3 Things That DESTROY Your GUT HEALTH | Mark Hyman

When we're over sterilized sanitized world, we end up creating imbalances in our gut flora. The top three things that are likely to cause problems for the gut are.

Give us the top three things that you see in your practice and through your own experiences over the years of being a functional medicine doctor, three categories that are major contributors to poor gut health function.

Well, I mean, the first one is what we call dysbiosis, which essentially means an imbalance in the microbiome in the gut. You've got maybe a hundred trillion cells in there, maybe 10 times as much your own cells, a hundred times as much your own DNA. And they're not just hanging out, they're doing stuff. They're producing all kinds of proteins and molecules. And if you have bad bugs, it creates bad downstream effects. And if you have good bugs, it creates beneficial effects. your microbiome produces vitamins and it produces all sorts of beneficial molecules like butyrate that can prevent cancer and so forth. But if you're feeding, you know, the wrong things are in your gut, it can actually end up causing more havoc. We call this dysbiosis. It's not necessarily an infection, but also infections can be a problem. So you have a worm or parasite or overgrowth of yeast or small bowel overgrowth of bacteria. Those are forms of dysbiosis that are more extreme. But but those all are related to disturbances in the equilibrium in the garden that you have inside your gut. It's like any garden, you don't want too many weeds, you want the right plants and so forth. So that's a huge area that I think has not even been on the radar of medicine, which is how do we optimize our microbiome? Now there's companies out there that are have microbiome kits at home, there's people talking about the gut, but in day-to-day medical practice, your doctor, if he's not trained in functional medicine, does not understand how to optimize the microbiome, doesn't even know what to do to look at it and test it properly. They'll do look for parasites, look for worms, they'll look for infections. They'll look for sometimes they'll look for inflammation, so they'll look for digestive enzymes if they're super fancy, but it's really not a comprehensive view of the gut. The second is toxins, and I think this is something we don't really appreciate very well. And I think I'm going to share a story later about how toxins have impacted a particular patient. in a very profound way that disrupts the normal equilibrium in the gut. So if you have heavy metals, if you have pesticides, toxins, they create all kinds of problems. There's even things in food that are not food that are chemicals like emulsifiers, for example, carrageenan and other thickeners that are hidden in food that actually cause leaky gut and all kinds of gut damage. One of them is called microbial transglutaminase. and that is basically manufactured gluten by bacteria in a lab that they put in food to make it stick together. Because gluten is glue, that's why I call it gluten because it's sticky and it's a way to hold food together that otherwise would fall apart because it's full of processed, nasty ingredients. And the third is stress. So any kind of physical, psychological stress will cause a leaky gut. If you go in the ICU, if you're healthy, you get a leaky gut. It just happens because of the level of stress. If you take soldiers on a forced march overnight in the morning, they'll have a leaky gut. So stress has a huge impact. And by the way, your microbiome is listening to your thoughts. Okay? So it's involved in constantly dynamically changing depending on your relationships, your experiences, your feelings. And what we don't understand even the profound nature of how the microbiome influences our health. And this was shocking to me. I was on a panel at Cleveland Clinic with a colleague named Stan Hazen, who's one of the top cardiologists there, but who studied the microbiome and heart disease. And I said, Stan, how many of the metabolites in our blood do you think come from the microbiome? And I thought he was saying like 5%, 10%. He's like, I don't know, maybe a third to half. So think about a third to half of all the molecules and the thousands and thousands of molecules floating around your blood come from the bugs in your gut. And if you're bad bugs, they're gonna create havoc.

And if they're good bugs, they're gonna keep you healthy. Well, let's dive into each one of those a little bit more. And let's start off with dysbiosis. You know, you mentioned one in particular, you talked about overgrowth of the wrong type of bacteria or even like fungal overgrowth, Candida. Just give us a little bit of a big picture of how does that come up in the front first place.

Yeah, so why are we having a pandemic of dysbiosis? It's basically the question. And the reasons are multitude. One is we've over-sanitized our world. So we're really not living in relationship to nature in the way we were. And the microbiome of the earth helps our microbiome. We're in the symbiotic relationship. So when we're over-sterilized, sanitized world, we end up creating imbalances in our gut flora. There's books written about this called Missing Microbes. the epidemic of absence, which are great books talking about how our modern life has really taken us out of an intimate relationship with nature. If you grew up on a farm, if you're, you know, living in a developing country, you're much less likely to have an autoimmune disease or allergies or any inflammation because of how those microbes have helped you regulate and normalize your immune system. And then there's all the gut-busting drugs that we take. The antibiotic, you know, is just massive amounts of antibiotics are used in this country and overuse in animals as well. Acid blocking drugs that people are taking like Candace, it's the third leading class of drugs after statins and psychiatric drugs. Basically, Prozac, Prevacid, acid effects, Nexium, all those drugs that you can buy over the counter now and people are taking horrible for your gut. They prevent you from producing stomach acid which you need to digest food and so you get all these imbalances and the pH goes up, which means you grow different bugs and you get overgrowth of different bugs. And one of the side effects of these drugs is irritable bowel syndrome. So you fix your reflux and your heartburn, but you get irritable bowel, which one do you want? And then there's obviously drugs like the non-steroidals, aspirin, which is irritating the gut, Advil, Aleve, all those drugs that we take for inflammation. Also damage the gut, the birth control pill, also in changes to gut flora, steroids that people take. There's a whole bunch of gut-busting drugs that are really common that we use. And of course, C-sections, lack of breastfeeding, early introduction of the wrong foods, the hybridization of our food supply, the extra antigens, all these weird things we're eating, chemicals, toxins, all the stuff, pesticides in our food, additives, all those go to destroying our microbiome and ends up causing this epidemic of gut issues. the number one reason for doctor visits is gut problems. It's huge. Irritable bowel, we think, oh, it's an irritable bowel, it's not a serious disease, but it accounts for 10% of the healthcare costs of major corporations for insurance. It's a big deal. So I think we have to understand that we live in a gut-busting culture and a gut-busting world, and that's why we're seeing such challenging issues around gut health and all the downstream consequences of poor gut health, which leads to so many other chronic diseases. We know that the microbiome now is involved in heart disease, cancer, diabetes, obesity, autoimmune diseases, allergies, dementia, Parkinson's, I mean, autism. I could go on and on. Pretty much every disease in some way can be linked back to the microbiome. And if you don't believe me, just go on PubMed, just Google PubMed, and they'll send you a link to the National Library of Medicine. Just put in microbiome and whatever disease you have or whatever thing you want to learn. And you'll see there's amazing amounts of data emerging. and this is all new stuff. Like when I was starting out in functional medicine, we knew the gut was a big deal and we knew it made a huge difference when we worked with the gut, but all the data wasn't there. And now it's just mountains and mountains of data. We're learning so fast about how the microbiome works and all the different species and what they do. But we've ended up with most people having pretty messed up guts in modern world. And I mean, there was one study where they looked at the stool from from kids in Burkina Faso, which is an African country, and America. And they found that their stool was so different, the microbiomes were so different based on what they ate. Dennis Burkitt was a famous scientist from the UK decades ago who studied the differences between the hunter-gather societies and their cousins basically who moved to the city in African cities and the differences in their diseases. And they found that the hunter-gatherers didn't have all the chronic diseases of Western civilization. but the city dwellers did. And he found that the city dwellers, their stool weight was four ounces. The hunter-gatherer soy was two pounds. Why? Because they were eating tubers and roots and roughage and all this fiber. And so they had giant poops, whereas the city dwellers were eating processed food and, you know, not a lot of vegetables and who knows what they're eating. And they had these tiny little poops. And it had a huge impact on.

