that when I buy something called germinated rice, brown rice, and I cook it in bone broth overnight for about 12 to 24 hours to where it just— it's complete mush, I digest it really, really well. In fact, I noticed that it really is good for me and my bowel movements and things like that. Yeah. I think sometimes we make gluten and some of these proteins villains when in fact, I don't necessarily think they always have to be. I think we've really lost the art of proper food preparation, especially when it comes to fermentation, of course, sprouting and germination and that type of thing. Anyways, I know that doesn't necessarily answer your question, but I think that gluten itself, I think it probably is the biggest issue today, but I believe it's the biggest issue because we've lost the form or the right way of Preparing foods properly.

You know, you had a nice section in your book talking about the prebiotic fibers and how important they are for nurturing good probiotic organisms within us and how we are really quite almost devoid of good sources of prebiotic fiber in our diets today. And you brought up a really interesting point, and that was that unpasteurized apple cider vinegar is actually a relatively good source of Prebiotic fiber. You know, normally when you're thinking about fiber, you're thinking of sawdust or something that looks like shredded wheat. Yeah, it was a bit surprising that you'd mentioned that. Tell us about that.

Sure. Well, you know, there, there are, there are different types of prebiotics. And when people hear prebiotic, typically, typically they're thinking of, you know, inulin fiber, asparagus, artichokes, dandelion greens, even sometimes, you know, plantains or bananas that aren't completely ripe. Those tend to be very high in those prebiotic fibers, but also Looking at raw honey is an excellent prebiotic, as are medicinal mushrooms. Shiitake mushroom, which is very popular in the Chinese diet. In fact, if you are in both Chinese and Japanese diet, in fact, they do a lot of miso soup with shiitake and green onion. Talk about— and broth. I mean, talk about a gut-healing remedy.

Yeah, yeah.

Absolutely amazing. So, yeah, so it doesn't always have to be necessarily one of the fruit or vegetables. It doesn't actually always need to be necessarily what we would think of as necessarily fiber. In fact, I even believe lactose is a very strong prebiotic as well, which is found in something like just a goat's milk or cow's milk, which—

Along with galactosaccharides that are found obviously in human breast milk. One of my favorite vegetables is jicama. It sure seems to be tough. I'm in Southwest Florida to find an organic jicama, so maybe that's what I'll end up doing Rest of my life, I'll be a jicama farmer. I think it's— they're kind of hard to grow. But that said, commercially, I really like acacia gum, and they sell at the health food store, there are various products that contain acacia gum. It's a very complex oligomer of fructose. And, you know, it's a very, very powerful prebiotic fiber. So, you know, one of the good things is you don't really lose prebiotic fiber content when these foods are cooked, so you retain that. But it was interesting you mentioned that, you know, because people are drinking a lot of this apple cider vinegar or using it a lot, and what a nice thing to know that that's a good source of prebiotic fiber. What about fermented foods? What can you tell us there?

Sure. Well, you know, I'm a huge fan of fermented foods, and I think that, again, this is— I really hit on this in my book, but, you know, we've really lost the art of fermentation. You know, part of the reason why people fermented foods Uh-huh. Hundreds of years ago, um, is for preservation purposes. You know, it's in fact another sort of side note in eat— in talking about eating dirt. You know, I was, uh, also reading about, uh, people used to take cabbage, dig a hole and throw cabbage in the ground and how it would naturally ferment, but also many of those soil-based organisms and it being where it was in the dirt really help in preservation. But, but, you know, some of my favorite probiotic-rich foods, one, um, this totally transformed my mom's health, but we went and got Raw goat's milk kefir. We drove out to this small Amish farm out in Ohio and would get that every single week. She would get her goat's milk kefir, and I think many people tolerate goat's milk better. But kefir really is the king of probiotic foods. It typically has the most diversity in terms of strains from what I've seen, and it really has so many benefits. In fact, one of the things we did with my mom is we did sort of a twist on something called the Budwig protocol, where what we had her

Budwig absolutely.