Chronic disease and their health. On the topic of gut dysbiosis before we get to toxins and stress and unpack those, what do you want to say about a lot of the microbiome testing labs that are out there? What can we know from them? What are their limitations? And are there any ones that you feel are more superior?

Yeah.

So here's the deal. As a functional medicine doctor, the microbiome typically means what bacteria or viruses or yeast or parasites are in there, right? What's in there? So it's basically like taking a population survey and seeing what you got. And it's helpful. And you, you, there's certain keystone species we need like our keramancia and others that make mucus layers for our, our gut to prevent leaky gut and the biofilm layer. And there's really, really importance in knowing what the balance of overall flora are. Do you have more from acute from mycetes, more bacteroides? So you kind of get a sense of what's the overall ecosystem and that's helpful. And there are a lot of companies that are testing that, but correlating that with particular conditions or diseases, you know, there's some degree that that's happening, but it's still in its infancy. And I think there's a lot of over interpretation of tests and, you know, I think we have to be really careful. As a functional medicine doctor, I look at the actual microbes, but I'm also interested in the function. of the gut, not just who's living there, but what are they doing? And often the indirect measurements are way more relevant to me. For example, I look at digestive enzymes and absorption of food and see if you're having fat malabsorption, because I know maybe other issues. I look at the immune system in the gut, things like Calprotectin, eosinophil protein X, the antibody levels of IGA. I look at is there some kind of irritation or inflammation. I look at something called short chain fatty acids, which are the downstream byproducts of bacteria consuming the food that we feed them. And there are certain of these short chain fatty acids that are extremely beneficial, like butyrate. And if you're low in them, it's a problem. It means you don't have a healthy ecosystem. Or maybe you have high levels of propionic acid, which is another short chain fat, but it's a bad one that can cause autism and cognitive issues. Or maybe you have high levels of an enzyme that's produced by bad bacteria called clostridia. called beta-glucuronidase that actually is linked to increases in estrogen and estrogenic diseases like cancer or fibroids. Or maybe you, you know, you have problems with various kinds of, of, of, of kind of commensal bacteria that are a little bit pathogenic. So you're not looking for a true infection, but you see, oh, this, this has a little bit too much of this nasty bug called Klebsiella. It's been linked to arthritis. I, I know I had to deal with that. I'll change my, my patients. treatment based on that. And then of course we look at parasites and we look at things like lactoferrin and we look at, you know, all kinds of things that we can look at yeast. So we start to look at the whole environment and that, that to me is way more relevant. And the test that I use is called GI effects from Genova. I don't really have any relationship with them. We've just been using them for decades in functional medicine. And I think it's a really, it's a really important way to look at the gestalt of what's going on. Cause just looking at little bits here.

And there, I think we'll be missing a lot of what's actually happening and, and the more clinically relevant things to do now. Yeah, the reason I wanted to bring it up is that people always write in from your community are like, great, you know, I always hear Dr. Hyman talking about going and test your stool, and there's no shortage of companies that are out there that are offering to test people's stool and send them information. But it's a little bit art, it's a little bit science is what I'm hearing from you when it comes to the interpretation of how to do it. That's where a good functional medicine practitioner could be helpful in helping people navigate that journey. Okay, let's go into the next categories. We have toxins and we have stress. So let's talk a little bit more about toxins and unpack exactly how like toxins, how can toxins contribute to an overall unbalanced microbiome?

Yeah, so toxins interrupt normal biology. They poison mitochondria. They jam up enzyme systems. They create inflammation. They create oxidative stress. They directly affect the microbiome, for example, like glyphosate. you know, I was shocked because, like, I I eat pretty healthy. I try to eat organic. I try. I never eat GMO that I'm aware of when I buy food. But I go out to eat from traveling, and you never know what you're getting. I could be getting canola oil. It's a GMO thing spray with glyphosate. It's made my. It's on my salad dressing, or it's made. They made my vegetables in or whatever. So I don't always know what I'm eating. And I checked my urinary glyphosate levels, and they were. Pretty high. They were in the 50th percentile. I thought it'd be really good, but they weren't. And I was like, oh boy, this stuff's everywhere. And that is a microbiome destroying chemical, for example.

Heavy metals or nothing. Let's just pause on glyphosate because I think some people hear that and they're like, shit, this guy watches everything that he eats and is paying attention and is the guy that's teaching people. So it was a little bit of.

Like, I just didn't want to leave it hanging there. Is it kind of like we're all doomed or is it- no. How are you mitigating that? well, now I'm a little more careful when I go out and I, I'm a little more cautious about what I eat and I, I'm just more smart about it. But, you know, if, unless you're, you know, buying all the food yourself and cooking all yourself, you always don't know what's in stuff.

And it's also a reminder that all these other things that you do regularly, you know, working out, sauna, et cetera, taking the right supplements, those things are helpful to get rid of that buildup in your body.

Yeah, and so the toxins just disrupt systems and they disrupt enzyme systems, they cause leaky gut and, and they're pretty ubiquitous and, and they can be quite profound. I mentioned, you know, another podcast about a guy who had mercury poisoning and I, I, this was my story. I, I didn't know what was wrong with me, but I, I had, lived in China for a year and was exposed to a lot of mercury through the air filter that I was cleaning out and ended up, you know, my life, I've always eaten fish. I grew up on tuna fish sandwiches. I liked swordfish. I had fillings. I just was exposed to a lot of mercury. And I was fine for a little bit when I got back, but then I was up in Maine and I was at some, you know, summer camp thing that I was at and ended up getting really a bad stomach bug. So I don't know what it was, but my stomach just blew up like a balloon, extreme bloating and really severe discomfort. And then my whole system just cascaded down. And that's when my chronic fatigue started. That's when I started having severe you know, cognitive issues, muscle injury issues, and but my biggest symptom was my gut. All of a sudden I couldn't eat anything. I was getting bloated. I didn't know at the time, but I had small bowel overgrowth. I had parasites, but I also had, you know, terrible dysbiosis. And I just, I just didn't know why. And I couldn't figure it out. And it took me a couple of years till I figured out it was mercury. and I had diarrhea and bloating and irritable bowel for like five years till I actually was able to get my mercury levels down to normal and then my gut normalized. So, you know, often it's kind of weird things that can sometimes be causing it. And I think it's important that people have got issues to start with the basics, but then you start digging if you see that you're really not getting better. Okay, let's go into stress next.

What do you wanna talk about when it comes to stress? And what do you want people to know when it comes to how stress can significantly destroy our gut health.

Stress is one of those things that is ubiquitous. We all experience it and learning how to deal with it is an important life skill, whether it's through meditation, yoga, hot and cold plunges, sleeps, whether it's massage, whether it's deep relational connection with somebody else, whatever it is that resets your nervous system. But many of us are just bombarded with chronic stress and it leads to changes in our health. And one of the ways it alters our health is through chains in our microbiome. And the microbiome literally is listening to your thoughts. The bacteria know what you're thinking and they actually change. And when you are under chronic stress, it changes the bacteria to be more toxic. The bad ones grow, the good ones die, and you end up with more and more dysbiosis, which has all these downstream consequences. So we know that, that, you know, people say they get gut feelings, right? This is a real thing that my stomach's in butterflies or my stomach's in knots or my whatever, whatever the metaphors we use because the gut is directly connected to your nervous system. And there's more neurotransmitters in your gut than there is in your brain, right? Which is crazy when you think about it. And there's a whole separate nervous system called the enteric nervous system, which is the basically means the gut nervous system. And it communicates with your brain but it's bidirectional. So stress here will cause stress in your gut. Stress in your brain causes stress in your gut. Stress in your gut will cause stress in your brain. So we used to think irritable bowel syndrome was because people were neurotic and that was what was causing the problem. But actually we found out that the inflammation from the irritable bowel because of dysbiosis in the gut creates inflammation in the brain, which makes you anxious and depressed. So it's kind of a bidirectional system. So stress will mess up your gut, but your gut can mess up your stress, if you know what I mean.

Yeah, it makes me, you know, it just reminds us that like there's so many things that can all build upon each other and lead to a whole host of gut challenges. There was recently a, a friend of mine that was on the, on my podcast. Her name is, Nishtha Patel. She's a nutritionist. It's based out of, London. and she had shared that her daughter, who suffered with irritable bowel disease and had a situation where it sort of showed up out of nowhere for her daughter. And in unpacking it, and that led to her to a path of learning about functional medicine and becoming a fan of yours and, you know, your podcast and everything. For her daughter, what had happened is that they were on a trip, I think it was in the Mediterranean, and they were jet skiing, and they were around this area where there was some either algae buildup or oil spill that was there, and her daughter fell off the jet ski, ingested a bunch of water, swallowed some sort of items, and pretty much her symptoms started to show up after that process, which naturally, especially when you didn't know where this came from, leads to more stress that stress builds on top of the dysbiosis that's.

There and it all cascades. Yeah, it's true. It's true. So, you know, I think you kind of have to deal with all the things that disturb the gut, right? It's your diet, it's stress, it's sleep, it's exercise, it's the right environments, you're not exposed to toxins at an excess level. All that is so important. And I think we're so bad in medicine and dealing with gut issues, it's just It's just embarrassing given what we now know and actually what we were doing. And unfortunately, in conventional medicine, you're either told to eat more fiber or do a five-meth diet if you have irritable bowel. Now they're treating bacterial overgrowth, but they just give you antibiotic and they don't deal with anything else to restore the gut. Or they give you acid-blocking drugs for heartburn, which makes more problems downstream. and it's really a crime because we know so much about how to deal with these issues. I've written many, many blogs about irritable bowel and reflux and heartburn and encourage, you know, check them out or link to them in the show notes. But the reality is that we now know so much about how to handle these problems in a much more effective way through diet and lifestyle and through dealing with looking for root causes and things that, and diagnostic tests that we just don't get at the traditional doctor.