So what we'd had her do was— my mom, we had her do a cup of goat's milk kefir, a tablespoon of flax oil, a tablespoon or 2 of flax meal, and then actually would also put a teaspoon of turmeric in there. And she would drink that every morning for breakfast and saw great results with it. Also sauerkraut. You know, sauerkraut and kimchi and fermented vegetables have a strain called Lactobacillus plantarum. Which has been shown to be really, really great for supporting digestive health. Also, another favorite of mine is coconut kefir. If somebody doesn't want to do dairy, I think coconut kefir is a good option. Also, there's a new beverage that I think a lot more people are going to be seeing on their shelf called kvass. Today, oftentimes, it actually traditionally was done as a fermented grain, like fermented barley, but today they're doing fermented beets, which I think is fantastic, especially for athletes or people who have heart issues or really want to nourish their blood. Yeah. Can be great as well. But I think just in general, adding 1 to 2 servings of fermented foods to your diet a day can just boast some tremendous benefits. And I love— one of my favorite recipes is I had my mom also do a— we called it a probiotic peach smoothie where she would do a cup of peaches, she would do some kefir, a little bit of raw honey, some cinnamon, and maybe some collagen protein powder and drink that every single day. And I think that's another— A good way to get it in.

It is very compelling that so much of our common disease situation is really now focused on— and you make such a great point in your book about focused on gut permeability. I mean, everything from, as you mentioned, Hashimoto's, ADHD, autism, Alzheimer's, you have a whole list. And I think that still, people are going to be quite surprised To, to look at the wide net that is thrown by this notion of changes in the gut bacteria, how they affect the permeability of the gut, and therefore how these changes stimulate the immune system and take it really out of balance.

Well, you know, I think when people hear the term leaky gut, I think very often they think, well, that sounds like a really serious digestive issue in terms of symptoms. And so If somebody would have maybe inflammatory bowel disease, they would think, well, I have leaky gut. But I think oftentimes the person with headaches and joint pain or somebody who's struggling with depression or a thyroid issue, their mind doesn't typically go to thinking, well, I have leaky gut, because we tie that with digestive issues. But I know that I've taken care of plenty of patients over the years who have no gas, no bloating. And, and they still have leaky gut. So I think that's one of the important things to consider is that, as Hippocrates— I know we've both referenced— over 2,000 years ago, all disease begins in the gut. It's also important to know that all health begins in the gut as well. Absolutely. And this is really where— and this is really where, you know, I know as you teach, if somebody is struggling with depression or something like joint pain, you know, the system today— and I see this a lot of times, Dr. Perlmutter, with People both in conventional as well as even the natural realm, if somebody has an issue such as arthritis, we tend to say, okay, well, we're going to try and treat that with an anti-inflammatory herb or anti-inflammatory medication. Really, my take in the book as well as something I've seen you do incredibly well is really saying, okay, well, we really— if disease begins in the gut, let's go ahead and heal the gut. Of course, things like ginger and turmeric, because they're anti-inflammatory, They help the joints, but really, I mean, is that coming right from the joints or because we're reducing inflammation of the gut? So, you know, I really believe that no matter what somebody's struggling with, focusing on healing and sealing the gut is of primary importance. And so, you know, one of the diet— the diet that I typically put people on is a diet that's very rich in collagen and a diet that's very easy to digest. You know, I don't actually believe there's a food that heals us, and I think that's an important point for people to consider. That if I have a cut on my hand, I don't need to put an ointment on there. I mean, of course you don't want it to get infected, but there's nothing I can put on there to heal it. The body heals itself. And this is why fasting has been used for, for, for thousands of years, and the people have reaped the benefits. But I think that fasting can be used. But I guess the point I'm trying to make here is it's not necessarily about getting as much stuff as you can, because I think that's what people tend to try and do, is I want to get everything I can. It's letting your body rest. It's the most important thing we can do. And so this is why what I've taught my patients to do is a lot of times do some intermittent fasting, and when they're eating, eat things to where your body is doing very little work. This is what I love about bone broth. It's already in its amino acid form. It's, it's very easy for the body to digest. That's what I love about cooked vegetables. Your body's doing very little work. And so the ideal meal, I believe, for people healing leaky gut and getting the root cause of disease is doing a simple slow cooker or crock pot overnight with a lot of Vegetables, organic meat, and herbs. That's it. Those things thrown in a crock pot, consuming that, you know, sometimes 3 meals a day, as I've done that with my patients, or sometimes adding in some probiotic foods with that. Probiotics are great because not only are they high in probiotics, but most of those foods are predigested for you, so it's easier to digest. So I think that's a key concept as well, is, hey, your body heals itself. Make it as easy as you can on your, on your own body.

Well, let's say, like myself, you are asked the question, well, gee, Dr. Axe, what do I do with your program because I'm a vegetarian or I'm vegan?

Yeah, I do get that question a lot. I'm

sure you do.