Mark, you talked about your first sort of bout with gut issues when you had mercury. There's a second time that you had gut issues that came up more recently. Can you share about that?

Absolutely. I basically have had the privilege or the curse or the blessing, I don't know, depends how you look at it, of getting pretty much everything and having to figure it out. And, I've shared about this before, but about five years ago, I had chipped a tooth, it broke, I needed a crown, it didn't work, I needed a in a root canal and the root canal went bad and I had to take the tooth out. And a doctor who was a friend of mine, the dentist, said, look, and he's, it was an integrative dentist. He says, look, I think, you know, it's pretty infected. You should take an antibiotic. And he gave me clindamycin, which, you know, is a regular antibiotic. It's been around forever, but it is associated with a particular super infection called C. Diff or Clostridium difficile, which kills about 30,000 people a year and is pretty nasty. And it, it, it's very hard to treat. Uh, many of the traditional medicines, which give other antibiotics to kill, it's like you give, you take an antibiotic, cause a problem, you take another antibiotic to kill that and it causes more problems. And, and, and, and, and, and then one of the best treatments is actually fecal transplant, believe it or not. It's actually 98% effective where you take the poop out of a healthy person and give it to someone with this infection. But that, that, that same time I had that, I also had a few weeks later broke my arm. and I was in pain and so I was taking like a non-steroidal anti-inflammatory because I didn't wanna take narcotics like morphine or whatever they were. I mean, maybe I should have taken the morphine, I don't know. And I ended up having terrible gastritis, which messed up my gut. So my stomach was awful. I was in pain, nauseous, it was awful. And then I developed colitis. So some people get C. Diff and they just get the infection and then it causes diarrhea. stuff and they get an antibiotic, it goes away. Other times it develops into colitis. So the walls of my colon were thick. They were red. They were inflamed. My markers of inflammation called Calprotectin were through the roof. I mean, normal is like 20, 30 less. Mine was like a thousand. And it was bad. I developed ulcerative colitis as a consequence of taking this antibiotic, which was for a dental procedure that I, you know, in retrospect, I probably wouldn't have taken it. I would have used other things. I may have nasal rinses or Ozone or something else, but. It was kind of bad and I think we have to be very careful when we take these medications because they can create untoward side effects that have long-term consequences. And so it took me a while to rebuild back my gut, but now I've been doing that and I feel much better. I developed a, we're actually launching a product that I developed out of suffering from that called Gut Food Soon, which is basically designed to rebuild your gut like a multivitamin for your gut. Yeah.

And you know, it wouldn't be a Dr. Hyman or Doctor's Pharmacy podcast episode if we didn't at least touch on a little bit of food. So we covered a lot of non-food contributors, again, stress, toxins, dysbiosis. But when it comes to healing the gut, let's give people a top three. So top three things that you think that support gut health and top three things food-wise that you think take away from gut health.

Yeah, I mean, the top three things that are likely to cause problems for the gut are gluten, dairy, and refined starches, like one, two, three. Those are big. If you have gut issues, get rid of those and see what happens. If you wanna go a step a little further, try getting off fermentable starches, greens and beans are a huge issue. And certain vegetables can be problematic. There was a very amazing book called Breaking the Vicious Cycle by Elaine Gottschall years ago written that talked about how to treat ulcerative colitis by using what she called a specific carbohydrate diet. so it took out all sugars that needed to be digested so you didn't get this fermentation and this bloating and distension and inflammation. So those are the things you wanna get rid of. The things you wanna add are three key things that are in foods that are not specific foods, but they're in specific foods, which are prebiotics, probiotics, and polyphenols. Prebiotics and prebiotic foods are things that provide fiber to the bacteria that they like that we can't eat. I mean, that we can't digest. So they're just food for them. And they're in all sorts of plant foods. Jerusalem artichokes, regular artichokes, plantains, asparagus. A lot of foods have chicory root. A lot of foods have these prebiotic fibers that can be consumed as part of our diet. And, and just fiber in general, high fiber diets in general are good for the bugs in your gut. then there's prebiotic foods, which we just talked about, and there's probiotic foods. So those would be sauerkraut, miso, natto, tempeh, just things that are fermented that have been around for a long time, that have been used to preserve food that end up actually having probiotics in them. And we barely eat any of those anymore. Pickles and pickled vegetables. Even pickles, I grew up on pickles, but pickles count. And then the third are polyphenols, which is set up a new discovery that that good bacteria like to eat these colorful compounds in plant foods. The reds, yellows, greens, purples, oranges, and the more you can include these polyphenols from a colorful rainbow colored diet actually helps fertilize the good bugs. Things like cranberry, pomegranate, green tea, turmeric, various kinds of compounds that we can get is just part of our diet help to fertilize and help the gut. So yes, it's cutting out the bad stuff and it's actually eating gut supporting foods.

All right, Mark, this is the part of the episode where we go into community questions. And the first question that we have here from our audience is, I struggle with chronic constipation. What are some things that I could be keeping in mind to alleviate my symptoms?

Well, constipation is very common and it's often, you know, we call it Irritable Bowel Syndrome C or constipation. There's Irritable Bowel Syndrome D, which is diarrhea. but constipation is very common and it can be many reasons for it that are not food related. Hydration is a big one, people not drinking enough water. Magnesium deficiency is a huge one. Now, magnesium deficiency is sort of food related but not necessarily. It's really because one, our diet is so deficient magnesium which comes from greens and beans and nuts which we eat very little of. And two, we do a lot of things that cause us to lose magnesium, caffeine, sugar, alcohol, stress, all cause you to leak magnesium. So getting enough magnesium is important and magnesium citrate can be very, very helpful. And then there's other factors that can cause constipation that are based on dysbiosis, like yeast overgrowth is a big cause of constipation. Dairy is a big cause of constipation. Even though for some people it can cause lactose intolerance and diarrhea, it can cause constipation for many people. In fact, it's the number one cause of constipation in little kids. And it's also the number one cause of anemia, which is kind of striking. Why? Because it's an irritating protein in a set of proteins in dairy that irritate the gut and cause bleeding in the intestines of little kids. Wow. Now think about that. I'm not making this stuff up. This is in National Library of Medicine, PubMed, major journals. So constipation is really common. and it can be also caused by parasites or other issues. So in one case I had was really fascinating. She had a tick infection, Babesia, which caused a nerve paralysis in her gut, which is really unusual. So there's some unusual causes, but usually constipation is really easy to fix by upping the fiber, upping magnesium, upping vitamin C, upping hydration, and for most people, you know, that'll work. I had a patient once who was a radiation oncologist. She was a resident actually at the time, and she had severe headaches, migraines, and she had been treated, she was a resident at the Mayo Clinic, right? She was a doctor at the Mayo Clinic, which is where everybody goes to figure out problems that no one can fix. And she saw everybody and no one could fix her. And she was taking all the preventive drugs and all these different drugs. and it was just stuck. She was on narcotics and Zofran and chemo drug, like chemotherapy, anti-nausea drugs that would be used for chemotherapy. I mean, it wasn't working. And she came to me and said, okay, she had migraines, but what else do you have? Let's talk. And so we went through a list and she had constipation that was severe. She had palpitations. She had anxiety. She had insomnia. She had muscle cramps. These were all magnesium deficiency symptoms. I said to her, so how often do you go to the bathroom? She says, well, I'm pretty regular. I said, well, how often do you go? She's like, I go every week. I'm like, that's not regular. Well, she says, it's regular for me. I go every week. I'm like, you should go every day or twice a day. She's like, really? It's amazing people don't even know what's normal. And so I gave her enormous doses of magnesium because it was what it took to get her to go to the bathroom and her headaches went away, her muscle cramps went away, her constipation went away. palpitations went away, all this insomnia went away, and so it really shed a magnesium deficiency problem. Hey everybody, it's Dr. Mark Hyman. I want to tell you about a gadget that's completely changed my life and helped me dial in on what I need to eat to feel great, stay lean and healthy. But before I get into it, I want to talk about the biggest contributor to chronic inflammation, weight gain, advanced aging, and every major chronic disease out there. 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All right, Mark, this is the next question from the community member. Is there a connection between our gut health and reflux?

Well, clearly reflux is a gut problem. So it means that you essentially have acid coming up into your esophagus or in your back of your throat. and it can cause all kinds of problems. It can cause cancer in your esophagus, cause vocal cord issues, it can be uncomfortable, and people, you know, people had a heartburn. Call it heartburn, right? And you see all these commercials, oh, don't worry, you can eat your sausage and your peppers and onions and don't worry, you just have to pop this purple pill and everything's gonna be fine, right? And you remember, you know, those commercials, I can't believe I ate the whole thing, and it was this guy named Alka-Seltzer or whatever. So these are really common problems and often they're treated very simply with traditional medicine using acid blocking drugs. They're problematic because they actually cause you to block stomach acid, which is needed to digest your food. It's needed to actually keep the pH of your lower part of your intestine normal and you end up with all these secondary problems. And the causes are often the medications we're taking, which can actually be an issue. It can also be a bacteria called H. pylori. It can be because of our diet is too processed and junky. If I eat fried foods, if I eat junky foods, I can get heartburn. So it's not that my stomach's a problem, it's what I'm eating is a problem. So I've written a textbook chapter on this. I've written many articles about this and it provided a guide on how you can get rid of reflux. But essentially, a lot of it is common sense. It's getting rid of the trigger foods. So it's often fried foods, processed foods, spicy foods for some people, citrus food, tomato foods can be an issue for some people, smoking, alcohol, caffeine, all those things are worth taking off the table for a short period of time. And then seeing how that works, checking for H. Pylori is really important. And also treating imbalances in your gut, magnesium deficiency can be also caused because the sphincter in the lower part of the stomach has to relax in order for you to actually let the food go down. So there's a lot of things you can do to help calm the stomach down, we use glutamine, zinc, carnitine, another form of zinc that can be very helpful, and licorice, deglycyrrhizated licorice, DGL, which is also very helpful. So there's a lot of ways to treat this and almost all of my patients with reflux get better pretty quickly.

By following a functional medicine approach. All right, Mark, so those are the questions that we had for today's episode. So this is a great opportunity to do a little bit of a recap on the top things non-food related that contribute to dysbiosis inside of the gut and just overall poor gut health.

Well, thank you Drew for asking that. But, you know, people think, oh, my gut is only problematic because of food, but it's so many other things we don't think about. It's imbalances in the gut flora that come from our gut busting lifestyle and medications, it's environmental toxins and it's stress, and sometimes it's latent infections or things that we haven't even thought about. So, uncrystalline is it's not take at face value that they have X or Y disease. I have reflux, I have irritable bowel, I have, you know, inflammatory bowel. These, these are just names that we give to people who share certain symptoms. They don't tell you anything about what to do about it or what the causes. And that's why in functional medicine, we focus so much on the gut, and we're so good at addressing gut dysfunction. You know, what I really love about the microbiome and your work, particularly in the microbiome, is that it, it's the one area of science where it's unequivocal that our old Paradigm of silo diseases and Specialties totally breaks down and, and it's being recognized in the medical literature, not just on the fringe that the microbiome is connected to every single disease almost, whether it's diabetes or obesity or heart disease or cancer, Alzheimer's or autism or depression or cancer, you know, you just go on an autoimmune disease, obviously. And so all of a sudden we're having this opportunity to rethink all these conditions based on looking at the body as a network and looking at the gut is in a way as the center of that network. And you mentioned that really the gut is the immune system, the gut is the endocrine system, the gut is the nervous system. It's like, wait a minute, I thought it was just a gut. But it's actually all of these things that dynamically interact together to determine the quality of your health. And it is where the source of most of our inflammatory problems come from. And your work has really helped us to understand that. So how is this latest science shown us that changes in our gut microbiome are connected to so many of these chronic diseases and even infections like COVID. I mean, the microbiome and the health of the microbiome plays a role in our susceptibility to COVID-19 even. So how are we learning about this? Tell us more about these links and what the science has shown.