Yeah, and here's what I recommend. If somebody is a vegan, I recommend that they focus on doing a couple things, but number one, focus on foods that actually support collagen production. within the body. Because if you do a bone broth, we know the benefit is you're getting amino acids like proline and glutamine, which are great for gut repair. But there are also other foods out there that support that. Asparagus, uh, beets are fantastic for this. Um, seaweed is actually probably the best, uh, things like spirulina, chlorella, ALA, any type of kelp. Um, but, you know, consuming a food that's really high in these amino acids that help support or have that specific amino acid profile. So it can definitely be done. I mean, you can do a veggie broth. I think mushrooms are great, especially shiitake mushrooms. Adding those into a soup, doing some miso can be great. Again, that's an organic form of a fermented soy. I don't recommend soy in a lot of cases, or most of the conventional today, but if you're looking at a miso, I think that's a good option. So, so there are ways to get around it, and I believe that's also where supplementation becomes important as well. I think really making sure you're getting Vitamin B12, you're getting, you know, omega-3 fatty acids, EPA, DHA. And EPA might be, you know, pretty hard to get in that case, but you can definitely get DHA and some, and some, and some ALA there, and some flax and chia and walnuts and things like that.

So as an algae-derived source, and, you know, I often really have to note that we've got to be super careful in terms of vitamin D as well, but I think you bring up a good point that with a variety of vegetarian sources, you can construct protein out of the essential amino acids.

Yeah, absolutely. And so I think that it just— it's a— it's just making sure you're balanced, as you're saying. It's really looking at your diet, making sure you're covering your bases. And also, if somebody is choosing to be vegan, I think it would be worthwhile doing something like a micronutrient test or organic acids test and making sure your B12 levels and certain other nutrients are where they should be, finding a good doctor of functional medicine who can work with you to get a baseline so you know if you are deficient in certain amino acids or vitamins.

Honey, how does that factor in because it is an animal product made by bees?

In working with a lot of vegans and vegetarians, I never know what, you know, which line they're going to follow, you know, which side of the line they're going to fall on. So if somebody can do honey, I think they— there's so many benefits there as being my favorite natural sweetener. And if they don't, you know, there are other ways to get your microbial exposures. As I mentioned, you know, having a pet is a great way. You know, just getting outside more on a regular basis, taking a soil-based probiotic supplement, a regular probiotic supplement on a regular basis can have a lot of benefits. So I would say, you know, the other The other thing is making sure you're getting plenty of probiotics because, you know, there was a great study done in Stanford just several years ago, and, and I think they were doing it on patients who had had gastric bypass, and they were looking at the— essentially how probiotics affected these patients. And one of the things they found was they had a much higher level, in fact 49% higher levels of Uh-huh. Of vitamin B12 and much higher levels of all the other B vitamins when they were taking a probiotic supplement. So we know— I mean, we've all heard the principle, you are what you eat. It's not completely true. Really, you are what you digest. And so I think also for vegetarians, it'd be important to consider doing supplementation with probiotics and focusing on those probiotic-rich foods because absorption of those nutrients is Probably just as important or more important as well.

Well, you made a point earlier, and I think it bears repeating, and that is that it's always good to test. And if— here's the situation, being vegetarian, where you're at risk for low B12, low vitamin D, low minerals, etc. So I mean, there are straightforward blood tests available for you. May as well get them done and see where you are. And you know, these are wonderful diets. We, you know, people have been talking about the health benefits of vegetarianism for a long time. With certain caveats, and I'm glad you brought that up. So I want to thank you for your time. It's been a very, very interesting interview, and all the best on the new book. I'm sure it's going to be very, very successful for you.

Well, awesome. Well, thanks for having me, Dr. Perlmutter. I also have a— I have a leaky gut quiz if anybody wants to check it out. They can go to the website isyourgutleaking.com and learn if they have leaky gut. I have recommendations from there. But I want to say,

your main website is

My website's draxe.com, so just D-R-A-X-E dot com, and we've got a lot of healthy gut healing recipes on there, some different health programs and other things as well. So, so yeah, I want to say, hey, thanks for having me on again. I've followed your work for years and I'm a huge fan of everything you're doing, and I appreciate you having me.

Well, I appreciate it as well. We'll talk soon.

Great. Thanks, Doc.

Bye-bye. Well, I don't know about you, but I learned a lot today. This was a fascinating interview with Dr. Axe. Again, here is his new book, Eat Dirt, and, you know, it really says a lot about the so-called hygiene hypothesis, that we're not doing ourselves any good by all of this incredible attention we pay to making sure that our environments are sterile. And beyond that, I think what an interesting discussion about the effect upon the human microbiome negatively by certain drugs to which we are exposed, drugs that are so commonly used in our society. So an interesting interview, and I hope you enjoyed it. I'm Dr. David Perlmutter.