Well, so, I mean, I should preface, I mean, this is still an evolving science. You know, if you know 10% of the system, I think it's a lot. I think there will be There's different ways of looking at the connection between our diseases, the microbiome, and what role, for example, the brain-gut microbiome axis or system plays in this. One is the microbiome is an ecosystem. We know a lot about ecosystems, about diversity, we know about relative abundances, richness. All this is, and not by coincidence, a lot of researchers, early research in the microbiome field came from ecology. They were ecologists because they could relate to this. So we're very good as humans in destroying diversity all over the place, all over the planet, certainly in our environment, just about anywhere in any dimension. And we know that change in the diversity and richness will lead to a decreased stability, resilience of the microbiome to perturbations, any perturbation. And you can substitute, I like to substitute stress for perturbations because it's stress from our diet and stress from our brain going down to the microbes that cause these so if you compare ourselves, for example, with people that live on the last remnants of hunter-gatherers on the Orinoco River, the Yanomami, which I was fortunate during my college time to be on a film expedition for six weeks and lived with them. So I never thought they would come back in my focus of interest. If you compare a microbiome with these individuals, they have the richest and most diverse microbiome of anybody in the world. and have lived with them.

So these hunter-gatherers that are in the Amazon.

Yeah, and sadly, they've been affected a lot by COVID in Brazil. So these people may actually disappear. Many of the areas that we stayed in, I've read about with a lot of sad feelings, were destroyed or wiped out from disease. also by miners that come in, you know, Brazilian. So anyway, that wisdom and how they live totally adapted to the jungle and the natural environment, to the wild animals. And it always, in retrospect, fascinated me. So they are surrounded by any species of animal and fish that you can imagine in great abundance, but they only eat a very small portion of them. you know, their meat is an unusual part of their diet. They live of all the plant-based foods that surrounds them as well. So it's a natural, you know, development of a very wise attitude towards the environment. And anyway, so we talked about the importance of an ecosystem resilience, diversity, richness. And then you have a second thing, which is the relative abundance of certain microbes. So we have identified some of them as the good guys, mainly because we have identified as the good guys because they produce substances like short chain fatty acids that have a lot of good effects on our gut and our body. so the so-called butyrate producers. So all the microbes that produce these short-chain fatty acids from plant-based fiber, we can say is a group of beneficial microbes that we have in our gut. And then there's a few that.

Are.

Involved in other functions like mucus production or the regulating the thickness of the mucus in the gut. in the layer insulating our immune system.

Like acyromancia?

Yeah, like acyromancia. That's kind of a controversial species because it's been involved both in or implicated both in good and bad aspects. It degrades the mucus. So it's not a mucus stimulating organism. It degrades the mucus and we normally don't want to break down the mucus layer. So it's still an incomplete understood system. But then we have the third thing. So I talked about the short chain fatty acids. We have these tens or the hundreds of thousands of molecules that these microbes produce. And that's really, you know, one of the most important factors. How do these, and again, we're dealing with networks, you know, tens or hundreds of thousands of distinct chemical entities that are produced by these microbes and that interact with our gut are partially absorbed. They interact with the nerve cells in our gut with immune cells. So, for example, all the microbes that interact with through their metabolites or signaling molecules with the serotonin containing cells in the gut, that's another group of mechanisms. So I would say we have on a big scale the health diversity and richness of the ecosystem. We have the number of beneficial microbes that live in that ecosystem that produce things that we know today are good for us. And then we have this, and we start really starting to look into this new universe of metabolites. that interact with each other and are ultimately responsible for the health promoting effects. So, it's a complicated system, but I think we have already identified a couple of things, diversity and short chain fatty acid production as sort of major factors.

So, is there a perfect poop? Is there a perfect microbiome? Is the indigenous microbiome that you found in the Yanomami Indians in the Amazon, something we should be striving for. How do we create that? If that exists in them and they don't have all these chronic Western diseases, is there a way to sort of help us to rebuild that through our own diet or other aspects? And the other sort of phenomena that is so fascinating to me about the microbiome and I love your sort of insights in this is talking to Stan Hayes in a Cleveland Clinic and he said maybe up to a third or half of all the metabolites in our bloodstream are non-human metabolites. they're things that are produced by bacteria in our gut when they eat certain things that we eat, and then they get absorbed and are circulating around in us and help regulate all sorts of things, good or bad. Like if they're the bad molecules that come from bad bugs in your gut, from basically a corrupt microbiome or unhealthy microbiome, it can cause havoc on your health. But if it's from the right bacteria that are producing the right molecules that our bodies actually thrive with, so Can you tell us more about that whole interaction between, because it's not just about leaky gut. It's not just about the effects on that particular system, but it's really a much bigger story.

Yeah, I mean, maybe we can come back to the leaky gut because that is obviously an interesting- yeah, yeah. One interesting aspect that we have understood from some of the others. Yeah, but what these microbes produce You know, they're the source of these molecules that they produce several fold. The biggest part is diet, dietary components, mainly fiber products from indigestible fiber from plant sources. Another group of molecules is those that our body produces like bile acids, sex hormones, that are excreted through the bile into our intestine. And the microbes modify those molecules so they can be reabsorbed and get back into our body and have all kinds of, you know, effects on, for example, estrogen levels in our blood are to a large degree influenced by these these microbes, particularly after menopause. Bile acids have become a major factor. And as you said, there are good ones and bad ones. Nothing is simple in this world. In general, people have always identified bile acids as being good for the brain, for brain health. But then there's secondary bile acids that are now implicated, have been found in the brains of postmodern brains of people with Alzheimer's disease. that seem to be playing a role in neurodegeneration and predict the transition from mild cognitive decline to full-blown Alzheimer's disease. Then there's a third group of molecules that are actually part of the microbes themselves in their cell wall. Lipopolysaccharide or a whole group of molecules, abbreviated as MAMPs, that interact directly with the immune system. So we have food-related signaling mechanisms, we have mechanisms that are related to microbes breaking down or modifying our own molecules in our body. And the third one is where the membrane molecules directly talk to the immune system. I mean, one of the best examples, best studies examples of the first one is what happens with the essential amino acid tryptophan. So, you know, tryptophan can be metabolized by certain microbes or the microbes can help in metabolizing tryptophan into serotonin. This happens in these specialized cells in the gut, but the signals to stimulate that that conversion come from the microbes. The microbes talk to our gut cells, turn tryptophan into serotonin. Most of the serotonin in our body is in these cells in the gut. A second, but that's not the only thing that the microbes do with tryptophan, they also turn into something called unpronounceable limb, which is a really bad guy. It's involved in neuroinflammation and neurodegeneration. and the ratio of serotonin production to canurine production is influenced by another group of microbes. So under chronic stress, you will produce more canurine, a bad one, and less serotonin. And then there's a third one, which is called the indoles. And the indoles, again, have been implicated for both positive and negative health effects. But this one 17 hydroxy indole endoxyl sulfate, which has now popped up in studies in Alzheimer's disease, autism spectrum disorder, and also depression. So this is just one amino acid, tryptophan. we have other amino acids and we probably have a lot more of these other metabolites that are being generated. But it opens up like whenever you look at one of those pathways, you know, it opens up into its own universe. So it's intimidating in some ways, you know, do we are we ever going to understand this? On the other hand, I think we know we've learned a lot in the last 10 years what this has really become the focus of science.

So diet plays a huge role in regulating what bugs are growing or not growing and how they affect everything from our mood to our weight and our cognitive function. But it was fascinating is that the other direction also affects us. In other words, our thoughts and feelings and emotions and stress actually create a feedback loop to the gut that can actually cause damage to the gut, alter the bacteria, create a leaky gut, create inflammation that actually is almost the same as eating a bad diet. Can you explain that?

Yeah, so this is the intriguing thing. So you asked me earlier, why are we, and how do we end up where we are today? One is the diet, the other one is the top-down influence of our minds and our chronically stressed brains. Our brains did not develop for that, so we developed very effective acute stress response systems that saved us human species from extinction many times. But these systems are not designed as adapted for chronic ongoing stress, which we experience obviously this the last year. We've seen the impact of that on people's lives. And the chronic stress will not go away now that the pandemic will be ending. There's enough other factors so what the brain does, and I like to call it the brain-gut microbiome system rather than an axis, because it is a. Yeah, a bi-directional system. Brain talking to the gut, talking back to the brain. And the signals that the brain sends via, like, the sympathetic nervous system can talk directly to the microbes and make them more aggressive changes there. Gene expression patterns and the way they interact with us as the host. But they also indirectly change the microbial abundances by changing the peristalsis and the motility and the transit, the secretion of fluids into the gut. So when you stress, your microbes live in a totally different world than if you're in a relaxed state. And what is one repeatedly, you know, long before the diet-related leaky gut syndrome appeared, is that both severe acute stress and chronic stress can increase the permeability of the gut, decrease the mucus layer, and lead to a low-grade immune activation at the gut level. So now imagine in our world an unhealthy diet that does exactly the same thing. together with this brain implants is, it's, it's the worst thing that we can do to our gut health. And since gut health doesn't stand up, you know, it goes very well. So I think that's really that.

Yeah, I think that's so key. I mean, everything we do affects this inner garden. And we just thought it was just inert waste material that now we're recognizing is regulating almost everything in our body and that the key to health and Longevity is to optimize our inner garden. and to figure out how to do that. And the fascinating thing to me was when I saw in my practice, and this was decades ago, how the gut microbiome, we didn't even have the word microbiome back then, but the gut flora affected the cognitive emotional functioning of my patients. And I have story after story of cases of, you know, ADHD or behavioral problems or depression. or neurodegenerative diseases. When you fix the gut, which we did as sort of a matter of course in functional medicine to address physical problems, that the mental or cognitive problems would get better. And sometimes in striking ways. And we wouldn't be able to measure the imbalances in various flora or the overgrowth of certain bacteria, the overgrowth of fungal components, and how those had huge implications for their cognitive function. And by treating them, people would get better. So what are you seeing in terms of the therapeutic strategies we need to be using now for chronic disease. Because when you go to the cardiologist or you go to the rheumatologist or you go to the psychiatrist, they're not saying, Can I please have a stool sample? I want to analyze your microbiome and tell you what you need to do to make it right. They're like, Give you the regular medication for their particular disease. How do we get past that hump in medicine and start to really have doctors and the system as a whole start to take this into account? And, what are these ways in which the microbiome specifically is affecting the brain. You mentioned tryptophan, but I think there are others.

Yeah, I mean, there's many other of these so-called neuroactive metabolites, for example, they're being generated by the microbes and the relative abundances of this, it's a combinatorial system. The relative abundances of these microbes determine ultimately what the output to the brain or to, I mean, it's not only the brain, it's other organs as well, but Having been interested in IBS for a long part of my career, now this has expanded to cognitive decline and to psychiatric disorders. I've seen the same thing as you do. I have to say the experience that I had being in the middle of the conventional medicine world at a university.

Was.

Ignorance and total rejection at meetings or so the whole brain system was something that people either were not interested in or put away as psychological, hysterical stuff. I have a quote from a very prominent colleague who called this the disease of neurotic housewives.

Irritable bowel, you mean?

Yeah.

So, that's what we learned in medical school. It was just people who had anxious and crazy and it wasn't really because of anything physical, it was functional. But it turns out we were just not very good at looking, right? So it's like saying, well, you know, like we won't be able to see bacteria until we had a microscoped, right? So now we have a different kind.

Of lens to look at all these conditions and we see these connections that we didn't before. But the, you know, I think I give you in functional medicine a lot of credit here because the emergence of that type of medicine. I'm not that I agree with everything, you know, being skeptical.

Sure.

I'm still have.

I don't agree with everything either.

If I can't, if there's certainly.

Yeah.

But on the other hand, I think it has another tremendous influence because all of our patients have already been to a functional medicine doctor, you know, and they come with these Concepts and. if we are open-minded at university, you would actually learn a lot. So for example, the leaky gut I learned from my patients, I learned it from physicians like yourself long before this became an accepted term. So I think that the system will gradually change. I mean, it's now like at UCLA or other places, like GI wellness programs that deal with relaxation, mindfulness-based stress reduction, diet, sleep. They really look at the whole human being rather than just the organ or the ulcer or whatever. In psychiatry, I think you will be slower. I think most psychiatrists are still very skeptical that this plays a big role. and I think we need to find, we need to get examples of, and unfortunately this will take well-controlled, randomized controlled studies to convince much of the medical world that this is actually happening. I can already hear it now. People say, oh, there was all this excitement like when you wrote your book about the Mind-God connection, but I haven't heard anything about this. Is that really true or was this just a fad?

Yeah, no.

So there's still this skepticism by the traditional medical establishment that this is not something important. We should also keep in mind, many of the medications that are being used, for example, in psychiatry are also metabolized by the microbes. So what our brain sees is to a large degree influence by what the microbes do with it. And that again determines, is determined by what microbes you have and what diet you're on. So, you know, it's this link. I think what's going to be easier, and I see that Trend already, there's a field now called nutritional Psychiatry that is gaining ground and. I think it's going to be easier through the dietary path. And there's physicians that are being trained in this, whereas I had maybe one hour of education in nutrition in my career.

It's not much better now.

But I think this, yeah, it's not much better now. But I think this will be changing. I've seen trends that just go in this direction. Younger physicians, they come to us and do research with us in our center. they're extremely interested in that and really want to pursue those kind of avenues. But I mean, I should say another thing, you know, what will slow this process, you make a lot more money with the traditional, with the conventional medicine, with the procedures. And so for it, for example, as a gastroenterologist. So we now know that, you know, people get colon cancer earlier at an earlier age. And so the way the medical system has responded to this, so let's move colon cancer screening guidelines to start at 40 instead of 50. So probably in 10 years, we're going to move it to 30 years of age. And when somebody gave a lecture about this a few years ago in, in our division, I was asking, you guys do any dietary assessment of this? people that developed colon cancer at age 40 and said, well, that's actually a good idea. We should. We should look into this. I mean, what a concept.

It's just.

It was amazing to me. But that shows. Well, what a concept. Yeah.

Well, you think about it, you put pounds of. But you make more money being colon cancer, right? Yeah.

That's true.

You make more money. But you put pounds of food in your gut every day. How do gastroenterologists not think that food has anything to do with digestive disorders? It's just. It's amazing to me.

Actually.

Oh, you need more fiber if you're constipated or, you know, avoid these Foods if you have reflux, but it's very limited and superficial. So. So if you had patients coming to you with mood disorders or neurodegenerative disorders, how would you approach treating them through the gut?

Yeah. So I, first of all, I start to explain to them this concept of the brain gut microbiome system and how it's influenced by both the brain and. and the gut and the diet. I present them with a very holistic model of treatment that we want to target all the parts of the spring up microbiome system at the same time that I don't think a single approach, just limiting to diet will be sufficient. So there's, you know, the regular moderate exercise. I mean, like all the things that we know are beneficial looking at the sleep. stress reduction. With depression, it depends on the amount of anxiety and depression that's actually there. I almost always now that we have these simpler versions, for example, of cognitive behavioral therapy, the online systems that are coming rapidly becoming available, anybody can do from their home in 10 sessions. So I recommend all these things plus the diet. And from a dietary standpoint, I mean, obviously this is a minefield, you know, as you know better than anybody else. Sure. I've come to this conclusion and pushes in my book that if you eat the things that are best for the health of your microbial system, you will automatically do the best for your health and for preventing or slowing cognitive decline and, you know, treating your depression. Depression, if you have a severe form of major depressive disorder, I don't think diet alone will do it. I think you will have to combine it with medication, at least initially. And then as a, if you get into remission, as a maintenance, you can rely on your diet part. Yeah. But I always look at this, you know, these multiple channels that we have to access the brain gut microbiome access. So, so this diet, you know. Yeah. The microbiome targeted diet makes it easy. You don't have to, you know, you don't have to argue how many grams of protein are best for you and, and how many grams of. carbs, what percentage, I think it becomes very simple. Microbes love complex carbohydrates that they break down into health-promoting molecules such as short-chain fatty acids. So, it's a very simple so I don't know how this is going to be perceived that recommendation once a book comes out. but I certainly have thought about this a lot and, you know, could get a philosophical twist to that as well, that microbes are the most abundant and ancient life form on this planet. So they know exactly what's best for the planet and its and the creatures that live in it. So providing them with the healthiest Food will take care of us too and the environment, as we know from a largely plant-based diet being beneficial for environmental reasons.

If you love that last video, you're gonna love the next one. Check it out here. It turns out that your social networks determine so much about your health. your friends, your community, and if your friends are overweight, you're far more likely to be overweight than if your parents are overweight. So your social networks are more important than your genetic networks in terms of.